Costa Rica Reflections

The following was a letter sent from Dr. Heather Brandt to students and colleagues at the University of South Carolina regarding her experience in Costa Rica for the Global USC in Costa Rica program.

Greetings! I have returned physically from Costa Rica back to South Carolina, but my mind and thoughts and heart continue to be in Costa Rica. I am processing my experience, and I am somewhat reluctant to write about it at this time because I know my thinking will evolve. However, I am equally excited to share with you some of the lessons I learned during my time in Costa Rica. 

I arrived in San José on May 14 for Global USC in Costa Rica (for those of you who have not had a chance to read my last chair’s email – this is the University of South Carolina), and I was in Costa Rica until June 6 for the program. This program provides students a unique opportunity to gain USC course credits while learning about health and culture in San José and across the country. Health-related courses are instructed by USC faculty (including me!). During this program, students have the chance to explore San José and immerse themselves in Costa Rican culture.

I had three USC undergraduate students, all public health majors, in my class – “Community Health Problems” (which I renamed, “Community Health Solutions” because communities are not a problem and solutions are in communities). Class went exceptionally well and was complemented by incredible service learning experiences. In fact, I said several times, “Community health class can be cancelled for the rest of the program because there is no way I can replicate what you are experiencing firsthand in the community in the classroom.” We experienced the Costa Rican Humanitarian Foundation in La Carpio, Hogar de Carlos Maria Ulloa (nursing home), Hogar de la Esperanza (a home for people living with HIV), and all three levels of the Costa Rican health care system and a private hospital as well. “Community” was all around us. Public health was evident throughout our entire program. Important community and public health lessons were learned in the community, not the classroom. We did a lot of listening while we learned. I am grateful for the generosity of these organizations and their willingness to host us.

I have attempted to summarize my experience around three salient points. 

First, community is defined in many ways. At Hogar de la Esperanza, we learned about a community for individuals who have HIV come to embrace life and live theirs. This is a diverse community in terms of country of origin, sexual orientation and preferences, and status, which is highly unique as there are only three such homes for people living with HIV in Costa Rica. Our idea of what constitutes “community” is not for us to determine, and often, a community of which you become a part happens organically. We witnessed similar communities of care in the local, area-level health care clinic in Cartago that is the first-level of care in the Costa Rican health care system, called EBAIS in Costa Rica. ETAPS who work within the EBAIS are tasked with improving the overall health of the community by working with people in the community. A strong sense of solidarity within the community, defined geographically by the organization of the EBAIS, was apparent. 

Second, when working with a community to improve health, meet them where they are. We have to ensure basic needs are met before we can focus on other needs. While in La Carpio, we heard from Gail “Giselle” Nystrom of the Costa Rican Humanitarian Foundation who shared with us their approach and how important it is to meet basic needs while always increasing self-esteem of those they serve. Our public health education and health promotion interventions must align with opportunities within a community and not focus on impractical approaches that are inconsistent with where they are. This was further evident in the EBAIS in Cartago. We witnessed a primary care physician committed to ensuring programming so that every child receiving care in the clinic had the chance to succeed. She implemented a play therapy program to aid children with development delays. The ETAPS ensure that these children are living in environments that will support their success. 

Third, solutions are truly found in the community. At La Carpio, Hogar Carlos Maria Ulloa, Hogar de la Esperanza, and across our visits to learn about the Costa Rican health care system, solutions were all around us in these communities. Solutions were initiated from within the community with minimal help from those outside – perhaps financial or other resources, expertise, etc. The resiliency and solidarity of Costa Ricans was inspiring, and solutions emerged from within the community. 

Mixed in with lifetime lessons, classroom time, and service learning experiences, we had a lot of fun too. We toured the city of San José, visited the National Museum of Costa Rica, travelled to Doka Coffee Estates and La Paz Waterfalls, ate “comida típica” (typical food) in Costa Rica, which is gallo pinto or rice and beans, visited Manuel Antonio National Park, and much more. Personally, I was captivated by the monkeys, sloths, and the vistas. 

In closing, as we face ongoing challenges to ensuring a strong public health system, focus on prevention, health equity, and access to health care in the U.S., I am struck by a common theme that emerged in our interactions with Costa Ricans. At Hospital Heredia (a regional hospital in the Costa Rican system), we had the chance to talk with hospital administrators and ask them questions. Someone asked if health care was viewed as a right or a privilege in Costa Rica. Without hesitation, the response was, "health care is a right, not a privilege, in Costa Rica." I believe this reflects the strong sense of solidarity I experienced in my interactions with Costa Ricans. Sure, the health care system is not perfect, but it is based on a fundamental belief that everyone is entitled to health care. “Pura vida” is more than a catchphrase or nuanced tourist lingo. Costa Ricans live pura vida. 

Heather Brandt
Chair, Public Health Education and Health Promotion Section
American Public Health Association