Five years ago, Garry Krakos, DC, Palmer College of Chiropractic's director of student services and international office director, went on a trip to Haiti with then-student Leon Taylor, DC, as part of a multidisciplinary team.
That health care mission has now grown into Palmer College of Chiropractic's Clinic Abroad Program (CAP). Today, there are approximately 300 students and 40-50 faculty, staff and alumni that venture forth each year on 12-15 trips. Students spend six to eight days in the clinic setting, and adjust an average of more than 100 patients each. Modeled after existing, nonchiropractic study abroad programs, CAP gives students (8-10th trimesters) an intense hands-on chiropractic experience in foreign lands, and a life-changing exposure to other cultures and health care practices.
Guy Riekeman, DC, president of Palmer College of Chiropractic, said CAP is "an expression of our responsibility as 'The Fountainhead' of the profession to bring chiropractic to the world." He noted the college would continue to expand the program overseas and to underserved areas in the United States.
"It's a very humbling experience," said Karen Stone, a 10th trimester Palmer student who went to Haiti in October 1998. "It makes you appreciate what you have. We went to a well-baby clinic and I didn't see one healthy baby. The mothers were so trusting of us, even though we were strangers who didn't speak their language. They just held their babies out to us -- babies who were suffering from things like malnutrition, malaria, AIDS and tuberculosis."
The program has grown in sophistication and organization. The Council on Chiropractic Education's site visit to Palmer College, gave the program highest recommendations. CAP has been to Mexico; the Caribbean (Bequia, Dominican Republic, Haiti); South America (Bolivia, Brazil); the south Pacific (Fiji); central Europe (Hungary); and south Asia (India, Nepal).
The latest trips were this past February 1999, when 112 students, faculty, staff and alumni went to various destinations. Later this year, there will be trips to China, Brazil, Nepal, Syria and other countries.
"We always refer patients to the nearest chiropractor," Dr. Krakos said, "but our goal is to go back to each location at least twice a year to provide follow-up care and outcome assessment until we're able to set up permanent facilities."
Foreign Protocols
"We work with the recognized chiropractic association in each country and coordinate with the local contacts to get government approval from the ministry of health or other appropriate government office," Dr. Krakos explained. "This is a requirement for every location.
"We bring our own tables and manage the clinic ourselves, and can set up in a variety of settings, from hospitals to community centers to schools. Care is always free of charge." Generally, one clinic location is set up for an entire stay. This allows the patients the opportunity to return for care and to be treated by the same doctor. "Our goal is to develop permanent, functional facilities in each country," continued Dr. Krakos. "Some of the students who have participated in the program are going back to practice in the countries they visited."
Jeremy Maxwell is one such student. He will graduate from Palmer in June 1999. Jeremy went to Fiji in October 1998 with CAP. "The generosity and hospitality of the people totally overwhelmed me," he recalls. "Words can't describe what it was like to show up and see 300-400 people waiting to have us care for them. The experience affected me so deeply that I'm planning to bring my wife and son to set up a practice in Fiji for three to five years after graduation," he said.
Jeremy recalls the curious condition of one patient. The man's arms began to fly up uncontrollably when he lay on the table. "Dr. David Hannah checked him, noting he'd seen this condition only three times in practice. The diagnosis was first rib neuropathy. After an adjustment the man improved dramatically.
New Perspectives
Students also gain a new perspective on their own lives. Dr. Oryan Salberg, a February 1999 Palmer College graduate, went to Nepal in June 1998. "We take so much for granted in the United States. We may complain about a bad restaurant meal, whereas people in Nepal might consider a grain of rice as a meal. We have carpet and tiles while they have dirt, if they have a floor and a roof over their head at all. They held us in highest regard during our stay. We were cheered and given flowers. They were so happy to have someone who cared about their well-being."
Dr. Salberg said the experience has reinforced his passion for chiropractic. "What I care about most is being a chiropractor. My goal is to help people. I've always felt that way, but now it's reinforced. To be able to give someone a better quality of life means everything, and being able to do that with my hands, my mind and my heart is even more incredible."
Kathleen Ruebbelke, DC, director of the pediatrics residency program at the Palmer Chiropractic Clinics, went to Fiji in October 1998. "What we did was a gift. By giving that gift openly, the gift I got back was realizing, once again, how grateful we need to be for everything we have here. The trip also gave me an improved perspective on my students. I got to know them better on a personal level and it helped me to relate to them better."
Preparations
Students who sign up for the trips go through months of preparation before departure. "Our pre-departure orientation begins months in advance and includes weekly meetings on safety, the history, government, politics, religion and language of the country, as well as the health care conditions students are likely to encounter," said Lori Curry, RN, coordinator of Palmer's office of international programs. "We coordinate all of the paperwork for passports, visas and insurance."
The faculty-to-student ratio is about seven-to-one, which allows for close faculty supervision. "The groups learn to work as a team to be successful," Dr. Krakos observed. "The experience rejuvenates the faculty. It puts them in touch with chiropractic from a humanitarian point of view."
Diversions
The trips do allow some time away from the clinical rigors, including recreational and cultural activities. "We've gone white water rafting on the Ganges River in the Himalayas, chartered a flight around Mt. Everest, rode elephants in Jaipur, India, and met with India's president, K.R. Narayanan," Dr. Krakos recalls. "We've had the opportunity to experience all of the different foods, learn traditional folk dances, and really absorb the culture of each country."
Program Goals
The program's goal, Dr. Krakos added, has remained constant. "It is a humanitarian experience with unparalleled educational and personal benefits for everyone involved. Students gain clinical skills and confidence, and most importantly, they realize they have a gift to offer people. It makes them better chiropractors. All of us, whether student, faculty, staff or alumni, go there to give, and what we get out of it is secondary."
The CAP staff hopes to expand Palmer alumni involvement in the program, and is looking for possible locations worldwide. Anyone who would like additional information about the program or who has a contact in another country which could be a possible site is encouraged to contact Dr. Krakos by at (319) 884-5430 or by e-mail at krakos_g@palmer.edu.
