My first full week of work!

Warning: long post ahead!  I wanted to take time to explain what a typical week will look like for me while I'm interning here in Costa Rica.  So, we'll just start with my first full week of work!

Monday – Monday I went to the EBAIS in Santa Rosa.  In Costa Rica, there are three levels of care facilities: EBAIS (similar to general/family practices), clinics (which may have several doctors and a few specialists in house) and hospitals.  At the EBAIS, I shadowed Dra. Alvarez for the day.  We saw a lot of kids that day, mostly under the age of three and just there for a checkup to make sure they were growing properly and eating well.  There’s also a stomach virus going around giving lots of people diarrhea and nausea, so we saw a few patients experiencing those symptoms.  Several “control” patients came in as well.  These are mostly diabetics or people with high blood pressure (or both) coming in to check their vitals and renew their prescriptions.  Dra. Alvarez was really nice and was pretty good at explaining things along the way, but she didn’t have much time to do so, as she had to keep every appointment to 15 minutes long.  She even had to essentially kick one woman out who kept asking questions, making her appointment last about 30 minutes (God forbid).  There was another student shadowing her as well – Fabian.  He’s about to start his final year of medical school here in Costa Rica.  He obviously knew much more than I did, but was very nice and wasn’t condescending about the fact that I haven’t even a clue about where I’ll be attending med school at this point!

Tuesday I returned to the same EBAIS and worked with Dra. Alvarez again.  Fabian was there again as well.  The morning was much the same as Monday, but in the afternoon, Dra. Alvarez ran the breast clinic.  We saw a few women just coming in for routine checkups because of high risk for breast cancer, as well as a couple women who had recently had surgery to remove a lump.  Even though it was more repetitive in some ways than the morning was, I found it really interesting.  It was also quite a nice break from the cases of diarrhea!

Wednesday – Wednesday I went to a new location – La Clínica Central de Santo Domingo.  There, I was in the emergency department.  Kim, the other volunteer with my program, was also there.  Although the vast majority of people who came in didn’t have an emergency, or didn’t seem to have anything wrong with them at all for that matter, it was still an interesting day.  I shadowed the head of the department (I don’t know his name…everyone calls him “El Jefe” – the boss), who was great at walking me through everything, allowing me to listen and feel along the way.  The only emergency of the day was an approximately 7-year-old boy who had fallen while running, as many little kids do, and split his lip open.  He needed two stitched in his lip – easy, right?  Ha.  I don’t think he could have made it more difficult for the doctors.  He kicked and screamed the entire time and it took 3 doctors to hold him down so that El Jefe could give him stitches.  Personally, I don’t think I would be quite comfortable sticking a needle into the face of a kicking, screaming kid, but that’s why I’m not the boss (yet)!

Thursday – Every Thursday, our schedule changes a bit and we attend one or two medical lectures in the morning at a private hospital in San Jose and then spend the afternoon at a non-profit organization called Obras del Espíritu Sanctu where there is a free clinic for people without health care.  This past Thursday, our schedule was a bit more of a deviation.  After one lecture about obesity in the morning, I had most of the day off before attending two lectures at a medical conference in the evening.  Of course, our supervisor failed to tell us that these talks were part of a very formal medical conference, so Kim and I were a bit underdressed, but it was alright.  The two talks we attended were about pain management and were very obviously endorsed by Pfizer to promote specific medications.  That being said, the first of the two talks was very good.  The second, well…the man spoke a million miles a minute and still didn’t get through his entire presentation.  Of course, they waited until after both these talks finished (around 9 pm) to feed everyone, which I don’t think was their best strategy, unless they wanted to guarantee that everyone would be in a bad mood throughout the presentations.  Ah well.  The food finally came, and it was DELICIOUS.  I’ve only been in Costa Rica about two weeks, but I’ve already had a life time’s share of rice and beans, so this dinner was a welcome change, complete with red wine and chocolate mousse at the end!  YUM.

Friday was an early, but very short day.  We attended a clinical session that consisted of three different specialists analyzing a patient’s progression of symptoms in the time leading up to his/her death.  It was way too early for me (it started at 7), but it was really interesting and a very thorough exploration of the patient’s symptoms.

