College of Nursing Student Kaléi Kowalchik Reflects on ¡Pura vida!

¡Pura vida!, the trademark slogan of Costa Rica, translates to “pure life” in the English language and describes the simplicity of the Costa Rican lifestyle. Pura vida is not just a phrase but rather a feeling found in the center of your heart that is filled with emotion, a positive attitude, and happiness. t I not only learned about the healthcare system but the country and its entirety this past week while studying abroad. Today, however, was the most bittersweet of all—the final goodbye.

As we adventured and trekked through Costa Rica one last time, all of the students tried to ignore the impending future—saying goodbye. First we occupied our minds with Catarata Rio Fortuna, a large waterfall located on a biological reserve in La Fortuna. With each descending step, the sound of the waterfall rushed through our ears providing a soothing melody of water and nature. Swimming, hiking, climbing on rocks—oh my, we spent this cultural immersion activity taking nature’s beauty all in.  During this trip, we learned about the importance of the preservation of nature and its wildlife so others may also have these types of experiences for many years to come. After a long morning of expending energy at Catarata Rio Fortuna, we stopped for lunch at Cafeteria Flory. The fragrant scent of homemade tortillas and pinto gallo mixed perfectly with the warm sunshine as the strumming of a guitar created tones of soul and happiness which danced peacefully through the restaurant. Here we learned about a small family owned luncheon business and the importance of serving authentic Costa Rican food to their customers. Our last cultural visit was spent at the Herpetological Refuge Costa Rica in San José where animal biologists and volunteers spend their time rehabilitating native animals to Costa Rica back into the wild. Walking through the refuge was like taking a stroll through a “mini” rainforest—scarlet macaws squawking  in the background, colorful flowers spread throughout trees so tall and full you can barely see the sun as the sound of trickling water runs in the background. From monkeys, snakes, sloths, and crocodiles—this refuge educated all of us on the uniqueness and importance of each animal to Costa Rica’s ecosystem.

La Fortuna Waterfall

We concluded with a final dinner where we all reminisced on the memories of the trip with our phenomenal tour guides Juan Pablo, Maria, Carola, and Fernando (Chino). While we all left that night with some tears, we realized how this trip has come full circle for all of us. We all came to Costa Rica to explore the healthcare system; however, we all took away so much more from the trip. Collectively, not only were we fortunate enough to learn and understand about Costa Rica but also see it applied in the multiple settings throughout the country as well. While I took away a lot of valuable information from this trip, the most moving piece I finally understand is that anyone can say pura vida; however, it is another thing to feel and understand the true meaning of pura vida—this is simply not obtained until you visit and take the time to enjoy Costa Rica’s beauty and wonder. Until next time Costa Rica–¡pura vida!

Day 5: College of Nursing Student Meghan Hixenbaugh Reflects on the Rainforest, Finding New Medicines and How this Tiny Nation Provides Healthcare for All!

Today we did really cool cultural visits. After the clinic in the morning, we went zip lining at Sky Adventures. The views we saw were absolutely breathtaking. Zip lining allowed us to see Costa Rica from a completely new view. The landscapes were absolutely gorgeous. It was something I will never forget. The zip lining was a little nerve-racking at first because we were so high up, but it was completely worth it to see the beautiful landscapes.
After zip lining, we walked through the rainforest and went on the hanging bridges. This was yet another stunning experience. The hanging bridges were a beautiful way to see the inside aspects of the forest. We could only go 10 people at a time across the bridges for safety reasons. Our bus driver, Chino, was such a great tour guide as we walked through the rainforest. He taught us about the various plant life and animals of the rainforest. For example, I learned that there is a type of tree that has adapted to “move” 3 millimeters in a year to be in areas with more sunlight. We also learned this morning at the Clinic that it is “snake season” in Costa Rica, and as we were on our walk Chino pointed out a baby snake. Chino also did this exercise with the group that I really enjoyed. He asked us to close our eyes and not talk for a minute to just listen to the sounds of the rainforest. This was so nice because I wouldn’t have done on my own. The sounds were really cool to just listen to. We heard the birds, the crickets, and the various other animals of the rain forest. Overall Chino gave us a great tour with lots of information about the wild of the rainforest. We learned that the rainforest actually helps us find new medicines.
After walking through the forest and going on the hanging bridges, we went to the Baldi Hot Springs. These are naturally occurring hot springs from the volcano. There were 25 different hot springs to go to. Some were bath water temperature, while others were too hot to stand in for more than a few minutes. There was a naturally occurring sauna we went into as well. It was really hot and I was so surprised to learn that these can occur naturally. The Baldi hot springs were a nice way to relax after the busy day and week we had. Overall this was a day full of super fun cultural visits. Having the chance to see the tourism side demonstrated how Costa Rica is able to have the health care system they do because they get the money from all the tourists.

