“So why don’t you do it?”
The question made Jeff Nadel pause.
He had spent the day interviewing elderly Costa Ricans in the small, rural town of Florencia. Now he was talking to a 71-year-old Peace Corps volunteer who had waited patiently throughout the afternoon to see him.
Nadel, a participant in ACM’s field research program in Costa Rica, was conducting an independent project on cognitive impairment, such as memory loss, among senior citizens.
Jeff Nadel teaching an English class for adults. He was helping Peace Corps volunteer Patricia Marin, who asked the question that spurred Nadel to develop the literacy initiative.
He described his project to the woman, who pressed him further. “Based on your early results, is there something you could do to help these people?” she asked.
“I told her, loftily, that I would provide them with an education,” Nadel recalled later. “She said six of the most impactful words that I had ever heard, which were, ‘So why don’t you do it?'”
So he did.
“The literacy initiative was the best thing I did while I was there,” he said. “It was the most life-changing thing I’ve ever done.” Life-changing for Nadel and possibly for a group of senior citizens in Costa Rica, too, by helping them stay mentally sharp as they age.
Connecting neuroscience to everyday life
A neuroscience major at Colorado College, Nadel arrived in Costa Rica last spring with plans to prepare for a career in clinical biomedical research. He already had gotten a taste of such lab-based work the previous summer when he was an undergraduate research fellow at the National Institutes of Health (NIH) in Washington, DC, a position he would return to in summer 2011.
He was intrigued by the ACM Costa Rica: Field Research in the Environment, Social Sciences, & Humanities program because it would give him the chance to tailor his research project to his particular interests and academic background in neuroscience and brain function. The program also afforded this self-described extrovert the opportunity to work with a variety of people every day.
Nadel chose the program’s spring trimester option, which is shorter than the 16-week semester that most students take, but includes the same rigorous elements – preparing a research proposal, a “Spanish for researchers” language class, substantial time conducting field research, and writing and presenting a final research paper.
The first step for Nadel was to work with his research advisor in the public health area, Dr. Diana Ulate. They talked about his interests and she suggested that he examine the prevalence of a condition called cognitive impairment among elderly people in San Carlos de Alajuela, a rural region in northern Costa Rica.
Jeff Nadel with his host family in San José.
“Cognitive impairment is more a symptom than it is actually a disease,” Nadel explained. It can show up as a problem with memory, learning, spatial awareness, or other mental function, and is a key indicator of dementia. The topic would match up well with his knowledge of neurological diseases.
What if he went further, Ulate advised, to consider social factors impacting cognitive impairment? In consultation with Ulate, as well as Program Director Chris Vaughan and statistical advisor Mike McCoy, Nadel’s project was broadened to go beyond just counting the rate and severity of the residents’ impairment. He would also try to find out what physical and social factors during peoples’ everyday lives may have put them at risk for cognitive impairment.
The broader focus would mean considerably more work, but it was a perfect fit for Nadel. “I’m interested in doing intervention work – not just the basic science and research, but actually going in and finding ways that you can prevent the problems,” he noted. “I had a lot of great people at ACM who were supporting me all the way through the process, who had expertise in different areas and gave varied perspectives that allowed me to develop a good study.”
Listening is an eye-opening experience
Through a social worker whom Ulate knew, Nadel lined up people to interview, mainly in senior centers and care facilities in a rural town and a small city in San Carlos. With each person, he would first administer the Mini Mental State Exam, a widely-used diagnostic test to measure cognitive impairment. Then the two of them would go through a questionnaire to identify possible risk factors for any impairment, such as the elderly person’s living situation, health history, and frequency of mental activities such as reading.
A facility for senior citizens where Jeff Nadel conducted some of his interviews.
The interactions were time consuming, lasting anywhere from half an hour up to nearly three hours in some cases. By the time his month in the field was up, Nadel had conducted nearly 100 interviews. Listening to the people talk about their lives, he said, was an eye-opening experience.
