This morning, as I read the news, I came across the image of millionaire Tom Brady with his millionaire model wife Gisele Bundchen in his arms at a luxury resort in Costa Rica, the lush landscape and further out, the ocean, behind them.
What image comes to mind when I explain to our LoveAIDS donors and prayer partners that we are continuing our work in Costa Rica? Are luxurious retreats and lavish beaches what come to mind when I explain that we are continuing our work with HIV and AIDS patients?
I try to explain that LoveAIDS works inland, far away from the beaches.
I try to explain that, far away from the limited number of fancy tourist locations in this developing-world country, I work in developing-world conditions, not first-world conditions,
That we work with socioeconomically disadvantaged individuals who have seen extreme suffering and that we work at facilities that are extremely resource-limited.
I try to explain that every dollar for us counts and that I live on a very frugal budget.
I try to explain that the impact of our work with our AIDS patients is felt tangibly at that AIDS facility I serve at.
This is a question I ask myself often, as I ask myself, “Am I effectively communicating the nature of our work, so that what we are accomplishing and our financial needs are understood? Am I communicating clearly so that you, our friends who support us, understand the impact of what your sacrificial and generous dollars are accomplishing? Here, again, is our story, of Loving AIDS Patients, Loving Jesus.
Immediately upon returning to Costa Rica, I find myself confronted by the cultural differences between this mountainous Latino country, a tiny drop of sunshine of only 4.8 million people, and the populous behemoth of the United States, with its equally-mammoth-sized population of 325 million. Both countries are bordered by both the Atlantic and Pacific oceans and boast of magnificent landscapes and captivating biodiversity, and can even boast about the diversity of its human populations. But the cultural differences I find myself engulfed by again are colossal. Those who have lived for significant periods of time in other countries and who have also spoken the local language and thus able to immerse themselves into the local culture to a significant degree know that each country might as well be its own planet. Immersing myself again in the Costa Rican culture, I experience again that things in Costa Rica are simply different, and even many of the simplest things have a different interpretation from the meaning they carry in the United States: Relationships are handled differently; conflict is handled differently; trust is built differently; decisions are made differently; and family and community have a different meaning than in the United States. To ignore this reality is to eventually harshly offend the Costa Rican people and become culturally and relationally ineffective, although the Costa Rican people will not inform you themselves, and find that you can only relate with other ex-patriots. I learned from my own mistakes made when I was new to the country years prior. I am eager to minimize any cultural mistakes I make this time around, move forward and get to work.
I have little time to reflect once I arrive. I try to rush to purchase basic things needed for living, such as clothes hangers, a clothes iron, a laundry hamper, a hair drier, as I had forgotten mine back in Seattle, an electronic surge protector to protect our organization laptop, some basic kitchen utensils…. But my attempts to hurry this process are met with the sarcastic laughter of the diabolical Costa Rican traffic and the harsh reality – or perhaps the privileged reality – that I have to use – or am at least allowed to use – the public bus system: time-consuming (3.5 - 4 hours to get to work & back home minimum, daily,) inefficient…but it is, at least, transportation.
My first days at the facility characterize themselves by a need for me to shadow the nurses and assess what the needs are. It is a more involved, lengthier process than I originally estimate. Because the Paso Ancho facility has fewer resources than the previous facility LoveAIDS partnered with, each staff member, with the exception of perhaps the staff psychologist, wears extra hats on a daily operating basis. The administrator and the two nurses also function as unofficial residence directors for our patients. One of the nurses helps produce financial and administrative reports. One of our directors, who served a Catholic priest in his younger years, and who holds, along with his theological studies, undergraduate and graduate degrees in sociology, carries out numerous training sessions alongside his wife and co-director, who uses her specialization in business management to help run the facility. Nurse Wendy tells me my first day there, in Spanish, of course, that, “Every day is a different day here. No day looks the same.” She also confesses privately “I have so much to do every day, I don’t know where to start.” I realize after a few days that she faces multiple urgent priorities daily, and, because of limited resources, still ends each day with many left undone.
