Week 1- Hematologia

Hola from Costa Rica! I have just finished a wonderful first week at Hospital Rafael Ángel Calderón Guardia where I was observing in the hematology department.

Hospital Calderón is a 630-bed public hospital in downtown San José, the capital city of Costa Rica and home to roughly half of the country’s 5 million inhabitants. Despite having a much lower GDP per capita ($12,000 USD) than the United States ($63,000 USD), Costa Ricans have an average life expectancy of 80 years (!!) compared to the US life expectancy of only 77 years. Crazy, right? This is partially due to socialized healthcare that the country has in place—roughly 90% of “Ticos” use the public hospitals, which are paid for by a 10% income tax.

During my week on the hematology service, I was able to see some of the strengths and constraints of Costa Rica’s public healthcare system. On the hematology service, there are 10 inpatient beds – 6 for men (all in one room), and 4 for women (all in one room). These beds are typically occupied by patients undergoing induction chemotherapy or suffering from consequences of that therapy (i.e. infections). There is an outpatient chemotherapy room with ~15 beds, and patients are seen in “consulta” (clinic) in various rooms on the ground floor. Bone marrow biopsies, lumbar punctures, and intrathecal chemotherapy procedures are done by a general doctor in a suite next to the chemotherapy room. There are five hematologists at Hospital Calderón, and only 32 in Costa Rica. One challenge that exists is the shared rooms – this is true of every ward in the hospital except for the COVID wing, and it greatly increases the risk of passing infection. Another challenge is accessing advanced biologic therapies for cancer patients – hematologists here must apply to a hospital committee for financial approval of these drugs, and they often get denied. Under these constraints, the hematologists do their best to follow international treatment guidelines. They also prepare and read all their own bone marrow smears, counting the cells in a station next to the office. This week, I took part in rounds every day and morning clinic with Dra. Acón! For lunch we usually went to a “soda” – basically a local breakfast and lunch café – to eat typical Costa Rican food!

Other than work, I have been enjoying my homestay in Pavas, a neighborhood of San José. I live with a retired couple and my house mom, Mayra, makes the best food! We like to watch fútbol and Caso Cerrado (essentially Spanish Judge Judy) at night. The week before last, I traveled with my partner to the Monteverde cloud forest and the western beaches of Tamarindo before starting my rotation. Yesterday, I went on a tour to Manuel Antonio National Park, a nature reserve—and 3 monkeys stole my sunscreen at the beach!! Anyway, chao for now – I’ll catch up with you next week after my primary care rotation!

Besos,

Allison

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