2016 Reflections
Outside the health clinic in Monte Verde
Inside the clinic
Telemedicine is used in this remote clinic for some services as the clinic is five hours from the closest hospital.
Vaccination against polio and other diseases is encouraged.
Danika Hoffman – Reflection Six
Tool six regards health care financing. In Costa Rica, the percent of GDP spent on healthcare is 9.9% (The World Bank, 2016). The majority of people pay for healthcare through the Caja Costarricense de Seguro Social (CCSS) system. The CCSS was created in 1941, and it functions as a social security system. Employees pay into the system from their salary, and employers also contribute on behalf of each employee. Then, when healthcare is needed, it is covered by the CCSS. If a person has a lot of money, they pay more into the system, and if a person does not have a lot of money, they do not pay as much into the system. However, everyone receives equal access to the system and equal care in the system. A very small percentage of people (3%), usually very wealthy, own private insurance. Private insurance helps people to receive care more conveniently, but often times when a medical problem is complex people with private insurance have to transfer from private hospitals to public hospitals because public hospitals are best equipped to treat complicated conditions. Also, all vaccines are done through the CCSS system, so people with private insurance are still vaccinated through CCSS. For people who struggle to afford to pay into the CCSS system, there is a state system to help them afford care. Children are a special population in Costa Rican healthcare. For pregnant mothers and people under the age of 18, healthcare is free. Furthermore, vaccinations are mandatory for children. A parent cannot refuse the vaccination of a child because that is against the law. This payment system has created a country with very good health outcomes despite its status as a developing nation. The only drawbacks are the fact non-emergency care likely includes wait times. Currently the waiting lists for orthopedic, ear nose and throat, and urology non-emergency treatments are extensive.
Ama Brown – Daily Log Five
During our time here in Costa Rica, we have visited many types of health facilities, all different in quality and ability. Regardless of all the differences, one thing that they all have in common is a mission to provide quality care to their patients. The first hospital that we visited during our stay here, Hospital Clinica Bilica, which is accredited by the Joint Commission International, is a high quality private hospital. In this facility, they have many of the technologies that can be found in the U.S. New in model, the facility possesses the same look that one would expect in a first world country. Though it provides care for people who have private insurance or financial ability to pay for service, the facility still devotes its time to creating a safety net for the underserved population through social action programs. This aim to help the vulnerable population in their communities is the first of many other provisions that Costa Rican hospitals provide for its people, whether private or public. On the lower end of things, the women’s hospital, Hospital De Las Mujers, was not equipped with many of the resources in Hospital Clinica Bilica. Nonetheless, this facility still provided proper care to the women they serve. In Hospital De Las Mujeres, their use of technology lag when it comes to using electronic health records. They have a room where patient files are kept. Regardless, the hospital makes up for it in other areas like social support. One of the departments in the women’s hospital is a social support room for cancer patients. The purpose of this room is to give women who are suffering from cancer a place to feel special by getting their hair, makeup and nails done. Again, regardless of its rank, social support is adequate. A last facility we visited today, Clinica Santa Elena, had equipment used for telehealth. This was very interesting because though considered as a developing country, it manages to succeed in using such a system even the United States have yet to figure out.
We got a special privilege to visit Dr. Rodolfo Hernandez, who is a pediatrician and Kidney doctor. What made this special was because Dr, Hernandez will be running for president. During our conversation with him, he confirmed how valuable the people of Costa Rica are to the authorities and health providers of Costa Rica. He stressed on the importance of good health for infants and adolescents. He stated that, “the baby in the tummy is the future of our country, it is like putting money in the bank”. This idea of investing in healthcare rather than spending seems to be a common theme here in Costa Rica. He further explained that the success of their health system is mainly due to several components. First is good drinking water. According to Dr. Hernandez, 97% of the populations have access to safe drinking water. A second component is their decrease in contamination. Unlike many developing countries, the people of this nation do not urinate or through feces outside. A third reason is due to their free administration of vitamins and vaccination. A last contributor is their screening program. Overall, 94% of their success is due to medicine and 4.6% is due to their environment.
