UNIVERSITY PARK, Pa. — Penn State students interested in a career in health policy and administration recently had a unique opportunity to immerse themselves in the culture and health care system of Costa Rica. 

Led by instructor Celeste Newcomb, 10 students enrolled in the course "Exploring the Health Care System in Costa Rica," HPA 499, visited the Central American country from Jan. 15 to 24.

Students toured three different hospitals to see three different levels of hospital care. Students also visited three community health clinics and shadowed community health workers in two different towns to see how preventive medicine is practiced in Costa Rica.

“In addition to seeing how health care is delivered, we studied the health care systems of Costa Rica, using morbidity and mortality data to investigate epidemiological factors impacting health,” Newcomb said. “We also examined the preventative health programs the country uses to reduce problems such as high infant mortality and Dengue Fever rates.”

The course was developed seven years ago through grant funds from University Office of Global Programs, the College of Health and Human Development and the Department of Healthy Policy and Administration. This was the sixth year students traveled to Costa Rica to study the country’s health care system.

Students learned about the government-run health care system first hand, but as shown in their journal entries, they learned much more.

Serena Carlson, health policy and administration major, Penn State World Campus

Patient Services Coordinator, Swedish Medical Group

Today I visited The Calderon Guardia Hospital in San Jose, Costa Rica. It was an eye-opening experience. We met with Dr. Eli Chaves who specialized in geriatrics. He gave us a detailed explanation of Costa Rica’s universal healthcare system. He also provided us with a tour and detailed explanations on quality and standard of care at his hospital.

On our visit, several things stood out to me as takeaways from Costa Rica: preventive care visits, maternity and post-natal care.

In Costa Rica it is common place for elderly patients to have four physical checkups to check in with the patient, monitor their chronic conditions such as dementia, coronary issues and mobility. Clearly, Costa Rica is aiming for true preventive care.

The maternity and post-natal services in Costa Rica are very different than what we have in the United States. We spoke with Dr. Barrientos, who specialized in pediatrics and neonatal medicine.

Dr. Barrientos cares for the weakest and youngest infants in San Jose. She gave us a comprehensive overview of how her nation delivers health care to its women and infants. First off, Costa Rica only has 10 percent of its births via caesarean. For the U.S, it is about 38 percent.

While in the hospital I observed how Costa Rica practices maternal and fetal medicine. In Costa Rica, the baby stays with mother at all times and shares the same bed to create bonding for both mother and baby.

Breastfeeding is highly promoted and only in exceptions formula was provided. A huge progression in what Costa Rica practices is their breast milk bank. This bank keeps breast milk on hand for premature babies, for babies needing extra care or for mothers who have trouble lactating. The hospital asks all mothers to pump extra breast milk and it is sent to the milk bank at a neighboring hospital in San Ramon, Costa Rica.

After the first day it is amazing to see how a poorer nation is striving to provide excellent health care to its citizens.

Katie Smith, health policy and administration major, Schreyer Honors student

Today we started our day by visiting Clinca de Abangares in Los Juntas. I was surprised that the clinic appeared to be even more modern than the first hospital in San Jose. I’m learning that the level of the clinic is not correlated with the infrastructure, rather, it is the age of the facility that determines the level of quality and high-tech equipment provided within the facility.

Unfortunately, this clinic was undergoing renovations so we were unable to tour the facility. I am grateful that we each had a chance to accompany the ATAP worker, short for Attention Technical Assistants of Primary Care, on one house visit.

The visit I witnessed was with a young woman who was about 25. She recently moved in with her husband so this was her first visit with the ATAP worker in this community. The ATAP worker recorded her personal demographics, health history and risk factors, living conditions, and vaccination records. No vaccines were administered as she was up to date with all medications, however, the ATAP worker did provide her with medication for parasites as a preventive measure since her living conditions put her at risk. The ATAP worker also counseled her on the importance of diet, exercise, sanitation and self-examinations for breast cancer.

An ATAP worker typically works about eight hours a day, visiting about five to eight houses per day. He or she is assigned to a geographical region of about 3,000 patients and must visit each house annually, sometimes more than once if needed.

The ATAP workers also go into schools and local businesses to provide primary medical care. They then record the health data they collect on their visits into a central registry which the public health workers use to determine the health priorities for that specific community.

In order to accomplish these tasks, ATAP workers receive six months of training as a basic primary medical technician. However, most said that the majority of their learning comes from on-the-job experience.

While the ATAP worker is not as educated as doctors or nurses, they are still well-respected in the medical community because they play a vital role in prevention, which is a core principle of the health care system in Costa Rica. They also develop a personal relationship with the community members they serve through the repeated house visits they conduct.

It was certainly interesting to see the patients being so welcoming and trusting with the workers, especially when they stop by unannounced. I could not help but think that this same relationship would just not be possible back home in the United States where everyone operates on a rushed, very busy schedule centered around work away from the home. This is just one of the many interesting comparisons I have made from my time in Costa Rica.