A Mission of Mercy in Costa Rica

PHOTOGRAPHS BY KAREN KASMAUSKI
TEXT BY SEAN MARKEY
The Norwich Record | Summer 2019

In March, School of Nursing Director Paulette Thabault led students on a service-learning mission to Costa Rica, where they staffed a medical clinic for refugees fleeing violence in neighboring Nicaragua. We sent long-time National Geographic photographer Karen Kasmauski—known for her Pulitzer-nominated work on global health, nursing, and refugees—to join them.

Nicaragua is one of the poorest countries in the Western Hemisphere. It is also one of its most beautiful and troubled. In April 2018, the country’s notoriously violent and corrupt president, Daniel Ortega, sharply cut social security benefits and raised taxes. “People who were already being squeezed were squeezed even harder,” says School of Nursing Director Paulette Thabault, DNP, JD, a frequent medical volunteer there.

Pensioners and students took to the streets to protest. Their nonviolent movement was met with a brutal crackdown by pro-Ortega paramilitary and government forces. Churches were attacked and the Internet shut down. More than 500 people have been killed and hundreds more imprisoned and tortured. UNHCR, the United Nations refugee agency, estimates that at least 62,000 Nicaraguans have fled the country since the violence began. Of those, some 55,500 have sought refuge in neighboring Costa Rica, a country that has long offered asylum to its Central American neighbors during decades of strife in the region.

The asylum seekers include students, former public officials, opposition figures, journalists, doctors, human rights defenders, and farmers, according to Geneva-based UNHCR spokesperson Liz Throssell. “A significant number arrive in need of healthcare, psychological support, shelter, and food assistance.”

To help meet a small portion of that need, Thabault led a weeklong experiential learning trip to Costa Rica over spring break in March. For nursing majors, it was also a chance to learn about community-based nursing and population health while putting their clinical skills into practice.

Working through the faith-based medical and humanitarian relief nonprofit Corner of Love, Norwich volunteers set up a temporary medical clinic in the Costa Rica village of La Cruz, located half an hour from the Nicaragua border. They brought with them 3,000 pounds of donated medical supplies, medicines, and other basic necessities—from soap, shampoo, and toothpaste to clothing, shoes, and reading glasses.

Paired with licensed doctors and nurse practitioners, nursing students and a few international studies and criminal justice majors worked long days to help distribute food, clothing, medical care, and fellowship to hundreds of Nicaraguan refugees bused in from San Jose, California, and other locales.

Patients presented a range of medical conditions—from parasitic infections and pneumonia to heart conditions, psychological trauma, and late-stage cancer. Some cases were easily treated with antibiotics or other available medicine. Other cases seemed all but hopeless, such as a mother of two who arrived with signs of metastatic breast cancer and advanced liver failure.

Simple things made a big difference. Children could play with coloring books and soap bubbles. Refugees received toiletries, food, and water bottles. At the end of each clinic day, they gathered in a group to share personal stories of fleeing their homeland and their worries about the uncertain future ahead.

Among the trip’s volunteers was Dr. Peter Gunther. A Burlington-based doctor who is also married to Thabault, he reflected on how the clinic benefited the refugees. “The most important thing, in my mind, is we gave them a couple hours of joy, hope, and maybe some laughter,” he said. “And I think, given these folks’ lives, that’s a huge gift.”

Cultural immersion was an important aspect of the learning experience for student volunteers, says nursing program director Paulette Thabault (left). “They were in a country where everyone spoke Spanish, and most of them did not.” For future nurses, cultural empathy is an essential skill. — Cultural immersion was an important aspect of the learning experience for student volunteers, says nursing program director Paulette Thabault. “They were in a country where everyone spoke Spanish, and most of them did not.” For future nurses, cultural empathy is an essential skill.

Despite the violence and turmoil back home, Nicaraguan asylum seekers remain intensely patriotic. Here, they sing the Nicaragua national anthem. “They were torn from their country that they love,” Thabault says. At the clinic, many refugees shared stories about family members who were shot, imprisoned, or tortured. Some patients had their teeth pulled in prison or showed scars from electric shock. Others had their hands and fingers broken. “They’re still suffering from [those] physical and emotional wounds and not knowing what is going to be in front of them,” Thabault says. “Their future is really unclear and uncertain.”

“All of the refugees were so grateful for what we could offer them,” says nursing major Morgan Smith (not pictured). “I [felt] blessed to be able to make even the smallest impact in their lives. I wish there was more that could be done.” Smith says her volunteer experience changed her, professionally and personally.

Nursing majors were challenged to consider the social determinants of health in the population of Nicaraguan refugees they saw. School of Nursing Director Paulette Thabault says the field known as community health looks at how factors such as birthplace, education, access to food, safe housing, and clean drinking water can affect the health status and outcomes of individuals and populations.

Dr. Peter Gunther and nursing majors treat a Nicaraguan refugee for a severely ingrown toenail. Other cases were far harder to address. Gunther recalls that of a 36-year-old meat cutter from Managua, who played baseball in his youth. “He wanted to be Big Papi,” Gunther says, referring to the former Boston Red Sox star. “Papi” explained that he felt chest pains for 48 hours starting on the same day every month, despite his otherwise perfect health. Gunther says he was told that on that date five months previously, Papi had been walking in Managua near a protest with his 19-year-son. Paramilitary members arrived and started shooting students. Papi's son was shot point-blank in the chest with a shotgun and died in his arms. — Dr. Peter Gunther and nursing majors treat a Nicaraguan refugee for a severely ingrown toenail. Other cases were far harder to address. Gunther recalls that of a 36-year-old meatcutter from Managua, who played baseball in his youth. “He wanted to be Big Papi,” Gunther says, referring to the former Boston Red Sox star David Ortiz. “Papi” explained that he felt chest pains for 48 hours starting on the same day every month, despite his otherwise perfect health. Gunther says he was told that on that date five months previously, Papi had been walking in Managua near a protest with his 19-year-son. Paramilitary members arrived and started shooting students. Papi's son was shot point-blank in the chest with a shotgun and died in his arms.

Paulette Thabault shares a hug and a teary farewell on the last day of the clinic. The woman opposite was the matriarch of a family of four in especially poor health. Her husband suffered heart problems. One of her children had an enlarged liver, and both suffered parasitic infections. The mother was in even graver condition, presenting signs of advanced metastatic breast cancer and liver failure. Student nurse Soon-Yi Dempher recalled working with the family alongside Thabault’s daughter, neonatal nurse practitioner Kaitlin Johnson. “I sat there and watched Kaitlin … tell the mother in front of her two children that she was very, very sick and did not have much time left on this earth.” Dempher said at that moment, she realized that being a good nurse was not just about charting patient interactions or assessing their lungs. “It was about compassion. So I held her hand, and I hugged her when she cried. Because in that moment, that was what she needed.”

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