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Development and Growth of the Santé Program
Since its affiliation with the Christian Foundation for Children and Aging (CFCA) in Kansas City in 2000, the project in Costa Rica, called "la clinica de la mariposa," or the "Butterfly Clinic" (La Clinica) has been subsumed by a tax-exempt non-profit organization, Santé, Inc. The new, larger, organization, founded in 2004, is intended to facilitate fund-raising for the current project in Costa Rica and possible later projects elsewhere.

La Clinica initially provided itinerant primary integrative health care services, at no charge, to residents in lower-income, neighborhoods or "barrios" served by CFCA in the Central Valley of Costa Rica in Heredia and Desamparados and, in the few years of its operation, has added clinic locations providing more diverse health care in the more distant towns of San Ramon, Cartago, Alajuela, and Los Chiles.

La Clinica has operated on a shoestring: with volunteer health care students and supervising professionals, CFCA transportation (van) and neighborhood meeting centers, and the invaluable CFCA neighborhood community workers, "las promotoras." Las promotoras are residents in the barrios themselves and organize the clinic logistics, including patient scheduling as well as a large noon meal and even occasional entertainment for staff, for each week of visits. Because of these valuable and caring promotoras, clinic staff have been able to begin seeing patients within minutes of their arrival, after portable treatment tables are unloaded from the van and set up and supplies are accessible. Clinics are usually operated on Mondays, Wednesdays, and Fridays during a clinic-week. Occasionally, such as in Los Chiles, where logistics require, clinics are operated daily. Volunteers are just that, they are provided some food and transport to clinics, but otherwise pay their own way. All Santé resources are devoted to providing health care for the residents of the barrios.

The staffing began operation with a supervising chiropractor, an occasional nurse (including a nursing professor), upper-level chiropractic students from the United States, a CFCA medical physician. La Clinica has gradually involved an additional Costa Rican MD as well as a Costa Rican dentist and psychologist. Later we were joined by massage therapists, a mental health counselor, and acupuncturists.

The current target population includes the residents of neighborhoods identified by the CFCA. There are approximately 3500 people identified as CFCA sponsored persons in Costa Rica. Because there is no CFCA-related qualification for service, family and friends of CFCA recipients can be added to this target population, resulting in an expanded number of approximately 20,000 persons in several barrios who are eligible for our services. There is a national health care system in Costa Rica, and La Clinica does not attempt to supplant, rather to supplement its many services. However, the Social Security System (responsible for National health care) does not include the many services represented within integrative health care. La Clinica augments the national health care system by providing residents health care services and contacts outside the system and by serving as a source of referrals for secondary care to the national system. La Clinica has treated over 1000 people who have made nearly 3000 visits to its providers.

During the initial clinic visit, each patient (or parent/guardian of the patient) is interviewed and information about his or her health history is gathered. Health exams and treatment is then offered with a health record of the initial visit and each subsequent visit assembled and, when not needed, kept in locked storage in CFCA offices, San Jose (Calle Blancos, a barrio). Clinical records indicate there is a representative demographic character to the current patient population. Women tend to be over-represented, but ages run the full gamut from very young (3 months) to older (98) patients. The number of children reported by adult patients has ranged to 19. We also track primary conditions and co-morbidities on all patients, so La Clinica can provide narrative and statistical graphics concerning "who comes through the door, and what conditions do people present." To date, twelve upper-level chiropractic students have been involved in four of the five trips during which services were provided. These students and others who accompanied them, have reported that the personal and professional contact with the people Costa Rica has been extremely positive, a life-altering experience. All who have participated have found the people to be very responsive to the loving and caring treatment provided.