La Clinica de la Mariposa: Desamparados, Cartago, and Heredia, Costa Rica
The La Clinica de la Mariposa trip to Costa Rica involved three weeks of travel, set-up, take-down, and clinical treatment of over 711 patient-visits from three neighborhoods, October 3 through 21, 2005.
We experimented successfully with a three week trip, working four days, instead of three, in order to concentrate our efforts and to leave time at the end of our time of service for volunteers’ personal travel. On this trip, there were five chiropractic students, three chiropractors and two massage therapists. For all participants except myself and our massage therapy coordinator, Kelly Martin from Minnesota, this was a first-time experience. One of our massage therapists came from Germany and volunteered for two weeks. A friend of hers joined us for a few days and acted as an additional interpreter.
We provided services in the communities of Desamparados, Cartago, and Heredia. Our clinics are developing a standard look about them with our long denim curtain providing privacy for us as we all work in this space together. As always we were served through administrative services of intake, Spanish interpretation, and our meals. We are indeed fortunate to be cared for so well and we are indeed thankful.
Dr. Rebecca Rice from the Twin Cities joined us during the first week and Dr. Mary Ann Ley, from Baltimore, Maryland joined us for our second week. As a test, I absented myself from the third week, which was coordinated by Dr. Don Eggebrecht from Northwestern Health Sciences University in Bloomington, Minnesota. All went well, our patients were served, and our students and doctors learned and were inspired. As always, we developed a servant’s heart.
Student members of the crew were Eric Brandt, Kenzie Satter, Lise Wall, Jody Shawn, Mateus Ferraz-Souza. They worked very hard seeing a total of 219 new patients and a total of 711 patient visits over the three weeks. Our total number of patient files maintained is now over 1700 including the new patients we saw this trip.
Patient Data and Research
The patient files are maintained in a secure space in the offices of the Christian Foundation for Children and Aging in Calle Blancos in San Jose.
During each clinic visit, a history was taken on each patient and was reviewed by the treating doctor before he or she began an examination. Many former patients returned with new conditions or flare-ups of previously existing chronic conditions. Hypertension and diabetes mellitus presented frequently as co-morbidities in our population.
During our October clinics, we provided donated clothing and shoes for small children. We also provided orientation for the children in dental hygiene and provided all the children (approximately 200) with tooth brushes, dental floss and toothpaste. We had great fun doing this and used a puppet demonstration model to show the teeth-brushing method.
We maintain a cumulative database containing patient characteristics and presenting conditions and generate reports that are used in regular clinic reports and grant applications.
In addition, we have begun to test our ability to conduct a pre-post outcomes, using a form our research team developed to provide a pilot study of outcomes of our treatment. We prepared Spanish-language (Costa Rican Spanish) the forms, using a patient-report scales from 0 (with no pain or difficulty performing tasks) to 10 (with maximum pain and great difficulty in performing tasks). The forms were translated and checked by our local translators before use for local understanding and sensitivity. The forms were administered by our on-site Costa Rican medical physician, Javier Vasquez, MD, as the patients entered for treatment and after three visits to the Clinic. Dr Vasquez has explained to each patient the objective of the outcomes research and exactly what information is needed from each patient.
We plan to use this preliminary research to be able to assess effectiveness in performing our tasks among this population.
Next Clinic Trip
The next trip is planned for January 30 through February 17, 2006. We will again follow the format of three weeks in Costa Rica, each week working four days per week. The students have been selected and we have most of the rest of the complement of professional staff committed. As we continue our work, our efforts become better known among those who are interested in volunteering. Students at Northwestern Health Sciences University hear about the Clinica opportunity early in their programs. Eventual student volunteers have frequently planned two years, studying Spanish and/or tropical health care, to make the most of the experience.
Public Relations and Project Fundraising
La Clinica has a non-profit corporation, Sante, Inc., that is charged with raising funds for the continuing project. There is a website, www.santesante.com, that has begun to achieve recognition for our work.
Recently, we received a grant (FY2005) from the Million Dollar Round Table (MDRT) Foundation. We have again applied for fiscal year 2006 and are optimistic.
We have also had an article printed in the Dynamic Chiropractic newsletter recently about La Clinica in Costa Rica. We have had several responses from interested doctors as a result.
If your schedule permits, please consider seriously providing funds and your time. La Clinica can always find uses for your support. If your are a health care provider, please also consider volunteering to work with us for a week or more!
Tom Davis, DC
President, Sante, Inc.
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