Health care internships in both Costa Rica and Nicaragua

An eight week internship program for pre-med, medical, nursing, as well as public health students.

An eight weeks internship opportunity that provides practical, hands-on experience in health care facilities in both Costa Rica and Nicaragua. An excellent opportunity not only to assist health care professionals in both countries, but also to observe two different health care systems and how economic conditions influence health and health care.

This program is designed for pre-med, medical, nursing, and public health students interested in interning in a clinical or health-care setting in both Costa Rica and Nicaragua.

Program outline

Nicaragua and Costa Rica: Two very different countries with different levels of development, health care systems, and causes of mortality and morbidity. Learn first hand how each country’s different histories, development paths, cultures, health-care systems, and socio-economic conditions influence access to health care and epidemiological profiles. This program not only provides students with practical clinical and/or health-care experience, but also demonstrates to them first-hand how socio-economic conditions influence health and the provision of health care.

FOUR WEEKS IN COSTA RICA

Working through Costa Rica Internship Institute (CRINI) in Costa Rica. Interns can work in either an urban area or rural area. Upon arrival in Costa Rica, interns will receive an extensive orientation that includes readings and lectures on the Costa Rican health care system and epidemiological profiles. Participants will then spend four weeks interning at a health facility. Interns will have the opportunity to work at either a rural or urban clinic, a children’s nutrition center, a school for disabled youth, a nursing home, or other health-related facility in Costa Rica. We match your skills, field of study, interests, and experience with those of the health facilities we work with.

FOUR WEEKS IN NICARAGUA

Interns will then travel by bus to Granada, Nicaragua. Upon arrival, interns will also receive an extensive orientation to the health care system in Nicaragua and its epidemiological profile. They will then spend four weeks working through Viva Nicaragua, at a health facility in either the city of Granada or rural areas in the south-west of the country. Internship work will be similar to the work done in Costa Rica, and includes work in hospitals, clinics, children’s nutrition centers, schools for disabled youth, women’s health clinics, health education facilities, NGO’s, nursing homes, or other health-care facilities. Upon completion of the internship, interns will return to Costa Rica for their return flight.

Program requirements

Participants must be currently studying medicine, nursing, public-health, or other health – related field. Proof of enrollment (transcripts) is required. Medical professionals are also welcomed.
Interns must have an intermediate or advanced level of Spanish. If upon arrival it is determined that participants do not have the required level of Spanish needed to complete their internship, they will be required to study Spanish at one of our partner Spanish schools at addicional cost.

Additionally, all interns must provide proof of international medical insurance.

Intern Responsibilities

All interns are required to keep a daily record of their activities and work in order to trace their adjustment process as well as the needs of the communities and/or organizations where they work.

Interns are required to present a written weekly report as well as a final written report based upon the work they do. These reports are often useful for developing future research projects or policy agendas for their host organizations and communities.

Academic Credit

While academic credit is not directly available, we provide all interns with a written evaluation of participation that may enable them to negotiate independent study credit from his/her home university. It is recommended that participants discuss credit options with their academic advisor. The evaluation is also useful when applying for graduate school or employment.

Application and Placement Process

All applicants must complete our on-line application. We review the application and then notify the applicant of their acceptance to the program.

We cannot officially begin the placement process until we have received the program deposit.

Lodging

CRINI places interns with carefully screened families or helps to find appropriate housing near the internship site.

Placement Fees

Program Cost: US$4,800

Included in the program fees: transportation to and from the airport, orientation, readings on each country’s health care system and epidemiology, internship placement based upon careful review of the intern’s application, family stay with two meals and laundry included, bus transportation to and from Nicaragua, pick-up in Granada, project support in both countries, written evaluations in each country, and 24-hour assistance for any reason.

Not included in the program fees: airfare, international health insurance, departure airport taxes, border crossing taxes (approximately $15, Spanish lessons (if required), personal expenses and weekend travels.

Each student should bring between $500 to $600 for personal expenses and weekend travels.

Why a Comparative Internship Program?

There are several social and economic factors which influence health. These include: unequal access to health services, lack of education, and poverty. Costa Rica and Nicaragua are very different countries with different histories and levels of economic development. They are perfect locations to observe first-hand how these socio-economic conditions influence the provision of health care and health.

Costa Rica

Costa Rica is one of the most developed countries in Central America. It is well known for being a country of peace and democracy. It has never experienced extended wars, as in other Central American countries, and because of its geographic location is not prone to natural disasters. This has allowed the country to devote more resources to economic development and improving socio-economic conditions.

