The project began in 2009 when members of MSU’s Department of Obstetrics, Gynecology and Reproductive Biology in the College of Human Medicine traveled to San Jose, Costa Rica to meet with leaders from the University of Costa Rica and the Caja Costarricense del Seguro Social. The purpose of the visit was to build a partnership with Costa Rican stakeholders for the creation of a bilateral exchange program for senior residents in Obstetrics and Gynecology in the MSU Affiliated residency programs and the University of Costa Rica.

The first resident from Costa Rica’s San Jose Women’s Clinic spent six weeks in the Grand Rapids area. The next leg of the exchange had a resident from East Lansing traveling to Costa Rica where they spent four weeks learning how a universal health system works, and how it is possible to treat patients using limited resources. The experience gave MSU residents the opportunity to understand the challenges of global reproductive health while ObGyn residents from Costa Rica had the opportunity to observe different surgical techniques using advanced robotics and simulation.

“We chose Costa Rica because it is a unique country— and they have a health system that is very different from ours,” said Obando. ”Universal health means that it’s a health system that is accessible to everyone, regardless of their ability to pay. The residents learn how a universal system work and how beneficial it really is.

Costa Rica’s health system is characterized by having a strong social component and a well developed preventive program designed to target the community through a structure known as EBAIS (Equipo Básico de Atención Integral en Salud) which are small health teams made up of a physician, a nurse, and a social worker. In addition, Costa Rica’s public health insurance system is available to all citizens and legal residents. According to Obando, the health system is made up of 25 main hospitals, 250 clinics, and nearly 980 EBAIS. The EBAIS are scattered around the nation, and are the first line of preventive and basic care for Costa Rica’s four million residents.

“It is an easy system, and economically, it works better than anything else. EBAIS are where people go for the common cold or a cut. If it is more serious, they’ll go to a clinic and if necessary, referred to a specialty hospital,” said Obando.

Still, it is puzzling to many U.S. health officials how Costa Rica can have such positive health statistics. Their physicians do not have access to many of today’s technical advances yet their health indicators are as good, or better, than the United States. During a visit to one of Costa Rica’s main hospitals, a faculty member asked about their low infection rate after birth. The answer to him was, ‘We are just careful.’

“To me this answer wasn’t shocking because I grew up there and I understand it. But it is hard to understand how that can work here. We want our residents and faculty here to see how to treat the same conditions with less money, less resources, but have same outcomes,” said Obando. “And we want them to better understand their role and the impact of the social context and/or socialized medicine in their health outcomes.”

Physicians from several Michigan hospitals have been part of the delegations to Costa Rica. Dr. John Hebert, medical director of Women’s Services at Hurley Medical Center, a teaching hospital in Flint Michigan, has been encouraged by the trips and opportunity to learn from physicians working in a different type of health system.

“The opportunity for young medical students to see first-hand how physicians in Costa Rica prevent complications with fewer resources is invaluable to their education,” said Dr. Hebert.

Recently, Obando and Bogdan-Lovis helped organize the first Latin American Conference on Womens’ Reproductive Health held in Costa Rica. Working along with the conferences sponsors, Obando and Bogdan-Lovis helped set up workshops and lectures on research exchange and training opportunities in endometriosis, reproductive health, bio-ethics, medical education curriculum improvement, and robotic surgical techniques. “The conference was a complete success and there are requests from Costa Rica to do it again next year”, said Obando.

“We are very excited about this. After the conference, I had the opportunity to meet with people from the University of Costa Rica and there is interest in collaborating on an online-masters in medical education,” said Obando. So the relationship evolves.

“I’m a believer that you don’t need to reinvent wheel, you can learn a lot from what other countries are facing and how they are responding to their health needs,” she said. “There is lot to be learned from each other, that is what global health is all about.”