Pura Vida, Part 1

What an incredible 10 days it has been! I already feel like I’ve been in Costa Rica for months, and surprisingly feel so at home in this country already. I’ve met some incredible people, learned a ton, and am really excited for what is to come. Here is a (rather long) recap of the past couple of weeks!

After an exhausting flight in, some lost baggage, and a quick trip to the supermarket, we finally arrived at the hotel that would be our home for the next two weeks in San Juan. After a good night’s sleep, I woke up on Thursday morning and groggily stumbled outside to breakfast. In most American hotels, the free breakfast you get in the morning consists of cereal, milk, and (if you’re really lucky) a waffle maker that produces a soggy mess. Here in Costa Rica, breakfast is a completely different story. I awoke to a spread of delicious cheeses, deviled eggs, fried plantains, rice and beans, beautifully arranged fruit, authentic Costa Rican coffee, and an omelette bar – all served out on the patio by the pool. Needless to say, the promise of delicious food in the morning has made it really easy to get out of bed and ready for the day’s work.

Speaking of work, we’ve done so much over the past 10 days! We hit the ground running on day one. We met Paul Fearis, the CEO of a consulting company that focuses on medical device innovation. He is also a professor at Johns Hopkins University, and he came to lecture us and a group of Costa Rican master students on what he calls “insight informed innovation.” He explained the importance of observing in clinical settings in order to produce insights, which can then be translated into a need statement which aids in the development of a design. His approach to design emphasizes the stakeholder (a patient, a nurse, a clinician, or a payer) and their unique needs. Paul was an extremely entertaining lecturer, and his ideas about how to produce user-driven engineering solutions was very valuable.

At the end of his lecture, we were placed into groups with the Costa Rican students and assigned a location where we would observe the next morning. I was assigned to the Hospital Heredia, where I would be viewing a bronchoscopy procedure. I was picked up the next morning by my group members, and we worked together to develop some interview questions. When we arrived at the hospital, we met the doctor, nurse, and patient who would be receiving the bronchoscopy. The procedure was very cool to see, and with Paul’s lecture fresh on our minds, we were on the lookout for things that could be improved or optimized. After leaving the hospital, we grabbed a quick lunch and then worked together to develop a mind map that outlined the procedure and our observations. The next morning, we returned to Coyol to hear the second half of Paul’s lecture and finish up the need-finding process. We essentially received the entirety of Paul’s 13-week JHU course in a 7 hour time span, and it was an awesome and informative way to start off the GMI program.

On Monday, we had the opportunity to return to some of the hospitals and do more observing. My team went to Hospital Mexico and got the chance to meet with Dr. Sandra Vargas, who has worked with the GMI program in the past and who will be an important point of contact for us as we move forward with projects. Dr. Vargas talked to us about healthcare in Costa Rica, and explained to us how it is structured. Costa Rican healthcare is very socialized, and everyone pays a 9% tax on their income which covers their healthcare and pension. They also emphasizes preventative medicine, and the hierarchy of the hospital system is set up to reinforce this. The lowest level, or first point of care is the IBAIS, which is in every community. It usually has 1 or 2 general doctors and basic equipment. The practitioners typically make house visits to check on the health of community members, and do basic procedures like administer vaccines, conduct pap smears, and take care of patients with chronic illnesses. The next level is the CAIS, which serves a bigger community, has more advanced equipment like x-rays and laboratories. Then there are regional hospitals, which typically consists of everything you would find in a hospital but a little smaller, and usually does not have specialists. Then there are provincial hospitals, which are still a little bigger and will have some specialists. Finally, there are national hospitals (like Hospital Mexico) which have many specialists, and are equipped to serve a very large population. For example, Hospital Mexico serves approximately 2.5 million out of the 4.8 million Costa Rican population.

After meeting with Dr. Vargas, we got the chance to visit a lab, observe a bone marrow aspiration, and speak with the head of the lab. We learned a lot about how the lab is structured, the obstacles they face with getting tests analyzed, and how the process works for patients. A big thank you to Cesar, one of the Costa Rican master students from out class who is also a physician at Hospital Mexico, for leading us around the hospital and giving us the chance to see the lab!

On Tuesday, we returned to Hospital Mexico and observed around the floors again. I was very interested in how the hospital is laid out. All of the departments on the first floor are very close together, with no walls to separate them – very different from the United States. The hospital is also very crowded, with patients lining all of the walls, either standing or in chairs, waiting to be seen by a doctor. We got a chance to meet with Mauricio Obon, a surgeon who has worked with the GMI program in the past. I saw him insert a stent into a patient’s stenosed artery, and he talked us through the procedure as he did it, pointing out various features of the technology he used. After leaving the hospital, we grabbed a quick lunch and headed to Heredia. Here, we got to see the Boston Scientific headquarters and talk to some of the employees before heading to another class with the Costa Rican master students, this time taught by Dr. Richardson.

On Wednesday, our short course on medical technology innovation began. This course was taught by Dr. Wettergreen and Dr. Richardson, and included our GMI group as well as 24 Costa Rican undergraduates and master students. This was a fast-paced course which walked the students through every aspect of the engineering design process, and included the development of a low-fidelity prototype which would be presented in a competition at the end of the week.

The ideas for the projects came from the needs finding that our GMI group did the previous week in Costa Rica, and we presented these project ideas to our groups. The idea for my project came from the bronchoscopy procedure that I observed at Hospital Heredia. While we were there, the nurse really struggled to insert the IV catheter into the patient’s arm so that they could administer the sedative. Because the patient was older, her veins were very fragile, making it difficult to insert the catheter properly. It took 8 attempts of sticking the patient’s arms and hands, 3 different nurses, and 45 minutes until the catheter was inserted properly. This sparked the idea for the development of a device that would allow IV catheters to be inserted more accurately, especially in geriatric and pediatric patients who have fragile veins.

My group worked hard to design, prototype and analyze a solution to this problem. I was lucky to work with two very hardworking and bright Costa Rican students, Nathalia and Joseph, who made this project so much fun! We ended up prototyping a device that functions similar to a mechanical pencil, allowing the nurse to control the length of needle injected into the patient with a button. The device also uses a guidewire, similar to what is used in central lines, to minimize damage to the vein and allow for more safe and accurate insertion. Our presentation went very well, and I was so excited to see all of the other groups present as well!

But it hasn’t been all work – we’ve definitely had our fun, too! We explored La Sabana and went to the park on our first Saturday afternoon. The park is huge and very green, and we played a little bit of volleyball (using a soccer goal as a net).

On Wednesday, the national soccer team had a World Cup qualifier match against Panama, and since the stadium is right down the street from our hotel, we were able to go to the game. Being in such a large stadium with such passionate soccer fans was a really exciting experience. Though the match ended in a draw, we cheered really hard for our team. A huge thank you to Dr. Richardson and Dr. Wettergreen for finding us these tickets!

On Saturday, after our last day of the short course, we hung out with some of the Costa Rican students outside of class. They showed us the cool places to go in the city, and we got a chance to talk and bond without the stress of presentations and prototypes.

On our day off, we visited La Paz, a huge ecological conservatory with beautiful waterfalls and wildlife. The animals that the park hosts are actually received from the Costa Rican Wildlife Ministry, who confiscates them from people who illegally hold them as pets. The park is expansive, and we got to see all the waterfalls and play in the water. It was a really awesome break from the hard work of the past few weeks! A huge shoutout to Chandler for filming and putting together this video from our trip!

Today, we are headed off to Guanacaste! Looking forward to even more adventures and learning!

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