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November 30th, 2016

Costa Rica

By Tyler Brobst

by Claudia Gutierrez and Simrit (Simi) Warring

Less than 12 hours after our microbiology final exam, we boarded a plane for Costa Rica. We spent a week at the rural Hospital William Allen de Turrialba, which serves local residents and an indigenous Indian population, the Cabécar tribes.

photo-1Day 1:

We were greeted in the pediatric unit by a child recovering from cutaneous leishmaniasis. The next patient we met was recovering from Ascaris lumbercoides so far progressed that the child had had vomiting with worms being excreted from the nose and mouth. The nurse told us the story, “As soon as the child started throwing up, I had to jump forward to grab the worms one by one as fast as I could from the child’s mouth so he wouldn’t choke.”

Day 2:

That morning we toured the microbiology lab. It was an incredible mix of modern technology and practicality. They had fume hoods, automated PCR machines, and microscopes similar to those at Mayo, but had a cart full of stool samples that patients had collected in cleaned out Gerber food jars - talk about being resourceful.

In the afternoon we met the Emergency Department (ED) physicians and saw countless patients: CMV, tuberculosis, a fractured tibia, Entamoeba histolytica, RSV, Mycoplasma pneumoniae, hand lacerations, dengue fever, pneumonia, leptospira, a miscarriage, chagas disease, diabetic ketoacidosis, a vehicle accident, STD, rotavirus. Each patient was greeted with warmth and once treated, frequently said goodbye to us with a kiss on the check – a common gesture of friendship in Latin American culture. The rapport between the physician and patients was incredible to witness.

Day 3:

photo-2An indigenous woman arrived to the ED after a 6-hour trek from her village to the hospital. She was only fluent in her native tongue making it next to impossible to communicate with the Spanish speaking hospital staff. In the ED, nurses determined that she was in the middle of labor and already 5 cm dilated. “Quick, get her to the OB/Gyn unit!”

While this was all taking place, the pediatric intern was walking us through the newborn exam on a healthy full term baby born earlier that morning. “They’re taking a woman to the OB/Gyn OR for a delivery. Quick get the scrubs on and get to the OR fast if you’d like to see a delivery!” We rushed to the changing suite, and as we stepped out in clean scrubs there was the woman delivering her baby in the hallway of the OB/Gyn unit. She didn’t make it to the delivery room. The baby was delivered prematurely at 26 weeks, with her mother only 8 cm dilated, in the middle of the hallway with staff members & secretaries shuffling by. We witnessed the delivery of the placenta and were afterwards called for by the neonatologist in the newborn nursery next door.

No cry could be heard and the baby had to be given respiratory assistance. We initially stood in the back of the room, out of fear of getting in the way. “Come watch!” The neonatologist summoned us to stand on either side of him. There was the baby, so small it barely took any space lying on a newborn bed in the nursery, the same bed we had photo-6used to practice the newborn exam. As the baby was being resuscitated we noticed all the signs of a pre-term baby we had just learned about – lucid skin, underdeveloped areola, and no skin wrinkles on the plantar surface of his foot.

After a few painful minutes, the baby was stabilized. We were told that it was a blessed day. Most babies that premature would not have presented with few enough complications to make it a case that could managed with limited resources. While they were able to resuscitate that baby, it would need to be transferred to another hospital where they could help support the critical weeks ahead.

Days 4–5:

We spent the remaining days rotating between the ER, pediatric unit, newborn nursery, and the operating room. Everyone we met was willing to teach us – nurses, residents, the town’s sole psychiatrist, microbiologists, pathologists, surgeons, ER physicians, and anesthesiologists.

We would like to thank the Mayo Clinic Hoffman Grant and the Hospital William Allen Turrialba for their funding and support that allowed us to have this incredible experience. We especially want to give a special thanks to Dra. Leiva for her generosity in opening her home to us - two medical students she had never met.

photo-3 photo-5

More from Claudia

Right before my mother could immigrate to the United States from Costa Rica, as part of her medical training, she had to complete a year of “Social Service”. In CR, medical education is made incredibly affordable for its students, but in exchange its graduating students must work for a year in an underserved rural area of the country. As part of my mother’s assignment she traveled by motor boat to various isolated communities on the Island of Chira providing preventive medicine, primary care, and birth control to over 100 patients a day. Like all of her classmates, she loved her year of social service and the opportunity to give back to her country.

