Monteverde Institute: Culture, Community, and Health

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  Assessing food security in the Monteverde Zone: a multi-method approach, August 4, 2002

  Jennifer Andia, Emilie Davis, Rebecca Klein, and Elisabeth Wirsing

  A multi-method assessment on food security in the Monteverde Zone. Our research focused on food insecurity and perceptions of nutrition and food resources in the Monteverde Zone. Information was collected through various methods, including an anthropometric assessment of nutritional status in San Luis, semi-structured interviews with mothers regarding what foods are considered healthy and what they feed their children, sixty-seven returned Radimer/Cornell Measure of Hunger and Food Insecurity Scales, and a focus group with seven mothers of young children concerning the idea of a community garden. A priority of the research was exploring solutions to improving nutrition and access to food resources. Food insecurity was an issue in all of the communities, with Adult Food Insecurity being the most prevalent. Adult Food Insecurity is characterized by “compromises in the quality and quantity of food eaten by adults” (Himmelgreen et al. 2000: 336). The semi-structured interviews revealed a high degree of nutritional knowledge, yet a lack of quality nutrition because of economic limitations. The community garden idea was well accepted by the focus group. The women felt that the garden would be a solution to the lack of nutritious foods by providing better quality and more affordable produce.

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  Valorando la seguridad alimenticia en la zona de Monteverde: un acercamiento del método múltiple, August 4, 2002

  Jennifer Andia, Emilie Davis, Rebecca Klein, and Elisabeth Wirsing

  A multi-method assessment on food security in the Monteverde Zone. Our research focused on food insecurity and perceptions of nutrition and food resources in the Monteverde Zone. Information was collected through various methods, including an anthropometric assessment of nutritional status in San Luis, semi-structured interviews with mothers regarding what foods are considered healthy and what they feed their children, sixty-seven returned Radimer/Cornell Measure of Hunger and Food Insecurity Scales, and a focus group with seven mothers of young children concerning the idea of a community garden. A priority of the research was exploring solutions to improving nutrition and access to food resources. Food insecurity was an issue in all of the communities, with Adult Food Insecurity being the most prevalent. Adult Food Insecurity is characterized by “compromises in the quality and quantity of food eaten by adults” (Himmelgreen et al. 2000: 336). The semi-structured interviews revealed a high degree of nutritional knowledge, yet a lack of quality nutrition because of economic limitations. The community garden idea was well accepted by the focus group. The women felt that the garden would be a solution to the lack of nutritious foods by providing better quality and more affordable produce.

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  Acceso al servicio de atención prenatal para las mujeres de la Zona de Monteverde hasta el momento del parto, August 4, 2002

  JoHanna D’Epiro, Aaron Lampkin, Loralee Trocio, and Jaime Wilke

  Retrospective, exploratory study of access and utilization of health care services for pregnant women in the Monteverde Community. The purpose of this analysis is to conduct a retrospective, exploratory study of access and utilization of health care services from the prenatal period through parturition in the Monteverde Community. Initial interviews indicated that although universal health care is available to all women in the Monteverde zone through the CAJA, many women were not satisfied with the services they received and still others chose private physicians for care. A quantitative survey tool was utilized to assess the satisfaction of women with clinic services. In-depth semi-structured qualitative interviews were also conducted. The research group focused on women of childbearing age. Women were questioned about clinic utilization, satisfaction with services, and suggestions for improvements. The results of our study show that, overall, 67% of women are satisfied with women's health services at the clinic. Women also reported their largest concern with the clinic is the quality of care and the experience of the doctors. Of those surveyed, 47% either disagreed or strongly disagreed that they were satisfied with the doctors at the clinic. The study also highlighted the need for additional services such as a birthing center, a laboratory, specialty services, and H1V/A1DS testing. While limitations to the current study exist, the findings warrant further investigation into the access and utilization of services at the Clínica Monteverde.