Regardless of the type of hospital, whether a clinic, community hospital, or private hospital, Costa Rican’s health care system devotes special medical attention to people, even refugees. Their facilities are capable of the same care that can be seen in the United States and even better. Whether it is use of medical records, tele health, or just a helping hand, Costa Rica has health care delivery figured out.
Caroline Kaschak
An important key for a country’s health is to have quality health facilities. This may seem like common sense that, clean hospitals, labs with the most up to date equipment, or even a specialty doctor can improve the health of an individual. Though, it is not just having the facilities that is sufficient, it is important that the health centers can meet the demands of the people in the community. This includes aspects such as access, appropriate specialties, enough space, and much more. In Costa Rica there are three different levels of health care: Level 1, 2, and 3. The first level of Clinics are known as Asistente Tenico de Atencin Primaria or ATAPs. This has a basic level of training for the medical professionals that requires about 4-6 months of intense training. The ATAPs normally belong to a certain clinic, but they do not serve at the clinic, instead, they go door to door of the population to handle vaccinations, prevent diseases, monitor blood pressure, provide parasite pills, and much more. ATAPs focus on preventative care. The ATAPs we visited in Las Juntas specifically just went from house to house and assessed potential disease causing factors as well as gave recommendations to the families. This type of intervention seems to be considerably adequate since Dr. Roldolfo Herendez said that 85% of individuals are vaccinated including refugees. This is a crucial part of the health system in Costa Rica because it reaches a wider range of the population health care that desperately needs it, instead of letting them fend for themselves. Also in the first level is general clinics that have very few specialties. There are 1004 of these small clinics throughout Costa Rica. So almost every town has access to health care, though it may not be the best quality because of the lack of specialties, they fulfill the basic needs of the people. The second level of care is larger clinics and basic hospitals. These hospitals/clinics have several specialties including Gynecology, surgery, pediatrics. There are 80 of these throughout Costa Rica to provide a better level of care to all citizens. The third level of care is large hospitals, this include almost all specialties. There are about 29 of these hospitals in Costa Rica. There are 64 pediatric specialties in their pediatric hospital, they also have multi-organ transplants and are the 3rd country in the world to develop skin graphs. Even as a 3rd world country almost any procedure can be done in Costa Rica. Many of the facilities we visited had up to date equipment, even the smaller clinics. Private and Public also made a difference in the facilities. Many more private hospitals have more bed space/rooms and better equipment than the public hospitals. Overall the I was very surprised at the quality of the facilities all over Costa Rica.
Today, we visited a small clinic in Montverde called Clinica Santa Elena. Philippe Casada, gave a us tour of the facility along with discussing the three levels of health care. Even though this public clinic was less advanced than some of the others, it still had a lab, dentist, vaccination room, and women’s health room. The most special part of the day was visiting a pediatrician and presidential candidate- Dr. Roldolfo Herendez. He spoke so eloquently about the health care system here and Costa Rica. He was able to highlight the effort of the Tico people who are trying to have a system with three levels of obligation. The 1st level is the personal level as in if you do not want to get lung cancer don’t smoke. The 2nd level of care deals with the community level. If you do not want Dengue then the community has to get rid of the growing level of mosquitoes. The 3rd level in this would simply be the health system itself. He also spoke how important the equal system was in Costa Rica because it can sustain itself and successfully provide care for all. A quote he left us with that stuck in my mind the most, especially with THON coming up- “Kids don’t belong to a country, kids don’t belong to a political party, kids are kids and they deserve the best care.” Such a wonderful experience to talk to a man who really care about the health of his people.
