Enhancing Practice with Cross-Cultural Experience

by Rebecca Sponberg

Ever since I was a junior in high school, I had been saving money towards the prospect of traveling abroad. Three years later, after my sophomore year in Pitt’s School of Nursing, I finally found the perfect opportunity to not only see a new part of the world, but also to gain my first international clinical experience: working with International Service Learning. Through this program, a group of American students helped provide health care and medical supplies to uninsured people in San Jose, Costa Rica.

Until I took my first steps onto Costa Rican soil, I had never encountered such gracious people. Their ubiquitous hospitality was surprisingly prevalent in even the inner-city slums of San Jose. Although their homes consisted of only stark wooden frames and corrugated metal walls and roofs, our patients always welcomed us inside to meet their families and appreciated any amount of interaction with us. During one of these visits, I was touched to see the entire community of Los Diques share the task of watching Emanuel, a 2-year-old toddler diagnosed with Down syndrome. It was refreshing to see this community and shared responsibility for his protection.

I could not conceive, then, how the Costa Ricans’ welcoming nature would profoundly impact my clinical practice back in the U.S. Despite a significant language barrier, I connected more on a human level with the ticos and ticas of Costa Rica than with some of the male and female patients that I have cared for in the U.S. Their eagerness to learn how to improve their health was so unlike the indifference I sometimes received in the states. Only equipped with my basic medical Spanish and the occasional help of a translator, I was able to speak to my patients about topics ranging from the importance of completing their entire antibiotic regime to decreasing risk factors for acquiring parasitic infections in their homes. We were only able to offer medication for acute illnesses, but they were genuinely grateful for just a bottle of children’s Motrin or cough syrup.

Although just a portion of the Costa Rican uninsured, the 220 patients I saw in two weeks provided me the opportunity to practice and perfect my head-to-toe examination and to reduce the time I needed to obtain a full set of vital signs. Their surprising patience and overwhelming curiosity made it easy for me to expand my questioning to gain a better understanding of their health knowledge and status. With each positive patient teaching experience, I gained more and more confidence. I cannot overstate the value of their gratitude on my psyche either: I will always remember the gigantic hug I received from a woman who reminded me of my grandma and I will always keep the crayon drawing one of my youngest patients gave me.

Returning to nursing in the U.S. was a challenge, as I had become accustomed to the friendly acceptance my Costa Rican patients had displayed. With my enhanced patient assessment ability though, I have had improved success delivering health education because I now know how to ask pointed questions that more quickly identify deficits in patient knowledge. I approach each patient as a blank slate, and as a result, I have seen a general improvement in my clinical rotations this year. Since returning, I have realized that the Costa Ricans had a greater impact on making me a better health care professional than my temporary presence had on them.