Community

Costa Rica Reflections

The following was a letter sent from Dr. Heather Brandt to students and colleagues at the University of South Carolina regarding her experience in Costa Rica for the Global USC in Costa Rica program.

Greetings! I have returned physically from Costa Rica back to South Carolina, but my mind and thoughts and heart continue to be in Costa Rica. I am processing my experience, and I am somewhat reluctant to write about it at this time because I know my thinking will evolve. However, I am equally excited to share with you some of the lessons I learned during my time in Costa Rica. 

I arrived in San José on May 14 for Global USC in Costa Rica (for those of you who have not had a chance to read my last chair’s email – this is the University of South Carolina), and I was in Costa Rica until June 6 for the program. This program provides students a unique opportunity to gain USC course credits while learning about health and culture in San José and across the country. Health-related courses are instructed by USC faculty (including me!). During this program, students have the chance to explore San José and immerse themselves in Costa Rican culture.

I had three USC undergraduate students, all public health majors, in my class – “Community Health Problems” (which I renamed, “Community Health Solutions” because communities are not a problem and solutions are in communities). Class went exceptionally well and was complemented by incredible service learning experiences. In fact, I said several times, “Community health class can be cancelled for the rest of the program because there is no way I can replicate what you are experiencing firsthand in the community in the classroom.” We experienced the Costa Rican Humanitarian Foundation in La Carpio, Hogar de Carlos Maria Ulloa (nursing home), Hogar de la Esperanza (a home for people living with HIV), and all three levels of the Costa Rican health care system and a private hospital as well. “Community” was all around us. Public health was evident throughout our entire program. Important community and public health lessons were learned in the community, not the classroom. We did a lot of listening while we learned. I am grateful for the generosity of these organizations and their willingness to host us.

I have attempted to summarize my experience around three salient points. 

First, community is defined in many ways. At Hogar de la Esperanza, we learned about a community for individuals who have HIV come to embrace life and live theirs. This is a diverse community in terms of country of origin, sexual orientation and preferences, and status, which is highly unique as there are only three such homes for people living with HIV in Costa Rica. Our idea of what constitutes “community” is not for us to determine, and often, a community of which you become a part happens organically. We witnessed similar communities of care in the local, area-level health care clinic in Cartago that is the first-level of care in the Costa Rican health care system, called EBAIS in Costa Rica. ETAPS who work within the EBAIS are tasked with improving the overall health of the community by working with people in the community. A strong sense of solidarity within the community, defined geographically by the organization of the EBAIS, was apparent. 

Second, when working with a community to improve health, meet them where they are. We have to ensure basic needs are met before we can focus on other needs. While in La Carpio, we heard from Gail “Giselle” Nystrom of the Costa Rican Humanitarian Foundation who shared with us their approach and how important it is to meet basic needs while always increasing self-esteem of those they serve. Our public health education and health promotion interventions must align with opportunities within a community and not focus on impractical approaches that are inconsistent with where they are. This was further evident in the EBAIS in Cartago. We witnessed a primary care physician committed to ensuring programming so that every child receiving care in the clinic had the chance to succeed. She implemented a play therapy program to aid children with development delays. The ETAPS ensure that these children are living in environments that will support their success. 

Third, solutions are truly found in the community. At La Carpio, Hogar Carlos Maria Ulloa, Hogar de la Esperanza, and across our visits to learn about the Costa Rican health care system, solutions were all around us in these communities. Solutions were initiated from within the community with minimal help from those outside – perhaps financial or other resources, expertise, etc. The resiliency and solidarity of Costa Ricans was inspiring, and solutions emerged from within the community. 

Mixed in with lifetime lessons, classroom time, and service learning experiences, we had a lot of fun too. We toured the city of San José, visited the National Museum of Costa Rica, travelled to Doka Coffee Estates and La Paz Waterfalls, ate “comida típica” (typical food) in Costa Rica, which is gallo pinto or rice and beans, visited Manuel Antonio National Park, and much more. Personally, I was captivated by the monkeys, sloths, and the vistas. 

In closing, as we face ongoing challenges to ensuring a strong public health system, focus on prevention, health equity, and access to health care in the U.S., I am struck by a common theme that emerged in our interactions with Costa Ricans. At Hospital Heredia (a regional hospital in the Costa Rican system), we had the chance to talk with hospital administrators and ask them questions. Someone asked if health care was viewed as a right or a privilege in Costa Rica. Without hesitation, the response was, "health care is a right, not a privilege, in Costa Rica." I believe this reflects the strong sense of solidarity I experienced in my interactions with Costa Ricans. Sure, the health care system is not perfect, but it is based on a fundamental belief that everyone is entitled to health care. “Pura vida” is more than a catchphrase or nuanced tourist lingo. Costa Ricans live pura vida. 

Heather Brandt
Chair, Public Health Education and Health Promotion Section
American Public Health Association

Look for the Helpers

We are barely three weeks into 2017 and what a year it has been already. I honestly wasn’t sure what to expect when Heather and I launched our consulting firm late in 2016, but it has, so far, been a journey like no other I’ve ever been on.

In a short time, our work has taken us across South Carolina and across the country.

  • On one of our projects, we’ve spent time reading, listening to residents, asking questions of the experts, and trying to better understand the challenges and barriers that exist to health and well-being in rural South Carolina. The challenges are real, significant, and deep-rooted.

  • Our team is back and forth weekly to Charlotte, NC working with a group of funders and philanthropists to develop a system of change that presents greater opportunity for the citizens of Mecklenburg County. Certainly not rural America, but the metro has its own challenges.

  • We are preparing to lead a board/staff retreat next week for a statewide nonprofit who is poised and ready to tackle the significant challenge of affordable, reliable housing in South Carolina.

  • Our travels have also taken us to Waco, TX, Tulsa, OK, and Washington, DC. All unique communities with their own challenges centered around race, poverty, and access to health, education, and financial resources.

What’s striking to me is that despite differences in size, region of the country, and demographics, the challenges in these communities are all very similar. From rural South Carolina, to metro-Charlotte, to the “heart of Texas;” all different communities with familiar challenges.

What’s even more striking is the massive number of helpers we have come into contact with. Without exception, one of the first things I notice when visiting a new community is that the helpers are already in place! So many kind and caring souls giving their all, dedicating financial resources and human capital to the causes that matter.

It was Mr. Rogers who reminded us that “when (you) see scary things… look for the helpers. You will always find people who are helping.”

Indeed.

Having recently celebrated a “day of service” in honor of Dr. Martin Luther King, Jr., it’s fitting to point out how many helpers there are among us. It’s also not lost on me that we are mere hours away from the Inauguration of the 45th President of the United States. To be sure, with so much uncertainty in front of us, those helpers will be more important than ever. So, my message to you today and in the days ahead is two-fold:

If you need help, whatever that means to you, please don’t be ashamed to reach out. If you are a helper, please don’t be afraid to stand up and make yourself available! 

President Forrest Alton Featured in Tulsa World

During a recent visit to Tulsa, OK to work with the Tulsa Campaign to Prevent Teen Pregnancy, our President Forrest Alton had the opportunity to sit down with a reporter from Tulsa World to discuss progress made in South Carolina and what Tulsa can do to better address teen pregnancy. Several things he made very clear: 1) the solutions are in the community and 2) teen pregnancy prevention is not a moral issue; it's a public health issue. 

Read the full article here.