My First Costa Rican Patients

I ride down the hill to the hospital with 2 Costa Rican medical students. I am to be working this morning with one of the 3 primary care doctors that operate out of the San Vito hospital. Within 2 minutes I am reminded of why I did NOT choose to work in primary care. We see a well-appearing woman who is 1 week post-partum (after having given birth). Any issues? Any bleeding? Baby doing OK? A quick exam and we close her chart and turn our focus to the baby. Problems feeding? Gaining weight?  Any fever? All is well so the talk moves to discussing family planning and birth control options. Prescriptions for folic acid are given and the patient and her baby are on their way.

The other patients are similarly unexciting to me. Diabetes. Checking your sugars? Watching your diet? Bloodwork OK? Hypertension. Eating low salt? EKG normal? taking your meds? Swelling of you feet? I am aching for someone with an acute issue: pulmonary edema, a stroke, an overdose, a traumatic injury.

Unfortunately I have no exciting pictures here except for the buildings that comprise the hospital. There are no HIPAA laws in Costa Rica so it is totally OK for me to photograph whomever I want in the clinic. (Seriously I confirmed this with multiple hospital administrators.) For those unfamiliar with this legislation HIPAA is what guarantees that your health information remains private, and is the reason hospitals and doctors in the US can't share your info without your permission. It's also the reason why if you come into an ER in say New York City in a coma after a car accident I have no way to check what medications you are allergic to and I might give one that induces an anaphylactic reaction. Anyways... my American medical education has deeply rooted the principle of patient privacy into my being and I just can't bring myself to whip out the camera and take pictures of patients as they visit their doctor.

The San Vito Hospital. It is composed of 3 main buildings linked together. This one contains the primary care clinics and also the other outpatient offices used by the internist (internal medicine trained physician) and other subspecialists such as a cardiologist. There is 1 internal medicine trained physician at the hospital. The other subspecialists reside in neighboring cities and come to San Vito a few times a month for clinic.

This is the Radiology Building. There is 1 radiologist in San Vito and when he's on vacation you have to read your own films. Earlier this month they got an ultrasound machine. The radiologist performs the scans himself. In the US this is done by a technician and the radiologist simply interprets the images. Likewise the physicians here do their own EKG's.

Further down the street is the Urgencias (Urgent Care) section of the hospital. This is actually setup rather similar to the US with an entrance for patients to walk in as well as a driveway where ambulances can pull up.