Exploring Costa Rica's Health Care

As we approach the end of our one week study abroad in Costa Rica, I can say that I am grateful to have pursued this unique educational experience. After learning about the Costa Rican healthcare system, I fully support study abroad opportunities because it provides a first-hand learning opportunity. I would like to thank the Master of Health Administration department and specifically, Jonathan Clark, Susan Sanders, and Tami Smith. What I have learned from this trip has allowed me to apply the components of a foreign healthcare system to what I am learning about the U.S. healthcare system in my graduate studies.

Today we visited and toured around villages with the ATAPS within Tilarian. We saw two different homes with two diverse families. The first house consisted of a young mother who was 19 years old and a one week old baby. The ATAP examined the baby and explained that the baby had a rash that could be an allergic reaction. This house was considered at high risk or “red” because of the teenage pregnancy and the condition the house was in. The next house we visited was also high risk. This house was in a lot worse of a condition because it had mud floors and most of the house was outdoors. The family was reviewed to make sure they were up to date on their vaccines. It was interesting to see the difference between the two houses with the families because the second house was in a lot worse condition than the first. I believe it is very interesting that no matter what your living condition is everyone receives healthcare. Today was a very eye opening experience and I am so glad that we got the chance to see and understand the diverse culture within Costa Rica.

Sarah Barr

Today we shadowed the ATAPs in Tilaran to be able to personally grasp the high value that Costa Rican’s place on preventative care. It was amazing to hear how much each ATAP knew about the family they were visiting just by looking through their chart. Even though their records are not electronic, the way they document patient information is still very efficient. We were able to see the interaction between the ATAPs and their patients. The patients seemed very comfortable and trusting. We also learned that they rate each family as either a 1, 2 or 3. A 1 is the most at risk type of family. They may be very impoverished, have poor living conditions, have domestic violence, or suffer from substance abuse etc. We were able to visit a few risk 1 families today. After this experience, I reflected on just how lucky and well off we are. We often worry about not having the best things and especially on this trip, we complained about seeing bugs in our hotel room. Our visits today really put things into perspective for me. While living conditions are often indicative of our health status, it is not always how well off we are in terms of money, Despite the poverty that these families were facing, they still managed to be extremely happy, friendly and close knit with their families and this alone, made their quality of life admirable.

Today we visited an EBAIS clinic and we followed ATAPs to their locations. We also had the chance to donate medical equipment to those in need. Out of all the days that we have experienced in Costa Rica I found this day to be the most rewarding and most beneficial to our learning experience here. My favorite parts of the day included following the ATAPs and donating the equipment. As for following the ATAPs my group of four went to an elder woman’s house. The lady who owned the house was 93 years old, which amazed all of us because she looked like she was in great condition for her age. While the ATAPs not only evaluated her, he also evaluated her daughter who was around 60 years old. It was interesting to see because after the evaluation they found that she needed to visit a gynecologist as well as be careful of her diet because she has diabetes. The visit once again proved to me how personal Costa Rican health care is. The ATAPs are great for patients because their periodic visits are reminders to patients to maintain their own health. Along with that, the ATAPs get to evaluate the patient in a more intimate setting. The second part of the day that really touched all of us was when we donated the medical equipment. The first patient we went to was an elder woman who needed a walker because all she had was a cane and needed further assistance when walking with it. After we delivered the cane to her, the joy that overcame her was incomparable. It shows us how the littlest things are still things to be grateful for. I am really glad that we were able to help her and I’m sure she is just as happy.

Today we went to a Clinic in Las Juntas. They focus more on the Ebais team that makes up of doctors, nurses and A-tap that is short for Attention Technical Assistants of Primary Care. The Ebais team goes to different houses in communities that have a lot of people who need medical attention. Patients can also go to the clinics but the team of Ebais will go to the houses to make it easier for the patient rather then having them travel out of their way. When the team goes into the houses they also check the animals the patients may have such as dogs and make sure they have their latest vaccines and also check to see if the patients have food and check for anything else that is health related. They go to about 700 houses and see close to 300 patients per community. Ebais is on the bottom of the basic primary care pyramid following by the clinic, regional and specialist. I thought this was very unique and different from the United States because we don’t have doctors making house calls and checking the patient’s homes and making sure they are in a safe and healthy environment. This was very remarkable for me and I loved a lot how open the patients were to allow us to enter their homes and absorb what was happening. After we visited homes we then went and donated a wheelchair, walker, and crutches to three very nice people. The first person we visited was an older lady who had a hard time walking and we were able to provide her with a walker. Her response to receiving the walker was, “This is the best Christmas present ever.” After she said that my heart melted and immediately brought a smile to my face. The second person we saw was a guy who has diabetes and had to get his foot amputated. We were able to also provide him with a new pair of crutches to make it easier for him to walk. He was very happy and appreciative. Lastly, we saw another older gentlemen who needed a new wheelchair. The wheelchair he had at the time he actually made it. His wheelchair didn’t have a seat so he put a plastic seat inside where the normal seat would have been. Just reading that you can tell that it was very unsafe and dangerous for him to be sitting in that chair. When he saw his new wheelchair he again was very appreciative and very excited. He even offered us some of his lemons he had growing off a huge tree in his backyard. These three people were so lovely and so happy to see all of us and especially excited to have brand new items that they desperately needed.

Today, we were extremely lucky to be able to experience firsthand what it was like to work with an ATAP workers, one of the most unique aspects of the Costa Rican healthcare system. This is something incredibly unique that the US system definitely doesn’t have. I’m learning very quickly that the US healthcare system definitely isn’t perfect, and that there are many other ways to achieve the same outcomes.

