Life and Death in a Costa Rican Nursing Home

We spent our last day at Hogar Jesus de los Manos preparing for a big celebration. It was one of the resident’s ninetieth birthdays and as with all birthdays at the nursing home, it was celebrated with a grand ole party for all. A large sheet cake was ordered, balloons and decorations were put up, and music was played. Every able resident (save the ones who were bedridden or on their final days) was to attend and excitement was in the air the morning we arrived for our last day of volunteer work.

As we were preparing for the party we heard the sirens approaching. My heart sank. I knew only too well what that could mean. One of the gravely ill residents, Franco, had passed away. I knew it could happen. We were at a nursing home. Yet for some reason it caught me off guard. We were having so much fun with the residents that death seemed miles away even though many of the residents didn’t have much time left on this earth.

The day before Eduardo had us visit Franco, hold his hand and say our farewells. He was dying of cancer and the nurses ensured us that he wasn’t in pain. Yet there was something lost and far away in his eyes that made me deeply sad. His skin was pale and he was extremely frail. I searched his eyes for something but they were staring blankly into space. I grasped his limp hand, held it tightly and said goodbye. I have not idea if he felt anything yet I hope it at least gave him a little peace before he left. A priest was called to give Franco his last rites and floral arrangements were ordered for the chapel. There would be a funeral the next day, in the afternoon, after the birthday party and after we left.

The death put a more serious tone to the day yet the party was still to go on. While we were decorating the main foyer workers were simultaneously decorating the chapel for the afternoon funeral. The irony between life and death was uncomfortably present yet quietly accepted.

Throughout the day I reflected on how amazing it was that we were able to so quickly make wonderful bounds with the residents. I had initially thought a nursing home placement would be very depressing but I was completely surprised. The residents were very peaceful and were cared for by a very loving, caring staff. Each resident was treated with utter respect and dignity and love.

On the last day, we were able to take some photos of our new friends and I took the opportunity to get some of my favorite residents.
Here I am with Javier, one of my favorites.  He would go on and on about how he had traveled the world and was half American, speaking fiercely in Spanish and English.  His stories were always the same and he obviously forgot half the time that he just told you the same thing two mintues ago.  He was full of fire and life and truly made me laugh.  He grew a fondness of me and preferred to have me wheel him into the dining hall or entertain him.  He always wore his cap and would fold up his artwork (colored pages from a children’s coloring book) and hide them under his hat.  He also loved to keep a small ball under his cap as well.  He was one of the funniest residents I’d met:

Here is a picture of Javier alone.  His expression truly portrays his sarcastic, full-of-life attitude:


Here is a picture of our only male volunteer, Cassiano with one of the ladies, Carmen. I did a red manicure on her nails and she loved it.  She was very sweet and extremely quiet.   She also enjoyed coloring and doing crafts.

Elena with Lillian, one of the sweetest, cutiest grannies there. She married one of the residents and they always walk hand and hand, and smile. Love can happen anytime!
Me with the “primero el mundo” , the best boxer in his days in costa rica. He always loved to do his punches and he smiled a ton:

Me with Miguel, or Mike, as he liked to be called. He loves to dance thus when we put on the Latin music he would hold our hands and we would rock to the beat. He also spoke a little English.

The birthday celebration began mid-morning and it was quite an effort getting all 32 residents moved into the hall. It was nice that we were there to help the small staff as over half the residents are in wheelchairs while the ones that could walk needed assistance. The cake was cut and served and gobbled up much faster than lunch. Then the music began. Thanks to our earlier Latin Dance classes, we were able to strike up a beat with the residents. Costa Ricans LOVE to dance, regardless of age, ability or disability. We danced with the able-bodied men and women and even danced with people in wheelchairs. If the men were not able to dance, they loved to watch us dance as they still embraced the machismo culture despite their age. Men are men, young or old.
The residents smiles of joy were contagious and we had a ball. Here are some photos:
The residents loved to dance or watch us dance (if they were in a wheelchair). Me dancing with “La Cubana”, the cuban woman who loves to dance and still has her groove.
Here is a picture of some of the residents who sat around in a big circle, listening to the music and watching the dancing.  Note La Princessa, in pink. She is in her 90s and always wears make-up and was once very beautiful in her days.
We also sang La Bamba in Spanish to them and they loved it. Overall, the party was a big success and brought a little bit of sunshine to Hogar Jesus de los Manos.  Leaving was the hardest part.  We had grown attached in such a short time and felt like we truly made a difference.   After we said our goodbyes, I could hear Javier’s voice in the distance calling my name to come back.  Slowly his voice faded away until you could not longer here a sound except the rapid beating of my heart.

