A Brave New World

As Samuel and I left his twin brother’s house to head toward Dr Ulloa’s office, we opted to journey over the mountain instead of around it.  The mountain in question is the Poas Volcano, topping out just under 9000 feet in elevation.  The 4 cylinder 4X4 pickup I was driving worked hard to keep going, switching frequently between first and second gears, attesting to the steep incline of the roadway.

A strong earthquake struck here in January, 2009, with the epicenter being in a little town called Chinchona.  A bunch of tourists at La Paz Waterfall and Gardens had to be helicoptered to safety, as were all the residents of Chinchona.  It took 2 years before the government got those residents settled into new homes, finally bringing that painful event to a close.  Samuel wanted to see what it all looked like, in the area of that destruction, so we chose our route accordingly.

DSCN5573DSCN5578The scenery along the drive was spectacular, with plenty of evidence of the earthquake still visible.  Unfortunately, the damage doesn’t photograph very well, so I have nothing to show you here, in this posting.  (There are images and video available on the internet from folks who happened to have their cameras in operation at that moment, if you’re interested.)  We saw the new town, called Nueva Chinchona -it looked like a trailer park but with little concrete houses instead of trailers, each on a postage stamp lot.  Each is probably much less than the residents used to have, pre-earthquake.

We did get to see a beautiful waterfall along the drive, called El Angel, and some impressive vistas.  Our destination for the night was the house we stayed in right after Samuel’s surgery back in April, belonging to his brother Gregorio.  A few blocks before we arrived, Samuel wanted to stop and visit a friend.

While I played outside with a few local kids, some of whom I knew, Samuel visited inside with his friend.  After a few minutes, they emerged with an invitation to “visit the gardens”.  I’m always up to see gardens, so I happily tagged along.  Very quickly I knew we’d entered some place more special than the traditional botanical garden, of which I have experienced many since they are a favorite place for me to wander.  This place, called The Ark Herb Farm, grows everything organically and specializes in herbs and medicinal plants.  In addition to the traditional plants-in-dirt growing methods, they also have a section where hydroponics are used.  All in all, it was not only beautiful but interesting.

As we took  our leave and drove the rest of the way to Gregorio’s, I began to hear wheels turning in Samuel’s head.  While the fix to his knee seems to be proceeding quite well, we both are concerned about how he will be able to earn a living in the future. The doctor would affirm this in the appointment tomorrow morning, indicating that the type and manner of former employment is too strenuous for the replacement knee to endure.  So, what then?  We’ve talked much about this, up to this point.  All of a sudden, Samuel is muttering excitedly.

He’s always planted beans, cucumbers and a few other crops, and enjoys the growing process as much as he likes to fish.  Perhaps he can grow food for restaurants and interested neighbors, using some of the techniques just observed!  It will require more thoughts, research and experimentation, but at least there’s a fire of enthusiasm in his heart for the future, as our time together draws to a close.

The Good Doctor

It is hard to express what I feel for Dr Jaime Ulloa as a result of this whole experience.  To call him a hero is an understatement; his contribution to this effort goes so far beyond any reasonable expectation that I am practically speechless.  (For the writer of a blog, that’s not a good thing.)

DSCN5580Initially he said he would donate his services, which was a $6000 statement.  He promised to “do what he could” with other aspects of the surgery, including to arrange a package price at a cheaper hospital than he usually uses.  If you read the very first posting in this series, you already know I encountered a different reality than expected when I arrived just after Samuel’s surgery, back in April.

It took a while for all the pieces to come together in my mind, and even longer for me to believe what this good doctor had done for Samuel.  Not only did he donate his services, completely and totally – including every followup visit, but he convinced the anesthesiologist AND the knee supplier company to do the same.  Then he went further and strong-armed the best hospital in Costa Rica to accept the fee that a much-cheaper hospital would have charged.  The level of care was beyond anything I’ve seen in my stateside experiences, all for a charity case. This left about 5 months of living expenses for Samuel’s family out of the money we’d raised – another important consideration in this surgery experience.

Without his heart, this story would not be told.  There would only be sadness and pain.