One fundamental difference between the Costa Rican healthcare system and the US, is the emphasis placed on prevention. The vast majority of Costa Rican healthcare professionals work at the base level, by reaching out personally to the Costa Rican community. On a very personal level, they can assess risk factors (such as financial income, or substance abuse) that would never be revealed under the US methods. It may be expensive to have so many ATAPs perform house calls, but ultimately money is being saved in the long run, due to the heavy emphasis on medical awareness, education, and prevention.

Additionally, the ATAPs keep an extremely close relationship with the patients that they interact with, encouraging a culture that is so proud of its successful healthcare system. ATAPs will determine which households they will need to revisit the most, depending on their risk level, which is determined through a combination of pre-determined risk factors.

While it would be nearly impossible for the US healthcare system to mandate house calls for every single US citizen, we can definitely take inspiration from several aspects of the Costa Rican healthcare system. First and foremost is how much room for improvement the US healthcare system has regarding primary care. The Costa Rican system is one proven example of how important it is to stress prevention – not only will it save money in the long run, but it keeps the population healthier overall. Unfortunately, the private US healthcare system seems to respond well to practices that lead to an immediate financial profit, so changes will need to be made to encourage long term success. Therefore, I think it’d take a fundamental policy change (possibly at a government level) to encourage a growth in primary care, such as increased salary benefits or reduced tuition costs, to provide incentive for more passionate professionals to work in primary care.

Today we visited Hospital San Rafael and it sees about 571,667 patients and has 36 medical specialities. The hosoital has 6 beds in their rooms, 280 total beds, 7 operation rooms, and 2 recovery rooms. In our discussion we mainly focused on Ebola. The first case was in 1976 and it is unknown if it was transmitted from person to person or animal to person. Ebola symptoms usually last from 2-21 days and involves internal or external bleeding. The most important way to prevent it is having no fluid contact with anyone that is infected with it. The reason why Hospital San Rafael is focusing on Ebola is because they are the closest hospital to the airport so people that have it can be transported there. Ebola has not been seen in this hospital but if it was it would be because of traveling people in december and July because that’s the tourism season so diseases spread more easily and readily.

Another thing I found so interesting was we saw two pregnant women standing in the maternity department that were ready to give birth. In Costa Rica women are advised to keep walking around until they go into labor and they also choose to. Here in the U.S. I feel like we become almost lazy when the time comes and we don’t have the energy like they do here.
-Disha Patel

Today we went to a regional hospital in Alajuela named San Rafael de Alajuela Hospital. This is the main hospital for cases of Ebola due to it’s location near the Juan Santa Maria Airport. Ebola is thought to be a threat to Costa Rica due to the large number of tourists and its location between North and South America. The hospital has 36 specialties and helps over half a million people each year, which is one eighth of the population of Costa Rica. San Rafael consists of three departments: emergency department, hospital treatment for short stay, and external consultation, which is used to refer a patient to a specialist outside of the hospital. Most rooms of the hospital consist of six beds, with a total of 280 beds. Approximately 30-35 surgeries are scheduled each day of the work week, not including emergency surgeries. The seven operating rooms and two recovery rooms of the hospital are heavily utilized. Personally, I thought that it was amazing that the waiting room on the first floor of the hospital had many seats (over 150 seats) available for patients. A hospital administrator of San Rafael was our docent who told us that the waiting room is commonly used only between 7am-3pm, and we noticed around 4pm it was nearly empty. The butterfly garden was beautiful and allowed people to visit who are visitors and patients to breathe the fresh air of Alajuela, Costa Rica.

After yesterday‘s visit to the children’s And women’s hospital, today‘s visit was very different. We visited a general hospital that cares for over 500,000 Costa Rican citizens. The general appearance of the hospital was very diverse compared to yesterdays visits. What I mean by this is that it was more open, had a lot of natural light and gave more of the “hospital appeal” to it. One thing that stood out to me was the waiting area for external care, which are the patients that need to be seen for general sicknesses like colds, injuries, etc. When I first saw the area I initially thought of a train or bus station because of how open it was, how the seats were set up in rows and rows and how the desks were set up to talk with incoming patients. I also noticed how numbers were flashing on the walls when it was a patient’s turn, which reminded me of a deli part of a grocery store. I thought that maybe since so many people wait for external care, the waiting time would be very long but the doctor explained that it’s only about 30 minutes. I found that very interesting because they are seeing so many patients a day because the wait times are shorter than I expected. This is another aspect of Costa Rica’s healthcare system that America need to implement to ensure a good quality of health to patients in an efficient manner.

Today was my first day being fully immersed in a Health Policy and Administration environment! I’m really glad the entire class is here to help answer my questions, no matter how trivial or silly they may seem. I’m definitely impressed with how much is common knowledge to the class, as I have no background in healthcare whatsoever.

Throughout the course of the week, we’ll be studying the differences between the US and Costa Rican healthcare policies. I’m also very interested in the trends and changes in Costa Rican policy, and the overall direction Costa Rica will move in the future.

I’m honestly learning just as much about the American system as the Costa Rican system. Two of the biggest differences between the two lie in organizational structure and funding, which I think is an accurate reflection of the culture as a whole. Americans may sometimes be aggressively focused on financial sustainability, while Costa Rica places much greater emphasis on building lasting relationships with individual people.

I really appreciate how much of a positive attitude the class has towards individual patient care (especially those who have their sights set on medical school). I initially expected to pay attention to the healthcare system from an overall, impersonal, and numbers perspective, but I truly believe that I will learn much more from the individual people.