Shaolin Mosely

While studying abroad in Costa Rica, I had unforgettable experiences and gained

valuable insight into a different culture, language, and way of life. Finding myself immersed in

the culture of another country prompted intrapersonal growth and a tremendous amount of

learning. I had the opportunity to observe the country’s healthcare model, learn some basic

Spanish, and shift my perspective from that of an “insider” to an “outsider” or foreigner. Some of

what I learned provoked me to reflect on my perspective on the functions of healthcare in the

United States; I also acquired skills and competencies that I will carry with me in my practice as

a nurse.

Learning about the ways that the healthcare system in Costa Rica is different from that in

the United States was interesting, but what I found even more interesting was the overall attitude

towards Costa Rica’s universal healthcare system. We learned that the responsibility of public

healthcare costs is divided among working residents, their employer, and the national

government. The amount that the individual pays into the system is based on income and this

money is taken out of their paycheck. However, it was the opinion of several key informants who

spoke with us that this expense was not a “tax” or any sort of burden to them. Rather, we once

joked at the notion that it was some kind of “mandatory donation”. Their point was that the

payment was useful, necessary, and otherwise a good thing that would benefit all in their

country. Even if the individual did not fall ill themselves, or opted to use the private system

instead, they felt content knowing their money would help someone in need. This is exemplative

of the collectivist culture in Costa Rica - a culture in which the health and wellbeing of one’s

neighbor is widely valued, and people do not resent their personal sacrifices that help others.

While there are setbacks to this universal system, including funding limitations and potentially

lengthy wait periods, it saddens me that the United States has struggled to unite on just the idea
 Shaolin Mosely

that healthcare should be a right, rather than a privilege, for all citizens. Regardless of which

exactly would be the best methods for achieving a system that provides coverage for all, I think

that foremost the division in opinion about who is deserving of good health is what really stands

in our way of making substantial healthcare reform. In part, observing the Costa Rican’s attitude

toward healthcare aided me in forming this viewpoint. Further, in addition the importance of

health in general, I gathered that there was also importance placed on holistic health.

I observed other implications on health in Costa Rica such as the importance of

screenings as done by the ATAPs, the impact of systemic and environmental issues on health as

we saw in La Carpio, and also the integration of religion into healthcare; these all may play a

role in holistic health. I was surprised to realize the role of the ATAPs in the community. While I

was expecting follow-up home health appointments, I realized that the ATAPs go door-to-door

to all the houses in the surrounding area. The ATAPs played many roles in the community, as

they performed a community assessment, granted an opportunity for families to express health

concerns, and gave preventative health teaching and preventative health measures such as

vaccines. I wonder if there are similar systems in place in any towns in the US, because surely

this would be an effective way to gain important information about a population and target

disease prevention. In La Carpio, we saw families living in shabby houses in a town with

hazards to health that included crime and violence, cramped living spaces, isolation from outside

resources, and improper waste disposal. I wonder what information the ATAPs would gather if

they did an assessment in La Carpio, and how it would compare to that of Santo Domingo. It is

important for a nurse to understand the impact that an unsafe living environment, lack of social

support, and emotional trauma can have on an individual’s health. We were given a lecture about

the “spiral” of advancement that is more practical in addressing the achievement of personal
 Shaolin Mosely

needs such as shelter, food, wealth, education, etc. I remember that Gail told us her view that

both self-esteem and community partnerships were vital to being able to ascend this spiral of life

success, and I wish that I had ask if she saw religion play a role in the health of those in La

Carpio. In the hospital and clinic setting, there seemed to be an emphasis on confiding in faith in

the journey to health or the end of life. There were multiple posters on the floors with pictures of

Jesus with biblical quotes. Spiritual health can play a major role in one’s physical health, and I

appreciated that religion may have played a role in addressing holistic health in Costa Rica. In

addition to these cultural features, I also learned a little bit of how to navigate my way in

healthcare through Spanish language.

Learning new Spanish words was the most fun (and challenging!) part of the trip. I am so

glad to have learned some words that will be useful for me in the healthcare setting when I have

Spanish-speaking patients. I cannot do it flawlessly, but I can at least introduce myself, ask how

my patient is feeling and if they are experiencing particular symptoms, and even learn about my

patient’s history or family – in Spanish! I came on this trip with absolutely no Spanish

background or classes, so I am really amazed at how much I learned in just two weeks of

practice. It means so much to me to know that I may be able to communicate with some of my

patients on a more personal level if they speak Spanish. While I understand that I will be needing

a translator often, I think it will make my patients feel a little bit better to know that I made the

effort to try to learn how to utter a few simple words to them in their language. Now that I know

what it feels like to be an “outsider” or at least speak a language different from the majority of

those around me, I know how comforting it is to hear someone try to connect with you in your

own language. Cultural competency is not knowing how to fluently speak another language or

totally understand another culture, but rather having the open mind and desire to try to connect
 Shaolin Mosely

with someone else despite your differences. In addition to adding some Spanish to my

vocabulary, I have gotten to develop some cultural sensitivity while connecting with clients in

Costa Rica.

Though I was placed in a quite vulnerable position as a foreigner with limited

communication abilities and little knowledge of my surroundings, Costa Rica and its people

created an environment where I could be present at ease and my learning could flourish. I am so

appreciative of Common Ground International, Lapa Verde Spanish School, and all of the

individuals who lead us on tours and educated us about Costa Rica’s healthcare system. All of

the people I met and places I visited made an impact on my understanding of the culture. I can

say, with evidence, that the Costa Rican culture is rich with valuable lessons. People from all

over the world can benefit from the community-oriented lifestyle and general contentedness that

the culture of Costa Rica exudes. Now that I have seen their positive effects, I can aim to change

my behavior in ways that would reflect these values so that I can improve the quality of my own

life and that of those around me. My time in Costa Rica has helped me to become a global

thinker and more enlightened global citizen, and for that I will always be thankful.