Day 4: College of Nursing Student Antonia Corma Discusses Vaccinations

I decided to go on this trip because I felt like this would be a great opportunity for me in my future nursing career.
At first, I was nervous because I was unsure of what exactly I wanted to research or how to go about doing it, but that nervousness has not held me back on this trip. Every day I wake up with excitement to experience and try new things and I can’t wait to learn more. Whether it is trying different food or getting out of my comfort zone to ask questions, this trip has been extremely beneficial and it isn’t over yet!
Today we began our day with a tour of a local clinic, Area de Salud Tilaran, and observed the care that the ATAPs provide to the people of Costa Rica. One of the aspects of care that I am interested in is vaccination. In Costa Rica, vaccines are mandatory and, more importantly, free. There are also campaigns that are done if an outbreak of a certain disease were to occur which provides the people of Costa Rica with the vaccines for free. If they have the vaccine previously, they will receive it again along with any other vaccinations they may not have or are due for.
Once the ATAPs go to the house, they do a number of things, but in relation to vaccines, the Costa Rican’s need to provide them with their vaccination card. Children are provided with books that document all of their information, including their vaccine record. Costa Rican’s can refuse the vaccines, but if that is done the ATAP reports it to someone with higher authority. Once that is done the police get involved along with the Ministry of Health to provide them with the vaccinations since it is mandatory for this country. The only two exceptions as to why someone is not being vaccinated is if they are immunocompromised or for religious reasons.
In the United States, there have been many cases of measles outbreaks due to people not being vaccinated. I believe that vaccinations are so important because those few who can’t receive the vaccinations benefit from the herd immunity. Without the herd immunity, those people along with everyone else are put at a much higher risk of getting the disease. I want to be a pediatric nurse. Therefore, I am extremely interested in how children are cared for in Costa Rica. Vaccinations are such a controversial issue in the United States today, while in Costa Rica it’s the norm.

Day 4: College of Nursing Student Madison Stewart Writes About Assessment of Risk Factors

In the town of Tilaran, we had the chance to follow the ATAPs around a fairly new neighborhood to visit a handful of houses. The job of the ATAPs is to basically make house visits and assess the home, the people, and the environment around the home. They provide vaccines if need be, blood pressure screenings, and patient education.
This form is used by the ATAPS to determine the number of risk factors present. This determines how many follow up visits a patient will have during a calendar year.
One specific thing these ATAPs do is they place the family into a risk category system called the “Family Risk Classification for the Primary Care Program” The risk categories range from 1-3.
1 meaning that the family scored over 25 points based on 9 different classifications. The classifications for risk 1 include things like families that have no forms birth control, young pregnancies, children that are malnourished or anemic, families with a history of drug addictions, alcoholism, or family violence, illiterate parents, families with a one-year-old, or families living in the slums. If a family were to fall into Risk 1 they then would be visited 3 or more times a year based on their needs.
Risk 2 families who score between 15-24 points fall under a list of classifications that consist of having birth control methods, having children between the ages of 7-14 who dropped out of school, having untreated chronic diseases, having teenagers with children, living with a family member who is disabled, living alone over the age of 75, living in a risk area, receiving a pap smear over 2 years ago, or testing positive for TB. Based on these families needs they would be visited 2 times a year.
Families who fall under the Risk 1 category and score 2-14 points have certain classifications like living with a chronic disease which is under control, having the head of the family without an income, having a poor water supply and poor sewage systems, delinquent children, or simply families which do not qualify for Risk 1 or 2. These families would then be visited only once a year.
These ATAPs provide an extremely useful and beneficial service for these families who may not get an opportunity to visit the doctor’s office as much as they would like to. If need be, ATAPs can request emergency services to a family or provide the required vaccinations. Their main goal is the prevention of diseases and illnesses. All services provided by the ATAPs are free of charge through the social security system in Costa Rica.

