Affordable healthcare, Board Certified surgeons, and highly trained medical professionals have made Costa Rica one of the world’s top destinations for medical tourism. Moreover, Costa Rica’s proximity to the States – most major cities are a five hour flight or less – makes it an accessible and convenient choice for the one million Americans who take medical vacations every year.

Medical vacations combine surgical procedures with pampered escapes, often at comfortable recovery centers or hotels that cater to patients on the mend. Surgery packages typically include airfare, recovery and sightseeing, and run 1/4 to 2/3 the cost of the surgery alone in the United States.

Costa Rica’s hospitals use cutting-edge technology

Of course, price is not the only concern when researching a medical vacation: safety and patient comfort also top the list. Costa Rica’s modern hospitals, cutting-edge technology, and Board Certified plastic surgeons are some of the country’s biggest draws. A majority of the country’s physicians have studied abroad, earning their degrees from some of the best medical schools in the United States and Europe. As in the United States, Costa Rican law requires surgeons to carry liability insurance to assure patients protection from malpractice.

All surgeons catering to medical tourists speak fluent English, and at many of the country’s most reputable hospitals, most of the staff is bilingual as well. Patient comfort is a priority, and Costa Rican physicians take pride in providing personalized follow-up care, visiting patients several times after surgery to review progress and addressing any concerns.

If you’re considering a medical vacation, research is key. Do your due diligence on any hospital and surgeon, and don’t be afraid to ask questions.

What do your surgery package costs include? What is not included?At which hospital will my surgery take place?Will I be able to speak to my doctor before arriving in Costa Rica?Do all doctors and staff speak English?What are the hospital’s recovery and post-op practices?What are the specifics of the hospital’s and surgeon’s malpractice insurance?Can you provide me with references and contact information for recent patients?

Cost Comparisons:

Cosmetic Surgery:

ProcedureUSACosta RicaBreast Augmentation$6,000-$10,000$2,500-$3,500Facelift$7,500-$15,000$3,500-$5,000Smart Liposuction$4,000 per area$2,000 per areaRhinoplasty$10,000-$15,000$3,000-$4,000Tummy Tuck$5,000-$8,500$3,500-$4,500

Medical & Dental Procedures:

ProcedureUSACosta RicaGastric Bypass$20,000-$35,000$10,500Heart BypassUp to $130,000$24,000Hip Replacement$35,000-$40,000$12,000Conventional Lasik$4,300 for both eyes$1,300 for both eyesIntraLase LASIK$5,100 for both eyes$2,500 for both eyesPorcelain Veneers$1,500 per tooth$300-$500 per toothTeeth Whitening$500-$1000$200-$300

Nestled between the picturesque foothills of Barva Volcano and urban San Jose, Heredia is the land of coffee-dappled countryside and city conveniences. Nicknamed the City of Flowers, the city is known for its constant spring-like temperatures and safe neighborhoods. It’s also one of Costa Rica’s most popular expat hotspots.

Heredia’s standard of living is high, and its cost of living is comparatively low. Cable television, high-speed Internet, and other services are readily available, and public transportation is extensive and cheap. A bus from downtown to any outlying suburb costs less than 50¢; buses to San Jose or Alajuela run about 70¢. Heredia has a weekly farmers’ market, a great place to get fresh produce at incredible prices. Rents vary greatly depending on your style and needs – a basic one-bedroom apartment can run less than $200 per month, while a posh mountain mansion can cost upwards of $2,000 monthly.

The Fortin de Heredia in downtown

One of the things I love most about Heredia is that it’s possible to live well on a small budget. For less than $550 per month, I live in a four-bedroom semi-furnished mountain home with high-speed Internet (1 mbps), cable TV, and a home phone. I take the public bus everywhere. I hang my laundry out to dry and have hot water only in the shower. My electric bill is seldom more than $15 a month. I love my town and my home, and the low cost of living frees up funds to splurge on extras like date nights or fancy dinners on the town.

Heredia is a bustling mini-metropolis full of modern amenities. Paseo de las Flores is one of Costa Rica’s nicest malls, with a multi-screen theater, upscale shopping, and plenty of familiar fast-food joints. Bargain hunters can shop at Pricemart, a warehouse store similar to Sam’s Club or Costco, that has deep discounts on bulk purchases. And “Florenses” – residents of Heredia – feed their inner foodies at Automercado, Costa Rica’s premier grocery store that carries organic goods, fines wines, artisan cheeses, and imported items.

