Wednesday May 9 – Picture Update

This morning we enjoyed an informative lecture at the Ministry if Health. The Director of Communications, Adriana Salazar, updated us with the current facts and figures and answered our numerous questions!

Rita Astúa, the communications spokesperson for the Calderon Guardia  Hospital, provided a fantastic tour.

Dr. Stevan Villarreal provided us with an informative overview of Puntarenas Hospital. HPA student Morgan Forr will provide us with an update on that visit.

This group of future doctors, nurses and managers is interested in all parts of the health system – including the morgue. This was a special request. The pathologist, Dr. Maria Eugenia was in the hospital and thrilled to give us a complete tour and answer our numerous questions

At Puteranas Hospital patients check themselves in at the Emergency Department and determine the level of care they need. A nurse then sees the patient and the level of care and wait time can be adjusted accordingly.

Later today we will travel to the town of Las Juntas where we will stay at Pueblo Antigo. We expect to have very limited Wi-Fi for the next few days.

Maggie Lee – Tuesday May 8 – Explicación del Seguro Social de Costa Rica

This afternoon, we had a wonderful presentation about the Costa Rican Health Care system by a Ministry  of Health employee, Dr. Jose Pablo. Here it is known “La Caja” or Seguro Social, which literally translates to Social Insurance, but the idea is the universal health care system of the country. Our speaker began by giving general health related statistics, such as the fact that 17% of the GDP in the USA is spent on the health care system while it is only 7% in Costa Rica. Another statistic which was interesting is that the primary causes of death include myocardial infarctions (which mostly affects those 65 and older), stomach cancer (45 and older) and traffic accidents (which affects mostly the younger population). Breast cancer is also a major cause of death specifically for the female population.

In order to fund this public system, three parts, the state/government, the citizens/employees and the employers/businesses all contribute towards a country-wide fund which is available to almost all of those residing in the country. For the citizens, the amount that is paid is a percentage of their annual salary, not on pre-existing conditions or family history.

The coverages that are provided to the public include the Elderly, Injured, Invalid, or Death of a provider, Sickness, Maternity, dependents of payers of the system (i.e. children of citizens) and to those that unable to contribute financially towards the system. This covers 95% of the population and the remaining 5% includes immigrants, those who have temporarily lost their jobs, and those not currently paying into the system for various reasons.

The main goals of this healthcare system include prevention, early detection and provision of information. In order to accomplish this, the system is divided into levels based upon specialty and intensity of care required. The highest level includes specialties (i.e. cancer treatment, neurology) and national hospitals, the next level includes regional hospitals and auxiliary hospitals which treats generalized pediatrics, OB/GYN, internal medicine, and surgery. Finally, level 1, which is the most basic provision of care, which includes home visits, EBAIS visits, annual check-ups, etc. An EBAIS is usually considered a team of care providers including a primary care physician, a nurse, and an ATAP.

Challenges of this type of health care system include a long wait time, accessibility, financial sustainability, system abuse, private vs public insurance plans, and immigrant usage and integration into the system. One of the incredible things about this country is the significance of the mother and baby’s health. As evidenced by the national symbol of the health care system (social insurance). In Las Juntas I will have the opportunity to shadow an ATAP worker and I will have the opportunity to go on a home visits and see first hand the focus on prevention. I had the chance to do some research before coming to Costa Rica and my focus was on breastfeeding and mother and infant bonding. I am very excited to see the emphasis on breastfeeding in this country and how it pertains to population health. 

There is a strong emphasis on breastfeeding. In the hospital we asked what percent of mothers breastfeed and the nurse told us that all mothers breastfeed. If they are not able to for a medical reason they use milk from the milk bank. The symbol of the national health care system in Costa Rica is the mother and baby.

Sara Wenger – Tuesday May 8, Learning About how Healthcare is Financed in Costa Rica and Visiting Volcan Irazu and a Coffee Farm

Day two of our trip to Costa Rica started very early with breakfast at 6am. Due to Costa Rica’s new President assuming duties today, we needed to leave early to visit Volcan Irazu in order to avoid road closures. Our first stop of the day was Volcan Irazu which is a volcano about an hour and a half away from San Jose. Volcan Irazu ranges from 2800-3432 meters (9186-11260 feet). On the volcano, there were two separate craters, one dormant crater, and one active crater. The last time that the active crater erupted was in 1962. In my time in the Army, I have visited and lived close to multiple mountain ranges, but this was the first time I was able to see a volcano in person. The view from the volcano looking down over the city was beautiful, and the clear blue water inside the crater was the most beautiful water I have ever seen.