2014 Trip Reflections
By definition, Costa Rica is a third world country. However, being on this trip and experiencing the way Costa Ricans live, I would have never guessed it. The people of Costa Rica were very warm and welcoming and I immediately felt comfortable. The culture is so rich and the people are very friendly, always willing to lend a helping hand whenever possible. The healthcare system in Costa Rica was another incredible attribute that astounded me. It was very clear to see that the main focus of all Costa Ricans, including the government, was caring for one another. The foundation of the healthcare system was based on preventive care for all individuals, regardless of their inability to pay or their citizenship status. The structure of their healthcare system is very efficient in the fact that there are different levels of care: the first being clinics, followed by regional hospitals, and then specialized hospitals. The main focus of the clinics are to provide as much care as possible in order to reduce the volume of people seeking treatment at regional and specialized hospitals. The physicians and ATAPs that worked at the various clinics we visited were keen on ensuring that everyone seen was stable, both physically and socially. I can not stress how impressed I am with Costa Rica’s health system. Their way of providing care supports the idea that it’s possible to provide exceptional care and still be a minimalist. Overall, this experience was a huge eyeopener for me. I’ve learned to not only be thankful for the life I live, but also to strive to appreciate the simplicities of life. I never imagined I would bond with a culture as closely as I did with Costa Rica’s, and I am eternally grateful for this experience.
Comments on Rural Care by Dave Bress
Today we went to Monteverde to an extremely rural clinic. Only four doctors and eight nurses work there and this clinic does not have access to ambulances. The doctors do not receive the same salary as physicians throughout the country, it’s actually much less. Telemedicine is of utmost importance in this clinic because the doctors do not perform the surgery unless utilizing telemedicine. The amount spent on administrative costs is close to four percent, which is extremely low. It’s very impressive that they are still trying to lower this percentage. The hours of the nurses and doctors would be very exhausting due to the twelve hours Monday through Friday and 24 hours on weekends. The doctor who provided information on the clinic told us about her hardest day, which entailed delivery ten babies! It was great to see a doctor so passionate in a rural area with a low salary and little technology simply because she loves to help others.
Reflections by Monique Bradley
Our next stop in this beautiful country is Monte Verde. Surrounded by beautiful greenery and long dirt roads, we visited the local clinic of the town. We met with one of the four doctors who work at the clinic, and she enthusiastically explained the dynamics of the clinic. I was shocked when we were told they had no ambulances and that the nearest hospital was approximately four to five hours away. It made me ponder exactly how they are able to receive immediate care if there was a short time span to save one’s life. Although they lacked in this area in relation to the United States, they were seemingly advanced in telemedicine. They used telemedicine in their practices every day, and had a different type of service for every day of the week. They would refer to a specialized doctor through telemedicine when services were needed beyond their knowledge and ability.
Overall, this trip has been an once-in-a-lifetime, eye-opener. When one thinks about a third world country, they automatically assume they have poor health and sanitation. This program proved that although a country may not have the best economy or riches, they are still able to provide healthcare to the best of their ability, even beyond that of a developed country. They are still growing and need some improvement in a few areas, but the United States can also learn a lot from Costa Rica’s public health, such as their advanced women’s health services.
Providing Care in a Rural Setting by Steve Slaney
Today we went to the Clinica de Monteverde, which is a healthcare clinic that supplies thousands of local residents with minimal resources. There are only a handful of workers at the clinic that are extremely dedicated to treating the underprivileged rural population in and around Monteverde. Staffers often work 12+ hours a day 6-7 days a week. Patients come from all over the country side and transportation is a huge barrier to care because the clinic does not have helicopters or ambulances to get at risk patients to and from the clinic. The doctor who spoke to us talked about the clinic’s affiliation with the Red Cross and their funding from the government that is inadequate. There is a tremendous incentive for preventive care because it is far easier and cheaper to practice and administer than primary care. Since funds are low, the clinic keeps costs at a minimum by keeping administrative costs as low as possible. Serving the underprivileged is gratifying to those who work at the clinic and there is a deep appreciation among patients towards those who dedicate their lives to serving them.
A Future Nurse Shares his Reflections – Mike Gutierrez
On our 5th day, I was able to gain a further and deeper appreciation for the ATAP program. Though we were able to tag along with the ATAPs yesterday, today we interacted with the individuals and learned more about their stories. Though I full-heartedly believe that the ATAP outreach program should be introduced and implemented into the United States’ health care focus, today I was more interested in the outcome of the visit in a personal/social sense. Hearing the various stories of the individuals we visited today was a truly unique experience. Viewing the smiles on the children’s faces to have visitors and receiving the appreciation of the parents struck an emotional cord within me. In an active pursuit of a career in nursing, I treasure a positive effect on all those involved with the reception of care. As an aspiring health care professional, I hope to be able to apply such indifference to all patients regardless of SES or other environmental factors as these ATAPs display on a day to day basis.
