Is The Soviet Health Care System Ready for Chiropractic?

In the late part of May and early June of 1990, a Minnesota chiropractic by the name of Jay Cherner, D.C. (Soviet born and raised) traveled with a delegation of business and political representatives to Kiev, Moscow and Minsk. There mission was to visit Soviet hospitals, doctors, medical students, and health care professionals. Dr. Cherner's mission was to introduce chiropractic care to the Soviet Union, with hopes of influencing them with the proper standards of care in order to lay strong foundation to bring about chiropractic as a fully established profession in Russia.

In the following exclusive interview with "DC," Dr. Cherner reveals his impressions of that memorable return-visit to his homeland. As you read, ask yourself, "Is the profession ready for global chironost?" -- Ed.

"DC": Dr. Cherner, you recently visited the Soviet Union by invitation from some of the major medical schools, universities, hospitals, and clinics. It is our understanding that your visit marked the beginning of some discussion about teaching chiropractic to doctors within the Soviet health care system. Would you please tell us about that?

Dr. Cherner: I think that the Soviet health care system is ready for the chiropractic profession, ready to establish a new profession there and develop it in full strength. I think the beginning of the new profession started about 10 to 15 years ago. At that time there was a Dr. Kasyan, who is a neurologist, whose father and grandfather were both bonesetters; bonesetting was in Russia for centuries. It wasn't recognized by the medical profession in the Soviet Union, but in the last 10 to 15 years, Dr. Kasyan was able to bring to the attention of people he was helping, the benefits of utilizing spinal manipulations. I talked to a few people about how he does it, and it really sounded to me like it is kind of primitive in a somewhat hazardous way. Anyway, there still will be manipulation and the people will be able to derive the benefit; some may not, but the majority will. So, he started the entire process or movement in the Soviet Union and it has started to spread quite rapidly. There were some other doctors who wanted to learn, so they were coming to see him too. They in turn started practicing this in some clinics and hospitals. The concept of spinal manipulation is developing very fast in Russia. I was quite surprised when I came to the Soviet Union. The first city I visited was Moscow. The people there knew what chiropractic is, and we would sit and talk about it. I believe that the development of the profession has already started in Russia and what is now important to develop is the proper schooling to direct the profession into the appropriate direction, the way we want it to develop in this country.

"DC": Historically, there hasn't been a great deal of communication from the health field in the Soviet Union. During your visit, did you have the opportunity to observe health care practices that would surpass or excel standards that we have here in the United States or would you say their methodology is behind? What could DCs here in the United States learn from the Soviet doctor?

Dr. Cherner: A discussion came about after I did a presentation in Kiev Medical College. There were a number of professors who were very interested in manipulative therapy. We started to discuss how chiropractic could be introduced and brought to the Soviet health care system, the way it is right now in the United States. I talked about the historical development of chiropractic in our country, to its present development. We also tried to compare the schools, the most difficult tests to determine the level of technical ability of the medical doctors engaged in the practice of manipulative therapy. I expressed the concerns of our associations and that of U.S.A.'s doctors of chiropractic, as well as our concerns about proper schooling, standardization of care without adequate teaching methods, and the number of school hours. With a limited scope of practice, it would not be possible to demonstrate the highest standards of care that we strive for in our profession. Without the standards of care, our profession would be at risk of getting a bad name and achieving limited results in patient care and ability to conduct research projects. When I was there, I heard about a friend of my father who went to one guy who claimed to manipulate the spine and naturally got hurt. Those concerns are important, and I tried to bring up things that would allow us to help them develop a true profession of chiropractic. I told them that I didn't believe there would be an interest in helping to develop chiropractic in the way they are doing it right now. We need to help them make this process legal, on an official note. There needs to be a health ministry and they need to have the people who actually make the decisions in that country meet with the people in our associations who would be interested in getting involved.

"DC": In your opinion, can we realistically expect that a true chiropractic profession might emerge through these efforts or will we end up with a situation of MDs being taught and then subsequently teaching manipulation techniques?