The Central Market has lots of fresh produce

The city and suburbs are also big on entertainment: museums, gourmet restaurants, live theater, and laid-back dance clubs line downtown streets. In the mountains, residents pass their time at local parks, public swimming pools, and family-run cafes. Monte de la Cruz, in San Rafael de Heredia, is one of my favorite places – the huge park has picnic grounds, hiking trails, and one of the Central Valley’s best views.

Families take advantage of good public education and high-quality bilingual and English language schools. Popular pre-K-12 options include the Lincoln School, American International School, and the Pan-American School. Each has English classes and offers a choice of U.S. or Costa Rican diploma. The European School, located in San Pablo, is a high-quality bilingual program that provides International Baccalaureate (IB) and National Baccalaureate degrees.

Stunning mountain views

Young newcomers love the nightlife and flourishing under-30 expat community. Retirees appreciate the quiet suburbs and access to first-rate medical facilities. The new, state-of-the-art Heredia Hospital opens in May 2010 – the facility cost $85 million to build and will provide medical consultations, x-rays, emergency care, surgical facilities, and more.

This eclectic mix of city fun and the great outdoors draws people of all ages, backgrounds and nationalities. The Heredia expat community includes Americans, Canadians, Spaniards, Venezuelans, and Italians, among others. In addition to the area’s amenities, everybody loves Heredia’s convenient location – it’s just 15 minutes to San Jose and an hour to the Pacific coast. I couldn’t imagine living anywhere else.

Expat Spotlight: Emma, Age 27

1) Why did you choose Heredia? Heredia offers the best of both worlds: peace and convenience. I love living in the mountains, away from the city sounds (and smog), but I’m only a 30-minute bus ride to major shopping, the movie theater, or anything else I could want. I also love how safe it is. In my mountain suburb, I’m not scared to walk alone at night – that’s very important when you don’t have a car.

2) What are the positive and negative aspects about living in Heredia? What I love most is easy – the views! My husband and I love to walk, and every morning we hike by coffee fields, corn plantations, and grass-covered mountains. From our balcony (about 4,300 feet above sea level), we can watch the sun set over the Pacific Ocean. Sometimes I wish I lived in a town where no one spoke English – there are a lot of expats here. However, the expat community is my support system and I could never live without my wonderful friends.

An Heredia sunset

3) What’s the expat community like? It’s a very strong and supportive community and represents all ages. There are plenty of interest groups that meet on a regular basis, and that’s a great way to meet like-minded people. I’ve met some of my best friends in the world right here in Heredia.

4) What are Heredia’s best neighborhoods for expats? That really depends on what you’re looking for. If you love an urban lifestyle with plenty of restaurants, shopping, and the arts at your front door, you can’t beat the neighborhoods of San Francisco, Santo Domingo, San Joaquin, and Belen. But if you love the mountains with the views, serenity, and slow pace, then I’d recommend San Jose de la Montana, Barva, Santa Barbara, San Rafael, or San Isidro. Each area has its own personality, so newcomers should visit them all before deciding.

5) Any tips or advice about moving to Costa Rica? Finding your Costa Rican home takes some work, so give yourself plenty of time to explore the country. Don’t buy a home or even sign a long-term lease before seeing as much as possible. Do your research, target a few promising places, and then live in each for a little while. And if you decide on Heredia, welcome!

In Costa Rica, the soil is said to be so fertile that if you plant a stick in the ground, it will grow. Although an exaggeration, it’s true that the country’s rich soil and moderate climate make it easy to grow colorful flowers and hearty produce– you just have to choose the right varieties based on where you live.

I live in the cool mountains above Heredia and recently began a container garden in my small backyard that receives only eight hours of sunlight per day. Container gardening makes it easy to create optimal growing conditions, as I can also relocate my plants throughout the day to increase or decrease sun exposure.

