Doing service work at the P.A.N.A.R.E. Rehabilitation Center is not for the faint hearted. It is a center for people with special needs and not all patients are responsive. The name P.A.N.A.R.E is made up of the first two letters of each of the words: PAtronato NAcional de REhabilitacion: the full name of the center. It was founded by Dr Humberto Rojas Araya who fought to improve the quality of life for children affected by the polio epidemic in the 1950s. With the help of the Sisters of St Anne, the center sought to rehabilitate polio sufferers towards greater independence through a holistic approach combining education, physical and occupational therapy and recreational activities.
Many of the polio sufferers were subjected to neglect by their families, and the center has become their permanent foster home. These children are now adults.
As the polio epidemic was controlled, demands changed and the center now cares for others with special needs, many of whom have been abandoned by their families.
The UWCCR students bring a burst of color and joy to the place and faces light up on their noisy, exuberant arrival. 
The activity is called “clowning”, and the students dress accordingly. The concept originated with Patch Adams, who has visited UWCCR and shared with students for many years. On arrival they first go around greeting everyone then stop and chat, sing songs, hold hands, play guitar, dance and generally bring life to the place.
Two of the nursing staff were kind enough to spend a few minutes talking to me via the expert translating skills of Sabrine Mignone from Italy and The Ivory Coast.
Nurse Melanie and Nurse Jason both informed me that UWCCR are the only group who visit the center. This was rather shocking news. Apart from very rare family visits, only at Christmas time do some local church groups offer to bake goodies and help celebrate. When I asked Nurse Melanie how she felt about the fact that no Costa Rican groups were volunteering any support, she said nonchalantly something I have heard a few times: “It’s just the way it is”.
I asked the nurses what they thought was the best element of the students’ visit and they both said the entertainment of the patients. Melanie said all the patients love music and “fiestas”. Jason commented that the students provide a refreshingly different approach to engaging the patients. They offer much needed distraction and the opportunity for patients to express happy emotions.
When I asked what the students could do to further develop their work they both had some very constructive 
suggestions. Nurse Melanie suggested more group activities, although she was quick to acknowledge this is difficult with patients who are bed bound and unresponsive. Some patients are obvious favorites with the students, and this is testament to the relationships being built by regular visits. Nurse Melanie suggested the students might consider spreading their attention to be more inclusive of all patients, even those who appear unresponsive.
Nurse Jason suggested the students bring balls and other games as well as the dancing and singing. He said some patients would enjoy simple table games. Jason also suggested the students take time to learn about what to beware of with patients who have tracheostomies so they can avoid any potential problems when engaging with the patients and know when to alert staff if a patient is experiencing difficulties.
This is perhaps an area that could be developed further and worked on together with the staff, and Nurse Jason agreed. A more detailed briefing session at the commencement of the service program that also includes some history about each patient could enrich the experience for all.
Reflection is an important process for all stakeholders in service work. The impact of the service needs to be
continually reviewed from all sides by givers and receivers, keeping an open mind to constructive suggestions for improvement or simply to acknowledge a job well done. This requires students not only reflecting about their involvement but also questioning the staff and patients on how effective their work is and critically evaluating their impact and revising practices and exploring new approaches. It is testament to the insight of the co-curricular coordinator, Jay David Terwilliger II that the students have a separate reflection and planning session incorporated into their service program each semester.
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