Hogar Jesus de los Manos

We followed the windy, maze-like streets into Guadalupe Cartago leading up to our final destination, The Hogar Jesus de los Manos. Along the way, we chatted happily and the energy in the van was quite high. Everyone was excited and we all couldn’t wait to arrive. A new member of the Costa Rica CCS team had joined us, Santi, who was just as alive and cheerful as the volunteers. As the Program Assistant, Santi works hand and hand with Jose and typically accompanies the volunteers to the site each day. There are two other CCS volunteer sites in Costa Rica, in different areas of the country, so Jose cannot be with the Cartago group all the time. He frequently travels to the other offices to check up on the volunteers and see how they are doing. Santi was an equally knowledgable and compassionate replacement and we were delighted to have him with us and we especially enjoyed all his laughs.

Santi told us that the nursing home was created in 1992 as an NGO that provides loving care and assistance to abandoned and abused elderly Costa Ricans that have no family or other place to go. Like most Costa Ricans, the residents are highly catholic and their faith plays a large role in their life and viewpoints. We were also prepared with some details on the residents before we arrived. About half of them were disabled and in wheelchairs, a few were mentally incapacitated, and a few were on their “last days” as Santi put it. We had to prepare ourselves to deal with anything but most of all, to give compassion, understanding and companionship to them. They were desperately lonely and isolated despite the excellent care of the staff. They were craving attention, fun, entertainment and simply someone to talk to who would listen to their stories. That was all we had to do.

We pulled up to the big wrought-iron gate and Santi buzzed the security (something we were getting use to in Costa Rica). We waited anxiously for the gates to open and the van to be let in. From a distance, we could see them; all thirty-two residents lined up in chairs or wheelchairs along the outdoor terraces on the L-shaped building. They were there, just as anxious as us, awaiting our arrival. My stomach dropped and anxiety raced through my veins. They are waiting for us! I realized in shock and disbelief. Then fear set in. How would I relate to them? I barely even speak Spanish. I have no experience with the elderly save my 95-year-old Grandfather who was one-of-a-kind. And even more nervously I thought, What if they found me a nuisance. Someone who couldn’t speak a lick of their language, a privileged American who didn’t have a clue? Then what would I do? What would I do if I failed?

I didn’t have time to answer that thought because before I knew it the gates opened and in we walked. We were instantly met and greeted by Eduardo, the thirtyish-looking Director of the home. I could tell instantly that I would like him. He was confident, yet extremely humble and caring. He looked everyone in the eye when introduced and you could really tell that he gave a damn.

We didn’t have much if any time to prepare for our introductions to the residents who were all desperately awaiting our arrival. All 32 pairs of eyes were on us as we walked down the long corridor and one by one, were introduced to every single Abuela and Abuelo at Jesus de los Manos. Eduardo made the introductions, lovingly placing his hands on each resident’s back and bending inwards close so that they could hear him speak. It was amazing. The compassion. The warmth. The love. The respect that Eduardo showed these people was unbelievable. I was completely taken aback. This is a good place I realized, in awe.

Insert: Picture of the entrance of Hogar Jesus de los Manos

Picture of the long, L-shaped corridor, lined with outdoor terraces for the residents to enjoy nature.

