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!

Day 2: College of Nursing student Darien Kase Reflects on Hiking up Volcan Poás

Today we departed the hotel at 7 am and made our way from San Jose to Poas Volcano, which is within a national park here in Costa Rica. Here, we geared up for a tour to see a crater and volcano here in Costa Rica. When we arrived, we were told new rules that were now in place since there was recently an eruption at this specific volcano. They said that we had 20 minutes to walk up to the outlook, 20 minutes at the outlook, and 20 minutes to walk back down the trail. We all had to wear hard hats to protect ourselves from any potential dangers the volcano could cause in the event of an eruption. There was not a worry that there would be an eruption today, but because it is an active volcano, we had to be prepared for anything!
We began our hike with a mist of rain and personally, I think it made the trail even more majestic. I love the forest and hiking, and this trail was very well maintained and had beautiful flora and fauna all around us. While on the trip, the group learned about the Poor Man’s Umbrella, a plant here on the trail and in the higher areas of Costa Rica. It is a huge green leafy plant that does look like umbrellas. The people that used to travel in the forests of Costa Rica used this plant when the rain started to cover themselves. We continued with the rest of our hike up to the outlook.
Due to the steady rain, we were not able to see too much at the top of the outlook in terms of the volcano. It was too cloudy to see anything at the top, but there was a sign that showed us what the outlook looked like and it is gorgeous when it is not covered. We waited for the full 20 minutes to make sure that the clouds did not move away and when they did not, we began the trek down the trail.
As we went down the trail, we saw more wildlife and plants that are common in the mountainous areas in Costa Rica. I can’t put into words how beautiful the rural areas of this country are to all of us. We ascended back down and when we reached the bottom we were able to take the hard hats off and shake the rain off from our hike.

Day 1: Schreyer Scholar Jacob Iwinski Reflects on Medical Records

The sheer amount of patient files.

That is what caught me when visiting the Costa Rica general hospital of Este. You know the feeling when you have a book or movie collection on a shelf that is almost full, but you are sure you can fit one more in there if you really want? So with the motivation of not owning a second shelf at your back, you push and shove until finally, it fits! But it would be simply impossible to fit anything else on it, until the next one.

This feeling describes Costa Rica’s filing system. They. Just. Never. Stopped.

The rooms they use are simply packed to the brim; Each with shelves as tall as possible and claustrophobically close together. On the shelves, more flies than one could possibly sort through in a lifetime jut out at odd angles. One of my new friends from the trip described looking at the room as “I now have anxiety.” Yet, the room continues to function. I saw a doctor walk in and get patient records. He has my respect. Why bring this up? I think the filing system of Este Hospital is indicative of the country’s public health system.

Costa Rica simply does not have the resources to take care of as many people as they want to. The healthcare system is just only so big. But the doctors, staff, and administration will be damned if they cannot squeeze every last inch of space out of it. The average hospital room in the US has 1-2 patients. Rooms in Costa Rica have 6-8. Nothing is wasted and everything is rationed. The government will fight citizens on their need to use meds because they need to save them for those who actually are in need. They need to ration surgery, but only because they can only perform so many, everyone is treated fairly, the system is just slow. It prioritizes quantity over quality, without slipping far down the quality pole. It was surprising to see it up close.

Costa Rica does not have the perfect healthcare system, nor are its standards of care in all measures better than the United States. The true magic and lesson of the Costa Rican public healthcare system is how it does more with less. If the US was only half as efficient as Costa Rica, I can only imagine the healthcare feats we could accomplish.

In conclusion, I’m glad Costa Rica’s file system is going digital.

Through immersive experience, students learn about Costa Rican health care

Jordan Corley | The Daily Collegian 

Mar 13, 2019

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

Exploring the Health Care system in Costa Rica

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


APPLICATIONS ARE NOW BEING ACCEPTED: The application for the Costa Rica trip has been re-opened, as two new spots are now open to go on the trip in May 2019 for all majors/Penn State campuses. If you are a Nursing student, the College of Nursing would like to fund one student to join us in Costa Rica  who otherwise would not be able to travel due to financial reasons. Join us on this study abroad adventure through Exploring the Health Care System in Costa Rica hosted by The College of Nursing.  The application for the 2019 program is due November 1, 2018 and 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.

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. For 2019, the student price will be $2,199, which includes 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 2019, we will follow the same model as we did in 2018 with a spring term one credit course and a May term three credit course.

Please note, the official program beings on Monday May 6th but all students should plan on flying in on Sunday May 5th. We will hold a general orientation and review the schedule the evening of May 5th. Please plan to be in Costa Rica by late afternoon on the 5th. The trip ends on Saturday May 11th and students should plan to depart on Sunday the 12th.  The program  price will be $2,199.

You can read what students have to say about the 2018 trip and access the application on our website at

If you have questions about the program, you can me directly at Please copy my teaching assistant Paula Tabaschek at

Schreyer Scholar Emily Yanoshak, May 13, Becoming More Worldly


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.