A LESSON IN QUALITY CARE
It’s impressive how quickly an operating clinic can be assembled with 19 pairs of hands to hang curtains, unfold chairs and set out medications and informational materials.
On any given day, the community center in La Carpio’s neighboring village, Guararí, serves as both a daycare for local children and a place of worship for community members. Children’s handprints in all the colors of the rainbow adorn the walls alongside Spanish biblical verses. But on this day, the entrance is transformed into a waiting area, positioned next to a makeshift pharmacy that a local pharmacist and a Clemson student will operate throughout the day.
Three other students — paired with a translator named Andrea who is a medical student from the University of Medical Sciences (UCIMED) in San José — form a triage group, ready to take in patients when they arrive. The day prior, the same students had performed house visits and handed out appointment slips to sick residents, and now they wait for patients to treat.
At 2 p.m., a patient arrives to her appointment 15 minutes early. The students ask her a detailed list of questions, stumbling over their Spanish and looking toward Andrea when their pronunciation of a word leaves their patient perplexed.
Do you have a family history of disease? What brings you here today?

“It’s becoming increasingly difficult to get clinical hours in the United States because of the numbers of students that are wanting to pursue health care as a career and the inability of practitioners to make themselves available.”

Junior nursing major Logan Young is the recorder on this case. As the woman recounts a story of falling down the stairs only two days earlier, Young takes notes, first of the pain in the woman’s back, arm and neck, then of her limited range of motion.
As the questions continue, the woman reveals a host of other symptoms, many of which seem unrelated to her fall. She has anxiety, she says, but she hasn’t been able to get medication for it in months. Her throat is sore; her eyes water; and she has persistent pelvic pain.
Young looks up from her clipboard to find that the woman is crying — and at once, all the students hold their questions. The language barrier overwhelms them because in that moment, they want nothing more than to verbally express their sympathies for what brought their patient to tears.
Instead, Young holds out her hand, and the woman takes it, the slightest smile an apparent attempt to overcome her fear. She is scared, she says, because she doesn’t know what is wrong with her. She knows that her living conditions are making her sick, and she is sad that she has to expose her children to the same environment.
Dr. Gloriana Saenz, a recent graduate from UCIMED, makes her rounds. The students pull her into their group and relay their patient’s symptoms and vitals to her. Saenz asks the students what they believe the woman is suffering from, then uses the woman’s case as a teachable moment. Pelvic pain and back pain, she says, are symptoms of a urinary tract infection, which can come in two versions: complicated and non-complicated. The farther the bacteria travel up the urinary tract, the worse the infection can become.
The woman takes a urine test, which renders positive for a UTI, and Saenz sends her home with antibiotics for the infection and ibuprofen for her pain. The woman gets the drugs from the pharmacy on her way out the door. As she leaves, she turns to Andrea to relay a message to the students.
“Thank you for being so caring,” she says. “Most doctors aren’t.”

CONFIRMATION OF A CALLING
Costa Rica continually ranks highest in the polls as the happiest country in Latin America, a result, in large part, of the country’s decision in 1949 to abolish its military and divert those resources into education and health care. As a result, Costa Ricans have universal access to health care and primary and secondary education, with the government providing for many of its citizens’ basic needs regardless of income. In 2018, Costa Rica even ranked higher than the United States in the World Happiness Report.
Yet for immigrants from north-bordering Nicaragua, who make up approximately 7 percent of Costa Rica’s population, health care isn’t always feasible. Many immigrants enter the country illegally, fleeing political unrest and economic oppression. Without the proper papers or a decent education, they aren’t able to find jobs that offer access to the best health care benefits. They work in physically intensive jobs as maids, shoemakers or construction workers, and when a sickness or injury occurs, they line up in the middle of night outside of the local clinic and wait for their chance to see a health care provider.
During the two weeks Clemson students work in the communities, the reality of poverty — broken-down houses, sewers running alongside children’s bare feet, the spread of illness and chronic workplace injuries — never ceases to jar them.
“For me, and for probably most everyone on this trip, you go into it expecting to be shocked,” says Megan Hays, a junior biological sciences major. “But I think the biggest part about it isn’t so much what the conditions are because you’ve prepared yourself for that. I think it’s the severity of it and the magnitude of it. Driving out to the clinic, you’re passing 10, 20 more communities just like Guararí and La Carpio, and this is only in one small area of Costa Rica.”
The people in these communities need help, Hays says, and every act of aid is met with a profound sense of gratitude from the patients.
“You go in, and your help is so appreciated,” Hays says. “You’re so welcomed, and these people that are complete strangers will let you into their home. They give you smiles, hugs, kisses, and they care about your life. And in that moment, the motivation to be a medical professional is not to build a résumé. It’s not to get clinical hours. It’s not that ‘you have to have this GPA to get into this school.’ It’s allowing yourself to be really hurt by the sad stories and really happy with the patients you can help.”