Visit to the EBAIS: Observations

We went on our first class-related field trip this morning. It was a medical mystery tour of sorts: all Jorge told us of our excursion was that we were going to visit the EBAIS. He did not tell us what an EBAIS was – only that we were going, he wanted us to talk with people there, observe and try to get an idea of what it was. It was another precariously bumpy ride through the mountains in the back of the OTS 4X4. The mountains are so beautiful – one of these days I want to take a walk down the road to San Vito and bring my camera. Pictures taken from the car are not quite adequate. Upon arrival, all eighteen of us gringos got out of the car, standing out like a sore thumb among all the Ticos and Ticas.

The EBAIS is a blue building in the mountains where people from 20-30 km surrounding area come for primary health care. The acronym EBAIS stands for equipo básico de atención integral en salud (basic team of primary health care). It is essentially a clinic with a doctor, a nurse, a pharmacist, a medical records clerk and a technician that makes visits patients to make sure they are cared for (they go on motorcycles and give vaccines - a couple of the guys marveled at the glory of this job). There are over 800 EBAIS facilities in Costa Rica. They are the baseline referral point for more specialized care in the bigger clinics and hospitals, although over 90% of all problems are resolved within the EBAISes themselves.

The EBAISes are evenly distributed geographically throughout the country in a very organized network of care that’s provided through the social security system for all Costa Ricans. This particular EBAIS serves about 2,500 people within a 20-30 km area and sees about 40 patients a day. Most consults are walk-ins, so an early morning rush around 5 am is not atypical. When we arrived, there was a line of people coming out of a salita, a little building attached to the main one. Initially, we deduced from a sign that all those people were presenting with flu symptoms, but later found out that wasn’t true (phew). They were in line to receive powdered milk for their children.

Other interesting tidbits:
• Jorge says, most towns consist of an EBAIS + a church + a soccer field. That’s really all you need, right?
• All Costa Rican physicians are trained initially as general practitioners – all EBAISes have basic obstetrical/gynecological equipment for Pap smears, deliveries and other such basic OB/GYN needs.
• Our other professor, Mariace, who is not an expert on tuberculosis in Costa Rica, but THE expert on tuberculosis in Costa Rica, does not speak of her expertise to her doctor or demand mutual respect as a colleague. Rather she just lets her doctor be her doctor. At her last checkup, he asked her about TB testing, and she said she just laughed to herself because he had no idea how much she new about it.
• Vaccination of children in Costa Rica is completely mandatory by law. Parents cannot keep their kids from getting vaccinated. Jorge cites the importance of herd immunity in public health as the primary reason. If parents do not comply with this rule, authorities will come, handcuff the parents, vaccinate the children, un-handcuff the parents and leave.
• The HPV vaccine is not offered in Costa Rica/not covered by social security. Reasons for this were unclear – something having to do with the vaccine’s effectiveness being limited to women who have never been sexually active. Though this seems bad upon first impression, screening practices for cervical cancer in Costa Rica are good. The EBAISes we visited devote one day a week to Pap smears – and the EBAISes also monitor their patients so closely that it is much more difficult for them to fall through the cracks and not get that important preventive care.
• Doctors are legally obligated to report crimes they come across in their practice (i.e. suspicion or evidence of rape/abuse/domestic violence).