After finishing the Medical Innovation Bootcamp on Friday, my friends and I decided to go visit the Arenal Volcano on Saturday. We booked a 15-hour trip with a tourist company that promised us a hike of the volcano, a traditional Costa Rican meal, and a visit to the hot springs. With our hiking outfit on and swim suit in our backpack, we headed to Arenal at 7:30 am. With music playing in the background in our van, a beautiful crispy morning without a cloud in the sky, and our contagious excitement beaming through our smiles , we couldn’t wait to see what the day had in store for us! 

Another Day, Another Adventure: Arenal Volcano  

Our first stop on the trip was at the city of Sarchi, Costa Rica which had a lot of colorful and intricately constructed handicrafts. We specifically stopped at the beautifully painted Oxcart whose artwork reflected the national symbols, folklore, and traditions of Costa Rica. Here is a picture of us in front of the Oxcart:

After Sarchi, we began seeing more of the volcano and caught breathtaking views of the mountain. At one point of the trip as we began going higher in elevation, the engine of our van seemed to overheat causing the vehicle to come to a complete stop. Since most of us had never really experienced this sort of issue before, we became kind of scared and anxious which was completely valid given that we were in an unknown country in the middle of what seemed like nowhere. As the driver attempted to fix the issue, we all looked at each other in terror. Luckily, after a couple of minutes of waiting and trying to get the car to cool down, we headed to Canton de Zarcero, a gorgeous and picturesque town. We stopped at the Zarcero Evangelista Blanco Brenes Park, my favorite place we have visited so far! We saw beautiful gardens and bushes that were transformed into fairytale topiaries–absolutely perfect for pictures!! Behind the park, we visited the Iglesia San Rafael Arcangel Church which has absolutely amazing architecture and symbols reflecting neo-Gothic influence. It was interesting to learn that many aspects of the church were brought from different places around the world such as the bells of the tower were from France and the via crucis and the pulpit were from Austria. 

Next, we went to La Choza de Laurel, where we had lunch (or brunch I guess since most of us didn’t have breakfast yet) authentic Costa Rican food. I’ll be honest, my favorite part of the meal was actually the freshly prepared pineapple juice that they had prepared. It was so sweet and refreshing. I almost drank all of it even before my meal arrived (oops haha!) 

We finished our meal with vanilla ice cream (it was just the perfect timing as we were all melting in the humid-hot weather) and Costa Rican coffee. I was a little confused when I received both cold ice cream with hot coffee but the combination of them together was quite delicious! After our brunch, we briefly drove to the Arenal volcano (of course we took pictures) and then headed to the Baldi Hot Springs for the rest of the day. We were disappointed that our tour did not include a hike as we had expected (based on the information on the company’s website) which was supposed to occur right after our lunch. While we did notify our tour guide that there was supposed to be a hike included in the trip, we were told that it was apparently not part of the plan 🙁 Nevertheless, as always, my GMI crew and I made the most of our trip through laughter, spontaneity, and our own fun! We then finished our day with a buffet dinner there and headed back to the hotel! Another day for the books 🙂

Clinical Need Finding Workshop 

Both Sunday and Monday were spent participating in the Clinical Needs Finding Workshop. After attending a Clinical Needs Finding presentation led by Dr. Cassandra Howard and learning the importance and application of clinical observations, I went to the Clinica Biblica Hospital located in Downtown San Jose. 

There I started my day by observing the pharmacy which was quite busy. There, I noticed that a lot of documentation and reporting was done manually. Also, due to being very busy, the pharmacy seemed a little unorganized. After the pharmacy, I went to the radiology department which was pretty much empty (it was Sunday so there were little to no patients present). There, I admired the various different radiological equipment from X-ray and mammograms to MRI and CT scans. 

