Month: December 2014

Today we went to Monteverde to an extremely rural clinic. Only four doctors and eight nurses work there and this clinic does not have access to ambulances. The doctors do not receive the same salary as physicians throughout the country, it’s actually much less. Telemedicine is of utmost importance in this clinic because the doctors do not perform the surgery unless utilizing telemedicine. The amount spent on administrative costs is close to four percent, which is extremely low. It’s very impressive that they are still trying to lower this percentage. The hours of the nurses and doctors would be very exhausting due to the twelve hours Monday through Friday and 24 hours on weekends. The doctor who provided information on the clinic told us about her hardest day, which entailed delivery ten babies! It was great to see a doctor so passionate in a rural area with a low salary and little technology simply because she loves to help others.

Our next stop in this beautiful country is Monte Verde. Surrounded by beautiful greenery and long dirt roads, we visited the local clinic of the town. We met with one of the four doctors who work at the clinic, and she enthusiastically explained the dynamics of the clinic. I was shocked when we were told they had no ambulances and that the nearest hospital was approximately four to five hours away. It made me ponder exactly how they are able to receive immediate care if there was a short time span to save one’s life. Although they lacked in this area in relation to the United States, they were seemingly advanced in telemedicine. They used telemedicine in their practices every day, and had a different type of service for every day of the week. They would refer to a specialized doctor through telemedicine when services were needed beyond their knowledge and ability.
Overall, this trip has been an once-in-a-lifetime, eye-opener. When one thinks about a third world country, they automatically assume they have poor health and sanitation. This program proved that although a country may not have the best economy or riches, they are still able to provide healthcare to the best of their ability, even beyond that of a developed country. They are still growing and need some improvement in a few areas, but the United States can also learn a lot from Costa Rica’s public health, such as their advanced women’s health services.

Today we went to the Clinica de Monteverde, which is a healthcare clinic that supplies thousands of local residents with minimal resources. There are only a handful of workers at the clinic that are extremely dedicated to treating the underprivileged rural population in and around Monteverde. Staffers often work 12+ hours a day 6-7 days a week. Patients come from all over the country side and transportation is a huge barrier to care because the clinic does not have helicopters or ambulances to get at risk patients to and from the clinic. The doctor who spoke to us talked about the clinic’s affiliation with the Red Cross and their funding from the government that is inadequate. There is a tremendous incentive for preventive care because it is far easier and cheaper to practice and administer than primary care. Since funds are low, the clinic keeps costs at a minimum by keeping administrative costs as low as possible. Serving the underprivileged is gratifying to those who work at the clinic and there is a deep appreciation among patients towards those who dedicate their lives to serving them.

On our 5^th day, I was able to gain a further and deeper appreciation for the ATAP program. Though we were able to tag along with the ATAPs yesterday, today we interacted with the individuals and learned more about their stories. Though I full-heartedly believe that the ATAP outreach program should be introduced and implemented into the United States’ health care focus, today I was more interested in the outcome of the visit in a personal/social sense. Hearing the various stories of the individuals we visited today was a truly unique experience. Viewing the smiles on the children’s faces to have visitors and receiving the appreciation of the parents struck an emotional cord within me. In an active pursuit of a career in nursing, I treasure a positive effect on all those involved with the reception of care. As an aspiring health care professional, I hope to be able to apply such indifference to all patients regardless of SES or other environmental factors as these ATAPs display on a day to day basis.

Today we visited a clinic in Monteverde. It was in a very remote area and the closest hospitals to the clinic are in San Jose and the Central Valley. The clinic doesn’t have any ambulances or medical helicopters so patients have to be able to get to the clinic on their own. They don’t do emergency surgeries unless it’s for certain circumstances such as car accidents. If they must perform surgeries they use telemedicine. There are 4 doctors at the clinic and 8 nurses and they have to treat a certain amount of patients and meet a certain quota in order to receive their full pay. After visiting the hospitals and clinics this week I now have a greater appreciation for Costa Rican healthcare. They face many challenges just as we do in the United States with our healthcare system but they are also better than the US in that they do a much better job of trying to make sure their population is being receiving the care they need even if they cannot necessarily afford it.

As we approach the end of our one week study abroad in Costa Rica, I can say that I am grateful to have pursued this unique educational experience. After learning about the Costa Rican healthcare system, I fully support study abroad opportunities because it provides a first-hand learning opportunity. I would like to thank the Master of Health Administration department and specifically, Jonathan Clark, Susan Sanders, and Tami Smith. What I have learned from this trip has allowed me to apply the components of a foreign healthcare system to what I am learning about the U.S. healthcare system in my graduate studies.