Whew!  Well, that’s about it for my first full week of work.  Stay tuned to hear about the weekend adventures I’ve had thus far, and the little cultural tidbits I’ve picked up on!

~Pura vida~

Hot showers are heaven

BIG NEWS in the life of CBK!  I had my first warm shower in 10 days today.  It was pretty amazing.

On another, but still bathroom-related note, I realize I failed to mention one very fun fact about Costa Rica - the plumbing system is not equipped to handle toilet paper.  Thus, you can't flush it and all toilet paper must be put into a trash can in the bathroom.  This is a huge departure for me, and you'd be amazed at how automatic it is to just throw toilet paper in the toilet when you're done with it.  I've made the mistake many times, and the remedy is not fun, but I would rather not damage the plumbing at my homestay and have to pay God knows how much to fix it.  (I was told that if I was determined to be the cause of a blockage or problem, I would be responsible for any costs associated with fixing it)  Woo!!!

Today at work was an interesting day.  Pretty slow, but still interesting.  I went to work in Santo Domingo at the central clinic there and was in Emergencies all day.  Nothing of great interest came through today, and the people who did show up in the Emergency Dept. didn't seem to me to be experiencing any health emergency at all.  For some of them, the head doctor pretty much said that they needed to go to a normal doctor's office (here called an EBAIS).  The only real emergency that came through was a boy of about 7 years old who had fallen while running (as so many little kids do) and split his lip open.  He needed a couple stitches, but it wasn't anything too major.  Unfortunately, he screamed as if he were in Hell and kicked and flailed in every direction.  I'm sure the entire clinic heard him crying and screaming.  It then took 3 full grown men to hold the boy down while they gave him stitches.  I was just glad that I wasn't the one trying to stick a needle into the face of a boy who was doing everything he could to escape my grasp.

Another thing I've picked up on thus far is the huge difference between patient confidentiality here and in the U.S.  Here, patients are constantly asked to call in the next patient when leaving the room, doctors talk about patients in front of other patients, etc.

But right now, I am absolutely falling asleep because of all the working out I did with my long afternoon, so tomorrow I'll explain a bit about the health system here and the differences between it and healthcare in the US.

Love you all!

Settling in

Well, now I'm off on my next international adventure - a medical internship in Heredia, Costa Rica!  I am so excited to see what this trip has in store.  It'll certainly be a huge change from my semester abroad, where I knew several people going with me and saw them everywhere.  This time, I've embarked on my own.  I came in knowing absolutely no one, and that's exactly how I wanted it to be.  This summer will be only what I make of it, and I can't wait to see how it all unfolds.

Now, for a bit about my accommodations:
I am living with a host family that has four adorable kids ages 5-11.  They are all very sweet, and the youngest, the only boy, has quickly grown fond of me because I'm willing to play "Just Dance 3" with him on the Wii.  I can already tell that this home stay experience will be drastically different than my experience in Madrid, where my host mom was genuinely interested in getting to know me and building a relationship.  Here, the family keeps their distance and lets us (there are two other American students in the house as well) have our space, which is nice at times, but I do think it's unfortunate that they aren't quite as emotionally invested as Cris was.  She was what made my semester abroad the wonderful experience that it was.
My room is pretty nice, with a bed and dresser and some space to hang clothes.  It's nothing too exciting, but it has everything I need.
The bathroom that I've been using for the past week has had no hot water, so I've actually become quite used to taking cold showers since I've been here.  Wooo!!!
Other than that, the food is good, though, repetitive, and by the time I get home I know I'm going to be longing for green vegetables and anything but beans and rice.  Our house does not have air conditioning, but we keep the doors and windows open to let light in, which helps bring the temperature down.  It also allows bugs to enter the house, and there are a ton of ants and moths crawling around, but I'm sure I'll get used to those.

The climate here is actually quite lovely...it's very warm in the morning (I would guess around 85+, and then cools off in the afternoon when it's about to rain.  Right now Costa Rica is starting its "wet season," so people expect it to rain every afternoon.  That hasn't quite been the case thus far, and we've had a couple issues with low water supply, but hopefully it'll rain enough to prevent that from happening too much more!

That's about all for the basics, and I'll be talking more about my work and this area throughout my posts, so for now, I'll say goodnight!