Ripening tomatoes

I began with a few vegetable and herb seeds – early tomatoes, mesclun salad mix, basil, oregano and cherry tomatoes – and a hefty bag of topsoil, organic compost and pumice stones. As directed by my local nursery, I layered topsoil over the pumice stones to provide drainage and mixed a small amount of compost into the dirt. Following the directions on my seed packs, I planted the seeds outside and placed my containers in the sunniest part of the yard.

I planted my garden in August, during the height of the rainy season, to maximize fruiting during the drier months of November-Aprl, when the sun is its strongest. Whether it was my sowing skills or the damp afternoons, my seeds all got slow starts. Instead of sprouting and then growing exponentially larger every week, they all – especially the tomatoes – sprouted immediately and then grew slowly over the next few months. The timing seems to have worked out perfectly: today, my adolescent plants are all large and very healthy. The tomato plants have bloomed and the first tomatoes are just days away. I can’t wait!

Manicured garden paths

Gardening in Costa Rica is a labor of love; you have to love it, or it won’t be worth it. For me, gardening is a relaxing hobby, and I grow fruit and vegetable varieties that are either more expensive in Costa Rica or impossible to find, especially heirloom species.

In order to bring seeds into Costa Rica, you must buy them packaged in labeled and sealed envelopes in order to clear Customs. The only exception to this rule – and one that is often overlooked – is for invasive species like squash, which grow wild if left untended.

Flower gardening in Costa Rica is even more varied, and for many expats botanicals are an adventure into the unknown. The town of La Garita, Alajuela has an incredible selection of plant nurseries that sell everything from passion flowers and bougainvillea to cacti and bromeliads. At some nurseries, plants are scattered over an acre or more, and you can easily spend a day browsing the selection. Before making a purchase, speak with an employee and assess your growing area. Where you live, hours of sunlight, available shade, and other conditions will greatly impact which tropical plants will flourish in your yard. Happy gardening!

I remember the first time I bit into a juicy mango, how the juices ran down my fingers as I devoured the sweet, orange fruit. Likewise, my first taste of arroz con pollo (chicken and rice), laced with spicy chili sauce, is forever imprinted on my mind. Tastes and scents create vivid memories, and I have found that local food is one of my favorite aspects of travel to foreign lands.

Costa Rica’s cuisine is mostly savory – instead of piquant spices, Costa Rican cooks favor fresh herbs, onion, garlic, and other mild blends to season their dishes. In kitchens around the country, you’ll find homestyle comfort food that tastes delicious and fills you up – dishes like gallo pinto (rice and black beans), or sweet and creamy arroz con leche (rice pudding), served as a warm snack or special dessert.

Gallo Pinto (Rice and Beans)
Just three days after moving to Costa Rica, a friend came over to my home, his arms weighed down by two heavy grocery bags. Their contents: white rice, fresh black beans, onions, sweet pepper, garlic, and cilantro. After a welcome peck on the cheek, he was off, pulling knives from drawers, washing vegetables, and heating oil on the stove. For the next hour, we diced, sautéed, boiled, and stirred as the aromatic dish took shape before us. When my friend pronounced it ready, we chopped up fresh cilantro and sat down to our delicious meal. Over juice and good conversation, we breakfasted on hearty gallo pinto (Costa Rica’s famous dish of black beans and rice), accompanied by fresh corn tortillas and a Costa Rican sour cream called natilla. To this day, gallo pinto is one of my favorite meals, and I hope you’ll enjoy it as much as I do:

1 lb. black beans – best if fresh, but dried will also work; use canned beans only if necessary
½ bunch (8-10 sprigs) fresh cilantro
1 small white onion
2 cloves of garlic chopped
1 small bell pepper
3 cups chicken broth; may be substituted with water
2 cups uncooked white rice
½ teaspoon salt
1 tablespoon + 1-3 tablespoons sunflower or vegetable oil
4 tablespoons Lizano sauce (worcestershire will substitute in a pinch)

If the beans are dried, cover them with water and soak overnight; if they are fresh, just rinse them under cold water. Drain and cover beans with fresh water and salt and bring to a boil. When the beans are boiling, cover the pot, reduce heat and simmer until beans are soft (approximately 3 hours).