Dr. Cherner: In my opinion, we can truly expect to see chiropractic development in the Soviet Union, but it will not be accomplished with just my effort. I really feel like I need help. I have tried to ask for help from the American Chiropractic Association and the World Federation of Chiropractic. I wish there was more involvement. If the leaders of this profession feel it is important for us to globalize chiropractic, they should step forward and help me with this. I have very good connections in the Soviet Union and I feel it could be accomplished. There is a great interest on the part of Russians, Ukrainians, and other republics to have chiropractic care as part of their health care system. It will be great for chiropractic to be in the Soviet Union because they do not have the antagonism that we have experienced in this country from the medical profession. I think chiropractic is generally an accepted form of therapy in the Soviet Union and would be highly appreciated in Russia and would have a green light.

"DC": There doesn't appear to be the same discrimination that we have here? To what would you attribute that?

Dr. Cherner: They have a socialized form of medicine. There is no money barrier, so there won't be any suppression of what is good. That is why the medical doctors are so eager to learn about chiropractic because they see the benefit of it, even on a primitive level, as they are currently administering manipulative therapy.

"DC": Obviously, there would be a concern that care must be exercised in maintaining adequate teaching methods and standards of care. What is being done to insure the proper development of these critical standards, as far as any programs currently in discussion with the Soviet Ministry of Health?

Dr. Cherner: When I had that presentation in Kiev, I met Mr. Sitnik, president of Ukrvneshmed, a foreign economic export-import association for medical service techniques and equipment. He is the right hand of the Minister of Health. That meeting was a very "hot" discussion on defending how much they already know about manipulation. They tried to say, "We already have a certain level, now how are we going to determine this?" I made it clear the reason I was there was not to offend them but rather to try to help them to see what could be done about it. They were very interested. Mr. Sitnik reported our conversation to the Minister of Health. The minister completely agreed that they really want high standards, and if we try to implement something, it has to be done the right way. He proposed sending 100 medical doctors already involved in some form of manipulative therapy to the United States to train as doctors of chiropractic, and maybe sometime later come back and organize a chiropractic college in Kiev. The question was: What kind of training would they need? These are medical doctors graduated from colleges and already in practice for a number of years. I told them this should be brought before my association and our presidents of the colleges to see what is really required. They tried to tell me that they were thinking of a certification program of six-months duration. When I came back and reported to Dr. Vincent Lucido, who is ACA's immediate past president; Mr. David Chapman-Smith of World Federation of Chiropractic; Dr. Louis Sportelli; and Dr. Donald Cassata, NWCC president, I found that a minimal requirement as far as the time spent by a medical doctor or physiotherapist in chiropractic school, by the Council on Chiropractic Education (CCE) rules, is two years, and that the only diploma that is given as a result of the college is a diploma of Doctor of Chiropractic. The questions the Soviets were interested in were how to get training in chiropractic manipulations in the shortest time period. They were not interested in a diploma of Doctor of Chiropractic at that time. They were asking about a certificate or something that would allow them to have only chiropractic training.

"DC": Why do you suppose they say they want high standards in manipulative care but seriously abbreviated training?

Dr. Cherner: I think it is due to financial concerns. They also asked what the cost of the program would be. They have a lack of currency so they asked if there were any United States government grants or other alternative ways of repayment. They told me that they had a contract signed with some New York hospital where they will send 100 of their medical doctors and 1,500 nurses for training in the current diagnostic and surgical techniques on the recently purchased equipment.

"DC": Who is subsiding that program -- the U.S. government?

Dr. Cherner: I'm not sure. I think it is privately subsidized through the hospital. These 100 doctors and 1,500 nurses will be trained in the United States for 6 months, and after that they have to stay for 6 months and work here in the United States as a means of repayment.

"DC": So, the primary obstacle right now or the primary objection would be financial constraints, not so much the time for the training but the money?

Dr. Cherner: Yes, definitely. Besides the cost of tuition, books, and equiipment, they would have additional expenses like room and board -- how they would live while they studied in the United States. It is a very sensitive issue for them. They really tried not to show it, but I felt that is exactly what the problem is.

Later on, Mr. Sitnik visited the United State at the end of July and beginning of August. I had two telephone conversations with him, and when I told him that two years is a requirement, he became very discouraged. Another thing that happened was his trip to Chicago was canceled; he was planning on visiting National Chiropractic College. That didn't happen. Maybe it was the discouragement or maybe they just didn't have extended visas.