During this recent visit, Samuel and I visited Dr Ulloa and I tried to express these sentiments to him; to make some attempt at gratitude comparable to what I feel.  He heard me out, then he heard Samuel talk about the massive change brought about in his life and how grateful he is, after which he turned the joy back onto us – onto each of you who partnered with Ginny and I in this journey.

To you I dedicate these entries; this is a story which is a joy to tell.

I’m no better at saying thank you to ya’ll than I was to the doctor, but I mean every meager word.  Samuel made a speech to his neighbors, in the middle of the barbeque at his house, in which he tried to give thanks and describe the impact ya’ll have made upon his life and family.  It was all heart, let me tell you.

Where Angels Tread

The journey towards a knee for Samuel has been the collective work of many people.  Most of my blog postings center around the steps made by Samuel, with full intention of double entendre.  However, working quietly in the background are some very special people.  True hero status must go to the doctor, but I want to introduce him slowly and savor the journey with you, here in my words.  As you can expect, since there has been so much mention of me this far in these blog entries, the initial burden was mine.

I was haunted by the feeling that the situation was simply WRONG; that Samuel and his family should not have to endure the future which so clearly lay before them.  Tragically, I quickly found out that my heart was bigger than my wallet.  Fortunately for Samuel, an angel crossed my path.

ElNiditoUp the hill from Sabalito, where Samuel lives, are dairy farms, neighborhoods, electricity-generating windmills, pasturelands – in short, gorgeous Costa Rican countryside with the occasional lake-and-volcano view.  One driveway along this road bears the name El Nidito, meaning The Little Nest.  Snuggled out of sight of the road, as a bird’s nest should be, is a gorgeous house owned by Mark and Ginny Walters of Cleveland, Ohio.

GinnyWindSurfingBoth active in watersports, they were drawn to the Lake Arenal area years ago by the world-class wind surfing available here.  The year before I arrived on the scene, Ginny decided to try her hand at a related sport – kite surfing, with painful results.  The plan was to get strapped into the kite them let the strong winds hoist her aloft for an enriching, thrilling time around the lake.  It was not to be, for a rogue wind burst blew her not into the air but over onto a bunch of boulders, breaking her wrist and pelvis.  Thus began Ginny’s initiation into Costa Rican medicine.

After being transported an hour and a half to Liberia, she checked into the hospital and began to wait.  In truth, she’d been waiting a good while already, since the kite surfing business lies a half hour from the ambulance station, and the ambulance is nothing more than a transport service – they are not trained in any advanced medical care.  Even so, with broken pelvis and wrist, she spent a long time in the hospital just waiting – not even ice was offered for her pain!

Eventually. she checked herself out of the hospital and into a hotel, while frantic phone calls to the stateside hospital where her husband works put together a better plan.  A team arrived from the Cleveland Clinic to collect Ginny from that hotel room, stabilize her for travel, and escort her back home for surgery.

By ANY standard, she is a plucky lady.  Lucky for Samuel, she also has a large heart.  During one of her visits down to their house for some wind surfing, a chance conversation with the cleaning lady (Samuel’s wife) elicited the comment that “Something should be done about that!”  Lourdes repeated that comment to me, whereupon I sought Ginny out and put a question to her:  Would you be willing to help me explore ways to help Samuel, potentially at significant personal investment?  To the joy of all, she did not shrink from the question.

From her own experience, she sought to bring Samuel to the states for treatment, via a conversation with the head of Orthopedic Surgery at The Cleveland Clinic.  While they were open to the idea (it’s nice to know people, isn’t it?), the doctor mentioned that there really was an exceptional orthopedic surgeon in private practice right here in Costa Rica – one they could recommend heartily, Dr Jaime Ulloa, of the Clinica de Especialidades Ortopédicas at Hospital Cima.  A phone call from Ginny to Dr Ulloa conveyed the essentials, whereupon he volunteered to help.

A couple of months later, Ginny and I were both in Costa Rica and arranged to meet for the first time; I brought Samuel and introduced him to her.  Within minutes we’d all come to agreement and scheduled a meeting with the doctor, which resulted in Ginny’s first bus ride in Costa Rica.  Dr Ulloa heard us out, in his San Jose offices, and pledged to do what he could.  Based on his projections, Ginny and I parted ways with mutual commitments to scrape together $3000 apiece to make this happen.