When they are almost cooked, finely chop the cilantro, onion and bell pepper. Add one tablespoon of oil to a large pan and sauté the dried rice for two minutes over medium-high heat and then add half each of the chopped pepper, cilantro, garlic and onion. Sauté for two more minutes, then add chicken broth, or water. Bring rice mixture to a boil, cover, and simmer until rice is tender (about 20-35 minutes).

The rice water should be absorbed, but the beans will have a significant amount of black bean-colored liquid – do not drain! Add the cooked beans to the pan and sauté on medium heat with the rice, Lizano sauce, and the remaining bell pepper, cilantro, garlic, and onion until everything is mixed and well cooked. Sprinkle with a little fresh chopped cilantro just before serving. Once the rice and beans is prepared you can also refrigerate or freeze it.

Arroz con Leche (Rice Pudding)
After several months of dating, my now-husband, Federico, decided it was time to introduce me to his parents. When I arrived for lunch, the kitchen was a flurry of activity: chicken was cooking on the stovetop, the table was full of salad dishes (vegetable, potato, pasta), and a sweet smell wafted out of the oven. Over the next couple of hours, I talked with Federico’s parents, swapping stories and laughing at family photos. As I said goodbye, Federico’s mother placed in my hands a large, still-hot portion of her homemade rice pudding, with the proviso that it was best served warm, but cold pudding is also delicious. On top of the container sat the recipe – I already felt like part of the family.

2 cups uncooked rice
4 cups 2% milk
4 cups natural or white sugar
1 tablespoon vanilla
½ teaspoon freshly ground cinnamon
½ teaspoon freshly ground cloves (or 6 whole cloves)
½ teaspoon freshly grated fresh nutmeg
4 oz butter, preferably sweet cream butter
1 cup raisins (optional)

Cook rice uncovered in 8 cups of water for 45 minutes until it is cooked soft. Drain any extra liquid. Stir remaining ingredients into the rice and simmer for 30 minutes or until mixture thickens.

New arrivals from the United States, Canada and Europe are often surprised that Costa Ricans do not rely heavily on the national postal system for receiving packages or other important mail. Deliveries through the Costa Rican post office can be slow and Customs clearances can be a hassle. Luckily, there are reliable options for getting mail from abroad:

Friends and Acquaintances
Whenever my friends visit the United States – or when their families and friends fly down to visit – they notify me a month or two in advance. If I have any pending purchases, I send them to my friend’s address, and they pack them up in a suitcase and bring them down for me. In return, whenever I fly home, I offer my extra suitcase space to them. Since I have many friends from the U.S., there’s almost always someone planning a visit within the next month or two.

Private Shipping Companies
Shipping companies like Jetbox, Aerocasillas and Mailboxes, Etc. are an excellent way to receive mail in Costa Rica. An account with each company gets you a U.S.-based post office box. When you want to ship something to Costa Rica, just send it to your P.O. box and the company will handle the rest: shipping to Costa Rica, Customs, and even home delivery.

Each company has varying rates depending on consumption. Free accounts do not include complimentary shipping, but are the best option for sporadic purchases. Companies or individuals that receive large amounts of mail are better off with paid accounts, which range from $15-$100 monthly and include shipments from 5.5-66 pounds.

To make the process even simpler, private shipping companies will handle the Customs process for you. If any customs duties are charged, they will pay the taxes on your behalf and automatically charge your debit or credit card. Additionally, if you purchase a big-ticket item of less than $500, for a reasonable fee (about $35), they will file exoneration paperwork and import your purchase free of duties. And for a small additional charge, most services will deliver mail directly to your door. All told, the entire process generally takes less than two weeks.

FedEX, UPS and DHL
These services are fast and efficient, but they’re also expensive compared to private shipping companies. A two-pound package shipped from the United States to the San Jose Greater Metropolitan Area costs upwards of $100; the cost with a private shipping company is approximately $25. However, FedEX, UPS and DHL offer direct shipping – from the U.S. to Costa Rica with no intermediary P.O. Box – and also provide additional services like shipping insurance and tracking numbers.  Offices can be found in most major cities including San Jose, Escazu, Heredia and Liberia.

On the afternoon of my arrival in Costa Rica, I had three priorities: hail a taxi to my apartment, unpack my bags, and find some food. The next morning, a new priority topped my list: make friends. I was excited for this new adventure, but knew that a few good friendships would be essential to enjoying my new home.

