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Nosara Red Cross
Emergency Doctors

By Adam Dietrich

Four Days with the Nosara Red Cross
If a medical emergency happens, Nosara can feel like an isolated place. The nearest hospital is 37 miles (60km) away in Nicoya, the two private health clinics are only open during the day and rarely deal with emergencies. When basic medical treatment is needed and an emergency requires a trip to the hospital as quickly as possible it is the Red Cross that handles it. Adam Dietrich, a Canadian photojournalist with the Voice of Nosara, spent four days living with the Red Cross to better understand their work, purpose and operations.

On occasion, Ilse Lopez Juárez, the full-time administrator at the Red Cross, also helps as a paramedic. In this case she helps clean and
dress a wound from a motorcycle accident.

It’s early evening on Friday February 3, the last light of my second day with the Red Cross is beginning to fade. In front of the office in Nosara centro, Victor Hugo, a paramedic, is being helped by a local man as he loads a heavy oxygen tank into the back of an SUV. The Red Cross ambulances are all out this evening so Hugo needs assistance to carry-out his job.

We arrive at the patient’s house in the neighborhood of Santa Marta as the sun falls behind the horizon. Inside the modest middle-class home are three generations of a family milling around; there is a nervous air. Inside one of the bedrooms a woman in her 80’s is lying on her bed too weak and frail to move, she is assisted by her children.

Hugo goes to work preparing the oxygen tank. Once ready, and with the help of the family, he is able to wedge the tank between the bed and the wall. As he attaches the breathing tube to the woman’s airway he tells the family about safety precautions for the tank. His work completed, Hugo quietly packs up and we leave.

Back at the Red Cross he tells me she has emphysema, a long-term, progressive disease of the lungs that primarily causes shortness of breath and leads to death. The realization is staggering; she is dying. I ask why she does not seek treatment at a hospital, “It would be the same thing there, she has a week, maybe,” Hugo tells me.

He returns to filling out paperwork - his time on the call and the cost of the oxygen tank must be accounted for through receipts. The job was outside the Red Cross mandate yet human and practical circumstances make it impossible to say no sometimes. In Nosara, the elderly woman’s options are limited; there is no home care and the nearest hospital, which is in Nicoya, would limit her family’s ability to be there with her.

Nosara’s health care issue is a catch-22; health services are based on district size in increments of 4000 people.

In 2010 the government estimated the insured population at somewhere around 3100. However, Nosara’s population is constantly fluctuating due to tourism. An Earth University study on Nosara’s waste disposal in 2007 says that Nosara has closer to 3600 inhabitants and during the high season, because of tourism and long-term residents, that number grows to 5000.

(from left to right) Carlos Villalobos Espinoza, the president of the Red Cross
committee in Nosara, takes notes at a call to a patients house while a member
of the patients family watches, (centre) Gabriel Chavarria Acevedo, a fisherman and volunteer paramedic, prepares to help Montiel (not visible) with a patient suffering an epileptic seizure. The patient (in blue) was treated and later taken to hospital for observation.
Santos Zuñiga relaxes and watches TV during the relatively slow day shift.
Zuñiga has worked for the Red Cross in Nosara since the station was founded
in 1993.
Victor Hugo, a full-time paramedic, prepares dinner. The Red Cross covers the
cost of food for employees and volunteers on shift. As a result they take it in
turns to prepare food for each meal.

The Red Cross also serves the neighboring community of Ostional, which is in the Santa Cruz District, therefore the government does not include them in the Nosara district population. So the health ministry uses the lower end of the estimate.

In June 2010 doctors in Nosara reported that they were receiving around seven patients per hour per day. The legal maximum is five. In August 2011 the government then agreed that there was an issue with access to health services. However, before an extension of the current clinic, or preferably a 24-hour clinic, could become a reality, a health commission needs to be established in order to evaluate the services provided here based on the population. That commission has not yet been formed.

Still, confusion exists about whom to call for health services in Nosara. The Red Cross, because of their visibility in the community, is the simplest call, yet, their only responsibility as a non-profit, non-governmental organization is to provide first aid service. But after 4pm when the health clinic closes, they are the only option.

The Red Cross only has three full-time paramedics, the rest are volunteers. Emergency response is already overwhelming work but without a 24 hour clinic in town the community will continue to expect them to provide basic diagnoses, hospice and other services outside their mandate.

As it is the Red Cross is unable to respond to every call that comes in. This has prompted anger and frustration in the Nosara community. Although much of the anger has been directed at the Red Cross, it stems from a larger systemic issue in healthcare. An issue the government, local doctors and the Red Cross recognize as a problem that needs to be dealt with. Until then everyone is making the best of a bad situation and night after night the calls keep coming in.

The over burdening of the Red Cross service was apparent on the night of Saturday February 4. At 8:45 the first call comes in and the President of the Red Cross committee, Carlos Villalobos Espinoza, along with two volunteer paramedics, Gabriel Chavarria Acevedo and David Perez Montiel, scramble into the ambulance. The patient is a man suffering an epileptic seizure. Montiel treats him and the seizure stops. For his safety he is loaded into the ambulance to be taken to the hospital

With the first patient in the back the next stop is a house in Los Arenales. A 17-year-old girl has just gone into labour, however, she is only seven months pregnant. Montiel and Acevedo perform a routine check and then she is also loaded into the ambulance with the first patient..

Gustavo Diaz, a volunteer driver, also helps with maintenance and repairs to the ambulances. Due to the poor quality of the roads around Nosara the suspension on the ambulances must be constantly maintained.
Despite the dust, Díaz tries to keep the ambulances clean as well.
At left members of the board of directors finish compiling notes for their
weekly Thursday night meeting. Beside them Hugo eats the food me just made,
the Red Cross has no table to eat at.

There is one more stop before the ambulance goes to Nicoya. At the Red Cross station a mother and her sick infant are waiting. They are added to the ambulance. Now three patients in the back, each with a family member, two paramedics and the driver ride off into the night, it is now shortly after 9pm and they will not return until after midnight.

Within ten minutes of the first ambulance departing there is another call and a second ambulance speeds off into the night, picking up two patients with non-emergency needs. One is a sick baby, another has an intestinal problem. There are no more volunteers left in the Red Cross station. For two hours the phone rings, radio calls come in but there is no one to answer them.

At 12:15 am the first ambulance returns, their passengers have been delivered safely to the hospital. Despite the patients’ issues not being life threatening, the doctors in Nicoya, who empathize with the Red Cross situation, signed off on the receipts as emergencies. It means they will be reimbursed for their work this evening. Tired from the long night-time drive they relax or nap in the dormitory and wait for the next call to come in.


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