Bringing the Art of Nursing to La Carpio, Costa Rica

As you may know, I had the opportunity and privilege this past spring break to serve the people of La Carpio through International Service Learning, as a part of Shorter University School of Nursing‘s Global & Community Health Practicum. Even having been on several international mission trips before, this experience changed the way I perceive poverty, healthcare, and my role as a nurse.

During the first day of clinics, we went door-to-door, surveying the population and giving appointment cards to those with acute illnesses that needed our care. This served multiple purposes. Primarily, it ensured that the patients that came to our clinics were in need of treatment and could be served by the resources we had on hand. We didn’t have the means to treat every condition, so by seeking out people that we could help the most, we avoided making promises of care that we couldn’t keep. Secondly, it served as a venue to provide therapeutic communication to even those who we could not treat. We spent the same amount of time with families that we could treat as we did with those that were beyond our scope of care.

That is not to say that choosing which patients to give appointments to came without a challenge. At first, that responsibility brought some intense anxiety. We were split into small teams and given complete independence in deciding who to give appointments to. I started to ask myself how I could be sure that I made the right decisions. I had to reconcile with my faith leaving a family’s house without having given an appointment to anyone. It became good practice in faith and trust. First, we had to trust in God’s guidance and sovereignty. Relying on the Holy Spirit took a lot of weight off of our shoulders and helped us realize that all we had to do was be obedient in His direction and trust Him to care for those that we were unable to. It also provided a great opportunity to trust the nursing judgement of ourselves and each other, which we will carry with us into our practice as future nurses.

We soon felt confident in the interviewing process, but the poverty we faced that day was impossible to ignore. Even though we prepared ourselves, what we saw changed us.

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(Photo credit: Travis Lugo, BSN Student)

Poverty plagues La Carpio unlike any city I’ve visited before, domestic or abroad. Two out of three residents ended up being Nicaraguan refugees. Some were there legally, but many didn’t have documentation, and therefor had little to no access to health care. The people who did have access to running water said that it was unreliable and sometimes unclean. Many of the adults had little to no education and therefor limited employment opportunities, if that. Their homes were built with whatever materials they could find, on steep, hilly terrain, and in the flood zone of a nearby river.

Yet, their joy and gratitude for what they had was often written all over their faces. They didn’t need us to feel sorry for them or give them “a better life.” They genuinely loved their life, and just needed our time and our genuine, loving care. Charity is something they could use, for sure, especially with regards to cleaner water, but that wasn’t the role God gave us there. We were there to give them holistic, patient-centered nursing care. We had to set aside our desires to provide them with every little thing we thought they needed, and accept the work God laid out for us. Through Him, we were making a difference despite their living situations remaining the same. The healthcare system only lets local doctors spend up to 10 minutes at a time with patients, and many doctors work without nurses. Taking the time to interview them and spending an hour evaluating them brought them more joy than we can know.

I had to continuously remind myself that I was making an impact on both their physical and spiritual health, despite not being part of my idea of a typical medical mission trip. At first it was a major struggle, because I didn’t get to spend hardly any time at all praying with patients or guiding their spiritual growth. During my service in Mexico, we prayed with every single patient, but in Costa Rica the focus was more on their concerns and well-being. While in Mexico, I saw up to a hundred patients a day, ISL’s program makes appointments with about 50 people, spread across three days and two clinic sites.

It was a contrast, for sure, with what I was secretly expecting, but perhaps not a bad contrast. I think both approaches could maybe learn from the other, but I grew an appreciation for ISL as the week progressed, because of the vast amount of time I was able to spend with each patient. I discovered issues my patients were dealing with that I would not have had time for in a fast-paced, high-volume clinic. Our thorough conversations were able to identify a patient whose history of sexual child abuse accounted for most of the presenting physical symptoms and a patient whose chief complaint turned out to be less serious than an existing condition that he had no idea about.

Even when the patient’s history had little to do with their presenting symptoms, the fact that we were interested in knowing about them brought them joy. They were excited to share their life and health with us. Their spirits were lifted by the amount of time being invested in them. We assured them with smiling faces that they were going to be taken care of today, and that is spiritual care. Even if I didn’t break open a Bible.

A healthcare role unique to the nurse is the opportunity (and responsibility, really) to strengthen a patient’s spirit. False hope does no good for a person, and I would never advocate that, but instilling genuine joy and a healthy hope for their future well-being works miracles. A nurse can make a patient feel like someone really cares about them and is willing to go beyond treating physical symptoms.

Although my father’s cancer diagnosis was absolutely terminal the day he found out (and deep down, we all knew it), his nurses kept his spirit up the whole time. When the doctors told us he wouldn’t make it past the weekend, he made it another month. And another month. Not because the nurses gave him the false hope that he would pull through, but they treated him like a real person. One asked him about his family and watched as his face lit up while he talked about us and showed pictures. Another used appropriate humor to get laughs out him. He not only got the best treatment available, but he was confident in the care he was receiving. The combined efforts of the doctors and nurses at Northside helped him believe he was in good hands. His body was actively destroying itself, but his spirit endured.

Solomon, one of the few men to ever be gifted by God with complete wisdom, said this about the importance of joy and spiritual care:

A joyful heart is good medicine, but a crushed spirit dries up the bones.
– Proverbs 17:22

We call this the art of nursing, and it can’t be taught by reading a book or listening to a lecture.

I chose Shorter University’s School of Nursing because of the commitment to integrating faith and profession. Our trip to Costa Rica confirmed I made the right decision. Seeing and caring for the people of La Carpio gave us a new compassion for our patients and a greater passion for our field of work.  We practiced nursing care through assessment and administering medication, but also the art of nursing through therapeutic communication and counseling. The local doctors working with ISL showed genuine interest and even eagerness in teaching us about what we encountered, and encouraged us in our own careers. Our translators, many of which were med students, proved to be a tremendous and irreplaceable aid to our work. All-in-all, it was incredible.

If I’m being honest, I went into this trip unsure of the impact I would make, but I have come out unable to ask for a better or more fruitful experience. If I ever came across another chance to work with ISL, I would definitely take it in a heartbeat!

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“Heal the sick who are there and tell them, ‘The Kingdom of God has come near to you'” – Luke 10:9