Day 3: Biobehavioral Health student Rachel Fife Comments on Preventive Care

Today we went to the Area de Salud Tilarán clinic in which Fernando, the director of the clinic, relayed various information of the clinic to us and we were given a tour of the clinic which included a pharmacy, vaccination room, laboratory, emergency room, and large waiting room occupied with many Costa Ricans. It was at the clinic that we picked up the ATAPs that we would be joining for the home visits.

We learned that the goal of the ATAPs is preventative care and that the home visits are carried out to make sure the homes and yards are in good condition. The neighborhood we traveled to contained houses that were paid for by the government and the neighborhood consisted of identical-looking homes. Families were moved from areas of extreme poverty to these houses in which residents only had to pay for water and electric. The ATAPs made rounds to these homes not only to ensure the health of families but also to examine living conditions.

An analysis of how the family lives are carried out to determine overall health. The analysis includes general information such as professions, birth dates, heights and weights, as well as documentation of vaccines and illnesses or family violence. The various health and living conditions of the families are totaled up to give an overall risk level of either one, two, or three for each household. Risk one is the highest risk and would mean that a social worker or police officer would be notified to do a follow-up visit and institute the necessary changes to ensure a healthier lifestyle.

The ATAPs carry a cooler bag filled with vaccines to the home visits. We got to see firsthand a Tetanus vaccine administered to a lady. This was performed because of lost vaccination records. I learned that if an individual loses their vaccination booklet containing the history of their vaccines and is not able to present it directly to the ATAPs, then the ATAPs administer necessary vaccines for free since vaccinations are mandatory in Costa Rica. I learned that pap smear exams and mammograms are offered for free under the Costa Rican Caja Security System; however, families that do not contribute money towards the Caja will only be told by the ATAP about the importance of the tests and encouraged to pay. They will not receive a reference form to get the given test under the Caja, as normal protocol, until they contribute towards the system.

The ATAP that I was following had not yet obtained a tablet and so data was collected in a paper file. A new record file had to be created for the one family as they had recently moved to the region. There is not enough technology or resources to transfer files from one clinic to the next and so the ATAPs must go through the extensive process of gathering all data from scratch. I also witnessed the ATAP give pills to individuals of the homes in which they were instructed to take them two times a day for three consecutive days. The pills were given in order to rid their bodies of parasites as a form of prevention. The work of the ATAPs is highly important and I admire their emphasis on preventative care. I truly enjoyed joining the ATAPs on their home visits and I learned so much.

Day 3: Health Policy Administration student Aminah Henderson Reflects on ATAP home visits and Career Changes

As a World Campus Student, I never thought that I would participate in a study abroad program, but I am very glad that I am. As a Health Policy Major studying Healthcare in Costa Rica surrounded by other students that are mainly nurses and are much younger than myself, I thought that this would be awkward for me, but we are all able to learn from each other and share in this awesome experience together. I have met some interesting people and we all seem to have our own story.

Wednesday May 8, 2019, I thoroughly enjoyed my experiences with our ATAP (Technical Assistant to Primary Care) Jairo Martinez. Shadowing Jairo has truly been the highlight of this trip to me. As Jairo visited homes of citizens I was able to accompany and participate first hand in one of Costa Rica’s preventative measures, and also another form of creating access to healthcare. This is particularly important to me because as a healthcare worker for so many years, I have seen the need for more preventative measures as well as greater access to healthcare.

As I followed Jairo and listened to him coaching patients on the importance of making doctors’ appointments, the importance of being up-to-date with their vaccinations, and making sure that everyone in the household is being compliant in order to ensure good health, what I found to be really important was that Jairo didn’t only ask questions regarding health, but he also focused on  the living conditions and the quality of life. In Costa Rica, the health of people and the quality of their lives are equally important. I really found that to be amazing that here in Costa Rica with limited resources and manpower, they still find a way to do much more in terms of access and prevention.

