» Comparative Health Care Program
Health care internships in both Costa Rica and Nicaragua
NICARAGUA AND COSTA RICA : Two very different countries with different levels of development. 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.
THE FIRST MONTH:
The program begins in Costa Rica, working through Costa Rican Internship Institute (CRINI). 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 one month 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. We match your skills, field of study, interests, and experience with those of the health facilities we work with.
THE SECOND MONTH:
After completing the Costa Rican internship, 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 one month working through Viva Nicaragua!
at a 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.
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• 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.
• Proof of international medical insurance
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PROGRAM COST: US$4800
Included in the program fees: transportation to and from the airport, orientation, lectures and readings on each country’s health care system and epidemiology,
internship placement based upon careful review of the intern’s application, family stay with all meals and laundry included in both Costa Rica and Nicaragua, 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, border crossing taxes (approximately $15), Spanish lessons (if required), and personal travel
expenses (US$400 monthly in Costa Rica , $200 monthly in Nicaragua )
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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.
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,
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.
-Samatha Feeld, 2006,
Pitzer University .
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, 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 VS NICARAGUA
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1) Download and submit your application to firstname.lastname@example.org
2) Submit your resume and two original or scanned copies of recommendation letters.
3) After receiving your application material, we will send you a confirmation letter begin the application review process.
4) Upon careful review of your application, we will notify you if you have been placed. You are not officially accepted into the program until you receive a placement confirmation letter. This process usually takes one week to ten days.
5) If accepted, you will then receive a placement confirmation and letter and an invoice for the program deposit.
6) Mail a signed copy of your application along with your deposit to:
P.O. Box 210
7) There will be no refunds after the program has begun. In the event of a personal emergency, we will review the situation and may issue a partial refund.
8) Complete payment is due on or before your program start date.
Questions? Contact us!
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