This summer, Stanford medical students contributed to projects in communities around the globe as part of the Medical Scholars Research Program. In this special back-to-school Q&A series, five students share their experiences developing preventive medicine strategies, gaining hands-on clinical experience and conducting field research.
The Osa and Golfito Initiative (INOGO) is an ongoing effort to develop a conservation and health-improvement plan in the Osa and Golfito cantons of Costa Rica. The initiative is facilitated by the Woods Institute for the Environment at Stanford.
Stanford medical student Lauren Yokomizo became interested in INOGO after learning how the effort used health statistics and demographics to educate government officials and community members about the effects of unsustainable environmental practices on human health, as well as the impact of community health on the environment.
One such project in the ongoing initiative involves an analysis of Costa Rica's health-care system. More than a half century ago, the country mandated (.pdf) universal social security services, including health-care coverage. As a result, the country implemented a strategy to deliver primary care to all citizens and increased its emphasis on prevention. Despite this effort, a significant percentage of Costa Rica's health-care spending goes towards hospital-based care.
This summer, Yokomizo traveled to the Central American country to investigate how hospital utilization in rural communities of the country compare to urban areas and differences in facility-use rates due to chronic diseases, specifically cardiovascular disease and diabetes.
I recently spoke with Yokomizo about her summer project.
What data did you analyze and what methods did you use in the process?
I'm reviewing hospital admissions at three levels of care - county, regional and national - to investigate any differences in access to higher level or referral care. Through the use of direct standardization methods, I will examine differences in hospital use between the wealthy central valley and [less affluent] rural counties of the INOGO study area. My analysis will include both general admissions and those conditions responsible for significant morbidity that require advanced care, such as cardiovascular disease and cancer.
How will your analysis offer insights into Costa Rica's significant hospital care costs?
The analysis will quantify and confirm whether there is any difference in access to hospital care, and if so the level of hospital care, for residents in Osa and Golfito in comparison to more urban areas. Answering this question will help address a more general question related to health equity: If 70 percent of the nation's health resources are spent in its hospitals and a majority of those funds are used in only five hospitals, does this allow for an equitable distribution of health-care services to the rural population?
Now that you've completed this field research, what are the next steps for this project?
Visiting the hospitals and clinics in the study area and meeting with local community leaders and government officials gave me a better understanding of how the Costa Rican health-care system works in both theory and in practice. It also provided an opportunity to obtain additional data needed for the analysis. Now that I'm back in California, I'll be focusing more on the quantitative aspect of data analysis rather than the qualitative, contextual assessment done in the field.
What was your most memorable experience working in Costa Rica this summer?
I was very impressed by the community leaders, which included pastors, farmers and mothers, we met in the small towns. Many were very motivated, organized and optimistic agents of change and are deeply invested in their communities. The local health-care teams' firm belief in social justice and health as a human right, as well as their dedication to their patients and the health of the communities under their care, was also impressive.
Previously: What I did this summer: Stanford medical student investigates early detection methods for glaucoma, What I did this summer: Stanford medical student works to improve emergency care in Cambodia and What I did this summer: Stanford medical student helps India nonprofit create community-health maps
Photo by Steve Ryan