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  Acceso y utilización a los servicios de salud para las mujeres en los periodos prenatales hasta el momento de los partos en la zona de Monteverde Segunda Fase, August 4, 2002

  JoHanna D’Epiro, Aaron Lampkin, Loralee Trocio, and Jaime Wilke

  Retrospective, exploratory study of access and utilization of health care services for pregnant women in the Monteverde Community. Following the initial exploratory study entitled Women's Access and Utilization of Health Care Services from Pre-natal Period through Parturition in the Monteverde, Zone, this phase of research focused on two areas which had been targeted for follow' up. Using semi-structured interviews and reassessing the original data, the topics of standard of care during pregnancy and birth histories were examined. This included a brief historical review of obstetric care and medical transportation from The Monteverde area. Three medical personnel and four additional women who had children within the last 12 years were interviewed for a total of 17 interviews. Many women (50%, n =36) chose to have their care with private providers. However, all the women in our study delivered their children in public hospitals provided by the CAJA. The results of the study showed that like their predecessors, women from Monteverde often choose to wait near the hospital before their delivery (57%) rather than risking having to make the difficult trip to the closest hospital during labor. The average wait time before delivery was 10.86 days among seven women for whom this data was available. The choice of hospital was made for three primary reasons: proximity of the facility, family or friends nearby and because of the hospital's reputation. Births occur frequently in transit as the local ambulance service reported that one worker alone had 14 deliveries over 17 year’s time. Despite these hardships, the majority (88%) of reported birth weights in our study was healthy and the district of Puntarenas has an infant mortality rate consistent with the rest of Costa Rica.

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  Acceso y utilización de servicios de salud desde el periodo prenatal hasta el parto por mujeres en la comunidad de Monteverde Fase I [PowerPoint], August 4, 2002

  JoHanna D’Epiro, Aaron Lampkin, Loralee Trocio, and Jaime Wilke

  Retrospective, exploratory study of access and utilization of health care services for pregnant women in the Monteverde Community.

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  Women’s access and organization of health care services from pre-natal period through parturition in the Monteverde community Phase I [PowerPoint], August 4, 2002

  JoHanna D’Epiro, Aaron Lampkin, Loralee Trocio, and Jaime Wilke

  Retrospective, exploratory study of access and utilization of health care services for pregnant women in the Monteverde Community.

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  Women’s access and utilization of health care services from pre-natal period through parturition in the Monteverde Zone, August 4, 2002

  JoHanna D’Epiro, Aaron Lampkin, Loralee Trocio, and Jaime Wilke

  Retrospective, exploratory study of access and utilization of health care services for pregnant women in the Monteverde Community. The purpose of this analysis is to conduct a retrospective, exploratory study of access and utilization of health care services from the prenatal period through parturition in the Monteverde Community. Initial interviews indicated that although universal health care is available to all women in the Monteverde zone through the CAJA, many women were not satisfied with the services they received and still others chose private physicians for care. A quantitative survey tool was utilized to assess the satisfaction of women with clinic services. In-depth semi-structured qualitative interviews were also conducted. The research group focused on women of childbearing age. Women were questioned about clinic utilization, satisfaction with services, and suggestions for improvements. The results of our study show that, overall, 67% of women are satisfied with women's health services at the clinic. Women also reported their largest concern with the clinic is the quality of care and the experience of the doctors. Of those surveyed, 47% either disagreed or strongly disagreed that they were satisfied with the doctors at the clinic. The study also highlighted the need for additional services such as a birthing center, a laboratory, specialty services, and H1V/A1DS testing. While limitations to the current study exist, the findings warrant further investigation into the access and utilization of services at the Clínica Monteverde.

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  La salud ocupacional en la Fábrica de Quesos Productores de Monteverde, August 4, 2002

  María Teresa Fregoso, Idalia Aracely Rodríguez Ayala, and Nancy Romano

  An occupational risk assessment of the Monteverde Cheese Factory. Our group was asked to do a basic risk assessment of the Productores de Monteverde, S.A. (cheese factory) to identify occupational risks and make recommendations for a safer work environment. We did observations of five areas in the plant: milk receiving, main plant, warehouse, offices and maintenance areas from July 2 to July 28, 2002. We also asked workers to fill out a questionnaire asking about their perceptions of work training, risks and possible solutions to workplace hazards. Along with the questionnaires, we did sixteen informal interviews asking workers how they felt about work safety at the factory. We found a variety of risks including blocked emergency exits and slippery floors. Workers identified many of the same risks in their questionnaires and interviews that we were also able to observe. From the data we received, we were able to make recommendations for the risks and label them as high or low. Our goal was to provide a report that would act as a stepping-stone for future change in occupational health at the cheese factory.

