Today was the 5th day of Exploring the healthcare of Costa Rica and we were able to engage with the ATAPs who are technical assistants to primary care workers (ATAPs). Our day included some clinic visits and cultural visits near the Las Juntas/Tilaran area. The focus of this post is to introduce the unique public healthcare system of Costa Rica through our multiple visits to patient’s homes with the ATAPs.
We started our day off by getting some breakfast in Pueblo Antiguo and departed for the Tilaran health care clinic early in the morning to continue our work with the ATAPs. The EBAIS is a Level 3 health care system that consists of ATAPs, nurses, pharmacist and a physician and currently, there are 1921 EBAIS systems throughout Costa Rica. The ATAPs, specifically, provide home care for patients in a specific designated region several times throughout the year depending upon their level of risk as recorded on the patient’s medical record. The goal is patient surveillance – to attend to patients more to ensure they are healthy and if patient needs a higher level health care, they can refer them to local physicians and Level 2 health systems. ATAPs are also responsible for prevention, providing resourceful information and detection of potential illnesses. The ATAPs play an integral role in providing health care to vulnerable populations and scan the environment for a variety of socioeconomic factors – quality of water & food, education, electricity (living conditions), occupation along with history of chronic diseases, medication use, immunizations in homes and act as a first point of contact for preventative care. The physician of the EBAIS team, however, focuses on disease management if there is a chronic illness and has more power to prescribe medications to control disease but ATAPs tend to monitor/manage the patient’s illness.
We were able to visit the Tilaran clinic on our way to Monteverde where we interacted with the ATAPs to know more about the services they provide to the patients in that area. ATAPs are very accessible to the patient and have their own bikes to get to a patient’s home with a vaccine cooler that needs to be kept in a sanitary place (needs to cool for 4 hours). They provide a multi-dose vaccine called pentaxim that can be used for tetanus, polio, diphtheria, pertussis and influenza viruses in a patient and they also have Hepatitis (A,B), pneumococcus vaccine (for patients above 60 years of age), meningitis, varicella vaccines and Tuberculosis medication if the patient needs it. The patients typically do not tend to refuse help from ATAPs since it is a simple checkup and patients are receptive to the ATAPs advice. ATAPs tend to provide a flu vaccine and more comprehensive care through multiple visits to at-risk populations such as pregnant women, older people with diabetes/tuberculosis, etc and visit these patients 3-4 times/year while the low risk patients typically only get 1-2 visits/year. Even without insurance, the patients can typically get all required immunizations and basic checkup of vital signs but the patient needs to have health insurance (need to pay into the Caja every month) for referrals to get treatment from other physicians of different levels. It was interesting to know that they typically make unscheduled visits to the patient’s homes and if the patient is not at their house, they go back the following day.
At the Tilaran clinic, we were also able to learn that Costa Rica currently has a pilot HPV vaccine program that is not yet covered by insurance. However, development of this vaccine can prevent warts and bacteria (HPV symptoms) that can spread infection and could potentially lead to cancer. We were also able to donate a wheelchair to an old patient who was admitted at the clinic so that she can navigate better. It was really emotional for all of us when her husband could not hold back his tears because of this gesture. The patient and her husband were extremely moved and they were thankful. We took some pictures with the patient and and she seemed excited to try her new wheelchair. We had 4 ATAPs join us on the coach to visit different patients of different socioeconomic status at their homes and observe the checkup. During our first home visit, we were able to notice that a middle-aged woman was living in very low socioeconomic conditions for the past 2 years– there were not many electric appliances, no potable water, inadequate supply of electricity & water. However, the government was able to provide new housing with 2 bedrooms to the woman, who classified as low income in a 200-house community. The community seemed really welcoming and the woman needs to be able to pay $100 to get access to utilities.
On our next visit, we met with a woman who was living in temporary housing since she lost most of her belongings in the floods a year ago. She has two twin boys but one of them has anencephaly so we provided them with a walker so that her son can walk better. During the floods, one son saved another from a mudslide. Their house was decorated with cross-stitched paintings and it was obvious that she likes to cook as she owns several cooking appliances. I was really moved by what one brother did to rescue another brother from the floods. The last patient visit with the ATAPs was to a low risk patient’s house who has moved to Costa Rica from Switzerland twenty years ago and he said that for what he can afford, the social healthcare system of Costa Rica is very patient-centered and the patient can go to any specialist for treatment as long as he’s paying to the Caja and costs 18,000 colones/month ($30-40), which is not too much considering the comprehensive list of services provided to the patient. He also said that at the end of the year, the government provides donations to high risk families. When the patient had a heart attack 2 years ago, it costed him 0 colones for specialist consultations and follow-ups. The ATAPs were able to check his vitals, medications, immunizations verify data, history of chronic diseases, dietary changes, check their financial status and signed off on blue vaccine card at the end of visit.
On the way to Monteverde, Luis, our very own tour guide told us that 97% of Costa Rica is covered by electricity that’s primarily powered by hydroelectric plants, wind and even volcano. It was also interesting to note that 97% of people have a basic level of education. It can be clearly seen that if the country is well educated, the people know how to care for themselves and know the importance of preventative care & disease management. Costa Rica was primarily formed by volcanoes and we were also able to see the continental divide (Caribbean and Pacific) in the Tilaran mountain range that was extremely windy due to low elevation. We were able to see a Cross in the wind mill park situated in the Tilaran mountains. Through these patient visits and interaction with families in Costa Rica, I was not only able to forge a relationship with these families but also want them to be healthy while living in adequate socioeconomic conditions. In the future, I realized that I would like to have a bigger role in disease surveillance and be involved with patient treatment because at the end of the day, health is wealth and being healthy is what makes people happy.