After we visited Volcan Irazu, we traveled about 45 minutes away to a coffee farm that is owned by two Americans that were from Connecticut. Since I have three daughters and am a full time student, I have a mild obsession with coffee, and was very excited to see how coffee is made. Our guide started our tour by showing us how coffee beans are roasted, and the chemical process that coffee beans go through from growth, to milling, and finally to roasting. She said that they are among very few coffee farms that grow, mill, and roast their beans on sight. After the tour was complete, we were able to taste the coffee that is made on sight, and purchase some.

Following the coffee tour, we made our way back into the city and stopped for lunch, and headed back to our hotel to change for a presentation on Costa Rica’s Social Healthcare Plan. Before making this trip, I was able to do a little bit of research on Costa Rica’s healthcare and found it to be very interesting. One of the things that I noticed about their healthcare is that everyone is covered. During our presentation, Dr. Jose Pablo discussed how Costa Rica is able to cover anyone in their country with healthcare, even if they are illegal immigrants. Hospitals in Costa Rica will not turn you away if you are sick or injured as it goes against their constitution of human rights. While this is slightly similar to the some hospitals in The United States, private clinics and free standing emergency rooms in the United States of America can turn you away if you do not have health insurance.

Tomorrow we will be leaving San Jose and Traveling to Las Juntas to visit Calderon Guardia Hospital. I am excited to visit the hospital as it is a smaller hospital than the one we visited in San Jose, as well as view a part of the country that has a lower socioeconomic status.


Serena Carlson – Monday May 7th Women’s Care: Leading the Way

Hospital de las Mujeres Dr. Adolfo Carit

By Serena Carlson

Today we visited the Hospital de la Mujeres or the Women’s Hospital in down town San Jose, Costa Rica. We had the privilege to be escorted by hospital administrator Jenny Velasquez Cubero, MBA. She gave us an informative and personalized tour. We were able to see firsthand how healthcare is delivered to women in Costa Rica.

The hospital follows its four main ethics: honesty, responsibility, compassion and courtesy. Similar to the ethics our U.S. hospitals operate under.

This hospital is classified as a “specialized hospital”, with national coverage; It is part of the group of Deconcentrated Hospitals and reports directly to the Medical Management of Hospitals and Major Clinics of the Costa Rican Social Security Fund. It also is a hospital that specializes in high-risk pregnancies and deliveries.

Costa Rica has a different approach to women’s care. We visited the maternity area of the hospital and found that babies do not leave their mother’s side after delivery. They co-share the mother’s hospital bed. Mothers and their babies practice the kangaroo method (skin to skin contact) the first few hours after birth to develop bonding. We had the pleasure of visiting an area that was for mothers in their post-delivery care.

Each mother and their baby receive support that is holistic in nature. Mothers receive education on infant care, breast feeding and post-partum depression. This enables the mother and her baby to be supported prior to discharge.

Costa Rica encourages breastfeeding and has lactation consultants at each hospital for delivering mothers. Costa Rica has milk banks for its babies. All mothers are encouraged to donate their extra milk. It is located in the Hospital Carlos Luis Valverde Vega of San Ramon, Alajuela, but serves most cities in the nation. 

Costa Rica offers universal healthcare to all of its permanent citizens. There are 2 parts of the system, public and private. All citizens pay into the system based on their annual income.






Hospitales. Retrieved from

2018 Program Underway in Costa Rica

All students arrived safely in Costa Rica and our 2018 program is underway! I will post an updated itinerary. We had a few schedule changes due to the transfer of power to the new President today. I’m including a few photos from yesterday and today. Thank you to everyone that helped to make this program possible.  -Celeste Newcomb

At the Hospital de las Mujeres the medical records room was interesting for our students. We later talked about electronic medical records and immunization records. In Costa Rica everyone is responsible for keeping their own immunization records. In Costa Rica they spend 9% of their GDP on health care compared to the 17% we spend in the USA.

Students were interested to see the high level of care available to mothers if it was needed.

The nurses were thrilled to learn we had a nurse on our trip this year. Special thanks to Darlene Clark for joining us! 

Visit to the pharmacy in the hospital

We enjoyed a visit to a coffee plantation to learn about how coffee is grown and roasted in Costa Rica. We also enjoyed learning about bananas.  Here is our 2018 group.