Being an HPA major I thought that the natural next step would be for me to become some form of manager or director in a healthcare facility, but being here in Costa Rica has made me think differently about my future career goals. I feel that my eyes have been open to options that I hadn’t even considered. Why limit myself to a hospital job? Maybe I can focus on public health, or work abroad in the same form as the ATAP’s in Costa Rica. I feel refocused and re-energized with that “Save the World” mentality and I am looking forward to a more focused career path.

Day 2: College of Nursing student Taylor Wright Comments on Labor and Delivery and More

Today consisted of going to the coffee plantation, going to Hospital Monseñor Sanabria in Puntarenas, and hiking to Poás Volcano.

In this post, I am going to focus on the hospital. In this hospital, we were able to meet with one of the main doctors who specialize in management and overseeing the hospitals numbers. We were also able to meet with one of the journalists that represent the hospital in the daily news.

During this conversation, we talked about cancer and how they screen. We also talked about the regional hospital and how it works within the community.

After that, we walked around the intensive care unit and saw how the rooms were set up. Following this, we were able to experience the pediatric burn unit. Here we saw a couple of kids and their parents who were stuck in the burn unit. Some parents were okay with us watching them and some allowed us to watch. Seeing their maternity floor was very similar to the ones I have seen in the United States.

Something I also found interesting was the fact that the hospital has little cars that the kids can ride into the emergency room. The nurse explained that the ride was utilized to help the children not feel scared. This is something that I wish I saw more in hospitals because the idea seems more fun than scary for children who have to go through something traumatic like the OR.

One of the nurses was kind enough to show us the Pre-OP room that the mothers go into before giver birth, whether through C-section or natural birth. We were able to experience some of the private birthing rooms that included the yoga balls and bed to have the baby in. One of the rooms had stirrups that were utilized as a way to see how dilated the mother is. The nurse was able to show us a video on how the mothers birth without epidurals and no screaming. The way they do this is by playing relaxing songs and bouncing on a ball to calm the mother down.

In Costa Rica, they have found ways to treat pain without medications. I found this amazing because of how different we treat labor and delivery in terms of pain. We always dramatized birth by showing the “pain” on TV shows and movies. Many women in the US “require” an epidural or some form of medicine to deal with the trauma. Here, birth is a different experience.

Finally, after the delivery area, we were able to see the morgue. At first, I was a little nervous at the thought of seeing dead bodies, but luckily there were only jars of hearts and a fetus. We also had the opportunity to see the place where the family washes the body before they either put it in a casket or they burn the body to ash for the urn. The room felt very plain and a little awkward to be in because they are so casual about the idea of death. Following this, we were able to take a picture for the hospital of our trip before continuing to the bus.

Day 2: College of Nursing student Alyssa Bubel writes about Doka Coffee Farm

Today we went to a volcano first and then on a coffee tour on our way to Las Juntas. It started with a sample of their coffee and the tour guide took us to see what coffee trees look like and then showed us the process.

The trees are usually kept there for 25 years (even though they can last around 100 years) in order to keep the best quality coffee. They harvest for 5 months starting in October.

The beans are green originally but turn red when they are ready to be picked. The beans are picked by hand for the best quality. They are put into a canasto which weighs about 28 pounds. This measuring unit of the coffee is called a cajuela.

The workers are only paid $2 for every basket (of 28 lbs). However, the 28 pounds ends up only being about 7 pounds once everything is removed and once they are roasted, the beans expand but they end up weighing less (about 6 lbs).

This system works because most of the workers come from Nicaragua for the harvesting season and the workers are provided with free housing, healthcare, water, etc. All they pay for during this time is their food so they end up making more in Costa Rica during harvesting season. They only have two chances to pick a good basket and if there is too much green beans or leaves then they will be fired.

During the process of making coffee, the good beans will sink in water and the bad quality will float on top. The quality usually relies on the density of the beans. After the coffee goes through all the machines, the beans are laid outside to dry for 5 days and they are raked every 45 minutes. Most of the coffee (85%) is high quality, 10% is medium and 5% is not good but they don’t waste anything produced there. After the tour, we went to another hospital and then to Las Juntas for the night!