Costa Rica abolished its army in 1948. With no military spending, it has been able to devote more resources to social programs such as health care, housing, and education, as well as infrastructure, such as potable water and sanitation systems.

Costa Rica has a universal health care system, meaning that the entire population is covered by the health care system. The State, employers, and employees pay into the system in order to provide health care for all, including the unemployed, informal workers, and non-residents (many Nicaraguans) who do not pay into the system. The system is divided into health-care outposts in rural areas, EBAIS (primary care facilities with teams that go out into communities to educate and provide primary care), clinics, hospitals, and specialized hospitals. Costa Rica’s universal health care system, combined with higher levels of education, greater socio-economic development, and improved infrastructure has resulted in improved access to health care and improved health including lower infant and mortality rates, greater life expectancy, fewer infant deaths from diarrhea and respiratory infections, and lower incidences of infectious diseases.

Costa Rica’s health care system, while rated as one of the best in Central America, and number 36 in the world (the United States is rated 37), has faced many challenges in recent years. There is limited access in some rural areas, especially indigenous communities. The number of non-contributors, including migrants and employers who do not pay into the system, has put a strain on the system, and made it difficult to require modern equipment, certain medicines, and improve infrastructure. Additionally, a greater gap between the rich and the poor allows the wealthy to use private health care facilities, and complain about the fact that they are paying into a system that they do not use and are subsidizing the poor, unemployed, and migrants.

Nicaragua

Nicaragua, in contrast, while currently politically stable, has a long history of dictatorships, wars, corruption, and natural disasters. These factors have impeded the country’s economic development, making it the poorest Central American country. Years of military spending and government corruption have limited the ability to invest in social programs and infrastructure. Most of the population has limited access to health care facilities, education, and potable water and adequate sanitation.

This, combined with high unemployment rates (with approximately 75% of the population unemployed or working in the informal sector) low salaries (a minimum wage of under $100 per month), and high birth rates has resulted in limited access to health care facilities and poor health indices including lower life expectancy, high infant and maternal mortality rates, malnutrition, and higher rates of morbidity and mortality from infectious diseases and illnesses including diarrhea and acute respiratory infections.

The health care system in Nicaragua is provided by the State (the public system), insurance companies, private health care facilities, and non-governmental organizations. A majority of the population (over 60%), including the unemployed and informal workers, have access to the public system. Because they are unable to pay into the system, it is funded partially by the state but primarily by international donations. Access is limited, especially in rural areas. Resources, equipment, and medications are often scarce. Workers pay for health insurance and are able to use clinics for insured workers (about 10%). Those with greater economic resources (about 15%) are able to use the private system which has better equipment and no waiting lists (which are a common problem with the public system). NGO’s fill the gap, providing care to many communities without access to health care services. Some Nicaraguans travel to Costa Rica for health care, where because of the universal system, they are able to receive better care at little to no cost.

Nicaragua is trying to improve the system by improving primary care. They have formed teams to visit rural communities and to educate the population on hygiene and the importance of pre-natal care in efforts to reduce infant and maternal mortality rates as well as infectious diseases. They have managed to lower birth rates, increase life expectancy, and lower infant and maternal mortality rates. While faced with many challenges, Nicaragua is a country that, despite its numerous problems, is working to improve the health and access to health care of its population.

SOCIO-ECONOMIC AND HEALTH INDICES COSTA RICA-NICARAGUA
www.estadonacion.or.cr/estadoregion2008

I have enjoyed this experience greatly and will take many medical aspirations and life lessons from it. – Colton Jackson, 2009, University of Colorado at Boulder.

Having the opportunity to experience the health care systems of Costa Rica and Nicaragua back-to-back helped put everything in perspective for me. After I worked with a health care outreach worker in Costa Rica, I was able to fully appreciate the challenges Nicaragua faces in bringing its health indicators up to the level of Costa Rica's. – Jessica Gould, 2006, Pitzer University

Venturing into Latin American, I never expect to see such dramatic differences between bordering countries. Traveling from Costa Rica to Nicaragua remarkably demonstrates the effects that political and economic differences have on regions. - Greg Contente, 2007, University of Michigan.

Studying the public health care system of Costa Rica and observing the effects of an impeding private sector highlights the positive aspects as well as the pitfalls of the two systems. And once compared side by side to the private/aid funded hospitals of Nicaragua, the differences between the two systems becomes drastically apparent. Samantha Field, 2006, Pitzer University.