Dear friends, We had to put this course on hold due to COVID travel restrictions. In the meantime, I accepted a new full time position advising and teaching in the Smeal College of Business.  I am thrilled to announce that this interdisciplinary class will run again in 2025 under the leadership of Biology Professor Mary Murphy.  If you are interested in participating, please feel free to contact her at mfm11@psu.edu. Thank you to the many people that have worked to make this program a successful and rewarding course for over ten years!

Sincerely,

Celeste Newcomb

Updated July 26, 2023

 Join us on this study abroad adventure through Exploring the Health Care System in Costa Rica hosted by The College of Nursing.  If you are interested in joining a future trip to Costa Rica, please fill out the google form linked here. Details to follow via email. At this time we are not running a program in 2022 due to COVID but we do hope to run the program again in the future. We are looking forward to hearing from you. If you are a Nursing student, please note that the College of Nursing has historically funded one student to join us in Costa Rica who otherwise would not be able to travel due to financial reasons. 

 The link to the application can be found in the tab above. There are no pre-requisites for this course. Drop off your hard copy in room 201 in the Nursing Sciences Building. Please email Celeste Newcomb at cgn1@psu.edu to let her know you dropped off an application.

On the trip, students will learn and see first-hand how health care is delivered in Costa Rica. In addition, students will meet with nurses, physicians, and other providers of care, along with policy makers and administrators, in an effort to learn how Costa Rica is able to achieve impressive health outcomes. The Learning Objective for this embedded program is for students to analyze information obtained on the trip and effectively present to others what they have learned and experienced. A highlight for many students in this program is the opportunity for independent research. In addition to the travel, this course requires class sessions and course work. In 2020, the student price was  $2,499, which included all student lodging, all food, and transportation to and from the base hotel in San Jose. Price does not include airfare or tuition. Most students obtain some type of support funding.  In the past, we have held a spring term one credit course to prepare students. The May term course with an embedded travel component will be two credits.

Please note, the official program beings on the first Monday of May term. All students should plan on flying in on the day before. We will hold a general orientation and review the schedule on Sunday, before the program begins on Monday. Please plan to be in Costa Rica by late afternoon on Sunday. Students should plan to be in Costa Rica from Sunday – Sunday.

If you have questions about the program, you can email me directly at cgn1@psu.edu.

Updated November, 2021

Through immersive experience, students learn about Costa Rican health care

Jordan Corley | The Daily Collegian

Mar 13, 2019

https://www.collegian.psu.edu/news/campus/article_266f54f4-4514-11e9-bb65-839db8addea8.html

A student looks over the Costa Rican jungle during Penn State’s Exploring the Health Care System in Costa Rica program.

Courtesy of Celeste Newcomb

A woman and her husband were brought to tears as Penn State student Paula Tabaschek and her team presented a family in Costa Rica with a wheelchair to help the woman navigate her home after losing both of her legs due to severe diabetes.

This was one of the moments that Tabaschek (senior-biology) said made her realize how much she wanted to be there and impact the community.

“I was shocked by how health care can really impact the overall aspect of a community,” Tabaschek said.

Tabaschek traveled to Costa Rica through Penn State’s Exploring the Health Care System in Costa Rica program, which provides students with the opportunity to earn class credit and travel to Costa Rica while learning about the country’s health care system.

“The program provides a unique opportunity for students to examine some important topics, such as why people live longer in Costa Rica than the United States. How is it that they only spend 7 percent of their GDP on healthcare compared to the 17 percent we spend in the USA,” Celeste Newcomb, a professor in the Smeal College of Business and the College of Nursing said. Newcomb is the co-founder of the program.

The program is currently hosted by the College of Nursing; however, students of all majors and semesters are encouraged to apply. Students from branch campuses may apply, as well.

In total, students earn four credits for completing the Spring and May term courses and traveling to Costa Rica. After being accepted into the program in January, students attend five classes taught by Newcomb where they learn background information about Costa Rica’s health care system.

