Learning to Adapt: My Healthcare Placement in Costa Rica

One of my primary goals for traveling to Costa Rica was to gain hands-on experience within another country’s healthcare system. As a registered dietitian, I was eager to learn how nutrition care is delivered in a resource-limited setting and to contribute in a meaningful way.

To be honest, the experience didn’t begin the way I had expected.

It quickly became clear that the placement organization wasn’t fully prepared to utilize the skill set of a registered dietitian. Like many dietitians have experienced throughout their careers, I found myself advocating not only for my role but also for ways I could make a meaningful contribution to both the residents and the onsite healthcare team.

I also learned that having a dietitian embedded in a long-term care facility is not common in Costa Rica. Residents generally followed the nutrition recommendations they received during a previous hospitalization or upon admission. For many of the residents that could have been years, which meant their nutrition plans often hadn’t been revisited despite changes in their health status.

While there were certainly limitations in staffing and resources, I also saw tremendous opportunity.

Rather than becoming discouraged, I worked with the leadership of the exchange organization to reshape my experience into something that was both educational and impactful during my remaining days at the facility.

Caring for High Risk Patients

For the remainder of my placement, I worked alongside a nurse and a medical student to evaluate twelve of the facility’s highest-risk residents.

Many of these individuals were living with severe malnutrition, dysphagia, chronic non-healing wounds, or required tube feedings. Together, we reviewed their medical histories, evaluated their nutrition plans and discussed the concerns raised by the nursing staff.

The work challenged me in meaningful ways.

Not only was I navigating medical Spanish, but I was also learning a different healthcare system, different standards of practice, and a setting with far fewer resources than I was accustomed to. Throughout the experience, I wanted to remain respectful of the local culture and the realities faced by the healthcare team rather than simply viewing everything through the lens of American healthcare.

For example, in the United States, we have strict protocols about what should and should not be administered through a feeding tube. In Costa Rica, however, limited access to commercial formula sometimes required difficult decisions. I found myself considering questions that I had never seriously faced before: Is it better to supplement formula with blended foods like mashed plantains and chayote, or to provide less nutrition than a patient truly needs because formula is unavailable?

Experiences like these further reinforced my belief that evidence-based practice must always be balanced with the realities of available resources.

Looking Beyond the Patient

In addition to individual patient assessments, the administration asked me to evaluate the facility’s menus and compare them with the Costa Rican Dietary Guidelines while taking into account cost, food availability and accessibility.

This gave me another opportunity to learn. I spent time speaking with the kitchen staff about traditional Costa Rican foods, food preparation methods and the practical considerations involved in feeding a large number of residents with limited resources.

Lessons I’ll Carry Forward

Although the placement wasn’t what I originally envisioned, it became one of the most meaningful parts of my trip. Before leaving, I submitted my nutrition assessments (written entirely in Spanish) to the clinical team and provided recommendations for wound-healing nutrition support and tube-feeding supplements that future volunteers could bring to the facility.

I hope those recommendations continue to benefit both the staff and the residents long after my visit.

More importantly, the experience reinforced something I believe is essential for every healthcare professional: cultural humility. Working across languages, healthcare systems, and resource limitations challenged me to think differently, ask better questions and adapt my practice without losing sight of evidence-based care.

I would absolutely encourage healthcare professionals to pursue international clinical experiences. They offer an opportunity to step outside your comfort zone, develop cultural humility, and gain a deeper appreciation for the many ways healthcare is delivered around the world.