During my pre-move research, I had read that Costa Ricans are famous for being friendly. I was prepared for big smiles and helpful directions, but I had no idea how genuinely sociable Costa Ricans could be. About a year before the “Big Move,” I had used a free website to find two Costa Rican penpals.

We corresponded a few times a week and they were both a wealth of information, helping me identify the best neighborhoods, prepping me on what to expect, and giving me tips on how to obtain a cell phone. After my arrival, we met in person and became good friends – one even introduced me to my husband!

As wonderful as my penpals were, I couldn’t rely on them to find friends for me. I knew I had to expand my social network, but I wasn’t quite sure how to go about it. I had no family in Costa Rica, no office job with coworkers as potential friends, and I wasn’t part of any student or alumni group. It was time to get creative.

As a member of Generation Y – also called the Net Generation – I grew up in a world dominated by the Internet and online social networks. So naturally, I decided to peruse the World Wide Web in search of groups and organizations that would introduce me to future friends. Three years later, I can happily report mission accomplished.

Most Costa Rican neighborhoods are full of friendly neighbors

Blogs: There is a huge network of English-language blogs written by expats in Costa Rica (such as ours!). Start by reading a handful, and seeing whose writing personality best fits your own. Leave a few comments. Send the author an email to introduce yourself and see where it goes. You won’t make friends with every blogger you contact, but if you make just one acquaintance, your time will be well spent.

Yahoo! Groups: There are several Yahoo groups populated by foreigners living in Costa Rica. Some, like Costa Rica Living, are general interest groups with thousands of members, while others, such as crgardening, cater to specific niches. Get a feel for which users seem like potential friends, and then email a few off-list.

Couchsurfing: Couchsurfing is an international hospitality community, and many members use the site as a social gateway. Couchsurfing’s Costa Rica network is very active and hosts regular get-togethers for all sorts of activities like potluck dinners, restaurant meals, and games. The community is on the young side – 20 to 35 is the median age – but there are some younger and older members, too.

Local Groups: What are your hobbies? Niche and interest groups are a great way to meet interesting people. An online search will reveal many Costa Rica-based groups; for example, the Little Theatre Group (Escazu) is ideal for live entertainment aficionados, while international communities like Ravelry (knitting & crochet) or Flickr (photography) have forums to find members near you. If you’re searching for a particular interest, try asking a blogger or posting on a Yahoo group – you’ll likely find that a group has already been established, or that there are other members interested in joining you in whatever activities you’ve suggested.Church is also an excellent place to meet new friends

These methods can take time, and you can even begin before the move. Once you’re in Costa Rica, you’ll have an even easier time making friends – just step outside and meet your neighbors!

Smile: A smile on your face lets people know you’re approachable. You’d be surprised how many first meetings start with a smile and a friendly “hola.”

Learn Spanish: You don’t need to be an expert linguist to make Spanish-speaking friends. Learn the basics online, from a book, in a class, or from an audio lesson, and then get practicing. Costa Ricans are generally patient and kind to language learners, so even basic Spanish skills will be enough to get the friendship ball rolling.

Buy a soccer ball: Costa Ricans love soccer and every town has a soccer field. Take a ball to the main park and start a pickup game; by the end of the day, you’ll have a whole team of new friends.

Be neighborly: Ring your neighbors’ bells and introduce yourself. If you like to cook, take over something typical of your hometown or country. I’ve made cupcakes, banana bread, and even jelly for my neighbors, and they’ve reciprocated with fresh fruits from the backyard, typical sweets, and baked goods.

Read the paper: Local newspapers like La Nacion (Spanish language) and The Tico Times (English language) feature weekend sections full of upcoming activities. Look for something you enjoy, and while you’re there you’ll meet plenty of other attendees with similar interests.

Go to church, temple, or mosque: Join your local religious organization. You’ll discover welcoming locals and an established social network.

Starfruit, also known as carambola, grows throughout Southeast Asia, the south Pacific and Latin America. If you’ve never tried it, the flavor combines both sweet and tart notes reminiscent of apples, pineapples and even lemons. When I lived in the U.S., starfruit appeared in my supermarket once every few months. I always bought several to feast on, despite their hefty price. The waxy, golden fruits were crunchy, sweet and mild – a delicious flavor combination.