For the remainder of the semester, students work on their independent research project. Following the end of the spring semester, students depart for the one-week Costa Rica trip portion of the program.

While in Costa Rica, students observe EBAIS clinics. The term is translated in English to mean “Basic Teams of Global Health Care.” They are the first level of health care in Costa Rica.

Tabaschek, a teaching assistant for the course, explained that the country is broken up into multiple regions and within each region there is an area of health. Each EBAIS group is responsible for providing health care within their area of health.

Tabaschek said that within an EBAIS group there are doctors, nurses, secretaries, pharmacologists and ATAPs, which Tabaschek said are basically community health care workers who go from house to house administering vaccines, especially to those who can’t afford health care.

Throughout the duration of the trip, students followed ATAPs around on local home visits and observed their interactions with the community.

This year, there are 13 students traveling to Costa Rica. Those attending include three students from Commonwealth campuses, an adult learner from the World Campus program and nine University Park students representing the College of Nursing, the College of Health and Human Development and the College of Liberal Arts.

Upon completion of this program, Newcomb said multiple students have presented their research in the Penn State Undergraduate Exhibition. Many other students have joined the Peace Corps.

Here’s a look into the immersion experience of three Penn State students

Paula Tabaschek

During her junior year, Tabaschek took the class as a student and traveled to Costa Rica in May 2018.

Tabaschek said she heard about the program through the College of Health and Human Development.

She said she was interested in taking the class because she had been a part of Global Health Brigades and wanted to continue doing public health work.

A group poses during Penn State’s trip to Costa Rica as part of its Exploring the Health Care System in Costa Rica program.

Courtesy of Celeste Newcomb

Tabaschek said she was interested in attending graduate school and obtaining a Ph. D, and believed this opportunity would be a unique experience to discuss during interviews and place on her resume.

“It’s one of those things where you talk about it and it’s a very unique experience because you’re in country, observing patients and hospital care, not sitting in a classroom learning about it,” Tabaschek said.

On Tabaschek’s trip, she said her group followed an ATAP to a family living in a small hut and was able to observe his relationship with the family. Tabaschek said the ATAP walked into the family’s home and told the family he was there to give them vaccinations.

“[The family] was grateful because [they knew] the ATAP was coming to help them,” Tabaschek said.

Afterward, Tabaschek said they visited another house with a well-off family, and the ATAP followed the same protocol. She said she was surprised by this Costa Rican custom because the health care she is used to seeing in the United State is so different.

“This was a very immersive experience,” Tabaschek said, “because we were actually there in the house with the family and watching.”

She was inspired by the influence public health workers can have on the community’s mentality and the respect the community had for the health workers.

Moving forward in the public health field, Tabaschek said she hopes to apply the knowledge and experience she gained from the trip toward her career.

Tabaschek also presented her research project at the undergraduate symposium fair hosted by the Eberly College of Science and continued her research into the summer following her trip with Johns Hopkins University.

Maggie Lee

Maggie Lee participated in the program during her junior year and went to Costa Rica in the summer of 2018.

Lee (senior-nursing and Spanish) said she heard about the program from advertisements through the nursing school.

Lee said her previous study abroad experience was a cultural immersion experience which lasted six weeks. She said she was interested in this program because it was only one week and was health-care based, focusing specifically on the administration aspect of health care.

“In the class we talked about communicable diseases,” Lee said. “When we were in Costa Rica it was interesting to compare their universal health care system to the United States because it’s not universal.”

For her research project, Lee wrote a paper about vaccinations in Costa Rica, touching on subjects such as the policies surrounding a vaccination, the differences in the vaccination schedule compared to the United States, general public opinion and the recent measles outbreak.

While in Costa Rica, Lee said her group visited several hospitals and clinics and went on home visits with the ATAPs.

One of the biggest differences Lee said she noticed between health care in Costa Rica versus health care in the United States was the sense of community present in Costa Rica nursing versus the less personal medical treatment in the United States.