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  Occupational health in the Productores de Monteverde Cheese Factory, August 4, 2002

  María Teresa Fregoso, Idalia Aracely Rodríguez, and Nancy Romano

  An occupational risk assessment of the Monteverde Cheese Factory. Our group was asked to do a basic risk assessment of the Productores de Monteverde, S.A. (cheese factory) to identify occupational risks and make recommendations for a safer work environment. We did observations of five areas in the plant: milk receiving, main plant, warehouse, offices and maintenance areas from July 2 to July 28, 2002. We also asked workers to fill out a questionnaire asking about their perceptions of work training, risks and possible solutions to workplace hazards. Along with the questionnaires, we did sixteen informal interviews asking workers how they felt about work safety at the factory. We found a variety of risks including blocked emergency exits and slippery floors. Workers identified many of the same risks in their questionnaires and interviews that we were also able to observe. From the data we received, we were able to make recommendations for the risks and label them as high or low. Our goal was to provide a report that would act as a stepping-stone for future change in occupational health at the cheese factory.

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  Women’s access and utilization of health care services from the pre-natal period through parturition in the Monteverde Zone phase II, August 4, 2002

  JoHanna Friend D’Epiro, Aaron Lampkin, Loralee Trocio, and Jaime Wilke

  Follow up study of access and utilization of health care services for pregnant women in the Monteverde Community. Following the initial exploratory study entitled Women's Access and Utilization of Health Care Services from Pre-natal Period through Parturition in the Monteverde, Zone, this phase of research focused on two areas which had been targeted for follow' up. Using semi-structured interviews and reassessing the original data, the topics of standard of care during pregnancy and birth histories were examined. This included a brief historical review of obstetric care and medical transportation from The Monteverde area. Three medical personnel and four additional women who had children within the last 12 years were interviewed for a total of 17 interviews. Many women (50%, n =36) chose to have their care with private providers. However, all the women in our study delivered their children in public hospitals provided by the CAJA. The results of the study showed that like their predecessors, women from Monteverde often choose to wait near the hospital before their delivery (57%) rather than risking having to make the difficult trip to the closest hospital during labor. The average wait time before delivery was 10.86 days among seven women for whom this data was available. The choice of hospital was made for three primary reasons: proximity of the facility, family or friends nearby and because of the hospital's reputation. Births occur frequently in transit as the local ambulance service reported that one worker alone had 14 deliveries over 17 year’s time. Despite these hardships, the majority (88%) of reported birth weights in our study was healthy and the district of Puntarenas has an infant mortality rate consistent with the rest of Costa Rica. Estudio de seguimiento de acceso y utilización de los servicios de salud para mujeres embarazadas en la comunidad de Monteverde.

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  Opciones recreativas para la juventud de la Zona de Monteverde, August 4, 2002

  Lauren Schmidt, Allison Hayes, and Sarah Adkins

  A study on the recreation and activity opportunities for the youth in Monteverde. In an open community meeting held Monday, July 1, 2002, members of the community in the Monteverde Zone (including Monteverde, Cerro Plano, Santa Elena, San Luis and Los Llanos), stressed that one of the major problems the community is facing is a lack of recreational activities for youth. They emphasized the fact that drugs and teenage pregnancies are an issue here in the Monteverde Zone, and it is their opinion that the lack of positive activities for youth has a direct correlation. The research team had been informed that lack of recreation and consequent alternative activities is a concern. To research the issue of lack of recreation, the research team used qualitative research methods to collect data. 25 structured interviews were conducted with area youth (ages 10-24) and adults (ages 25 and above), focusing on the towns of Cerro Plano and Santa Elena, but also including Monteverde and Los Llanos. Through the interviews information was compiled about what both youths and adults currently do in their free time for fun, and what they would like to have available for youth in the future. Informal conversations also took place addressing recreational activities for youth, as well as background research on a previous study conducted in 1996, addressing youth recreation, education and family life in the town of Monteverde. After compiling interviews, informal conversations and background information, it was necessary to analyze the findings. Lists and graphs with the most frequent responses of activities that both youths and adults do in their free time, what activities are now available for youth, what activities are most desired for youth in the future, where a new recreational area would best be physically located, if they would be willing to pay to use a recreational area, and ideas for new uses of the bullring in Cerro Plano, have been configured. The interviewees gave similar answers and suggestions, but also ranged in diversity, for the needs and wants of the community. After analysis and discussion of data, various recommendations for community action and further research are presented.