Appreciating the Use of Telemedicine in a Remote Village by Lauren Wilson
Today we visited a clinic in Monteverde. It was in a very remote area and the closest hospitals to the clinic are in San Jose and the Central Valley. The clinic doesn’t have any ambulances or medical helicopters so patients have to be able to get to the clinic on their own. They don’t do emergency surgeries unless it’s for certain circumstances such as car accidents. If they must perform surgeries they use telemedicine. There are 4 doctors at the clinic and 8 nurses and they have to treat a certain amount of patients and meet a certain quota in order to receive their full pay. After visiting the hospitals and clinics this week I now have a greater appreciation for Costa Rican healthcare. They face many challenges just as we do in the United States with our healthcare system but they are also better than the US in that they do a much better job of trying to make sure their population is being receiving the care they need even if they cannot necessarily afford it.
Applying the Components of a Foreign Healthcare System by Amulya Khajuri
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.
Going Door to Door in Costa Rica by Sarah Barr
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
Identifying High Risk Families in Costa Rica Kelsey Sims
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.
Seeing the Health Care System in Action by Avni Kothari
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.
2013 Trip Reflections
Day 6: Monteverde
Now that we are up in the mountains, the temperature is a bit lower than in San Jose and Las Juntas. We spent a full day in Monteverde, which is a rural town in close proximity to a cloud forest. The morning was spent at a primary care clinic, where we had the opportunity to talk to health professionals and administrators about both the successes and the challenges of Costa Rica’s health care system in rural areas.
In Monteverde, there is a clinic where people can go to receive primary care as well as emergency care. Minor emergencies can be treated in this clinic; however, if specialty care or surgery is needed, the patient is transported to either a public regional hospital or a national hospital in San Jose. When we toured the facility, we learned that the emergency room here in Monteverde is never full because they usually only treat patients who do not need to stay the night.
The clinic tour included the emergency room, general consultation rooms, the laboratory, vaccine storage, pharmacy, dental rooms, psychology, and medical record storage. In the pharmacy, each medication has a specific number that indicates its classification/use, and when a patient is prescribed a drug, the information is all stored in an electronic system that can be accessed nationwide. In addition, while in the laboratory, we learned that Costa Rica uses standards developed in the UK, and samples are tested monthly for quality assurance purposes.
An interesting and memorable part of the tour was our visit to the telemedicine room. Every day, the clinic in Monteverde spends a minimum of one hour doing telemedicine. This means that the primary care physician and the patient meet with a specialist (in one of the regional or national hospitals) via video conference. This has been a major advancement for health care in the rural regions of Costa Rica. From Monteverde, the closest hospital is over one and a half hours away, and for those patients who live even farther, it can take hours to travel to a hospital. Therefore, the patients can meet with a specialist, virtually, at the clinic in Monteverde. In the event that the specialist decides that he wants to meet with the patient face-to-face, a referral is made for the patient to travel to a larger hospital.
In addition to ATAPs, who travel house-to-house, the Monteverde clinic also has a mobile EBAIS. The mobile unit consists of a doctor, nurse, pharmacist, and social worker. They travel to more remote places to deliver care, dispense medications, and help improve the health of families in rural Costa Rica.
That’s all for tonight! More student reflections were added to the “Reflection” tab. Stay tuned for more information. Tomorrow is our last full day in Costa Rica – time flies!
Posted in Costa Rica
Photos: Part 2
Listening to a presentation about the regional hospital system.
San Rafael Regional Hospital
One of the operating rooms in the Regional Hospital
Caylor Johnson with one of the patients that we visited with the ATAPs
Posted in Costa Rica
Photos: Part 1
The photos below are from a combination of days.
The symbol of the health care system in Costa Rica is a mother and baby. This is interesting as we have learned that in Costa Rica the bond between the mother and child is valued and greatly supported.
