Rural Medicine Rotation- Guanacaste, Costa Rica
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My medical school has an awesome opportunity for students to travel to Playa Del Coco, Guanacaste, Costa Rica, for a clinical rotation during either our 3rd or 4th year for a rural medicine rotation. This September, I had the privilege of spending 4 weeks in the beautiful Guanacaste province of Costa Rica. Here are the amazing experiences I had during my rotation and the places we visited on our weekends off!
The Medicine Side
The clinic we rotated at is a part of Mission Activation, an organization whose mission is to "Activate positive community transformation through compassionate, holistic, and empowering programs that put God’s love into action." There were three amazing doctors whom we rotated with during our time there, all of whom were from Costa Rica, and one nursing student also from Costa Rica. The clinic serves as both a primary care office and what we would consider an urgent care here in the U.S. Day one, we were taught how to give steroid injections, IV medications, and assisted with stitching up a patient's finger after he sliced it on a mirror. Some afternoons were slower at the clinic; on those days, we would practice our procedural skills,s such as suturing on pig skin at the clinic or placing IVs (yes,s we used each other as patients). (Pig skin has a similar texture to human skin, so it's a more realistic feel than our practice pads for suturing.)
At the end of the first week and the beginning of the second week, we did community clinics. This entailed packing up our equipment for expeditions and traveling to different churches in rural areas around the Guanacaste province. We would set up our equipment at the church, and patients would come to us with various problems. Sometimes we could write them a prescription or give them medicine from the stock that we brought with us, but other times we would recommend they come to the clinic for a full examination. I absolutely loved these community clinics. Even though most of the churches did not have air conditioning,g so we sat in our sweat all day, the bathrooms were a little rough (or just unusable), and our water was hot by lunchtime, the patients made it all worth it. One clinic in particular was specifically for children. We did physical exams and addressed any acute issues they had. We happened to catch a head lice outbreak, so we prescribed medication and educated parents on how to get rid of them for good.
During our clinics, we saw patients of all ages, some with simple colds/allergies and others with chronic illnesses that needed managing. One family in particular, the mother and son, came, and both had pre-diabetes. We counseled them on healthy eating and exercise, and the mother immediately began crying. She explained that since her husband died last year of cancer, they don't have money to buy food since he was the one who worked and provided for the family. This obviously broke our hearts. After clinic that day,y we went to a local grocery store and all pitched in to buy them some food. We personally took it to their home, and I was shocked at their living situation. The house consisted of tin walls and a roof, with holes in various places, and minimal electricity. It was a humbling reminder of how blessed we are in the US, and it made us all so thankful we decided to use some of our travel money to bless this family in need instead of spending the money on ourselves.
Some of my favorite cases we came across at the clinic obviously included the skin and kiddos. We drained some cysts, burned off some warts and pre-skin cancers, and counseled many patients on the importance of sunscreen use any time they would be outside exposed to UV rays. One patient came in after stepping on a sea urchin, and we had to remove the spines. Many of the patients had some level of chronic kidney disease because they did not drink enough water and were in a chronic state of dehydration. The health ministry of Costa Rica actually made pamphlets on this issue that they gave to the clinic, and we would pass them out to patients suffering from this. Because of the climate of the Guanacaste province, people living there need to drink above the average amount of water: women about 3 L a day and men about 4 L a day.
Because I am a D.O. student, I learned what we refer to as osteopathic manipulative medicine. I like to describe it as a mix of chiropractic, massage therapy, and physical therapy. We were able to use many of the techniques we learned during our didactic years on the patients we saw in the clinic. Any patient we had with joint pain, back pain, neck pain, or headaches, we were able to use our techniques to help alleviate their pain. Many patients also had chronic constipation (partially because they don't drink enough water), and we were able to use colonic stimulation massage to help with this issue, as well as teach it to the patients so they could do it on themselves.
The Tourist Side
I flew from Fayetteville, AR > Dallas, TX>> Miami, FL > Liberia, Costa Rica. I had to stay overnight in the Dallas airport, and I highly recommend staying at Minute Suites. They have locations at both terminals and in the Dallas airport. I stayed in Terminal A on both my trip to Costa Rica and on my way home. Both times the staff was very friendly, and the accommodations were nice. Much better than sleeping on the airport floor. Also. Cafe Versailles in terminal Datf Miami airport has the absolute best cappuccino EVER yes, add the sugar and cinnamon).
1. Playa Hermosa This beach is on the must-do list if traveling to the Playa Del Coco area. Not only is the surrounding scenery beautiful, but the water is clear and calm, and the beach is lined with nice restaurants. My favorite- Aqua Sport - has fantastic food, good prices, and a great atmosphere. It is right on the beach and has tables, swings, and lounge chairs for you to use during your time at the beach. I highly recommend trying the fish tacos (coconut-crusted) and the shrimp ceviche. Also, can you say $2 smoothies? This place is even fun on a rainy day when you can't enjoy the water. This is one of my favorite places we visited during our time in CR.
