San José, Costa Rica, since 1956

Health: Steps Forward, Backward

Infrastructure, or lack thereof, was the name of the game in health in Costa Rica in 2006.

In a never-declared competition between the country’s parallel public and private health-care systems, the government Social Security System (Caja), burdened with increasing demand for dwindling resources, has always struggled, but did make some advances this year.

A report issued by Ombudswoman Lisbeth Quesada denounced what it called damaged infrastructure, dangerous working conditions and unacceptable waits at the capital’s San Juan de Dios Hospital. Her office vowed to work with the Caja to resolve these problems.

Long waits have been the norm at Caja facilities, especially in the areas of radiology, cardiology, ophthalmology, orthopedics and vascular surgery, occasionally resulting in worsening of patients’ conditions.

Indeed, an August shortage of anesthesiologists was the result of several vacations at San Juan de Dios and MéxicoHospitals, and delayed many surgeries. A shortage of nurses is expected here, a longer-term problem, with Costa Rican nursing students being recruited to offset shortages in the United States.

Help is on the way in terms of foreign and corporate contributions: Intel donated a computer system to Hospital México’s dialysis unit, replacing previously handwritten records to create a true database.

Taiwan donated the funds for a new building at San José’s CalderónGuardiaHospital. A fatal fire gutted two floors of the facility in mid-2005. A former nurse has been charged with arson and 19 counts of murder in the case.

A new Caja hospital is planned for Heredia, with construction scheduled to start next year, and opening expected for 2009. It will supplement the northern Central Valley city’s existing San Vicente de Paul Hospital.

On the private-sector side, San José’s Clínica Bíblica inaugurated a new sevenfloor, 18,000-square meter building, which is opening in phases and scheduled to be completed in 2007. The hospital also performed the country’s first artificial cornea transplant in July, in a process developed in Australia.

Human cornea transplants are a long-standing procedure here.

Hospital CIMA, in the western suburb of Escazú, began using laser treatment for enlarged prostates, a process known as photoselective vaporization of the prostate, which causes less pain and fewer side effects and is deemed to be more efficient than other methods.

Public-health preparedness was a mixed bag this year, with the chloroquine-resistant Plasmodium falciparum form of malaria showing up in the Caribbean region. The strain was last seen here a decade ago.

Costa Rica also registered a worrisome increase in infant-mortality rates, which rose from 9.25 to 9.78 per 1,000 live births from 2004 to 2005. The figure is one of the prime benchmarks of a country’s development.

Cases of dengue, the country’s age-old health problem, were down nearly 73% compared to last year. The 2006 State of the Nation report gives Costa Rica high marks for preventing dengue resulting in death, but warns that the country faces “enormous vulnerability” to the potentially fatal hemorrhagic form of the disease.

The Ministry of Public Health announced a strategy for the next four years to combat HIV/AIDS, a condition estimated to affect 15,000-18,000 people here. Better public education and improved access to treatment are hallmarks of the plan.

The ministry also pronounced sound its plan to ensure avian flu preparedness with a watch over migratory birds and vigilance over poultry farming operations.

The disease has yet to rear its head here, but has worried the world.


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