In the past month, I have often thought that if I were a novelist, I would like to write a book about my experiences with the Humanitarian Foundation in Costa Rica. How can a five page essay begin to convey the depth of a culture so unlike American society, to describe the people who touched my life in countless ways, to explain what it was like to volunteer at a children's hospital and work with cancer patients and severely burned infants? On my last day in Costa Rica, five of us from the Foundation had an interview with Radio for Peace, an organization which broadcasts various peace-related programs all over the world. The last question was, "If you could tell the world one thing about Costa Rica, what would it be?" There are a lot of things I would like to share about Costa Rica, but my response to that question was the people.
Costa Ricans are affectionately called Ticos because every other word in their spoken language is a diminutive. A boy is not a chico, but a chiquitico. My name was not Sarah, but Sarita. I mention these idiomatic differences because I think it exemplifies the endearing nature of the Ticos. The people I met in Costa Rica opened up their hearts and their homes to me even in the two months I was there. The host family I lived with was typical of a middle-lower income family in Santa Ana, Costa Rica. There were three women from three generations and no men. Multi generational families as well as children born to single women are very common in Costa Rica, and the latter is not looked down upon as it often is in the United States. Mariana, the six-year-old girl, is raised primarily by her tita, her grandmother, because her mother Yvonne works in the city from seven in the morning until six at night. Nevertheless, she is a precious child whose laugh always makes me laugh and whose appetite always exceeds everyone else's, despite the fact that we rarely ate anything but rice and beans. Although there was sometimes tuna or meat on the side, I don't exaggerate when I say that I ate rice and beans for lunch and dinner every day of the week. Tita always tries to keep Mariana from eating so much because she is what one would consider a pudgy, if not fat little girl, but I think that is part of her charm.
In addition to the family I called my own for two months, I met many other Ticos and Ticas who also welcomed me into their lives. One of the things I enjoyed most in Costa Rica was working with young women from a low income housing project called El Esfuerzo to start a soccer team. The idea started when one of the women suggested that a team be formed because the men and the younger boys always play, but rarely do you see any women out on the make-shift dirt field in the center of the project. So two months ago, my friend Fernando and I started out with about six or seven women who had never really touched a soccer ball before but were eager to play. (I should mention here that women's soccer is a growing phenomenon in Costa Rica, and although it is nowhere near the level of women's soccer in the United States, there are teams in most towns and cities which compete against one another in different leagues.) Back in June, we started by teaching them how to pass the ball, how to stop it, how to use your thighs, chest, and head but never your hands. We played every afternoon it didn't rain, which during the wet season in Costa Rica was sometimes three or four times a week, sometimes only once. There are still no soccer stars in the group and the team would not stand up to stiff competition, but they are a different group from the first day. Most importantly, they have something they can compete in, something that was traditionally only a men's sport. On my last day in Costa Rica, the team came by the Humanitarian Foundation for a going-away party and gave me notes they each had written to thank me for my patience and all of the time I spent with them. One of the girls even pulled a silver ring off her finger and handed it to me so I could remember them all by it. How could I forget?
The people in Costa Rica were the heart of all my experiences, and the experiences in the hospital taught me more than I could ever have learned working as an intern in the United States. I worked at the Hospital Nacional de Niños, the only children's hospital in Costa Rica, in the burn unit and later in the oncology unit. For the first three weeks, I put on a white robe and scrubbed my hands and arms up to my elbows to minimize the risk of infecting the children who had severe burns. It was difficult to see kids as young as seven months old with bandages wrapped around their heads, staples in their arms, and IV tubes placed in their hands or feet for the administration of morphine every 4-6 hours. These kids were in pain, but they were brave. The voice of one girl, Lili, will forever echo in my head: "Me duele, me duele", it hurts, it hurts. My job mostly involved playing with the kids or painting pictures and feeding them when they needed help. Although I was able to watch the cleaning of the burns in the operating room, my work was not as related to a future career in medicine as I had expected. However, after some time there, I realized that I was learning a more valuable lesson. The children in the burn unit taught me that compassion and human interaction come first in the doctor-patient relationship, and that science and medicine come second. In some ways, I did as much for these kids by holding their hands as they came out of general anesthesia as the trained physicians did in the operating room.
In my second three weeks, I worked in the oncology unit where I saw
as many as 100 kids with various forms of cancer: cancer of the lymph nodes,
the abdomen, the kidneys, the brain. I had never realized how common it
is in young children, nor would I have guessed that statistically 70% of
children recover with combinations of chemotherapy, radiotherapy and surgery.