“[The program] allowed me to think about what the universal health care system is,” Lee said. “[I] had never really experienced it before and it made me realize how big an impact a universal health care system could have on the United States population.”

Steve Slaney

Steve Slaney, a Penn State graduate of the Class of 2014, traveled to Costa Rica as a student in the program during his fall 2014 semester and returned to Costa Rica two additional times as a translator with the program.

Slaney (graduate-health policy and administration) currently lives in Costa Rica while volunteering with the Peace Corps.

Slaney said he decided to apply for the program during his extra semester after changing his major halfway through his junior year.

A woman administers vaccines to a child in Costa Rica as part of Penn State’s Exploring the Health Care System in Costa Rica program.

Courtesy of Celeste Newcomb

As a student on the trip, Slaney said he appreciated the first-hand experience of learning how Costa Rica administers their health care.

“To me, experience is one of the most invaluable things,” Slaney said. “It’s priceless.”

Slaney’s research assignment was a report comparing the Costa Rican, Cuban and American health care systems. He said he researched the demographic variables beforehand and found it interesting to witness the cultural aspects in-person during the trip.

“My favorite moments were when we were in the more remote areas and we would go on visits to people’s houses,” Slaney said. “I thought that was really personal and interesting because for people who couldn’t get themselves to facilities, [local providers] came to them.”

Slaney’s group followed local health care providers on the job and observed as they interviewed different families, administered vaccinations and performed health check-ups on children and senior citizens.

Slaney said the community members were accustomed to seeing the health care providers and were gracious enough to let his group observe.

“It put us in an interesting situation because [we were] kind of invading someone else’s home,” Slaney said.

Slaney said the experience was very beneficial to him and opened his eyes up to different aspects of both health care and himself that he never would have known had he not traveled to a foreign country.

“To have an opportunity to do something like this under the umbrella of Penn State is just something that I would recommend to anyone,” Slaney said. “I think that whenever you can combine your academic life with some international exposure and experience, it will make you a better student and a better citizen.”

Minor corrections to article made on April 9, 2019

Music in Costa Rica

 

When I heard that there was a course called “Exploring the Healthcare System in Costa Rica,” I knew I had to sign up immediately. As someone who sees themselves working as a physician in Doctors Without Borders, I realized this class would provide me with the opportunity to gain a global perspective on a topic that the US has struggled with for some time and is very important to my future goals- providing quality healthcare to citizens.

This week I’ve had the pleasure to travel Costa Rica’s luscious landscapes with other individuals as invested in the health field as myself. I’ve learned much about the clinical and business aspects that make up a successful healthcare system. During the week, we’ve seen several healthcare facilities and even got to partake in home visits with the local ATAP’s here. From these excursions, I’ve learned that Costa Rica’s healthcare system, the Caja, allows many, if not all, people in need to receive healthcare services.

Additionally, we’ve been able to tour the Costa Rican environment. Throughout the week, we’ve been in the nation’s capital, San Jose, as well as less populated areas, like Las Juntas, and Monteverde. The diversity of these venues has allowed our group to not only see different levels of the healthcare system, but breathtaking rainforests, sunny beaches, and magnificent volcanoes as well. Probably one of the most notable parts from this side of the trip was the Cloud Forest and Zip Lines in Monteverde on Saturday. At the Cloud Forest, our group was able to walk several suspension bridges that overlooked the tops of trees in the area. We also enjoyed hearing from our tourguide, Luis, who taught us about the wildlife living in the rainforest. After that excursion, we tested our bravery on several zip lines. To our pleasure, one of them was over 800m long!

However, on a personal level, I’ve learned more over the course of this week than would have ever been possible to absorb in a classroom setting. As someone who is not very familiar with the policies of healthcare, learning about the Caja in Costa Rica has provided me with a fresh perspective on the importance of having policies that suit a broad range of people. Additionally, I’ve been able to fully immerse myself in Costa Rica’s culture. I’ve been able to step out of the comfort zones of common language, and areas of study I was unfamiliar with prior to this trip. From that stretch of discomfort, I have grown to be more worldly and more knowledgeable about healthcare. Because of this growth, I know I’ll be able to apply what I’ve learned during this week to my profession in the future. When I am able to do that, I know I’ll be able to treat my future patients with proper care they deserve.