Costa Ricans prefer the fruit slightly green, which produces a tart and crunchy flesh. They are available throughout the year, but are most prevalent from June – October, and cost about $1 per pound. The first time I bought starfruit (Averrhoa carambola) at my local farmers’ market, I was surprised. I had purchased a two-pound bag, oblivious to the fact that the fruit was faintly green, rather than golden. Here, the most common preparation is as a fresh fruit drink, and so the fruit is sold slightly unripe to produce a more robust juice.

Fruit sliced into five-pointed stars

Starfruit will ripen at room temperature and develop brown lines on the edges of the fruit when ready to eat. Even when yellow and perfectly ripened, carambola has tart undertones. Not only is this starry fruit delicious, it is an excellent source of vitamin C and antioxidants. Starfruit is also low in calories, sodium, acid and sugar, making it an ideal snack for anyone trying to maintain a healthy lifestyle. Fresh starfruit slices add a unique touch of flavor and texture to salads; add starfruit to your morning smoothie or try this refreshing natural juice:

Starfruit Juice
1 whole starfruit
1 to 1 ½ cups water, depending on your preference
1 lemon or lime, juiced
Sugar, to taste

Remove brown spots from the fruit and slice it up, removing any seeds and leaving the skin intact. Add starfruit, water and citrus juice to the blender. Blend until smooth. Add sugar to taste. Strain if desired and enjoy!

Starfruit and Avocado Salad
Romaine lettuce
Cherry tomatoes, halved
1/2 red onion, thinly sliced
1 avocado, cubed
2 starfruits, thinly sliced

Arrange lettuce, tomatoes and red onion on four salad plates. Top with slices of avocado and starfruit. Drizzle with a mild vinaigrette.

Covered in a sweet, creamy pulp, cacao seeds are used to create some of the world’s most delicious chocolate treats. The cacao plant, which has a long history in Latin America, was once considered a valuable currency among Meso-American cultures. Today, the plant is valued more for its culinary worth – even fresh off the tree, the cacao pod’s silky white pulp makes for a delicious snack.

After falling prey to a rampant fungal disease several decades ago, Costa Rica’s cacao crop diminished considerably. Luckily, the country’s Caribbean coast held on to old traditions and today, this region is the nation’s hotbed for organic chocolate production. To share their ancient knowledge and love of this valuable crop, indigenous families host daily cacao tours. Learn about the cacao plant’s history, participate in harvesting pods, grinding beans, and extracting creamy cocoa butter.

Cacao seeds drying in the sun

Cacao (Theobroma cacao) is considered one of nature’s top brain foods: the bean is rich in iron, magnesium, chromium, manganese and zinc. These minerals may help balance blood sugar, boost the immune system, fortify the liver, and promote healthy skin. Raw chocolate is the only known plant to supply the endorphin anandamide, a chemical that induces bliss. Additionally, the plant contains tryptophan, an essential amino acid, as well as serotonin – a neurotransmitter known to improve mood.

In Costa Rica, fresh cacao pods are seasonally available at your local farmers’ market or grocery store. Organic cocoa powder and bar chocolate – both the bittersweet and milk varieties – are available at many local supermarkets and at small farms located in the country’s tropical regions, especially along the central and southern Pacific and Caribbean coasts.

Though there are myriad ways to enjoy Costa Rican cacao, one of my favorites is rich, creamy hot cocoa:

Homemade Hot Cocoa:

1/3 cup organic, unsweetened cocoa powder
3/4 cup raw cane sugar
1/3 cup boiling water
3 1/2 cups 2% milk
3/4 teaspoon vanilla extract
1/2 cup evaporated milk
Pinch of salt
Mini marshmallows (optional)

Combine cocoa powder, raw sugar and salt in a medium saucepan. Slowly add in the boiling water, whisking constantly to incorporate completely. Reduce heat to medium and continue stirring. Bring the chocolate mixture to a boil; be careful that it does not scorch. Add milk and continue stirring until the mixture is very hot but has not boiled. Remove from heat, add vanilla and divide between three or four mugs. Add evaporated milk to achieve desired creaminess.