Exclusive breastfeeding for the first few months of life is supported by the family, health care system, employers and the government. Paid maternity leave is provided for four months, and a mother’s jobs is protected. All women in Costa Rica breastfeed their babies, unless there is a medical reason that they are not able to do so. This provides the best possible start to the baby, and has health benefits for the mother as well. When we visited the Women’s Hospital on Day 1 we saw many women breastfeeding their newborn babies. Mothers were present in the nursery, and the nursery had rows of rocking chairs to accommodate the mothers. This is very different from most infant nurseries in the United States, where there is typically a stark absence of mothers. In the USA, formula is often routinely given to babies instead of the baby being given to the mother for the first feeding. Pacifiers are routinely used in the United States as well, and this also contributes to difficulty breastfeeding. In Costa Rica, pacifiers are not seen in the hospital as it is documented that the use of pacifiers can make it difficult for a baby to nurse.
Dr. Pablo Garcia Solano explained how the dental program in Costa Rica works. Patients can come to the dental clinic for free, as part of the Social Security program. We learned that they even take a dental clinic to local and remote schools and can perform simple procedures at that time. Oral health is an important component of health care and it is valued. Dr. Pablo has a private dental clinic, and he explained that approximately 90% of the population unitizes the public system, but about 10% of the population uses the private system. He said there is no difference in the care provided, but at his private clinic he is able to do many procedures at once. For example, if a patient needs to have several cavities filled they can have all of this work done in one visit. Sometimes patients prefer to receive care in this setting. Dr. Pablo had dinner with us and was able to tell us more about his training, his views on the health care system and his passion for soccer. After work and before dinner he participated in a community soccer game.
The community in Las Juntas is very focused on improving the health of community members, and providing opportunities for exercise. We were excited to see a BMX bike ramp and skate ramp system being built for all to use.
The ramps were being built right in front of the health clinic. The hope is that the youth will use these, exercise more, and have a place to focus their energy. We asked how hard it was to obtain permission for the bike ramps to be built downtown in Los Juntas, in the town center where there are gardens and fountains. We were told it was not hard.
The community recognizes the importance of providing this for the community and the government was able to allocate resources to build the ramps. We are impressed with the ability of the Costa Ricans to get things done. Can you imagine bike ramps being built in Central Parklet in State College? We can. That is what they are doing in Las Juntas. Thank you to State College resident Jamie Bestwick for having this dream and for advocating to have bike ramps built in the downtown area of State College.
(Photo captions in this post were written by Celeste Newcomb).
Posted in Costa Rica
Day 5: Mid-day Update
We are getting ready to leave Las Juntas after a productive morning. We had the opportunity to deliver a walker and a wheelchair to people who really needed them. Special thanks to Mount Nittany Medical Center for donating these items to us.
We also wanted to give a shout-out to all of our sponsors and supporters:
Thank You to the Following For Student Scholarship Funding
The Health Policy & Administration Department
The College of Health and Human Development
The Eberly College of Science
Global Programs
Commonwealth of Pennsylvania
Schreyer Honors College
Penn State Altoona
Eberly College of Science Cooperative Education Student Enhancement Fund, Mr. and Mrs. Jeffery S. Deitrich
Arnold B. Rosenthal Family/Northeastern Chemical Association Science Scholarship
Rosenthal Endowment, Ms. Cydney Kirschbaum and Mr. James Amaroso
Thank you to the Mount Nittany Medical Center for the donation of a wheel chair and walker.
Posted in Costa Rica
Pictures
ATAP Jairo Martinez taking a patient’s blood pressure during a home visit.
ATAPs from the clinic in Las Juntas, Javier Mojica and Jairo Martinez with course Instructor, Celeste Newcomb (center). Celeste first met Javier and Jairo three years ago when she traveled to Las Juntas with former PSU Health Policy Administration Director of the MHA Program, Karen Volmar. With funding and support from Global Programs, The College of Health and Human Development and the Health Policy Administration, Celeste and Karen traveled to Costa Rica and met with health administrators and clinicians to develop the embedded program for HPA 401, Comparative Health Systems. This is the third time that Penn State has visited the clinic in Las Juntas.