Traffic is moo-ving slowly today!

 

In the previous days here in Costa Rica, we were able to explore many of the healthcare services provided to the people in Costa Rica, alongside the structure of the actual healthcare system including the three levels of healthcare. For example, the first and third days we explored the women’s hospital and the country’s national hospital respectively, which belong to the tertiary level of healthcare where more concentrated services are provided for much more serious cases with specialized surgeries and care available for the patients. On the fourth day, we also were able to explore the primary level care that could be provided to the people of Costa Rica, including the work of the ATAP workers from the local clinic and see how they went from house to house throughout the day in a neighborhood to ensure that all the people were receiving their deserved care and were staying up to date with their vaccines and overall health.

Today we followed similar ATAP workers, Jessica Lopez, Olger Diez, Majorie Carmona Salazar, Marcela Solano and Ana Yanci Ulate, and went from house to house to not only see the types of services they provide, but to also witness the lives of several Costa Rican people and their reliance on the healthcare system. We were able to witness people from different socioeconomic statuses being treated and taken care of by the ATAPs.

In the morning we went to the local clinic at Tilaran and met with nurses who talked and showed us the numerous vaccines they administered. It was fascinating to see that many of their doses of vaccines administered to the people could have up to five vaccines for five diseases called a pentaxim. The pentaxim had vaccines for polio, pertussis, diphtheria, tetanus, and flu. They store the vaccines in a cooler that maintained the temperature between 2 to 8 degree Celsius. After learning about the vaccines, we donated a wheelchair to an old lady who recently lost her leg which was such an overwhelming experience.

Once we visited the clinic, we alongside the ATAP workers, traveled to several families from different socioeconomic statuses including people living under extreme poverty to people living quite comfortably from the United States settled in Costa Rica who were all covered and treated by the Caja, including all their costs for treatment and medication. One of the families that really stood out to me was a small family with a pair of twins, one of which suffered from anencephaly. The family was relocated to a different location after a flash flood. Their house was demolished during the flood which took place in the middle of the night. Their story is truly amazing. During the flood, the whole family was asleep, with no light at all, it was pitch dark. They could not see anything at all, all they could do was hear the roaring water of the stream. During the flash flood one of the brother carried the other brother on his shoulders in only their underwear to safety. Their story was truly inspiring and touching. When I observed their house, even though the house was small and not so luxurious, they had wonderful and new appliances, and all the necessities. Their house as decorated beautifully by cross stitch work done by the mother and we learned that one of the brothers was obsessed with soccer.

After leaving that family, we left with the ATAP workers to a different house whose residents were much higher on the socioeconomic scale. The man, Han, was from the United States and had settled in Costa Rica many years ago and lives with his wife and son. He told us stories about his diseases and injuries. He suffered from cardiac arrest two years ago and continue to suffer from heart issues, but he said the Caja was amazing at taking care of him. We witnessed how the ATAP workers checked their blood pressures and provided them the proper medication, all covered by the Caja as Han pays about eighteen thousand colons per month which is about $33 per month for the complete household. However, when he got in an accident and got injured, the car insurance of the driver was not under the Caja, and so he received attention from completely different hospital and system. He was not tested properly till after two weeks and found that he had fractured his spine and tibia. This shows how efficient the Caja is in Costa Rica and how people of different socioeconomic status really rely on it.

There was so much we learned not only about the actual healthcare system, but also about the diverse socioeconomic statuses and everyone’s dependence on the Caja system. It was truly amazing and awe inspiring. There are truly several things we can learn from Costa Rica’s healthcare system and try to apply them to our own system in the United States, particularly the maternal care and the neonatal health which is part of my research. The emphasis in prevention and pregnant women’s health really makes Costa Rica really different from the Unit

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.

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.

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.

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.