San José, Costa Rica, since 1956

Program Benefits Coffee Pickers

GUATEMALA CITY, Guatemala – Southern Costa Rica’s coffee farms do more than provide the cups of java that fuel workplaces across the industrialized world to the north. They also serve as a lifeline for impoverished indigenous people from south of the border in Panama.

Every year, families from that country’s Ngöbe Buglé territory roam about 100 kilometers to the southern Costa Rican canton of Coto Brus to pick coffee – a job that only 15 years ago was still being carried out mostly by Costa Ricans.

The visiting Ngöbe’s numbers have tripled in the past four years, up to 13,660 during the 2008 coffee harvest, according to Dr. Pablo Ortiz, Coto Brus’ public health director.

Dr. Ortiz and his team won international praise recently for their work on improving the health care of the temporary population of Ngöbe-in-residence. At the fifth edition of the Social Innovation Fair, organized by the United Nations’ (U.N.) Economic Commission for Latin America and the Caribbean (ECLAC) earlier this month at San Carlos University here, Ortiz’ health project received the third-place prize out of 13 finalists from across Latin America. This honor carried a $15,000 award from the W.K. Kellogg Foundation, a philanthropic trust started by the late United States breakfast cereal pioneer.

Ortiz described the Panamanian indigenous group’s situation as dire.

“Their living conditions, according to U.N. statistics, are comparable to those of Sub-Saharan African countries,” he said. He listed the indicators: high infant mortality rate, elevated instances of tuberculosis, poverty at 95 percent, extreme poverty at 85 percent and child malnutrition at 75 percent.

These levels come in stark contrast to the fast-paced development in Panama and the robust public and private health care systems of Costa Rica (TT, Aug. 21).

One of Panamanian President Ricardo Martinelli’s first visits after taking office was to hospitals in Costa Rica, in order to “copy some aspects of (Costa Rica’s) health system” (TT Online Daily News Subscriber’s Edition, July 17).

However, indigenous groups traditionally have fallen through the cracks of Latin America’s varied health programs – a point that makes Ortiz’ project all the more noble, said ECLAC.

The Coto Brus program is a “pioneer initiative,” the commission said, as it is a publicly funded project that attends to a group whose medical needs were previously unnoticed and unmet. Most other projects that  were displayed at the fair in Guatemala were grassroots, community-based efforts or initiatives of nongovernmental organizations, which are striving for such government-level approval and funding.

“The innovation is that we don’t wait for them to come to health centers. Rather, we go to the coffee farms looking for them,” Ortiz told The Tico Times. He said teams of one nurse and three nurse assistants visit the Ngöbe’s workplace from 4 p.m. sometimes until 10 p.m., providing general checkups, parasite treatment, condoms, rehydration salts and other services previously out of reach to the community. The medical teams also give talks on issues ranging from prenatal care to HIV/Aids and prevention of other diseases.

Started in 2003, the program’s impact has been remarkable. Ortiz said that since the project began it has helped almost halve the region’s infant mortality rate – once among the highest in the country – from 17.2 deaths per thousand live births in 2001 to 9.2 in 2007.

One of the keys, Ortiz said, has been a high degree of “cultural respect.” He gave the example of a situation in which  contaminated water supplies were causing widespread diarrhea among the Ngöbe.

“Logic told us to boil the water,” Ortiz said. “But ‘no,’ they said, ‘we can’t boil the water because water is alive.’ I didn’t understand.

I imagine that it’s like telling a Catholic to take the wine they give you at Sunday Mass, bring it home and stick it in the microwave till it boils and then drink it. The blood of Christ is contaminated? How can you say that?” the doctor exclaimed.

Instead, Coto Brus’ modern medical staff conferred with a traditional indigenous medicine leader and this time, Ortiz said, they took a different approach: “The water is sick, how do we cure it?”

They then began a water treatment program that reduced diarrhea cases from being a leading community health problem to a secondary issue.

The coffee pickers spend September, October and November in San Vito de Coto Brus before moving on to spend the next three months in the Los Santos region, a bit further north toward San José and at a higher altitude. After that, they return to Panama. But Ortiz refuses to call them immigrants, instead preferring the term “highly mobile population.”

“According to anthropological studies, this population has been living in this territory for more than 3,000 years, (roaming) in this pendulum-like movement. There are findings that show that they used to travel all the way to Guatemala,” he said. “These are not immigrants.

This is part of their ancestral land. I’m the immigrant, the last one to arrive.”

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