HPA 401 students learning about how coffee (one of Costa Rica’s major exports) is grown and processed
Learning about how the ATAPs review household conditions to classify each home as either Red, Yellow, or Green, depending on the living conditions and health of each family member. Homes classified as Red and Yellow receive more visits each year from the ATAPs than the Green homes.
Yordi, Katie, Chris, Javier (ATAP), Carola, and Lourdes after a home visit in Las Juntas
Posted in Costa Rica
Day 5: Preview
It’s a beautiful morning here in Las Juntas. After breakfast we will head back to the clinic to meet with the Director. Afterwards, we will head with out with the ATAPs (Javier Angel Mojica and Jairo Martinez) again for a special project. We were fortunate to have brought a wheelchair and walker along with us, donated by Mount Nittany Medical Center, and we will be giving these away to local community members. I know all of us are looking forward to this event!
This afternoon we will be traveling to Monteverde. Stay tuned for more updates! I’ve added some more pictures for you, as well as a new tab on this website called “Reflections.” Please visit this tab to read excerpts from some of the students’ daily logs.
Posted in Costa Rica
Day 3: Public Regional Hospital
*Due to poor internet connection, apparently our Day 3 post didn’t upload last night. Below is from yesterday’s activities:
The day started off with a visit to a public regional hospital, Hospital de Alajuela. We were greeted by Jose Pablo Arce and Dra. Marcela Leandro, and they gave us a PowerPoint presentation about the hospital and the health region. Hospital de Alajuela is one of the largest and most advanced regional hospitals in the country, and their statistics regarding health outcomes, readmissions, infection rates, and community programs are quite commendable.
The presentation was followed by a tour of the hospital and its various specialty and emergency departments. The tour included a visit to a butterfly garden that was built for not just environmental reasons but also to promote good mental health.
Due to limited internet access, and extensive travel, we are keeping this short today, but we will be sure to provide additional updates when we are able!
Tomorrow will include a visit to a primary care clinic in Las Juntas as well as house visits with ATAPs, who are specialized public health workers and clinicians who provide care to Costa Ricans in rural areas that have limited access to facilities and health services.
Below is a picture from one of our hospital tours:
Posted in Costa Rica
Day 4: Las Juntas with the ATAPs
This morning we went to the clinic in Las Juntas and met ATAPs, which are health workers who make house calls in the rural areas. They provide basic care, take vitals, give vaccines, and collect data on households and families. It was very interesting to see how health care has been brought to the rural areas where people don’t have the resources and find it difficult to get transportation to the larger clinics and more populated areas.
For this afternoon, we will continue to follow the ATAPs and be exposed to their work, and we will also have an opportunity to rotate through the clinic in Las Juntas.
Tian, Steve, Caylor, and Jayme after one of the house visits in Las Juntas.
The little girl, Kimberly, in the picture really enjoyed our visit and was passionate about getting a picture with us.
After a quick visit to Poas Volcano on the drive to Las Juntas!
Posted in Costa Rica
Day 2: San Jose, Hospitals and the Ministry of Health
Today was a very full day for us, yet the experience couldn’t have been more rewarding.
Children’s Hospital
After an early breakfast, we braved the rush hour traffic to head into downtown San Jose. Our first stop was the Hospital de Niño’s, which is the Children’s Hospital. We started by touring some of the facilities and then headed into a conference room where we met Dr. Rodolfo Hernandez, Director General of the hospital. A past candidate for the Costa Rican presidency, Dr. Hernandez oversees the entire institution and took time out of his incredibly busy day to give us an overview of Costa Rica, the health system, and the Children’s Hospital.
The Children’s Hospital is the only children’s hospital in Costa Rica, yet it provides services to all Costa Rican youth, as well as children from all over Central and South America. The law states that all children have healthcare, no matter where they are from or their socioeconomic status. Dr. Hernandez reinforced this idea with a powerful quote, stating, “Children do not have nationality; they are children of the world.”
Celebrating it’s 50th anniversary in May 2014, the Children’s Hospital directly treats 30% of Costa Rica’s population and is the busiest and most developed hospital in the nation. It houses 64 specialties, provides 13,000 surgeries each year, an treats 140,000 emergency cases each year with just 178 physicians.