I was also amazed and relieved to see how the residents reacted to our arrival. They were like little kids in a candy shop. The smiles, the boisterous talk and even the hugs of a few, made us all feel instantly welcomed and at home. I couldn’t believe how quickly they accepted us. They drank us up, every last drop, like an ice-cold drink on a summer hot day. Ok then, no worries about us not making any impact I instantly believed. It was going to be possible to make a difference.

After the introductions of each resident and staff member of the home, we moved on to a brief tour of the grounds and the home itself. The building wasn’t the least bit modern yet it wasn’t as rundown as I had imagined. Of course before you visit a place you, you always conjure up images and perceptions of what it is going to be like. Well, this place was only slightly what I had imagined. The rooms were fine; minimally furnished but clean. Each resident had their own space which was nice. There was a huge room used for entertainment (music, dance, birthdays, etc) and there was also another large room adjacent that was set up with card tables and chairs where the residents could do activities such as color, paint or socialize. In the corner of that room, there was equipment for physical therapy sessions as well. At the end of the L-shaped corridor was a large dining room lined with long tables and chairs. Finally, the upstairs of the building contained more bedrooms and an office space for the staff.

The best part of all about Hogar Jesus de los Manos was the location. The building was inside a walled-in lot set within the perfectly, lush and serene Central Valley. Nature surrounded you once you were outside, which explains why the residents spent much of their day outdoors on the terrace relaxing in the sun and gentle breeze. View of the green-blue mountains could be seen in the distance and the far end of the courtyard contained a large garden where residents could grow and tend plants and flowers. It was lovely and so incredibly peaceful. A perfect place to age (if there can be one).

After our tour, Eduardo spent a short amount of time listing the objectives for the week. The most important thing we could help with was the residents. Since the Jesus de los Manos was a non-profit organization, its funds were very limited meaning they had an extremely small staff for all the residents. Just taking care of the residents required almost all their time so unfortunately the residents often got a bit bored and depressed. That was where the CCS volunteers as well as other volunteer organizations could help. They could entertain the residents. Talk to them. Play ball with them (yes, just like the ball I play with my young children; tossing a ball back and forth). Color pictures with them. Make jewelry or art with them. And for the ladies, give them manicures and pedicures! (Yes beauty is very important in Costa Rica and the women absolutely loved having their nails done!).

Eduardo decided to split up the volunteers into two groups: One group would work with the residents and the other group would work on the grounds. They desperately needed some gardening and planting to be done in order to beautify the landscape. I chose the path of least residence, perhaps, for the first day and opted to do the dirty work: Gardening. We dug out weeds, planting flowers and tried to straighten things out in a garden that probably had not been touched in weeks. Some of the residents adore gardening yet needed help with it. That was where we stepped in to help their aging, arthritic hands to tend to the garden. It was a relaxing way to spend the first morning. Outside, with the gentle breeze coming off the mountains and touching my face. With a few, attentive residents smiling at everything we said (which they probably couldn’t understand). But sometimes smiles and gestures can mean much more than words, I discovered. Another thing I enjoyed that morning was one resident, an elderly man perhaps in his eighties, especially enjoyed to water the garden. He spent hours watering the flowers and tending to the garden, never saying a word but with a smile in his eyes. He wore a white floppy hat, long-gray pants and a red sweater, and every morning when we arrived, he was out tending the garden. It was quite special.

Insert: Photos of the garden and my favorite gardener:

The morning passed quickly and before I knew it, we said our goodbyes to our newly made friends and were loaded up in the vans. We heard the distant protests from some of the residents not wanting us to leave yet but they understood we’d be back tomorrow morning. We heard from Eduardo that day two was going to involve some other activities. Rumor had it that the ladies wanted a special treat. They wanted manicures and pedicures. They wanted to look “pretty” and feel young. The men, meanwhile, were looking forward to playing more ball and perhaps having a dance with the female volunteers. Once a man, always a man.

