Alana Sagin February 2010 Course on Tropical Diseases San Vito, Costa Rica

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Brittany Jacobs
6 years ago
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Alana Sagin February 2010 Course on Tropical Diseases San Vito, Costa Rica I spent the month taking the Course on Tropical Diseases run by Dr. Pablo Ortiz in San Vito Costa Rica.

1 Alana Sagin February 2010 Course on Tropical Diseases San Vito, Costa Rica I spent the month taking the Course on Tropical Diseases run by Dr. Pablo Ortiz in San Vito Costa Rica. San Vito is a small city in southern Costa Rica not far from the border with Panama. It was founded by Italians who were drawn by the prospect of coffee farming and it is still known for its great pizza. It is located in the mountains at around 3,000 feet and is cooler than the lowlands -the days are hot but the nights are very cool. San Vito is also known for the Wilson botanical garden, which is just down the road from Dr. Ortiz house. Dr. Ortiz is a wonderful man and a great host. He was an emergency room doctor in the Hospital San Vito before he as quit clinical work to be the hospital administrator. He usually has both Costa Rican and international medical students staying with him and taking the course in tropical diseases. There is plenty of room in his house for visitors, although it is not exactly a house because most of it is open to the rainforest. It is on a huge platform in the rainforest canopy and there are walkways going to different areas. There is a kitchen, dining room, fireplace, pool table and hot tub all open to the air. To get to our room you walk out along a walkway. The room is

all glass on three sides so you are always surrounded by treetops. Dr Ortiz also has lots of animals not too far from the house pigs, sheep, turkeys, goats and chickens.

2 all glass on three sides so you are always surrounded by treetops. Dr Ortiz also has lots of animals not too far from the house pigs, sheep, turkeys, goats and chickens. There is a hiking trail around the property too. At first it was hard to sleep because there was so much noise, crickets, trees creaking, growls, screeches, squealing, and one really loud rooster who started crowing at four in the morning. Flor is the cook and she makes three amazing meals a day for the house all of the meat she cooks comes from the animals on the property. Each day we had Spanish class in the morning and we went to clinic in the afternoon. The Spanish classes with our teacher Alisa were great, and were often one on one or with one or two other students. After class Dr. Ortiz took us to clinic, called the Ebais either at the Hospital San Vito, or at nearby Agua Buena where we shadowed the doctors and assisted with physical exams. I was placed in the Agua Buena clinic with Dr. Jimenez, who is an internist. We saw a wide range of patients with acute and chronic conditions. Our patient load often included children and pregnant women who came for prenatal visits. Dr. Jimenez sees five patients an hour so things go pretty fast. There is a pharmacy in the clinic so once Dr. Jimenez writes a script the patient can walk over and pick up the medicine. Common conditions we treated included hypertension, diabetes, abcesses, urinary retention, back pain and depression.

3 Costa Rica has excellent social services and 95% of the population is literate. It also has a national health care system, which means that everyone in Costa Rica gets free health care, even if they are not a citizen. Citizens are taxed to pay for the system, and people with higher incomes are taxed proportionately more. Private hospitals do exist and people who can afford it sometimes choose to pay to be treated in them because they receive more personalized attention and do not need to wait as long. However, the public hospitals provide excellent care and many wealthy people still choose to go to the public hospitals and clinics, especially when they need to receive expensive treatments. Dr. Ortiz told me that people from other parts of Central America travel to Costa Rica to receive expensive treatments for free. Primary care doctors are very accessible and in the clinic where I was people showed up without scheduling beforehand and few were turned away. The country is divided into regions based on population and each region is assigned a certain number of doctors and a certain amount of medical technology. Most doctors in the country are trained in Costa Rica and most go into family medicine. The life expectancy of the population has risen and the infant mortality rate has drastically decreased since the advent of national health care in the 1990 s.

Over the month Dr. Ortiz gave us various lectures on topics ranging from the health care system in Costa Rica to the plight of the indigenous population he works with the Ngobe people.

