Lets begin with the health care. All employers must provide health care for its employees, health care supported by the state. This system, which is called seguro social (social security), is extended to all Costa Ricans who are employed. But what about the people NOT employed or cannot find employment? There is no state safety net.
All children born in Costa Rica are given seguro social until the age of 18. The health care system is set up with a three-line of clinics. First, there are salas (offices) where you go when you are sick for immediate treatment. If you need further examinations you go to the second type of clinic where clinical exams are done for a myriad of tests – blood work etc. Then the last is that you go to the hospital for major treatment or surgery. If you have seguro social you do not pay for your visits or the medicines. If you do NOT have SS then you pay.
So people who have the employment and we are assuming some finances to pay for doctors visits and medicines do NOT have to pay, but people who do not have employment must pay in full for treatment. There in lies a serious gap in the country; the poor the sicker and sicker and often go with out treatment.
Unemployed parents of children that have seguro social will often not seek treatment because they often have no money to get to the clinics. So, children with SS stay sick and untreated.
FIMRC once a year has a traveling clinic that works in a very poor community of Costa Ricans with roughly 560 inhabitants. Nearly all of the families are unemployed or have intermittent employment. Even though the children have SS the parents often cannot get to a clinic. FIMRC contracts Dr. Rebeca Quesada, a bone surgeon to work on her vacation in a traveling clinic the community Colon. She tells me that she loves this work because the people desperately need the attention. Community members have multiple illnesses that are treatable, but because they do not seek a clinic they suffer needlessly. In addition, community members have chronic diseases that go untreated.
The community of Ciudad Colon lies outside of San José and while the bus runs into the community if you have little money you may not choose to spend it on a bus and the expenses of a day-long trip to the capital.
Ciudad Colon has the problem that there are no schools near their community, so while education is free they do not have access to schools for their children. The children stay home and remain uneducated, like their parents creating cycles of poverty.
The marginalized become more marginalized.