“For some people, it was more therapeutic for them to sit there and tell me their life story [rather] than to just answer my questions,” he said. “What I learned from them I will always carry with me and will shape the way I practice medicine in the future.”
Nadel began to notice that people who had attended elementary school – the only schooling available in the region up until about 35 years ago, according to the residents – tended to be much less impaired than those with little or no schooling.
“Perhaps education does more than just teaching us how to count to three,” he said. “Maybe being able to maintain that education over time through the jobs that you do, or the places that you live, or any type of mental stimulation just coming from the generalized environment, could actually help to stave off these neuro-degenerative mental diseases.”
Putting research results into action
It was during a day of interviews that Nadel was asked the question – “So why don’t you do it?” – that inspired him to put his research results into action. But how would he provide the elderly residents with education?
In his spare time, Nadel put together a funding proposal, in Spanish, along with an accompanying PowerPoint presentation. Then, computer in hand, he went around and knocked on the doors of government agencies, businesses, and organizations – any group he thought might be willing to support the project.
At his host grandparents house in San Carlos, Jeff Nadel feeds a macaw.
His persistence paid off. After a succession of meetings, the Costa Rican Ministry of Education signed on to the initiative, with a promise to provide a place for the classes to meet, school supplies, and a teacher certified in elderly education.
“I wanted it to be sustainable and I wanted it to be a community intervention, where the people in the community were taking hold of this project and helping other people in the community,” Nadel said. During the last three weeks of the program, when he was analyzing his research data and writing his final paper at the ACM center in the city of San Jose, Nadel traveled to San Carlos each weekend to help with the planning. “I needed ten people to be able to run the program, and by the time I left, more than 40 people had signed up,” he said.
“It was really for me a very life-changing experience,” Nadel said, “I had always been of the mindset that the best way to help people with medical problems was by giving them medicine or surgery or physical therapy or something like that. Being a direct part of developing a social intervention that I think will actually do a lot to stave off the progression of [elderly people’s] mental problems and at least give them some type of a feeling that they’re taking hold of their lives, I think that will provide a large impact for them.”
Leaving “a piece of my heart” in Costa Rica
Back at Colorado College for his senior year, Nadel has kept in touch with the people he worked with in Costa Rica, doing what he can to help get the literacy project off to a solid start. He and Diana Ulate have also put the finishing touches on a research paper that they co-authored and have submitted to a scholarly journal for possible publication.
During a program field trip to the FINMAC organic cacao plantation, Jeff Nadel points at a sloth in the tree above.
“I loved being able to do research in a foreign language,” said Nadel. “I learned a lot, not only about myself, [but also from] seeing health disparities through the lens of another culture and another language. I think that’s very valuable. Working with a population that has a different culture … provides a secondary perspective, and it provides a perspective you wouldn’t normally see.”
Not surprisingly, Nadel has kept up his fast-paced academic schedule on campus, taking courses this year in statistics, biochemistry, animal cognition and language, and economics. He’s also writing his senior thesis on the future clinical applications of deep brain stimulation, such as with neuro-degenerative diseases like Alzheimer’s and Parkinson’s.
Although he hasn’t yet chosen his next step after graduation in May, Nadel is leaning toward combining a doctorate in public health with a medical degree at some point in the future. “I’m planning on going into more public health and community-based intervention work for my career,” he said, “and that is a direct result of what I did in Costa Rica.”
“It was a very remarkable experience,” said Nadel. “I was able to leave a piece of my heart in Costa Rica, and a piece of me that hopefully will endure in that community.”
Photos are courtesy of Jeff Nadel.
- Costa Rica: Field Research in the Environment, Social Sciences, & Humanities (spring semester and spring quarter/trimester)
- Costa Rica: Language, Society, & the Environment (fall semester)
- Read more about student research in Costa Rica:
- “Hands-on Field Research Meets Cultural Immersion During Project in Rural Costa Rican Schools“
- “Costa Rican EMT” by Andrew Flynn, Macalester College
- ACM field research advisors and potential areas of research
- Student blogs for the ACM Costa Rica: Field Research program