I quickly observe that a number of the residents need physical therapy care to regain mobility. For the many who are not familiar with the health care system in Costa Rica, the country has a private hospital system (which the wealthy use and pay out of pocket or use private insurance to access) and a public health care system (funded by taxpayer dollars, or, to be more accurate, Costa Rican colones.) This public health system is set up so that HIV-positive individuals receive free medical care, in a preventative attempt to reduce HIV transfer to others. However fantastic this sounds, a structural problem exists which limits HIV patients’ access to this care: this health care system is structured for highly-functioning individuals who 1) have access to resources that afford them the transportation costs to regularly attend appointments, 2) have the internal discipline and structure to consistently make it to appointments and 3) have the corresponding mental health to empower them to make it to their appointments. But if a patient can’t afford the cost of a bus ride, or simply has not developed the internal discipline of keeping a calendar system to make it to appointments, or is too depressed or overcome with anxiety to have the strength to attend a medical appointment by themselves, they won’t make it to the appointment. And socioeconomically disadvantaged HIV & AIDS patients often fall into this second demographic. THESE are our patients.
Mental health and internal self-discipline are “resources” that empower individuals to have a higher level of functioning and thus be more successful in even the basic things of living. For some reading this, this may appear a novel idea. Or it might simply strike one as common sense but they may not realize they lack an accurate understanding of the profound and painful implications of this truth. It is an every-day reality for our patients. Global health researchers, medical anthropologists, missionaries and medical workers around the globe witness this daily in their work and write about it. I face this daily in my work with these patients, and I am trying to write about it. I struggle personally with how to communicate this painful reality to those who, for many innocent reasons, may not be able to comprehend how severe the suffering of the socioeconomically disadvantaged really is. The suffering far exceeds not having enough food to eat daily, access to health care, a job, a high school education or a stable, secure home to live in, although these are realities for almost all of our patients. It extends into a poverty of a lack of a healthy family system to grow up in, in which a high level of personal discipline and functioning and emotional and mental health are taught and developed. Without having developed an inner personal discipline and functioning and a significant of emotional and mental health, these socioeconomically disadvantaged individuals struggle greatly with the basics of living. Their lack of sufficient education (often not even having completed high school) and difficulty in affording basic food and housing only deepens the suffering they feel as they strain daily to live life.
As the days and weeks go by, I learn that more than a handful of the patients at our facility have needs for physical therapy and range of motion exercises. By building relationships slowly with each patient and asking questions carefully, I learn from their personal stories that they failed to receive the treatment they needed because they have difficulty getting to their physical therapy appointments. Hiding in the silence between the answers they do provide are the hard realities they don’t share, struggles of addiction, depression, lack of finances for transportation, lack of social and emotional support in their support system, lack of an internal discipline that they are too ashamed to confess and too hurt to admit they never developed. These are stories that require significant maturity and discernment in knowing how to respond. I find myself praying often in these moments, seeking wisdom from a loving God whose wisdom does not fail.
After the initial weeks of shadowing the nurses and assisting wherever there is a need as each day progresses, I begin helping our patients with range of motion exercises as well as providing them the emotional and spiritual support in conversation to empower them to restart the lengthy process to receive physical therapy. This process requires them to meet with multiple doctors before they are allowed to meet with a physical therapist. This means that for the first appointment, they show up at their neighborhood health clinic at 5 AM to wait all day in a long line and hopefully get a few minutes with the community health doctor before the clinic closes at night. They receive a referral from this community health doctor, which is usually assigned a few weeks or months out. Then they need to ride the bus to their assigned hospital to meet with another generalist, before they can be referred to a specialist, before they can be referred to a physical therapist. This process takes months. My offer to attend the appointments with them motivates them, and they are eager to have me join them. Having someone who cares about them and who is willing and able to join them provides them an external structure and emotional support for something they want to do but do not feel that they have enough strength internally to do by themselves. Some of my patients have lived with their AIDS-induced loss of mobility for over fifteen years because they did not have the emotional support and resources needed to get treatment. They have given up hope. But hope starts to grow in their hearts again as I encourage them and show them by showing up again and again at the facility that they will have the emotional and structural support to move forward.
