1. Costa Rica - Water Sanitation Laura Roberts

2. San Jose, Costa Rica

3. Objectives My personal objectives for this trip were to Discover first-hand what healthcare in another country is like Analyze how aspects of Costa Rican healthcare could be applied to U.S healthcare Identify health indicators prominent in Costa Rica Be immersed in a different culture Step outside my comfort zone

4. Background Information Universal Healthcare for Costa Rican citizens who have jobs (required to pay into the healthcare system) Income Level: $6,810 in USD Infant Mortality: 8.95 per 1,000 births Life Expectancy: Male: 77 Female:82 Costa Rica has a total population of 4.7 million people ○ About a quarter of the population lives in San Jose (1.17 million people)- very congested

5. Description of Site La Carpio is located on a landfill in San Jose Low air quality and resources are very scarce Low education levels Mostly Nicaraguan immigrants Average income is $130-165 USD per month Very little green space The water supply is contaminated ○ These citizens have minimal access to clean water for drinking, bathing, gardening, etc. ○ Easier access to sodas and packaged food.

6. Topics/Issues ● The government has tried to implement a filter system to improve the water supply here, however this has not proven to be effective ● The contaminated water causes many health issues such as gastrointestinal problems and parasites ● Due to a stagnant water supply, mosquito-borne illnesses such as Dengue Fever and Zika Virus pose a problem ● The Costa Rican population is very apathetic to this neighborhood ● Residents turn towards drinks like pop and juice instead of water causing further health issues

7. Water Sanitation Primary Information: ● The population in La Carpio has very limited access to clean water supplies ● Many health issues arise from the lack of water sanitation ○ If residents drink the water they are prone to parasites and gastrointestinal problems ○ Many choose to stay away from the water and instead turn to less healthy options like soda. This contributes to the high cardiac and diabetes rates. ● Without clean water there is little fresh produce, so malnutrition is a common problem.

8. Water Sanitation ● The filter system the government tried to implement was upstream from La Carpio and was an attempt to clean the dirty water before it got to the neighborhood ○ The landfill around the neighborhood causes all of the water coming into La Carpio to be very dirty ● It would be very beneficial to the health within the community to have access to clean water ○ Nutrition could be improved ○ Gastrointestinal problems could be reduced ○ Mosquito-borne illnesses from stagnant water could be reduced ● This population needs people to advocate for their health and wellbeing in the community

9. Water Sanitation: Interventions ● Individual Level ○ Implementing individual ceramic water filters in homes would provide families with a clean water supply ● Community Level ○ Educating the community on the importance of clean drinking water for health and how to maintain these filters would ensure long term clean water access ○ Spread awareness throughout Costa Rica about the hazardous living conditions here ● Systems Level ○ Advocate for the government to implement a better filter system and water supply ○ Advocate for relocation of the landfill

10. Conclusions/Suggestions ● Implementing individual ceramic water filters in homes could help reduce disease and improve health in this very vulnerable population ● This is a very underserved, underrepresented population that needs a voice ● In the future, KU Nursing students and other volunteers could visit this community and continue efforts to improve health here ○ Students could provide health clinics and much needed education to this population

11. Most Profound Clinical Experience My most profound clinical experience was exploring LaCarpio and interviewing residents. The issues experienced here are very eye-opening and the people were very warm and welcoming. I realized how much assistance this area truly needed and I felt like my efforts were very appreciated.

12. Most Profound Cultural Experience I really enjoyed seeing all different terrains of Costa Rica. We experienced the rural, urban, and tourists sides of the country. I enjoyed trying the seafood on the coast and learning about the Arenal Volcano. We learned about the rainforest and saw different animals in their natural habitat. We met an indigenous tribe and learned about their customs and culture. We lived with a host family and were immersed in a different culture speaking a different language. It was a great learning experience and forced me to step outside my comfort zone!

13. References Goal 6: Ensure access to water and sanitation for all. (2016). Sustainable Development Goals. Retrieved from http://www.un.org/sustainabledevelopment/water-and-sanitation/ http://www.un.org/sustainabledevelopment/water-and-sanitation/ Index Mundi. (2014). Costa Rica Demographics Profile 2014. Retrieved from http://www.indexmundi.com/costa_rica/demographics_profile.html http://www.indexmundi.com/costa_rica/demographics_profile.html La Carpio. (2016). Costa Rican Humanitarian Foundation. Retrieved from http://www.crhf.org/community-services/la-carpio/http://www.crhf.org/community-services/la-carpio/ 32 Envio (2005). La Carpio: Sensationalist Reporting and Clear Voices. Retrieved from http://www.envio.org.ni/articulo/2782http://www.envio.org.ni/articulo/2782

14. Cultural Experiences

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