Blog Post 3: Clinical Needs-Finding Galore and the Not-So-Much-of-A-Hike on Arenal

This past week was definitely a blur. As I’m writing this blog post I can’t believe that we are closing in on 2 weeks in Costa Rica. I think for this blog post, I am going to touch upon our cohort’s venture to La Fortuna and Arenal Volcano National Park, the last bits of our bootcamp which focused on clinical needs-finding in medical settings, and the first couple of days at my internship at Hospital Clinica Biblica in San Jose. Buckle up your seatbelts – this is going to be a crazy ride.

 

Arenal Volcano and Baldi Hot Springs Excursion

At the crack of dawn, we woke up from our slumber in the quaint Hotel 1492 and boarded a Civitatis tour to the Arenal Volcano and the Baldi Hot Springs near La Fortuna. A big van had picked us up and we were on our way, on the extremely bumpy road. At one point of time during the journey, the van actually broke down (the check engine light was on and we suspected it was that the engine had overheated), and all of us were very scared because if we were stuck, we would be stuck in practically the middle of a hilly jungle. Vanessa and I kept looking at each other in panic mode, and now as I think back to it and write about it, it’s actually kind of hilarious. Nevertheless, we chugged along the trip, getting closer and closer to La Fortuna. Our first stop was Valverde Vega canton, where we stopped at Parque de Sarchi and observed the beautiful colors of the city, including the beautifully decorated oxcart, which is one of Costa Rica’s symbols.

The next place we stopped at was Alfaro Ruiz (Zarcero canton), a very cute province that had small houses and neatly-cut shrubs in front of a small church.

As we got closer and closer to Arenal Volcano, we could start to see it hiding through the fog as we made multiple hairpin turns throughout the hilly region. Every time our group would try to take photos through our car window, a tree would get in the way, or there would be too much glare through the window. Whatever the case, Asma probably has all of the better resolution photos, so I put below one photo to summarize the pain of taking photos on a very rugged ride. (Our shuttle driver had a footbal in the front of his car, which is why there is a football in the one of the photos.)

When we finally made it to Arenal, after stopping by a lunch place that was mysteriously named after me, we drove around to get a better shot of the volcano. Unfortunately, due to miscommunication issues with our driver’s boss, we did not actually go hiking around Arenal, or even walk around it. While that was a shame, we still were able to have a lot of fun at the Baldi Hot Springs, where the geothermally-heated mineral waters warmed us up from the rain outside.

Needs-Finding Bootcamp

During bootcamp, which was half virtual and half in-person, we really dialed in on how to take notes while in the hospital. We saw that we could observe not only pods in the emergency center, but also in the pharmacy, in the waiting rooms, and other patient intake areas. To me, this experience was really insightful – it demonstrated how problems are not always found in the traditional sense, but instead, all around the hospital. For the first day of needs-finding, we arrived at Hospital Clinica Biblica in San Jose, which is the main hospital with around 73 beds. It also the oldest private hospital in Costa Rica, which was founded by Catholics from Ireland. After arriving, we were put into groups with ticos and ticas, and roamed around different stations within the hospital, including the pharmacy, the clincal chemistry lab, radiology, and patient intake areas. On the second day, we went to the Clinica Biblica in Santa Ana, which was a lot smaller, but had similar facilities. I thought that it was most interesting to see that many devices, such as fridges, had to be calibrated manually through preventative maintenance checks, rather than done through a software. I also saw how disorganized some of the shelves were in the pharmacy, as boxes of medications and pharmaceutical equipment were stacked on top of each other on racks, going all the way up to the roof! In the bootcamp, we also learned how to broaden needs-statements so that they could be more applicable to a wider variety of settings, as well as narrow needs-statements so that you could build effectively for the user at hand. This would prove to be particularly helpful for my internship, where my job is to perform clinical needs-finding at Hospital Clinica Biblica.

Internship Commencement at Hospital Clinica Biblica

For the first week of my internship with Raniyah and Dr. Camacho at Hospital Clinica Biblica, we were placed in the molecular biology and clinical chemistry labs to shadow their daily workflow. We asked many questions about which processes were inefficient and what could be improved upon, and we interestlingly found that managing data was such a common theme. With older molecular diagnostic instruments, I noticed how workers had to manually input test results on reciepts (yes, actualy reciept papers with the work order # and the patients identifying info), and then this was recorded onto a general computer system that the lab manages. Then, this lab system’s info is automatically transferred to the patient management system the Hospital Clinica Biblica has. Seeing how Hospital Clinica Biblica is a private hospital, it was interesting to see how they still had to use manual processes despite having more money (though they are non-profit, which I thought was really cool).

Internship Takeaways

• Problems
  • Big data from test results transferred manually; takes multiple steps and time
  • Gram staining station for bacteria slides is super messy; we saw violet stains everywhere on the table (they used to have a machine that sprayed stain on, but it broke!)
  • Noscomial infections have affected around 7 patients due to antibiotic resistant bacteria; need a device or mechanism that can tag these and show on which surfaces these exist (e.g. catheters, bed, tables)
• Potential Solutions
  • Some sort of program or system that will automatically transfer test results from a diagnostic machine to the patient management device
  • Some sort of battery-powered, modified angled tip pipette bottle that, when a button is pressed, can dispense the correct mL of stain, and a similar bottle with DI water as well so that the area is not messy
  • Some sort of barcode scanning-like device (we are still brainstorming of course) or some spray that can indicate where a certain bacteria exists on a surface

Moving into Selina

I was so happy to finally move into Selina after the first day of my internship because it was a lot more hip than 1492 and also because we could finally do our own cooking and shopping for the first time in a foreign country! Jhalak, Katy, Raniyah, and I went to multiple markets, including the San Jose Central Market, to barter for some groceries. Oh, and the breakfast here is included and is absolutely amazing!

 

That’s all for this episode folks. Until the next one!