1. Costa Rica - Maternal Health Taylor Garies

2. San Jose, Costa Rica

3. Objectives My goals for this trip were to learn about healthcare in another country and gain an understanding of the differences between our healthcare system and theirs. I wanted to become immersed in another culture to have a broader view of the world and way other people live Improving my medical Spanish was another goal of mine for this trip.

4. Costa Rica Background Information Language: Spanish is the official language, English is widely understood in tourist areas Life expectancy: 79.7 years Mortality: 4.49 per 1,000 people Health care in Costa Rica is provided to all through a national healthcare system if you work and pay into the system 17,000 fewer children die each day than in 1990, but more than six million children still die before their fifth birthday each year Maternal mortality ratio – the proportion of mothers that do not survive childbirth compared to those who do – in developing regions is still 14 times higher than in the developed region Only half of women in developing regions receive the recommended amount of health care they need

5. La Carpio Background Information ● Costa Rica has a total population of 4.7 million people ○ San Jose houses 1.17 million of the population ● La Carpio is a neighborhood within San Jose ○ This is a very poor, neglected neighborhood consisting of mostly Nicaraguan immigrants ○ Unless you are born in Costa Rica and have a job that pays into the healthcare system, you are not allowed access to the free public healthcare ○ Therefore, most of this population does not have any access to healthcare services ○ The living conditions here compared to San Jose are very poor with little resources and support ● Health care is extremely lacking here, especially maternal health ○ Most of these mothers are not provided with adequate pre- or post-natal care

6. Description of site ● Most of our clinical experience was in a nursing home, Hogar Carlos Maria Ulloa, in San Jose ● We were able to visit La Carpio with a group of missionaries that focus efforts on helping this population. ○ La Carpio is located on a landfill in San Jose ○ Resources are very scarce ○ Mostly Nicaraguan immigrants ○ Average income is $130-165 USD per month ○ Very little green space ○ Lack of clean water supply

7. Barriers to Maternal Care Because the majority of these people are not Costa Rican citizens, they do not have access to healthcare. Very little education Few resources: contaminated water supply, dangerous neighborhood, no place to exercise Prenatal care at the EVICE (the community health clinic) is not efficient: - Expecting mothers are hardly touched during their clinic visits - Baby is not monitored - Vitals are not taken - Minimal resources/funding for vitamins

8. Maternal Care Primary information: Mothers in La Carpio lack education and resources in terms of prenatal care, postnatal care, and contraception - If you are not a Costa Rican citizen, you are not allowed prenatal or postnatal care at the EVICE. They are allowed to deliver in the hospital but get the bare minimum of care There are limited resources to provide mothers with this information (staff, money, etc). Many of these mothers are young and have not done advanced family planning

9. Maternal Care ● The missionaries we worked with used to host classes for mothers and go into homes to check on these mothers ○ Time and money constraints forced them to place their focus on other issues that affected this population ● It would be greatly beneficial to have classes and workshops to teach mothers about what to expect during the prenatal and postnatal period ○ This could include dietary requirements, information about breastfeeding, developmental stages, etc. ● There is not a lot of emphasis on family planning and birth control in this area ○ It would be important to provide information to these women about family planning strategies, birth control methods, and possibly providing options for birth control

10. Maternal Care: Interventions Individual Level Nursing Education: visiting homes to provide maternal health information and establish a trusting relationship with the mother Community Level Providing courses/workshops at the missionary’s center - open to all community members Providing information on birth control methods Systems Level Advocate for policy change allowing babies born in Costa Rica proper prenatal/antenatal care Advocate for water filters and a cleaner supply Advocate for more green space: allows mothers to get some physical activity, community members can grow more fresh produce

11. Conclusions/Suggestions Provide the community with monthly maternal health care workshops Promoting policy change and granting Costa Rican born children prenatal care would alleviate maternal stress and lead to better pediatric outcomes Spread awareness of the health hazards experienced in this community We hope KUSON students can continue to experience life in La Carpio annually and advocate for this vulnerable population

12. Most Profound Clinical Experience The most profound clinical experience I had was being able to talk to the residents in La Carpio about their health. Most were very open to our questions and really highlighted the needs and health concerns in this area. I learned so much about how underserved this area is and how they need people to advocate for their health. I was shocked by the extremely poor living conditions and large of a role the physical environment played on their health and wellbeing.

13. Most Profound Cultural Experience The most profound cultural experience I had was during our travels throughout the country. We were able to see all different aspects of Costa Rica and the way people live in each area. Most of our experience was in the city of San Jose, but we also had the chance to travel to many different regions. The vast variety of terrain was very interesting with volcanoes, beaches, rivers, and rainforest spread throughout rural, urban, suburban, and tourist areas. We got to meet people from an indigenous tribe of Costa Rica, seeing where and how they live. It was so interesting to observe the different ways of life throughout the country.

16. References Costa Rica. (2016). Unicef. Retrieved from http://www.unicef.org/infobycountry/costarica_statistics.htmlhttp://www.unicef.org/infobycountry/costarica_statistics.html 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 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/ 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