It is in these capacities that I wear two hats, serving as a traditional nursing assistant and also that of a mental health technician, something that, with my licensure and formal studies I am equipped to do. I join a group bi-weekly for training provided by the director of the facility in the harm prevention model that is implemented here. (I do also help provide basic nursing care, changing briefs and bedsheets, helping dress patients, and so on, but it is not my focus to write about in this blog post.)
This plaque hangs on the wall in Director Orlando Navarro Rojas' office. Don Orlando opened the first home for AIDS patients in Costa Rica in 1992, when both men and women with AIDS had nowhere to go and, abandoned, rejected, and stigmatized by their families, they were dying of AIDS on the streets with no food, water, or medicines and in their illness unable to fend for themselves. In a strong shame-based culture, the suffering was intense and society's rejection mercurial. President Clinton praised Don Orlando for his commitment to provide for AIDS patients and to showing compassion and minimizing their suffering in their last days. At LoveAIDS we say, "Jesus loves the AIDS patient. They need to know they are deeply loved."
The third hat that I wear is that of a ministry worker, or, more simply put, someone who loves Jesus. My job is to love wisely. This is where I need great discernment and much compassion. I ask God to help me with this every day. Every one of our patients in our facility has experienced significant abuse, whether it be from what was done to them or from addictions or struggles they somehow became involved in. An overwhelming most, if not all, have experienced emotional and relational abandonment. They come to our AIDS facility from living in the streets, because in their abandonment they had nowhere to go. In this loss, with this abandonment, there is trauma, often deep trauma. And with that trauma, abuse, and abandonment, they have had their personal boundaries crossed or violated, often deeply violated. They arrive at the facility needing to know that they are safe, that they can start over. It is in this context that I show love and serve and give them a listening ear. And it is in this context that my patients walk up to me when I arrive at the AIDS facility and ask me if I will be working with them that day. And I respond with a big smile and a firm handshake or a hug, and show them that I care.
I also encourage our patients spiritually by encouraging them to trust God for their recovery. Many of our patients have a faith in God and find strength drawing strength from Him. "Let's see how much mobility we can regain," I suggest with a big smile. "Your life is worth is, isn't it? Let us have a little hope in God, and put our faith in Him, and see what can happen." So many of our patients feel they need permission to be able to hope again. It is in being the hands and feet of Jesus, serving them quietly, day after day, that I see their hope being to light a flame again and grow.
I remember something one of my psychology professors said years ago, something I never forgot and that is relevant to my work here in Costa Rica, I was studying counseling in graduate school, and what she said transformed my worldview. I didn’t like to admit it, but I had been trained to highly value the academic and clinical specialists and discreetly overlook the individuals whom I perceived as having less prestigious training or “qualifications.” “Research shows,” she explained, “that being able to spend time regularly and at least weekly, with someone who genuinely cares and is committed to that individual’s well-being – whether that person is a mentor, a friend, a counselor, a ministry worker, it doesn’t matter – is more transformative in the life of that individual who is trying to grow or make changes or is going through a difficult time in their life than meeting with a therapist or social worker who communicates a neutral concern for the individual” (paraphrased.) It would be years later, as I was serving as a nursing assistant in my previous work with AIDS patients here in Costa Rica, where I was recognized only as the (lowly) “nursing assistant volunteer,” -- not the "smart" premedical student or the "accomplished" young lady who has already been to college and graduate school, or the director of a young organization who leaves the AIDS facility daily and still puts in more hours doing administrative work once at home -- where I would understand far more profoundly the impact an individual who truly cares makes. I never forgot each of my patients -- poor, lacking high school educations, coming from the streets, ex-prostitutes, ex-drug addicts, often not even speaking proper Spanish -- who told me, “Thank you for coming. It is because of you that I can ____.” They each start to have a hope and a future.... My prayer for you is that you will also profoundly and tangibly understand the impact an individual who truly cares makes. May I encourage you in your walk with Christ not to underestimate the good you can personally bring to others as you go through your day today.
I cherish your prayers and support as I continue to work with our patients. God bless you.
Together, Loving AIDS Patients, Loving Jesus.
Ingrid Anne Stavrica
LoveAIDS would like to remind our partners & public that we are limited in both the stories and photos we can share do to needing to protect patient confidentiality, complying with patient privacy laws originating within both the U.S and the countries we work with.