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  Recreation options for youth in the Monteverde region, August 4, 2002

  Lauren Schmidt, Allison Hayes, Sarah Adkins, and Nihal Hassan

  A study on the recreation and activity opportunities for the youth in the MonteverdeZone. In an open community meeting held Monday, July 1, 2002, members of the community in the Monteverde Zone (including Monteverde, Cerro Plano, Santa Elena, San Luis and Los Llanos), stressed that one of the major problems the community is facing is a lack of recreational activities for youth. They emphasized the fact that drugs and teenage pregnancies are an issue here in the Monteverde Zone, and it is their opinion that the lack of positive activities for youth has a direct correlation. The research team had been informed that lack of recreation and consequent alternative activities is a concern. To research the issue of lack of recreation, the research team used qualitative research methods to collect data. 25 structured interviews were conducted with area youth (ages 10-24) and adults (ages 25 and above), focusing on the towns of Cerro Plano and Santa Elena, but also including Monteverde and Los Llanos. Through the interviews information was compiled about what both youths and adults currently do in their free time for fun, and what they would like to have available for youth in the future. Informal conversations also took place addressing recreational activities for youth, as well as background research on a previous study conducted in 1996, addressing youth recreation, education and family life in the town of Monteverde. After compiling interviews, informal conversations and background information, it was necessary to analyze the findings. Lists and graphs with the most frequent responses of activities that both youths and adults do in their free time, what activities are now available for youth, what activities are most desired for youth in the future, where a new recreational area would best be physically located, if they would be willing to pay to use a recreational area, and ideas for new uses of the bullring in Cerro Plano, have been configured. The interviewees gave similar answers and suggestions, but also ranged in diversity, for the needs and wants of the community. After analysis and discussion of data, various recommendations for community action and further research are presented.

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  Los Resultados de la Clínica de San Luis 11 de julio 2002 [PowerPoint], July 11, 2002

  Monteverde Institute

  The results can be utilized to identify individuals with a high risk of malnutrition

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  Investigación preliminar sobre los efectos de la Industria Turística en la Zona de Monteverde Costa Rica [PowerPoint], 2002

  Urinda Alamo, Marcela Tamayo, Victor Polanco, Kelly Benjamin, and Mwenza Bell

  A preliminary investigation of the effects of the transformation on the community due to tourism.

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  Nutrición y seguridad alimenticia en la Zona de Monteverde [PowerPoint], 2002

  Jennifer Andia, Rebecca Klein, Elisabeth Wirsing, Emilie Davis, Gretchen Goodrich, Katarina Johnson, Nancy Lashway, and Michelle McArdle

  A multi-method assessment on food security in the Monteverde Zone.

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  Evaluación de riesgo preliminar de Productores de Monteverde, S.A. [PowerPoint], 2002

  María Teresa Fregoso, Idalia Aracely Rodríguez Ayala, and Nancy Romano

  An occupational risk assessment of the Monteverde Cheese Factory.

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  Recreación y Jóvenes [PowerPoint], 2002

  Nihal Hasan, Sarah Adkins, Allison Hayes, and Lauren Schmidt

  A study on the recreation and activity opportunities for the youth in the Monteverde Zone.