E04aFor my part, I reached out to a number of people and invited them to give a damn….and damned if they didn’t!  Some of those belong to a hiking group I’m affiliated with, in Charlotte, NC.  I’d led a tour to Costa Rica the month before and they’d all met Samuel.  His situation touched their hearts; in return they opened their wallets when asked.  My family and some friends joined in as well.  Each of you know who you are, as does Samuel.  It is my hope, through writing these blog entries, that you know how special you are – words do not do justice to the magnitude of your impact in so many lives.

Ginny threw a party, taught yoga and gave door prizes – soliciting contributions towards her portion.  It was the first time she’d ever done a fundraiser, and was impressed by the heart she encountered among those she asked to help in this quest.  Fortunately or unfortunately, as Scoutmaster for 10 years, I have had the pleasure a number of times – this was my first for an almost-personal goal.  Now she also knows the immense thrill that comes when you see people living up to more than is expected of them…when you get to witness selflessness in action.

Dr Ulloa was happy to receive our next call, and scheduled surgery for early April, 2012.

Socialized Medicine – the Good, the Bad…and the Ugly

I realize that, in these blog postings, I’ve not painted a very good picture of the program of socialized medicine in Costa Rica.  Maybe that’s fair; maybe not.  In the interest of fairness, let me add a chapter designed to restore equilibrium to the narrative.

DSCN5564Samuel has mentioned from time to time that he has a twin brother, but I’d never heard much about him.  Partly out of curiosity and partly from a desire to become acquainted with more of this beautiful country, I asked Samuel to go on a several-day journey with me wherein we would visit his far-flung family.  He agreed, made the arrangements and we set off.

I’d met one of his older brothers in those days following the surgery, back in April, when we stayed at Gregorio’s house.  During this journey I would learn that there were a total of 14 children in the family, 11 of whom are alive today.  I met another brother and a sister at the barbeque, then met 5 more as we cruised around the countryside.  Without exception I was welcomed into their houses and lives; the hospitality they showed me was their gesture of thanks to all who partnered to bring this opportunity to Samuel.

While talking with the twin brother, Daniel, I learned that he had occasion to use the medical system in late October with excellent results.  He awoke about 2am one morning with severe abdominal pain.  He called an ambulance which took him to the hospital about 15 minutes away.  In short order he was in surgery; they removed his appendix which was on the verge of rupturing.  The scar looks good, although bigger than would have been the case in similar surgery performed in the states today.  Everything in this story happened just like you would hope, and the medical care was free to Samuel’s brother.  The system of medical care performed what was needed and as advertised.

On the other hand, another family member who lives deep in the country was suddenly afflicted with debilitating pain in his leg, which preliminary investigation by the rural doctor was unable to diagnose.  He was in need of, probably, an MRI to investigate further.  During the time I was around, he tried to get an appointment in the big city to discover why he couldn’t walk and why he was in constant agony.  The system of socialized medicine offered him an appointment to begin that investigation of the pain TWO YEARS from now.  I’m not sure what benefit that might have been intended to produce, but it certainly would not result in this man being returned to productivity.  It only seems to me to encourage people to resign themselves to whatever their condition might be, and then to find a way to move forward without medical care.  In that sense, the system serves more effectively to ration care than it does to provide needed care.

In so doing, it pushes the cost of whatever care is provided off of the government and onto the family.  A neighbor of Samuel’s has been bed-ridden for 3 years and could really benefit from a bed which has adjustable parts – in other words, a hospital bed.  (Such a bed helps tremendously to prevent the formation of bed sores, which is a major cause of deteriorating condition in bed-ridden patients.)  The family – all poor people, is trying to raise the needed money.  Samuel spent several days lobbying on their behalf with the medical system and local bureaucrats; I worked with a doctor I know to push the system where I could, while also contacting charitable organizations in pursuit of available programs.  Where this will end, for that particular individual, I have no idea.