Despite all that this hospital does annually, its budget is only $100 million per year. Though it receives some funding from the government, the hospital operates and does so much because of the people. Charitable donations from Costa Rican citizens really drives the finances, mainly due to the fact that Costa Ricans really value healthcare and consider their donations to be extremely valuable investments.
Lastly, the Children’s Hospital also runs lab tests, cancer screenings, and other preventive screenings for the other adult hospitals and all pediatric clinics in the country. In fact, 98% of all newborns are screened (for basically everything) at birth. (Just for reference, this is the highest newborn screening rate in the whole world). If anything is abnormal, doctors visit the family at their home to discuss the results and possible treatment plans.
Ministry of Health
Next we visited the Ministerio de Salud, which is the Ministry of Health and met with Vice Minister of Public Health, and psychiatrist, Dr. Sisy Castillo Ramirez, MD, as well as other prominent members of the Ministry of Health (MOH). During this meeting, we learned a lot about what the MOH does for the health system, as well as recent legislation that has been proposed and/or passed to influence health.
We were given a history of the MOH, which was created in 1948, with mutual cooperation between the Social Christianity Party, the Communist Party, and the Catholic Church. The health system advocates equality and solidarity, while staying conscious of Catholic values and beliefs. Major advancements were made during the Kennedy years, when Costa Rica received considerable financial support from the United States to develop various social programs.
Current financing for the Health System and the Social Security System comes from a mandatory 9% income tax. Employers and the government also pay into the system. Under this universal system, everyone is covered and has access to care in public clinics and hospitals. It is optional, however, to purchase supplemental private insurance. The benefit to this is to avoid lines for elective or non-emergency surgeries, treatments, and procedures.
Costa Rica is able to support its health system and various other social programs because of one very important thing: they have no military (and therefore a military budget). Therefore, there is considerable funding that is allocated to the health security and pension funds, which is a unique opportunity that most other nations do not have. Dr. Ramirez told us that Costa Rica is very proud that they do not have an army and have no enemies. She said, “The only reason our country would ever bring back an army is if someone were to threaten our health system and try to take that away from us.” Costa Ricans are very proud of their system and its many successes, and this national pride is evident everywhere you look.
The MOH also monitors food, drugs, and vaccines in Costa Rica. Restaurants and food vendors are subject to MOH regulations. In addition, all vaccines recommended by the World Health Organization are paid for by the MOH, and it is mandatory for all children to get these vaccinations.
Women’s Hospital
Following lunch, our group visited the Public Women’s Hospital, or Hospital de la Mujer Carit. Dr. Richard Comacho took us on a tour of the gynecology and obstetrics departments. We were given an overview of how maternal, prenatal, and neonatal care is delivered in Costa Rica. Though not necessarily the most visually appealing hospital we toured, the Women’s Hospital offers top-tier care for Costa Rica’s mothers. In the event that a newborn has a severe congenital disorder,
the baby is sent to the Children’s Hospital, where he/she will receive treatment or undergo surgery in state-of-the-art facilities with the latest technology.
Looking at 2013 data, Costa Rica has a very low infant mortality rate of 8.9 infant deaths per 1,000 live births. (The U.S. has a rate of 5.9 infant deaths per 1,000 live births). The rate in Costa Rica is considerably lower than other Central American countries, and Costa Rica is quite proud of this feat. However, we also learned a very important fact. In Costa Rica, abortion is illegal, except only in cases where the mother’s life is at risk. Therefore, high-risk pregnancies that may be typically terminated in other countries, still result in delivery.
Resources:
https://www.cia.gov/library/publications/the-world-factbook/geos/cs.html
https://www.cia.gov/library/publications/the-world-factbook/fields/2091.html#cs
Posted in Costa Rica
Day 1: Arrival
Just a quick update to let everyone know that we have arrived in Costa Rica! Our hotel is beautiful, and we enjoyed a nice dinner, while getting an overview of the week’s activities. We will be getting up early tomorrow for a full day of meetings and tours of the public hospitals in San Jose. Stay tuned for a full update tomorrow evening!
Link to 2012 web site: http://pennstatehpacostarica2012.blogspot.com/