As we come to the end of our hospital visits, I am reflecting a lot on the fundamental structures that I have seen here in culture and structure of this region. As I have mentioned before, there seems to be a general sense of trust and friendliness in Costa Rica. I have noticed this in other work that we have done here and it is especially notable in the hospital. On my day observing one doctor give consultations, I had patients questioning whether I was a member of his family or perhaps another patient, when they became curious about my presence in the room. Once I explained that I was doing observations of the health system as a part of my education, they were extremely welcoming and would interact with me as a part of their consultation, making comments in my direction.
Again, in my observations in the pediatric unit, new mothers seemed to have no problem with my presence in their consultations or even in the room during the birth. Many of us were able to see births, interact with the newborns and new mothers, and invited to ask any questions of the doctors that we pleased at any time. After a birth, we talked to a doctor who had visited his sister in the United States and visited perhaps more national landmarks than most of us! I have never visited the Niagara Falls which he was surprised about, since I live relatively close; at least relative to someone who lives in Costa Rica!
This hospital does have its unique concerns. The general consensus around the hospital seems to be that it is often difficult to find providers willing to work in such a remote area with so many health needs. Although the pay is better, certain doctors are often still unwilling to work in rural settings and tend to prefer working in cities. It seems that those who are from the area are likely to stick around and return after completing their education, but that those doctors who are originally from the city prefer to stay in San José or move to another country.
Some of the motorcycles that the Ministry of Health uses to reach each home in the community on a regular basis to spread information about health and to give vaccinations throughout the region.
They often find that the culture is very different in a rural setting, and some even return to the city each weekend to be with their families. I imagine that it would be extremely difficult to be placed in a rural location where you have no family around, and indeed the only way to be social is through work. Some doctors have been placed by the government in this region and find that they prefer to work elsewhere, but what would this region do without their specialties and expertise? Some providers see, on average, 50 patients per day, both in their specialty and in general care where their expertise is much needed. These questions are complex, and ones that the health system struggles with continually.
I don’t think there could be a better way to get to know the healthcare system in an intimate way and reflect on what we know about public health than to talk to so many providers and patients every day. Many of us have been invited to continue returning to the hospital when we are available to observe more of our favorite departments next week, even though our scheduled observations have ended.
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