In my opinion, therefore, the system of socialized medicine does not adequately serve.  These examples merely reinforce the gratitude I feel for those who reached out to help my friend.

Testing the knee, and rejoicing later

It was an emotional reunion with Samuel’s family when I finally arrived in Sabalito, near Lake Arenal in Costa Rica.  So much of what has passed has been quite foreign to them, everything else filled with uncertainty.  Meanwhile, life hasn’t stopped for those around them, which is just the way things are.  His oldest son, Flander, and wife Marylis are living in a small house behind Samuel now; his older daughter and her 7 year old child have moved an hour away in search of employment opportunities; the younger daughter, Yuri, has graduated from high school and is about to start a new life out of her parent’s house – just for a few examples.

Through all of this, and the strong emotions associated with each such change, Samuel and his wife Lourdes have managed to not only hang on but to keep making progress toward recovery.  I spent about 3 days living in the midst of their family, right at the start of this trip, catching up on news.  Watching him walk around, stand up and sit down, and perform the various movements of ordinary life went a long way toward reassuring me of general fitness and mobility on Samuel’s part.  Now it was time for a more serious test.

DSCN5398DSCN0006Previously, readers of this blog briefly met Ashton, who helped me install bathroom handrails in anticipation of Samuel’s return home following surgery.  Not only is he a neighbor and an all-around good guy, he is also a hiking buddy of mine.  When Saturday rolled around and Ashton would be off work, the 3 of us headed to Rincon de la Vieja National Park for some physical and mental therapy.

I won’t bore you with tales of gorgeous vistas, or talk at any length of the Enchanted Forest which lies along the trail – I’ll merely show you a few pictures and encourage you to hike La Congreja Trail when you get the chance.  It wasn’t a particularly hard trail, speaking from the standpoint of a healthy and fit person, but it did serve as a 7-mile test of Samuel’s knee, including boulder hopping, with an enticing waterfall and a refreshing swim.

DSCN5416

DSCN5347DSCN5438I’m happy to say all went well.  Rincon Park is about 2 hours from Samuel’s house.  When we arrived back at home after the hike, Samuel shifted gears, lit the bargeque grill and started cooking.  The day before, we had butchered a young bull in preparation for tonight’s feast, held in joint honor of oldest son Flander’s 27th birthday and this moment in the progress of Samuel’s knee.  Seven hours later, he finally sat down, his leg tired.

It has been an awesome day.  We all have much to celebrate, in this moment.

Time for a check-up

I last wrote of Samuel’s surgery event, his condition immediately post-surgery, considerations of handicapped housing and mobility, and the impact upon his family.  It has now been 9 months and I’m back down here in Costa Rica to see how things have been going.  To some degree, I’ve kept in touch as these months have gone by, but never enough for either one of us.  As I sit in the plane seat and the hours of travel drag by, I wonder what I will find.

In the intervening months I have heard that Samuel has been very diligent with the physical therapy exercises, that the doctor has been repeatedly pleased with the post-surgery progress and that the family has mostly adjusted to the new reality.  Also I was thrilled to hear that someone loaned Samuel a stationary exercise bike and that another person loaned him a road bike.  Upon the latter, he only took one tumble which, thankfully, caused no damage to the knee.

DSCN5480Physical therapists emphasize exercises which build muscles surrounding the knee – the goal being to build a cage of muscles to support the joint.  As soon as possible, the patient should begin use of a stationary bike.  Cycling helps develop range of motion, which is hard to regain after knee surgery.  With variable tension settings, the amount of force required can be adjusted to the patient’s capabilities, preventing undue strain.  Best of all, cycling results in no impact to the site of the surgery.

Accordingly, I was extremely glad to hear that someone had loaned Samuel their stationary bike to use during this crucial period of his recovery.  I wasn’t quite so happy about the road bike, and fretted a good bit after he told me of the fall.  All seemed to be well, however, and I heard reports from several people who have seen him being out and getting around.  My schedule finally permits another trip; I have a head full of thoughts….

