Most times we think of studying abroad in a more social sense; sure, we are traveling to learn, but primarily to explore a new environment. They warn not to close yourself off to another culture when surrounded by familiar students, and this is very important to get the most out of a study abroad experience. So far, we have met many professionals, and some locals that are not prepared to meet foreigners, so it comes as a great change of pace to be put into an environment where you are able to interact with both. Since we are here to study public health we have had most mornings begin with a charla by a health professional or group devoted to health-related services. The original plan to learn about the hospital here was to begin each morning by having a hospital worker speak to us about his or her department and work. Instead, the director suggested that we all shadow each department so that we could get a better feel for the people the hospital receives and the wide variety of workers. This way, after eight days, we will have a feel for many different departments including medical records, pediatrics, dentistry, inpatient treatment, and social work, among others.
My first day was with medical records, where I learned about how each patient is taken in to the hospital for evaluation and treatment. I had the entire Costa Rican social security system explained to me while filing records—I learned that while many places are equipped to do electronic records, every hospital in Costa Rica is required to keep full medical records on paper since internet is not available all over the country and the national healthcare system is a public enterprise. Still, this hospital is aiming for a full electronic system by next year, and the clinic that we visited in San José is already running on an entirely electronic system. This office also handles the statistics of the hospital, and reports on the efficiency and intake of the hospital each month, which is the charge of one employee. It was a great first day, and we had lunch with the hospital social worker.
Ayleen is responsible for all the social work needs of the clinics in the area and this hospital, which is designed to cover a region of 40,000 inhabitants. She works without a secretary or assistant and kisses and hugs all of us and her coworkers every morning and before we leave. When not involved with patients, she was very talkative about the region and the strengths and challenges that it presents.
Ayleen, the social worker for the district of 40,000. All day, she takes in cases from the hospital and surrounding clinics under the public hospital system. She works daily without any assistants to serve this population.
In the Costa Rican healthcare system, there are local clinics, or EBAIS, where people are able to go to get basic care (at the very least) in their region. Each EBAIS has a team of providers that visit houses to do basic check-ups on patients and give vaccines to children. On the day that I observed the clinician, we visited houses of members of the nearby community that she was assigned to for that day. All were houses with small children, which get visited more frequently than the homes where members are considered to be normal-low risk. Something that surprises me about this region is that there are few divisions between economic levels in neighborhoods, with middle-class families living next door to families that live quite minimally, without services like electricity. The sort of diversity probably has its benefits but certainly would present an interesting case for workers that were not accustomed to it.
Without bias, this clinician flowed between all types of homes to deliver health information for the household and all its family members, as well as vaccinations for newborn children. Even in somewhat uncertain situations, she was able to make the family laugh and decide to help with public health efforts like eliminating breeding areas for mosquitoes like the Aedes Aegypti which transmit dengue, and to fix and remove health hazards for small children in the house. She was also able to calm children down in the presence of a bunch of needles, so she is certainly well-versed in this type of work!
As a whole, we have all grown a lot from navigating these visits and absorbed an immeasurable amount of knowledge about the surrounding area and the lives of people here. I will definitely have a few more stories as we continue to explore health care here.
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