I grew up falling in love with her stories and I dreamed of one day experiencing rural medicine in Costa Rica myself. I never expected the opportunity to be afforded to me through a medical school curriculum and let alone with one of my mother’s former classmates! A few months after starting medical school, my mother sent me a video of one of her former classmates, Dr. Rocio Leiva, a pediatrician with over 20 years of experience. In the video she described the challenges the Hospital William Allen de Turrialba faced in serving a large pediatric indigenous population with limited resources. After watching the video (found here), I became inspired to visit the hospital – an environment that could not be more different from the Mayo Clinic.

One of the greatest parts of this selective was that I got to share my mother’s stories and this experience with one of my own classmates, Simi. This experience also reminded me of how fortunate I am to have grown up speaking Spanish, and how lucky I am to be able to travel hundreds of miles away from home and still be able to communicate with others. I will forever be grateful for the stories my mom shared and the generosity of Dra. Leiva for opening her home to us - two medical students she had never met.  The incredible learning opportunity her and her colleagues afforded us is one I will never forget. They welcomed us as colleagues and treated us like family. Their immense love of medicine and unwavering passion for taking care of others was a beautiful reminder of why, despite its extensive time commitment and rigorous emotional and academic demands, I had chosen this career path.

More from Simi

Planning our trip to Turrialba for the selective week following our Microbiology & Pharmacology block was not particularly calculated, but there could not have been a more ideal week for us to have chosen. The weeks prior to our trip we arduously learned and committed to memory the numerous lists of bugs and drugs, despite knowing that we may never see many of the presentations, particularly the tropical diseases, first hand.  After the trip we arrived back to the states with a heart full of appreciation for the love and kindness the health care staff and patients at Hospital William Allen de Turrialba showed us. Any attempt to express our gratitude to the hospital personnel in Turrialba or the Mayo Clinic Hoffman Grant would inevitably fall short as this opportunity would not have been possible without their generosity.

Having traveled on a handful of international medical trips, I became accustomed to playing the role of a learner when visiting communities and assisting physicians. This trip was different. Although still a learner, I became a part of each patient’s care team with the knowledge I’ve learned thus far in medical school. What a whirlwind. I won’t easily forget listening to each child’s lung identifying rhonchi vs rales, and running a differential through my head. The numerous x-rays I examined with the ER doctors, and the stitches I threw in a man’s hand with an injury from his job as a mechanic, made me feel privileged and thankful for all of my learning experiences at Mayo Clinic thus far. These experiences would not have been possible without the radiology portion of our anatomy curriculum or the longitudinal surgical skills curriculum during which I’ve thrown hundreds and hundreds of stitches for practice in fabric and live tissue. Traveling abroad and volunteering comes with the responsibility of knowing when you are appropriately trained to be of service or when it’s most appropriate to take a step back and appreciate the learning experience. I don’t expect or hope for my role as a learner to ever come to an end. Choosing medicine meant happily embracing the role of a lifelong learner, but it’s humbling to be that much closer to having the privilege and capacity to improve someone’s well being through direct patient care.

photo-8

 Claudia is a 2nd year medical student with a background in biomedical engineering. Claudia has a passion for bridging engineering and medicine through her various research and extracurricular endeavors. She is particularly interested in reconstructive surgery and plans to incorporate the use of regenerative medicine into her future practice. In her free time she can be found salsa dancing or traveling to a new city.

Simrit is a second-year Mayo medical student, originally from Northern California. Having completed a Master of Science in Global Medicine at the University of Southern California and participated in multiple international medical efforts, she is passionate about making humanitarian aid work a priority each step of her career. Simi is interested in pediatrics, obstetrics & gynecology, and surgery. Her favorite extracurricular activities include photography, exploring new landscapes, and sipping on coffee. 

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