Home at last

There is a saying in Spanish – vale la pena, which expresses the sentiment that the pain and suffering being endured is worth what the outcome which will result. We’re talking, in this article, about recuperation from knee replacement done only 15 days ago.  In all, Dr Ulloa used 35 metal staples to close the surgical incision in Samuel’s leg.   Yesterday the staples/stitches came out while the doctor gave Samuel more good news.  In short, it has truly been worthwhile to endure the pain to this point.

In the doctor’s opinion, everything looks great in the surgery site – no infection, no tearing, and only minimal inflammation remains at this point in the process.  Samuel demonstrated adequate flexibility with some movements of his leg, then the doctor sent him away with a return date in about 2 weeks.

By this point, Samuel has been away from his house and children for more than two weeks.  His wife, Lourdes, couldn’t stand it any more and took a bus home a couple of days ago – she needed to be there for her kids and she really needed some hugs for herself too!  Samuel stayed on in his brother’s house, diligently doing physical therapy exercises and receiving visitors in a steady stream.

Now, with permission from the doctor and with good news to carry home, he’s arranging a driver and getting antsy.  The 4 hour drive will be uncomfortable but, this too, is a case of vale la pena.  His children await.

As he and I occasionally have been together, over the last three years, we’ve talked frequently about his kids.  His five children range in ages from 29-year old Jessica to 10-year old Emmanuel.  Flounder, Yuriella and Samuel Jr complete the set.  Jessica now lives next door, with her 7-year old daughter Angelina, and Flounder lives a couple of hours away with his wife, Marylis.

Jessica and her daughter, Angelina

Jessica has assumed the point position for her siblings during the  absence of her parents, making sure Emmanuel, Yuri and Samuel Jr get meals and to school when they are supposed to, as well as tending to her own daughter.  She, in her time, made it through 6th grade before she started working – where she’s been ever since.  This is not really uncommon among the country people, where it is a long way to anywhere.  Elementary schools are nearly ubiquitous; the higher grades require long bus rides and are more inconvenient to attend.  Her dream is to go back and finish school; for the time being, her time doesn’t  belong to her.

Emmanuel with his Dad

Emmanuel is a quiet one who dearly loves spending time with his Dad.  While I never heard him complain, I know these recent weeks (and the recent months of reduced mobility on Samuel’s part) have taken their toll on this young man.  I know he’ll be glad to have his Dad back!

Meanwhile, he’s in 5th grade and being obedient to his older sister while his parents have been away.

Samuel Jr, at the bar-b-que pit

Samuel Jr spent several years out of school, during what would ordinarily have been his high school time, working.  After awhile, he decided that he needed and wanted better in life, so he’s been back in school the last couple of years and is moving as fast as he can towards graduation.  At the same time, he’s handling a couple of  landscaping  contracts for his Dad, to keep things moving while his Dad isn’t able to do the work.  Samuel Jr’s plan is to join the police force when he’s able, which is a pretty good way to make a living.

Flounder and his wife, Marylis

As I mentioned earlier, Flounder lives a couple of hours away, with his wife and near her family.  He is very excited for his Dad and the new knee, but isn’t part of everyday life right now because of the distance.  I visited her parent’s farm last year and met another whole branch of the family in a delightful afternoon, far from anything touristy.  Flounder now has 7 cows, each addition to his herd being eagerly welcomed.  In another year, he hopes to begin construction on a house for them, with children to follow thereafter.  Marylis (and Lourdes) will be thrilled with that!

Yurielle

Yuri, short for Yurielle, is pushing hard to finish high school while also attending a technical school in Business Administration.  She’s in school 6 days each week, with a 2-hour bus ride each way for the classes on Saturday.

These are the lives which are central to this drama about Samuel’s knee, and are the reasons this man has pushed himself for the past 18 years, even though his knee hurt.   Those of you who joined in this effort to put Samuel back on his feet are right in the middle of these lives, and in the hearts of each of these children.  No matter what age they may be, it is their father who has been suffering – the rock in their world.

His brother's family, where we stayed in Alajuela for 2 weeks

No introduction to Samuel’s family would be complete without mentioning this lovely and gracious crew.  I am grateful for the huge efforts made by Gregorio and Elieder, and all the rest of his brood, where we stayed in Alajuela.  I look forward to a return trip to visit these new friends!