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  Pesticidas, herbicidas y salud, July 21, 2001

  Edgar Amador, Terra Bredeson, and Laura Severance

  Attitudes of local residents as to perceived sources of pesticide contamination in waterways through the use of pesticides in the area. Recommendations for further study included. We conducted archival data research, informal interviews, semi‐structured interviews, participant observation, and questionnaires over the course of four weeks. (It is important to note that we were in class most of the time.) Although we were unable to take any environmental measures, we discovered through key informant interviews that there are potential risks of contamination to the local waterways from herbicides, pesticides, and fertilizer run‐off but mostly from fincas that contain livestock – ganaderos not agricultores. We also discovered that there is a threat of contamination to the milk because the pastures are often sprayed with pesticides and the cattle is given toxic parasite removers. A possible additional threat comes from people’s attitudes toward pesticides, which reveal that people may not be fully aware of the potential effects of long‐term exposure. We recommend further study into this issue in the coming year particularly involving a group that can evaluate environmental and human contamination from pesticides.

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  Pesticides, herbicides and health, July 21, 2001

  Edgar Amador, Terra Bredeson, and Laura Severance

  Attitudes of local residents as to perceived sources of pesticide contamination in waterways through the use of pesticides in the area. Recommendations for further study included. We conducted archival data research, informal interviews, semi‐structured interviews, participant observation, and questionnaires over the course of four weeks. (It is important to note that we were in class most of the time.) Although we were unable to take any environmental measures, we discovered through key informant interviews that there are potential risks of contamination to the local waterways from herbicides, pesticides, and fertilizer run‐off but mostly from fincas that contain livestock – ganaderos not agricultores. We also discovered that there is a threat of contamination to the milk because the pastures are often sprayed with pesticides and the cattle is given toxic parasite removers. A possible additional threat comes from people’s attitudes toward pesticides, which reveal that people may not be fully aware of the potential effects of long‐term exposure. We recommend further study into this issue in the coming year particularly involving a group that can evaluate environmental and human contamination from pesticides.

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  Adolescent pregnancy and contraceptive use in the Monteverde Zone: A preliminary examination, July 21, 2001

  Deepa Bhat, Michelle Cockerham, and Amy Malliett

  A preliminary assessment of contraceptive use and availability in the Monteverde Zone using qualitative field methods. Recommendations for improved contraceptive practices are included. The research team had been informed that adolescent pregnancy and various reproductive health issues are important problems that need to be addressed in the Monteverde area. To research the topic of adolescent pregnancy, qualitative field methods were used to gather data. Ten structured in-depth interviews on issues surrounding adolescent pregnancy were conducted with various community members in the Monteverde Zone. A number of informal conversations were also included in our qualitative data analysis. The authors conducted a preliminary assessment of contraceptive use and availability in the Monteverde Zone. Furthermore, the Globalization, Nutrition and Health field course conducted 19 reproductive histories in the San Luis area as part of a methodological exercise. This data was then analyzed and incorporated into the authors’ findings. Findings included that there are varying opinions with regards to adolescent pregnancy, and that lack of recreational resources contribute to adolescent pregnancy and to drug and alcohol abuse. Moreover, abortion is available in surrounding areas, if an individual is seeking one. There were varying opinions with regards to the sex education within the schools. However, many respondents called for even more education and information for adolescents. The major influences on adolescents’ sexual decision-making were first their friends, and then their family. Based on the information gathered from these interviews, various recommendations are presented for future research and methods to help alleviate the problem.

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  El embarazo de las adolescentes en la Zona de Monteverde: un examen preliminar, July 21, 2001

  Deepa Bhat, Michelle Cockerham, and Amy Malliett

  A preliminary assessment of contraceptive use and availability in the Monteverde Zone using qualitative field methods. Recommendations for improved contraceptive practices are included. The research team had been informed that adolescent pregnancy and various reproductive health issues are important problems that need to be addressed in the Monteverde area. To research the topic of adolescent pregnancy, qualitative field methods were used to gather data. Ten structured in‐depth interviews on issues surrounding adolescent pregnancy were conducted with various community members in the Monteverde Zone. A number of informal conversations were also included in our qualitative data analysis. The authors conducted a preliminary assessment of contraceptive use and availability in the Monteverde Zone. Furthermore, the Globalization, Nutrition and Health field course conducted 19 reproductive histories in theSan Luis area as part of a methodological exercise. This data was then analyzed and incorporated into the authors’ findings. Findings included that there are varying opinions with regards to adolescent pregnancy, and that lack of recreational resources contribute to adolescent pregnancy and to drug and alcohol abuse. Moreover, abortion is available in surrounding areas, if an individual is seeking one. There were varying opinions with regards to the sex education within the schools. However, many respondents called for even more education and information for adolescents. The major influences on adolescents’ sexual decision‐making were first their friends, and then their family. Based on the information gathered from these interviews, various recommendations are presented for future research and methods to help alleviate the problem.

