It’s one thing to study an international health care system in a classroom with a textbook. It’s another thing to travel to another nation and observe health care providers implementing that system.
Led by instructor Celeste Newcomb, 15 students enrolled in Embedded Trip to Costa Rica, HPA 401, visited the Central American country from Nov. 29 to Dec. 6. The course was developed roughly five years ago through grant funds from University Office of Global Programs (Global Penn State), the College of Health and Human Development (HHD) and the Department of Healthy Policy and Administration (HPA). This was the third year students traveled to Costa Rica to study the country’s health care system.
Students learned about the government-run health care system firsthand, but as shown in their journal entries, they learned much more.
“I want them to appreciate another health care system and think about how we can improve our own health care system in the future,” Newcomb said. “But I also think they gain so much more because they also think about other issues, such as how can this country afford not to have a military. It's an interesting concept to ponder. They also consider quality of life and length of life in a developing nation. I think that it raises so many questions on so many levels for students. It's not only health care that they learn about on this trip.”
Dec. 2
Amulya Khajuri
What interested me most about today was the emphasis that Costa Rica puts on primary care. With prevention and primary care categorized as the first level of care, many people do not need to use the second or third level of care, which are the general and special hospital services. I find it interesting that health care workers of the first level go to homes to educate and ensure that people are taking care of their health.
Citizens in this country pay 9 percent income tax in order to receive these kinds of services. I am surprised that an idea such as this was implemented because this is a relatively high income tax and approaching people at their homes would be a potential privacy issue in the U.S.
Alex Ardito
The most significant thing that I learned a lot about today was the second location we visited. The Women’s Hospital was really incredible because it had many sectors and programs in place to increase the quality of life of both the Costa Rican mothers and their newborns.
Firstly, similar to Japan, Costa Rican health providers encourage their patients who are new mothers to stay together with their newborns. This includes the mother sleeping with the baby to make sure the baby is secure overnight.
Secondly, the hospital has established a milk bank to ensure that the newborns receive proper nourishment. Thirdly, the hospital has a breastfeeding clinic. These clinics prove to be the most important because they are educational programs for new mothers specifically set up so that they can feed their newborns safely and effectively. These factors together heavily attribute to Costa Rica’s low infant mortality rate and mother mortality rate.
Dec. 3
Sarah Barr
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 more than 500,000 Costa Rican citizens.
One thing that stood out to me was the waiting area for external care, which is for the patients who 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 health care system that America needs to implement to ensure a good quality of health to patients in an efficient manner.
Dave Bress
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 its 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 more than 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.
Dec. 4
Chelsea Cucura
Today, we went to a Clinic in Las Juntas. They focus more on the Ebais team, which is mades up of doctors, nurses and ATAP, which 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 than having them travel out of their way.
When the team goes into the houses, they also check animals the patients may have, such as dogs, and make sure they have their latest vaccines. The team also checks to see if the patients have enough 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 followed 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 patients’ 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. 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.
Dec. 5
Sarah Barr
Today, we visited and toured around villages with ATAP within Tilaran. We saw two different homes with two diverse families. The first house consisted of a young mother, who was 19 years old and had a 1-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 worse condition because it had mud floors and most of the house was outdoors. The family was evaluated 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 conditions are like everyone receives health care. 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.
Chioma Maduforo
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 health care 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 health care system was based on preventive care for all individuals, regardless of their inability to pay or their citizenship status. The structure of their health care 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 who worked at the various clinics we visited were keen on ensuring that everyone seen was stable, both physically and socially. I cannot 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 eye-opener 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.