My Salud Experience

By Ana – Guest blogger studying in Heredia, Costa Rica
I am a fourth year medical student specializing in Family Medicine with Intermediate Spanish speaking ability. I was given the unforgettable opportunity to observe the socialized medical system in Costa Rica for two weeks and two days. This was made possible through the coordination and hard work of the school in .Heredia
I was given an introduction of the three parts of the Costa Rican public medical system "Caja Costarricense de Seguro Social" (CCSS) which is referred to as "La Caja" for short by Dra. Quiros. The system is like a ladder which treats patients and transfers them to the facility best able to beat their ailment The first rung of the ladder is the Ebais, the second is the Clinica, the third and top of the ladder is Hospital. Hospitals are separated into classes A through C based on their resources and equipment available to treat different ailments. Most class A hospitals are in San Jose, Costa Rica and are the most well equipped. In my short amount of time I was able to observe/assist all three rungs of the CCSS and two different classes of Hospitals.
For two days I shadowed Dra. Quiros, a Neonatologist and Pediatrician in San Jose Costa Rica. One day was spent in the Hospital Dr. R A Calderon Guardia, the other day was an overnight stay in San Juan de Dios. I was able to view the facilities and departments through a personal tour of the hospital and observed first hand the management of patients in the Neonatology unit while improving my Spanish and expanding my medical Spanish vocabulary with the patients of Dra. Quiros. I was able to observe a birth in the labor and delivery unit of Calderon Guardia and the immediate neonatal care of the baby. This was a rewarding and familiar experience and was a great introduction for the weeks to follow.
I spent the mornings of five days of first full week in the Bernardo Benavides Ebais with Dra. Cespedes and Dra. Santamaria. This was an opportunity to see the entry point of the CCSS in action. There were a steady flow of patients with many of the basic medical ailments and some with more grave states which were transferred to the Hospital for evaluation. I was able to listen to the patient/doctor dialogue closely and experience the similarities and differences in primary care between this sampling of the Hispanic population and those patients in the United States. I brought basic medical supplies and over-the-counter medications from the United States as donations to the Ebais which has the fewest resources of the three parts of the CCSS.
In the beginning of the first full week I also spent afternoons and evenings (until 6pm or 8pm) in 'San Vincent De Paul" Hospital in Heredia with Dr. Quiros (brother of Dra. Quiros) and Dra. Alfaro. I was given a personal tour of the facilities and was explained the differences in resources and equipment in comparison to a Class A hospital such as those in San Jose I visited the week before. Dr. Quiros is an Emergency Physician who was stationed in "La Capilla" during my week there. La Capilla is the chapel in the hospital where patients admitted to the Hospital through the Emergency Department are kept until they are found room in their corresponding unit in the hospital. I was able to follow the management of patients in a non-acute setting and perform an Ingreso (patient interview) in Spanish. I was able to observe/participate in the San Vincent De Paul Triage room with Dra. Alfaro, Emergency Department Director, for two nights at the end of the week. I was able to experience first-hand how patients are evaluated and channeled as either requiring medical care in the Hospital or the Clinica depending on the severity of their ailment With the assistance and the observation of Dra. Alfaro and Dr. Quriros I further improved my Medical Spanish vocabulary, and given the opportunity to witness the management of Dengue.
My second week was spent in the Heredia Clinica where I observed, examined, and interacted with patients with Dra. Mendez, an Internist at the Clinica, as my Medical Spanish has much improved at this point. I attended regularly scheduled Medical Forums with the internists and discovered that the grievances of patient noncompliance, and the hurdle of trying to encourage lifestyle changes are consistent with the grievances and obstacles of those physicians in the United States as well. I was able to grasp more of the nuances of patient/physician relationship with this second half of the experience as well as expand my understanding of the CCSS system and practice my Medical Spanish.
This experience has changed my perspective of the medical system in America. I can now clearly see the differences and begin to understand how a socialized medical system serves a community, This new understanding will help me serve my patients in the future and I hope to return to Costa Rica again as a physician to learn and serve some more. Thank you for this excellent opportunity!