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  Anthropometric and nutritional assessment of the community of San Luis, Monteverde, July 21, 2001

  Ann Bretnall, Scarlett Hutchison, Lourdes Rodríguez, Claudia Sanchez-Castillo, and Ann Smyntek

  Findings and recommendations resulting from an anthropometric and nutritional study in San Luis, Monteverde, Puntarenas. The Anthropometric and Nutritional Assessment aimed to collect and analyze anthropometric, nutrition, and hemoglobin levels, and to conduct a general clinical exam. This study was done at the San Luis Clinic on July 9, 2001. A 24 hour dietary recall survey of the mother and one child less than five years of age, who has been weaned, were conducted on July 10th and 11th, 2001, at the homes of people living in the San Luis area. Qualitative food frequency data and quantitative data were collected. The anthropometric data was analyzed in the computer programs Epi Info 2000, SPSS 10.0 for Windows, and Microsoft Excel. Food frequency data obtained from the dietary recall surveys was analyzed in Microsoft Excel. We found that malnutrition does not appear to be a problem in the sample studied, and that between 5% and 10% of boys and girls below the age of 12 are at risk for stunting. Young girls are more at risk for being overweight than boys, and women are much more likely to be obese than men. The results of the hemoglobin test indicate that anemia does not appear to be a problem in the community studied, although results are unclear for children under 3 years of age and pregnant women. The clinical exams detected low levels of goiter in women and children. The food frequency analysis indicated that the most common foods eaten were rice, beans, and café con leche. Oil and sugar were frequently used in the population studied. This analysis indicated that children are not getting enough of good quality protein, such as animal protein from red meat, milk and eggs, and that people’s diets tend to be low in vitamins A and C. Recommendations regarding healthy eating habits were made, as well as more detailed recommendations for future research.

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  Valoración antropométrica y nutricional de la comunidad de San Luis, Monteverde, July 21, 2001

  Ann Bretnall, Scarlett Hutchison, Lourdes Rodríguez, Claudia Sánchez-Castillo, and Ann Smyntek

  Findings and recommendations resulting from an anthropometric and nutritional study in San Luis, Monteverde, Puntarenas. The Anthropometric and Nutritional Assessment aimed to collect and analyze anthropometric, nutrition, and hemoglobin levels, and to conduct a general clinical exam. This study was done at the San Luis Clinic on July 9, 2001. A 24 hour dietary recall survey of the mother and one child less than five years of age, who has been weaned, were conducted on July 10th and 11th, 2001, at the homes of people living in the San Luis area. Qualitative food frequency data and quantitative data were collected. The anthropometric data was analyzed in the computer programs Epi Info 2000, SPSS 10.0 for Windows, and Microsoft Excel. Food frequency dataobtained from the dietary recall surveys was analyzed in Microsoft Excel. We found that malnutrition does not appear to be a problem in the sample studied, and that between 5% and 10% of boys and girls below the age of 12 are at risk for stunting. Young girls are more at risk for being overweight than boys, and women are much more likely to be obese than men. The results of the hemoglobin test indicate that anemia does not appear to be a problem in the community studied, although results are unclear for children under 3 years of age and pregnant women. The clinical exams detected low levels of goiter in women and children. The food frequency analysis indicated that the most common foods eaten were rice, beans, and café con leche. Oil and sugar were frequently used in the population studied. This analysis indicated that children are not getting enough of good quality protein, such as animal protein from red meat, milk and eggs, and that people’s diets tend to be low in vitamins A and C. Recommendations regarding healthy eating habits were made, as well as more detailed recommendations for future research.

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  Mental health and alcoholism, July 21, 2001

  Melanie de Luna, Renzo Rosales, and Jennifer Avery

  Findings and recommendations for further studies on the incidences and causes of mental health issues and alcoholism.