Helping the ‘Mountain People’
A member of the Costa Rican Social Security System’s mobile medical team examines an elderly Cabécar patient. Courtesy of Lucas Iturriza
From the print edition | Read Part I
By Lucas Iturriza | Special to The Tico Times
ALTO TELIRE, Talamanca – The blue and yellow helicopter with the white, circular logo of the Costa Rican Social Security System (Caja) touches down in the plaza of Bajo Piedra Mesa. We are now in the land of Costa Rica’s Cabécar indigenous group, high in the Talamanca Mountains, in the southern Caribbean region, in an area known as Alto Telire. It is one of the most isolated places in the country.
Though the helicopter is spacious, multiple trips are needed to transport the entire medical team plus equipment, including a generator, food, aid and medical supplies. Members of the team include a doctor, nurse, a regional health specialist (known as an ATAP), a pharmacist, administrative personnel, a cook and volunteers.
No one is comfortable. We sleep wherever there is space atop foam mattresses on the ground – there are no outside-world luxuries here.
The medical team examines up to 120 people a day, depending on the location. It is an exhausting effort, but deeply gratifying for those involved. As Dr. David Montenegro, who heads the team, notes, “I consider this place to be very special, with a totally distinct energy. Although the work is arduous and the hours extremely long, it’s very enjoyable here. It’s gratifying to be able to bring a little bit of health care to people who really need it.”
A five-hour medical evacuation on foot. Courtesy of Lucas Iturriza
On the first day of the Caja team’s arrival, no one approaches. “The people from the mountain,” as the local Cabécares refer to themselves, are cautious at first. Are we doctors? Are we police?
Once the mission’s objective is known, families begin arriving on the second day in large numbers. They walk up to five hours to meet with doctors and receive free medical attention, donated items (sometimes), and if they’re lucky, a hot plate of food.
During my first trip to the region in October 2010, a man in his 50s approached the doctor in charge, Heinz Acosta, and said his 20-year-old son was bedridden, unable to walk or eat for six days. Those types of situations are dangerous here in the mountains, as the only means for survival is hunting – the Cabécares are skilled hunters – or planting subsistence crops, both of which require strength and stamina. Ailments like pneumonia or diarrhea can kill in a matter of days.
The Cabécar man – who spoke through a translator, as most local residents do not speak Spanish – said his house was “close by,” perhaps an hour away. As it was the first day and no patients had arrived, Dr. Acosta decided to hike to the man’s home to examine his son. The trek lasted more than two hours.
We arrived to a disheartening scene – the young man had pneumonia and a kidney infection. To leave him there without medical attention would be to let him die. Because the patient couldn’t walk, the doctor decided the team would carry him to Alto Telire’s EBAIS.
The team set to work fashioning support rods from tree branches and affixing a hammock for the patient to lie on. The “one-hour” trip was an exhausting affair undertaken heroically by Caja personnel, who were concerned only with saving their patient. We hiked through mud up to our knees, leaping over ravines and streams, and stopping momentarily to catch our breath along the way. The journey required everyone’s participation in order to carry 90 kilograms, two people at a time, up and down the mountain’s dramatic contours. Without caring about rank, the doctor, medical specialists, nurse and volunteers all shared in the effort.
There were falls and a few scares, but the march continued. Almost five hours later, we arrived at the EBAIS, where the team administered nebulization and intravenous antibiotics. It was an intense first day.
Franklin Méndez, an ATAP who carried the patient the most, said he felt as if he had been trampled by a herd of elephants. But he was “happy to have succeeded in the effort.” Having participated in the rescue, I became a witness to the level of commitment espoused by the men and women of this Caja team.
Nevertheless, there are setbacks. Although doctors treated the patient with a battery of medication for two days, it was necessary to transport him by helicopter and ambulance to the nearest hospital in Limón. The next day, the patient had left. It is a cultural and economic barrier, says Dr. Acosta, and unfortunately there is little they can do when it happens.
When doctors decide to evacuate patients to Limón, patients’ relatives often accompany them. They are transported by helicopter to a clinic in Hone Creek, a few kilometers from the southern Caribbean beach town of Puerto Viejo. From there, an ambulance drives them to Tony Facio Hospital in Limón city.
During a 2010 trip to Alto Telire, doctors discover a 20-year-old patient on the verge of death with pneumonia and a kidney condition. Transporting him to a mobile clinic took five grueling hours on foot. Courtesy of Lucas Iturriza
Doctors treat them. But what happens next? Family members have no money for food or lodging. How do they get back home? The return trip requires a bus ride and several days of walking up the mountain. Going to the hospital can disrupt a family’s life for months, and so far, government agencies haven’t figured out how to solve the problem. Nothing is easy for the Cabécares of Alto Telire.
But there are people who are committed to helping change the situation. Missionaries led by David Jones and John Whited built a multiuse salon that serves as Alto Telire’s EBAIS. Jones’ father arrived in Costa Rica in 1952, and by 1954 he frequently was visiting Alto Telire as a missionary. He was the first white man to speak Cabécar in the region, locals say.
David Jones, the son, has been hiking in these mountains alone since he was 15. Today, he is 40 and well-known in the area. With his blond hair, fair skin and blue eyes, he has all the physical traits of a Gringo, but he was born and raised in Costa Rica, and is fluent in the indigenous languages of Cabécar and Bribrí, as well as Spanish. He is charismatic, calm and sincere. He looks you in the eye when he talks.
Together with John Whited, a retired military man, engineer and missionary, the two have spent years helping this isolated community. Together with Caja employees, they helped create “Puentes de la vida” (Bridges of Life), a program that has helped build two hanging pedestrian bridges that cross the area’s most dangerous rivers. More bridges are planned.
Before the project, residents crossed the rivers on dangerous bridges improvised from tree trunks tied together. In heavy rains, crossing the rivers became like playing a game of Russian roulette. A simple slip meant a perilous fall and almost certain death.
“In recent years, there have been about eight to 12 deaths a year in the rivers,” says Dr. Wilman Rojas, director of the Caja’s Talamanca Health Area. “And those are the ones we know about. The number is likely higher.”
The Caja has played a fundamental role in these medical missions by coordinating additional help thanks to the use of its rented helicopter. “We have enlisted the assistance of other institutions not involved in health care,” Rojas says. Agencies include such as the Costa Rican Electricity Institute, National Housing Mortgage Bank, Costa Rican Water and Sewer Institute, the Education Ministry, the Agricultural Development Institute and the Mixed Institute for Social Aid. “We bring people from other institutions so that they can see the reality of these communities and take responsibility for what every agency should be doing.”
Because of the collaboration, AyA built an aqueduct in Bajo Bley, and ICE installed two telephone lines and a satellite antenna with Internet. This helps patients who need specialists, as doctors from the medical team can consult them via videoconference.
One of the biggest challenges, though, is how to help without interfering in the way of life of a community isolated from the rest of the world. And who will help?
It’s clear that these types of medical and aid missions should become standard government policy. But new actors – both government and private – need to get involved and bring aid to these communities, which desperately need it.
As Dr. Montenegro notes, “The population [of Alto Telire] needs a lot of help, they need education, they need tools, not to give them the final product, but to give them the tools so that they can forge a better future.