Today we visited and toured around villages with the ATAPS within Tilarian. We saw two different homes with two diverse families. The first house consisted of a young mother who was 19 years old and a one week old baby. The ATAP examined the baby and explained that the baby had a rash that could be an allergic reaction. This house was considered at high risk or “red” because of the teenage pregnancy and the condition the house was in. The next house we visited was also high risk. This house was in a lot worse of a condition because it had mud floors and most of the house was outdoors. The family was reviewed to make sure they were up to date on their vaccines. It was interesting to see the difference between the two houses with the families because the second house was in a lot worse condition than the first. I believe it is very interesting that no matter what your living condition is everyone receives healthcare. Today was a very eye opening experience and I am so glad that we got the chance to see and understand the diverse culture within Costa Rica.

Sarah Barr

Today we shadowed the ATAPs in Tilaran to be able to personally grasp the high value that Costa Rican’s place on preventative care. It was amazing to hear how much each ATAP knew about the family they were visiting just by looking through their chart. Even though their records are not electronic, the way they document patient information is still very efficient. We were able to see the interaction between the ATAPs and their patients. The patients seemed very comfortable and trusting. We also learned that they rate each family as either a 1, 2 or 3. A 1 is the most at risk type of family. They may be very impoverished, have poor living conditions, have domestic violence, or suffer from substance abuse etc. We were able to visit a few risk 1 families today. After this experience, I reflected on just how lucky and well off we are. We often worry about not having the best things and especially on this trip, we complained about seeing bugs in our hotel room. Our visits today really put things into perspective for me. While living conditions are often indicative of our health status, it is not always how well off we are in terms of money, Despite the poverty that these families were facing, they still managed to be extremely happy, friendly and close knit with their families and this alone, made their quality of life admirable.

Today we visited an EBAIS clinic and we followed ATAPs to their locations. We also had the chance to donate medical equipment to those in need. Out of all the days that we have experienced in Costa Rica I found this day to be the most rewarding and most beneficial to our learning experience here. My favorite parts of the day included following the ATAPs and donating the equipment. As for following the ATAPs my group of four went to an elder woman’s house. The lady who owned the house was 93 years old, which amazed all of us because she looked like she was in great condition for her age. While the ATAPs not only evaluated her, he also evaluated her daughter who was around 60 years old. It was interesting to see because after the evaluation they found that she needed to visit a gynecologist as well as be careful of her diet because she has diabetes. The visit once again proved to me how personal Costa Rican health care is. The ATAPs are great for patients because their periodic visits are reminders to patients to maintain their own health. Along with that, the ATAPs get to evaluate the patient in a more intimate setting. The second part of the day that really touched all of us was when we donated the medical equipment. The first patient we went to was an elder woman who needed a walker because all she had was a cane and needed further assistance when walking with it. After we delivered the cane to her, the joy that overcame her was incomparable. It shows us how the littlest things are still things to be grateful for. I am really glad that we were able to help her and I’m sure she is just as happy.

Today we went to a Clinic in Las Juntas. They focus more on the Ebais team that makes up of doctors, nurses and A-tap that is short for Attention Technical Assistants of Primary Care. The Ebais team goes to different houses in communities that have a lot of people who need medical attention. Patients can also go to the clinics but the team of Ebais will go to the houses to make it easier for the patient rather then having them travel out of their way. When the team goes into the houses they also check the animals the patients may have such as dogs and make sure they have their latest vaccines and also check to see if the patients have food and check for anything else that is health related. They go to about 700 houses and see close to 300 patients per community. Ebais is on the bottom of the basic primary care pyramid following by the clinic, regional and specialist. I thought this was very unique and different from the United States because we don’t have doctors making house calls and checking the patient’s homes and making sure they are in a safe and healthy environment. This was very remarkable for me and I loved a lot how open the patients were to allow us to enter their homes and absorb what was happening. After we visited homes we then went and donated a wheelchair, walker, and crutches to three very nice people. The first person we visited was an older lady who had a hard time walking and we were able to provide her with a walker. Her response to receiving the walker was, “This is the best Christmas present ever.” After she said that my heart melted and immediately brought a smile to my face. The second person we saw was a guy who has diabetes and had to get his foot amputated. We were able to also provide him with a new pair of crutches to make it easier for him to walk. He was very happy and appreciative. Lastly, we saw another older gentlemen who needed a new wheelchair. The wheelchair he had at the time he actually made it. His wheelchair didn’t have a seat so he put a plastic seat inside where the normal seat would have been. Just reading that you can tell that it was very unsafe and dangerous for him to be sitting in that chair. When he saw his new wheelchair he again was very appreciative and very excited. He even offered us some of his lemons he had growing off a huge tree in his backyard. These three people were so lovely and so happy to see all of us and especially excited to have brand new items that they desperately needed.