Bridges of Health: Culturally Relevant Hospital Care Program for Indigenous Communities in the Chirripó District, Turrialba

Background: In Costa Rica, the Cabécar Indigenous communities of the Chirripó district face significant geographic, linguistic, and cultural barriers to accessing specialized health services. In response, the William Allen Taylor Hospital developed the Bridges of Health program—an institutional strategy designed to ensure comprehensive, humanized, and culturally relevant care for this population.

 

Approach: The program combines intramural and extramural actions, linking hospital services with Indigenous communities, local leaders, development associations, and both governmental and non-governmental organizations.

Key components include: monthly extramural specialized consultations in Chirripó (pediatrics, gynecology, dermatology, social work, psychology, nutrition, and obstetric nursing); community health fairs open to all insured persons; hiring of Cabécar interpreters; educational materials and hospital signage in the Cabécar language; dietary adaptations for hospitalized patients according to their customs; and staff training in Cabécar culture and language.

Coordination with local associations, the Turrialba Health Area, and the Ministry of Public Education ensures access to venues, transportation, lodging, and accompaniment.

Planning involves participatory diagnosis, co-design with community leaders, impact evaluation, and continuous feedback with the beneficiary communities.

 

Results: Between the first semester of 2023 and the first semester of 2025, there was a steady increase inthe number of Indigenous patients served by the hospital.

In emergency services, attendances rose from 909 users (2.77%) in 2023 to 1,531 (3.44%) in 2025; in outpatient consultations, from 1,836 (2.18%) to 3,207 (3.11%); and in hospitalizations, from 338 to 453 cases—reflecting greater trust in hospital services. Absenteeism slightly increased from 5.33% to 6.5%, linked to the overall rise in appointments granted.

Regarding childbirths, Indigenous users increased from 25.58% (2023) to 30.87% (2025); cesarean rates dropped from 10.81% to 7.44%, while out-of-hospital deliveries rose from 18.91% to 22.31%, indicating closer ties with the hospital even after delivery.

For extramural care, between August 2024 and the first half of 2025, the following increases were recorded:

Gynecology and Obstetrics: from 80 users (2024) to 108 (2025).

Social Work: from 27 (2024) to 48 (2025).

Adolescent Care Program: from 100 (2024) to 103 (2025).

In 2025, consultations were also provided in the Lactation Clinic (6 users), Pediatrics (33), and Audiology (100 users aged 0–4 years).

Community health fairs expanded their coverage from 252 users (April 2024) and 283 (October 2024) to 315 (May 2025) and 435 (August 2025), with a third fair scheduled for November 2025.

This trend confirms the effectiveness of the Bridges of Health intramural–extramural model, which has brought specialized medical services closer to indigenous communities, reduced geographic and cultural gaps, and strengthened users' trust in hospital care.

 

Implications: Bridges of Health is a replicable experience in culturally diverse settings, demonstrating how hospital care can evolve into an inclusive and collaborative model.

Its culturally relevant approach promotes health equity, strengthens institutional management, and fosters community participation—improving the quality of life of historically vulnerable populations.

It offers lessons on integrating Western medicine with Indigenous worldviews within a single care system, building a human bridge between cultures, and consolidating comprehensive and respectful healthcare.