When we visited the room with the MRI equipment, the doctor that led the tour showcased how strong the magnet of the machine was using a scissors held by a rope and then standing a couple of feet away from the instrument. After simply holding the scissors by the rope, the scissors immediately drifted towards the MRI. This showcased how important it is to keep magnetic objects, from phones to jewelry, away from the machine. We then ended the day by observing the hematology lab where we visited the blood bank and the lab where blood is handled and stored. One of the things that caught my attention was how messy the microscope staining location was at the sink. There were splotches of violet liquid on the wall, even near the outlet. I also noticed that the fridge storing patient blood did not have a lot of it. This was possibly due to less people donating blood or possibly the increased use of blood for patients in the hospital. The next day, I visited the Clinica Biblica Hospital located in Santa Anna. This hospital was much smaller than the one located in downtown San Jose as it did not include a maternity ward. There I first visited the radiology department. Fortunately, I was able to get a glimpse of a patient getting an X-ray scan of their knee. Because he was unable to completely extend his legs, the X-ray was taken as he stood against the wall. For another patient who required a CT scan, the nurse provided him with 5 large cups filled with water and and small amounts of contrast agent that he was required to drink within two hours in order to perform the examination. When instructed to the patient, I noticed that there was some hesitation and anxiety as the patient wanted the CT scan be done immediately. After radiology, I went to the pharmacy department. Unlike the previous day, the pharmacy at this location was very neat and organized and there seemed to be an apparent structural organization as to how the medications and treatments were placed. However, similar to my observations before, there seemed to be a lot of manual documentation being done. Then we went to the hematology labs and then ended the clinical needs observations at the ER department. The ER department, to my surprise, was quite different than what I had expected. The atmosphere seemed pretty quite and relaxed (possibly due to less patients admitted) and all the patients that were present there were young children with breathing issues. Having never really performed this type of clinical observation, I was quite surprised to see how much we can learn about the hospital system, structure, mechanism, etc. by simply observing the patients in a waiting room or in a hallway. After these two days, I became really excited to begin my internship at Clinica Biblica in downtown San Jose the next day. 

First Day of Internship

On Tuesday, I started my internship at Clinica Biblica in downtown San Jose. Laurel and I started our day by performing clinical needs finding in the microbiology lab. There we met Sofia and two microbiologists, Gabriel and Carla, who we shadowed and learned a lot about their work and their day to day activities. It was really cool to see the behind-the-scenes of the testings that are conducted based on the patient information requested. For instance, we saw how results from a rapid RT-PCR COVID test and paternity tests are conducted. We also saw the microbiologists take a nail, obtained from a patient, to analyze it for different types of bacteria and fungi. 

One of the interesting things that I learned about this week is a bacteria called Pseudomonas aeruginosa which is an antibiotic-resistant bacteria that is apparently present in every hospital and is extremely fatal. Our clinical observations started with research into this bacteria and possible solutions that could be engineered to help detect this virus and prevent it from spreading to patients. Other than performing clinical needs finding, I also learned cool facts about the hospital as listed below: 

• There are 73 beds in the Clinica Biblica Hospital downtown and the ER department has 15 beds in each trauma room.
• Cardiac infarction is the most common illness in Costa Rica with cancer (specifically gastric cancer) right behind it. 
• Public and private hospitals have their own medical record, and each private hospital has their own medical record as well. 
• Because of strict policies, clinical research is not typically conducted in public hospitals. 
  • Also, research is not done at a large scale throughout Costa Rica, therefore, a lot of data gathering is dependent on other countries. This also means that the data obtained is not a good reflection of the Costa Rican population and its people specifically.

The Other Side of Things

Outside of academic and professional life, I finally moved into my long-term temporary housing. With the GMI crew, I went to the Central market where we obtained ingredients to make our first homemade dinner which happened to be bean taco with guacamole and plantain chips (it was quite delicious if I do say so myself or ). 

While life in Costa Rica has been quite challenging for me, I am thankful that each day is better than the one before and there are small moments in between that make the trip so much more worthwhile 🙂