4 Over the month Dr. Ortiz gave us various lectures on topics ranging from the health care system in Costa Rica to the plight of the indigenous population he works with the Ngobe people. The Ngobe have homes on a reservation in Panama and live there March through October. They cross the border to spend the rest of their year in Costa Rica where they pick coffee beans. Dr. Ortiz has started an outreach program that has drastically changed the disease and infant mortality rates of this population. He sends community health workers to their homes to teach about hygiene and sanitation, diseases such as HIV, and about the importance of prenatal care. One afternoon he took us to see the shacks they live in on the coffee plantations. On one plantation there was no electricity or running water, just filthy rooms in a large barracks with one family per room. Apparently fair trade labeled coffee in the U.S. means that the coffee was made in an environmentally friendly way but not necessarily in a human friendly way. Dr. Ortiz has been working with the plantation owners to change these conditions and some have, but it has been a slow process. Another day Dr. Ortiz took us to a banana plantation. This plantation happened to be a co-op owned by all of the

5 workers. Nevertheless, the workers salaries were equivalent to two hundred and fifty dollars a month. Some workers were in charge of cutting banana bunches from the trees and hanging them by chains to an elevated rail. They would then pull the line of banana bunches behind them along the rail to the processing area. Dr. Ortiz told us that these workers suffered frequent back injuries as a result of their work. While the bananas were still hanging from the rail other workers would spray them down and measure their width. Then the bananas were cut into smaller bunches and put in a large tank of water where they were assessed for quality. They were sprayed, stickered, and packaged into boxes. Many different companies buy from this plantation; on the day we visited they were going to Del Monte and Ole, a European banana company. On the weekends we would travel the first weekend we went to the beach and surfing town of Dominical. If you go here I recommend staying a weekend at Hacienda Baru. Hacienda Baru is a wildlife preserve that offers rainforest tours and also has cabins and a restaurant. You have access to a secluded beach, rainforest trails where you can see

6 monkeys, sloths, and a ton of other animals, as well as a pool and a butterfly garden. It is a great deal. While we were there we took a zip line tour of the rain forest canopy. Dominical is not far from Manuel Antonio, the most popular national park in Costa Rica. Another weekend we went to Puerto Jimenez and Corcovado. It is about three hours by bus from San Vito to Golfito and from there you can take a ferry to Puerto Jimenez. This little town on the Osa Peninsula is a jumping off point for any kind of wildlife or adventure tour you can imagine but the most popular adventure is a trip to Corcovado national park. We spent a day walking in the park, and despite all of the warnings we did not see a single shark, crocodile or pit viper. We did see monkeys, pizotes, ant-eaters, scarlet macaws and whales. This is a great trip if you are into wildlife viewing. One day we visited the finca of Dr. Ortiz s good friend Gale, just down the road from Dr. Ortiz house. Gale is from San Francisco but moved to Costa Rica and worked at the Wilson Botanical Gardens for ten years. She bought her land from an American actor who had tried to run a coffee plantation and failed. In the fifteen years she has owned the property she has completely reforested it trees grow fast here and she pointed out some huge ones that I would have never guessed are barely in their teens. She also has a craft shop where you can buy your gifts and real fair trade coffee. The last thing I recommend doing is taking a rafting trip. The trips can be pricey I paid $70 for a day on the Pacuare river but it was definitely worth it, it was the most fun I had in Costa Rica and the river was rated the fifth best for rafting in the world by National Geographic. The cost for the month with Dr. Ortiz was $ and it included meals, housing, Spanish lessons, and various clinical experiences. The cost of the plane ticket was $500, and I also spent more than $400 on my travels. It is not cheap to travel in Costa Rica often prices are similar to the U.S. or only slightly cheaper, and gas is expensive if you are travelling by car. My advise to students on this rotation: don t overpack, you only need a scrub top and jeans to wear to clinic (I brought way too many collared shirts and nice pants). Do bring warm clothes for chilly nights in San Vito. Be flexible, because you may be one of many medical students

7 on the rotation and may not be able to do exactly what you want. But if there is something you really want to do, like work at the clinic for the Ngobe people, let Dr. Ortiz know and it may be possible to set up.

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