2. Playa Ocotal: I LOVED this beach. It is absolutely beautiful. The water is crystal clear, the sand is black volcanic sand, and there is a secret beach that appears only when the tide is low. We were lucky enough to get to climb the rocks and hike over to the beach during low tide. The turquoise water crashing against the volcanic rock was mesmerizing, and the little tide pools left over after the tide went out had a whole ecosystem of sea slugs, hermit crabs, and cute little fish. There is a restaurant, Father Rooster, right on the beach that has great food and the best smoothies. I highly recommend the strawberry smoothie and patacones here.
3. Hotel Hacienda Guachipelin- hands down, this was my favorite excursion of my entire trip. Now, full disclosure, this was the weekend my husband came to visit, and after two weeks apart, I missed his cute face. But aside from that, Guachipelin was such a unique and beautiful resort. The resort picked us up on Saturday morning, and that day we did the "all day adventure pass" excursion. We started the day with a horseback ride through the jungle. We were able to stop at some pretty waterfalls along the trail. Next, we went white-water tubing down the river. This was insane, but for those who like a good adrenaline rush, this would be for you. Lunch was included at the resort restaurant.
After lunch we went ziplining. It started as true ziplining through the jungle, but the last few lines were legit through a canyon above a rushing river, and to top it off, it was raining with lightning and thunder the entire time. When I say through a canyon, I mean the wood platform was held by suspension cables over the river. At one point you have to climb along the canyon wall to a little flat portion of the rock and Tarzan swing across the river to the platform on the other canyon wall. This was not for the faint of heart, and if you have any kind of physical disability, this is probably not for you. However, it was fun, and the workers are extremely helpful and encouraging. After a long day of adventuring, we were relieved to relax the rest of the evening in the hot springs at the resort.
We spent Saturday night at the resort. The resort accommodations are fantastic. They have two restaurants, one coffee shop/bakery, a pool, a spa, and a gift shop . The resort also has many waterfalls to hike to, and is close to the Rincon de la Vieja National Park. The resort has complimentary shuttles that continuously shuttle visitors to the different waterfalls, national park, and excursions. Sunday we chose to hike to Oropendola waterfall, which was stunning. The hike is about 20 minutes from the drop-off point. It does include a massive suspension bridge (purely stairs) that goes across the river. It's a little freaky but also beautiful. The water was freezing, but after a sweaty hike its refreshing.
Overall, I can't say enough great things about this place. It's a great value for the price you pay; the staff is so welcoming and helpful, and the mission of the resort to be a sustainable tourism site in Costa Rica makes this place a must-visit during your time in the Guanacaste province.
4. Playa Calzón de Pobre. This was a nice beach we went to one Sunday per the recommendation of the receptionist at the clinic. It was quite a hike to the beach, so only take what you need for the day, but it is a nice and secluded beach. The water was nice, and because there are no restaurants or resorts along the beachfront, it is very clean and untouched. FYI- you will have to park your car up the hill from the beach, and the drive to the "parking lot" is best achieved with an off-road recreational vehicle.
5. Playa Buena We only spent half a day at this beach because we wanted to hang out at Aqua Sport one more time before leaving, but it was a cute little beach. Again, no restaurants or resorts along the beach, so it's pretty natural and clean.
6. Playa del Coco I saved this one for last since we stayed here during our month-long rotation and had more time to explore and get to know the area. The beach here is not as nice as the other beaches we visited. It's pretty crowded, and the water is not as clear or the sand as clean as the others. However, the scenery is stunning with the boats in the water and the sunset in the background. There are plenty of beachside restaurants, and there is a walking trail along the beachfront that many people use for their morning jog.
Some of my favorite restaurants we tried include:
Masala- fantastic Indian food
Santorini- hands down the best Greek food I've had to date (tzatziki, chicken gyro are great)
Café de Playa- best meal I had the entire trip and best beachfront seating- absolute must (I had the stuffed red snapper and still think about it from time to time)
El Capricho Mexican Restaurant- great tacos, amazing elote
Verde Salvia- I actually got a salad here, but it was delicious! Super cute aesthetic
Pura Vida Juice Bar- my kind of place.Top-notch acai bowls and iced coffee
Bar El Ancla- good tacos, great atmosphere, and right on the beach so a perfect place to watch the sunset
Heladeria El Coco- one word: gelato
I am so thankful for the opportunity I had to experience everyday life and medicine in a different country. Not only did I truly experience rural medicine, but I saw how not having access to health care can impact a community. It opened my eyes to issues I had not experienced before. Those who know me know my reason for attending medical school stems from my passion for medical mission work. This trip fueled my passion to help those communities who are medically underserved and was the much-needed spark I needed to finish the next 2 years of school strong.