Most of the kids were animated and full of life despite their illness,
and their courage is an inspiration for anyone battling cancer. Of course
I also saw one child who fell into the small percentage of children who
do not respond to any form of treatment. This boy had a tumor behind his
left eye which had pushed the eye out of the socket so that all he had
left was a large protrusion of flesh and a small slit where his eye should
have been. In his neck, he had a mass that looked to be the size of a small
melon, and this prevented him from swallowing any food or liquid. I saw
this eleven-year-old boy on the day he came in for surgery: they were going
to put a tube into his stomach so they could administer nutrients directly.
This boy would not live for more than a year, and I had to leave the room
so his mother would not see the tears in my eyes.
I observed the physical examinations of kids with all types of cancer
in one stage or another, and one day a week I scrubbed down, put on a green
robe and latex gloves, and became a surgeon. The other surgeons addressed
me as doctora and directed me to use the vacuum to clear away blood and
smoke, generated as they used electricity to cut or cauterize the tissue.
In one particularly difficult tumor removal, they even had me place my
gloved hands on the cancerous mass so that they could cut away underneath
it. In the United States, a pre-med student would never have been permitted
to participate so directly, but I learned a lot from being so close to
actual surgery.
My experiences in the children's hospital have strengthened my interest in medicine and opened my eyes to fields of medicine I had never before considered. I saw the respect in the eyes of the children and their parents, I saw their hope and exhilaration when the doctors in the oncology unit said that they no longer needed to come in every three weeks for chemotherapy. To be able to give these children a life in the future, that is the most rewarding and satisfying job there is. Through all of the people I met and the experiences I had, I began to understand a little of Costa Rican culture and learned to speak Spanish fluently, or close to that. I don't know how to summarize what it means to be Tico, and any description I offer will seem to me inadequate in its ability to capture the essence of a culture so unlike our own. The rhythm of life in Costa Rica crawls at a snails pace in comparison to the pace of an average American lifestyle. Ahora directly translates to mean now, but if a Tico says he will do something ahora, it may not be done until tomorrow. It is not unusual to have to wait an hour or two for someone to show up for an appointment, and at first this was very hard for me to get used to. But Ticos teach you to be patient, and I learned to expect delays as part of my day.
A second element of Costa Rican culture which stands out in my mind
is the prevalence of machismo and the status of women in the society. My
blond hair and blue eyes stood out against the dark complexion and eyes
of the Ticos, and I could not walk through the center of the town without
hearing "macha, macha, psst, psst". (Macha translates to blond). At first
it made me angry: I hated being called at as if I were a dog, but I learned
to ignore it after a while. Women in Costa Rican culture are responsible
for the cooking and cleaning and traditionally female work, although this
seems to be changing slowly. Two of the doctors I worked with in the hospital
were female, and I think women are increasingly entering professional fields
that had been predominantly run by men. Although Costa Rica is very different
from the United States where we have made dramatic changes since the women's
rights movement, the women of Costa Rica are stronger than I had expected
from a Latin-American culture.
I would like to share a final experience which epitomizes the challenges
faced by many families in Costa Rica and a standard of living well below
the average in the United States. I mentioned earlier the low income housing
project, El Esfuerzo, and it was there that I worked with other volunteers
to complete the construction of a home started two years ago by the Humanitarian
Foundation. A family with ten children had been living together in a single
room, and our idea was to add on an additional room adjacent to the current
one. We used scraps of wood collected from all over Santa Ana and bought
nails and sheets of tin to construct the walls and roof. Later that night,
after we'd finished the room with the exception of the floor, we walked
past the house and saw two of the children in the new room. They were holding
their homework above their heads so that the light from the other room
would catch the words or numbers they had written. Although it took only
one day of labor and a small amount of money, building that house was one
of the single most rewarding things I did in Costa Rica. It is technically
no longer a third-world country, but poverty is still prevalent and there
is much work to be done.
In five short pages, I have tried to summarize an experience which
taught me more than I can put into words, more than I now realize. I will
always remember the friends I made there, the people of the Humanitarian
Foundation, the voices of the children I worked with, and the beauty of
country. How could I forget? Until you have been to Costa Rica, you cannot
imagine the green mountains enveloped in clouds, the black sand of the
beaches, or the richness of the rain forest. Someday I hope I will
go back to Santa Ana, perhaps as a doctor, to continue the work I started
this summer and to find the people who gave me so much.
A special thank you needs to be added here for all of the people who made this experience possible for me. I would like to thank the Dickey Foundation and the Dartmouth class of '71 who supported me financially for the two months I was in Costa Rica. I would also like to say thank you to everyone from the Humanitarian Foundation in Costa Rica: to Gail Nystrom, the director of the Foundation, and to her assistants, my friends, Fernando and Alejandro. The work they do is immeasurable and their dedication and caring are unmatched.