The Midnight Arrivals

I had slowly drifted off to a deep sleep, thanks to the cold medicine, and was out cold when I heard the gate buzz. It was pitch black in my spartanly furnished bunk room save the pale, low light shining in through the cracks of the open windows. It was so quiet that you could hear a pin drop making the opening of the gates sound like the crashing sounds of the weekly garbage collection. I pushed the light button on my watch and it flashed the time of 12:15 am. Judging by the noise and commotion, our three other volunteers from Atlanta had finally arrived. Of course I was happy they arrived safe and sound yet slightly unhappy about the fact that I most likely wouldn’t be able to fall back asleep again for hours. Unfortunately sleeping in new environments is not my forte thus I usually have trouble when I travel. That is where a good pair of ear plugs, an eye cover and a sleep aid come in handy.

Everyone was woken up and went out to meet the new arrivals: Beverly, Ophelia and Jo, all from “hot Lanta”. They were a gregarious, loud, cheerful group of ladies that came from the most opposite walk of life as could be. I had never met a Southern Baptist before and now I would have the opportunity to meet three! It was going to be interesting to see how their faith played a role in the volunteer experience as well as being in Costa Rica during the most religious week of the year. I realized that I would be exposed to a lot more culture this week than originally planned.

I woke up Monday morning around 6am as the sun slowly began to rise over the Central Valley. I could hear birds singing cheerfully, something I had dearly missed over our long Minnesotan winter. I laid in bed for a few minutes enjoying the beauty of the birds’s music and also trying to access how I felt. Tired, disoriented and still sick. Bummer. I truly didn’t want to infect any of the nursing home residents (luckily I packed plenty of Purell!) The smell of freshly cooked eggs found it’s way along the long narrow corridor and filled the rooms, making my stomach grumble. It was the first day of our volunteer work and I was looking forward to it.

One by one, the other volunteers began to rise and the once quiet Home Base came to life with movement and noise. Excitement was in the air about our new arrivals and the start of our work at our volunteer site. We did not have much information on the nursing home, just that it was located here in Cartago, not far from the Home Base and had about 40 residents, all abandoned abuelas and abuelos (grandmothers and grandfathers). To most Americans, nursing homes are a fact of life and perhaps the most common route for the elderly. In Costa Rica, however, the entire family structure is much different. Generations of families live together. Adult children are responsible for taking care of their parents as they enter the twilight years of their life. Thus most grandparents live at home with their children and grandchildren all under one roof. This is customary so you can imagine the stigma on the elderly people who are abandoned from their family and have no place to go. Hogar de los Monos de Jesus Nursing Home was established as a place for these kinds of people to live and be cared for in a loving, faithful manner. The residents had no family to visit them. They only had the staff and each other. That was why the volunteers were so important. Besides helping with various odds and ends around the nursing home, the main duty of the volunteers was to interact with the residents and entertain them. As we would learn, this was by far the most important gift we could give: Friendship, Companionship, Compassion and Love. This was how we would make a difference in only one week. Something that seemed impossible but was within our grasp.

Allan, our driver, pulled the van up outside the Home Base at 8 am. Jose told us to gather up a big sack full of supplies to bring to the nursing home so we loaded in markers, colored paper, balloons, beauty products (for the ladies), books, music and other miscellaneous items. We were all dressed in t-shirts and long pants, the uniform required for working in Costa Rica. Shorts or short skirts were not permitted nor were tank tops or flip-flops. We had to remember that Cartago was a very Catholic place and the nursing home was religious-based meaning we were expected to dress conservatively. I was curious to see what the nursing home would be like and had very mixed feelings about the placement. Would it be depressing? Would it be hard? Would I feel like we were having any kind of impact on the residents? Would we be able to make a difference in only a week? These were all thoughts that raced through my mind as we winded around the narrow, serpentine streets of central Cartago.

Here are some photos of the CCS Home Base:

Inside the building, the long corridor lined with lounge chairs for reading and relaxing:

Inside the entrance to the Home Base:

One of my favorite things about the inside of the Home Base, all the wonderfully, inspiring quote written by past volunteers. Each volunteer wrote a quote and added a handprint to the wall before they left Cartago. I could spend hours walking around and reading them. Here are a few of my favorites: