Week 3 – Ginecología

Hola! Qué tal? This week I rotated through obstetrics and gynecology at Hospital de las Mujeres Adolfo Carit Eva. Hospital Carit, a public hospital only for women, is named after Adolfo Carit Eva, a French physician who studied at the University of Paris and then lived in Costa Rica. Upon his death is 1912, he donated various properties to the Costa Rican government with the stipulation that one be used as a “Hospital Maternidad.” Since then, the maternity hospital expanded beyond labor and delivery services to include comprehensive medical and surgical services including high-risk obstetric care, gynecology, gynecologic oncology, urogynecology, general surgery, psychology, and emergency medicine as related to women’s health.

I spent my first three days working with a general obstetrician. In contrast to the United States, women at Carit do not have individual labor rooms. Rather, they rotate through “Salones” – group rooms with 6-12 patients. There is one room for labor induction, another for the latent phase of labor (0-6cm dilation), and another for the active phase (6-10cm dilation). When expectant mothers are about to deliver, they are rolled down a short hallway to one of two delivery rooms. There are also 3 operating rooms in the hospital if a C-section is needed (I got to see an urgent C-section for my patient with a bile duct infection).

At Hospital Carit, the obstetricians do not use continuous electronic fetal monitoring (which is widely used at UCSD, though it has been criticized as a practice that increases C-section rate without necessarily improving other fetal measures). Rather, the obstetrician used intermittent fetal heart rate monitoring. Likewise, because of economic constraints, women at the public hospital cannot have epidural anesthesia for vaginal births, though epidurals are available at the private hospitals in Costa Rica.

On Thursday and Friday, I rotated through gynecology with Dr. Rojas (a wonderful, kind physician who made learning really fun for me). I went on gynecology rounds – Dr. Rojas saw 32 patients, all presented by THE SAME OVERNIGHT RESIDENT (gasp, poor woman). They included women with ovarian, endometrial, and cervical cancers, elective hysterectomy patients, and patients with incomplete abortions. [Abortion remains illegal in Costa Rica, except when a mother’s life is threatened. While there is a movement to legalize abortion in the country, no law has been officially put in place due to strong reactions from conservative sectors.]

I also spent time in colposcopy clinic and urogynecology clinic. A national program for HPV vaccination (which protects against cervical cancer) only started in 2019 in Costa Rica. Consequently, most women of childbearing age remain unvaccinated, and I saw several patients with advanced cervical lesions. According to the World Health Organization, the incidence of cervical cancer in 2020 in Costa Rica was 14.4 / 100,000 women, versus 8.1 / 100,000 women in the USA (where HPV vaccination was introduced earlier, in 2006).

Overall, it was so special to work at a women’s-only hospital this week. And sooo incredibly precious to see mamás and papás cuddling their hour-old babies. Other than work, I am continuing my Spanish classes—with very slow progress, let me tell you—and enjoying my afternoon runs to La Sabana (San José’s “central park”). On Saturday, I went the neighborhood farmer’s market, and then to El Museo del Jade in downtown San José, which houses pre-Columbian Jade artifacts.

Catch up with you next week! Hasta luego!

– Allison

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