"DC": Is Mr. Sitnik expected to return to the United States again soon?

Dr. Cherner: Yes, he comes quite often.

"DC": Perhaps he can arrange to visit a chiropractic college at that time.

Dr. Cherner: That's true, you know, but what is important is the communication must be maintained. They have a contact with me, and if I don't keep up the communication there will be no future developments. It is very difficult for me because I am not in the position to do it on my own. I cannot say that I am truly representing the entire profession, and I think the associations have to get involved.

"DC": Again, from your point of view -- I know that you talked about the globalization of chiropractic -- do you foresee a day when there will be a chiropractic college in Kiev, as Mr. Sitnik and the Minister of Health have indicated?

Dr. Cherner: I think it could be easily established within the next two years. With the proper support a college of chiropractic could be a reality.

"DC": Obviously, as stated, this is not a one-man effort. This is a situation where a great deal of support is needed. What can the established associations and the colleges do to assist?

Dr. Cherner: The World Chiropractic Federation, Mr. David Chapman-Smith; the ACA; and/or ICA must step forward and take the responsibility of establishing chiropractic in the Soviet Union. They should let me know if there is interest and offer whatever support they can. If there is any way we can get some money through the U.S. government, it would be good.

I want to thank with all my heart, Dr. Joseph Sweere, the director of the Department of Occupational Health; Dr. Donald Cassata, president of Northwestern College of Chiropractic; and Mr. Jim McDonald, NWCC vice president of Clinic Affairs, who supported me when I was going there. My Minnesota Chiropractic Association supported me also. The college offered two tuitions at a 50% discount. I just read in the paper that Life College offered two tuitions at no cost. I think if these effort could be combined, we really could achieve chiropractic globalization, a new college in the Soviet Union -- a new profession. It is so exciting.

"DC": I also understand that another exciting result of this trip to the Soviet Union was they invited you to come to the Goodwill Games, up in Seattle. Tell us about that.

Dr. Cherner: When I was in Moscow, I met with Mr. Kolesov. He is the chief of staff at GOSCOMSPORT, the National Sports' Association. We were talking about how chiropractic is effective in sports' medicine and that it is not used today in the Soviet health care system. He was very certain that chiropractic could be beneficial for the Soviet athletes. He asked me if I would come to Seattle and work with the Russian National teams in Seattle during the Goodwill games. I couldn't go for the entire two weeks; I stayed for four days. The results were just tremendous. I started to work with the athletes on the second day. On the third day I saw quite a few athletes but then started treating the entire delegation. I treated the cosmonaut, Popovich; the coaching staff; and probably half of the medical staff. I had a line of people all day and finally I quit at midnight. I was the only DC who was working with the Russians. There were two other DCs, Drs. Daniel Nelson and Julia Hanson from the Seattle area, who worked with the other athletes. There were 70 medical doctors assigned and only 3 chiropractors. I treated the chief of the medical staff, Dr. Roy Farrell, and he was very surprised that there was always a line of athletes to use our services while the medical doctors were standing around getting bored.

"DC": Was that the first adjustment he had ever received?

Dr. Cherner: He said it was the first adjustment he had ever received and before he got on the table he said, "Look, I have this disc between the fifth and sixth vertebrae that was operated on." I told him, "Don't worry, I won't touch it." So, he received his first adjustment. At the end of the games he came to our room and said, "You know, I really understand now, there should have been 70 chiropractors and 3 medical doctors. Dr. Farrell was the head of the medical staff for the entire medical services for the Goodwill games.

"DC": It sounds like a remarkable experience. Is there anything else that you would like to share before we conclude?

Dr. Cherner: I think it was a tremendous experience, both going to the Soviet Union and participating in the Goodwill games. I have also been offered to be a chiropractor for the Soviet national teams during the next Olympic games in Barcelona, Spain, in 1992. I was also invited to do a seminar for the entire medical staff of all the national teams in Moscow for a week. In conclusion, I feel that effort from the entire profession has to be made if we want chiropractic to be truly globalized where countries will be able to use chiropractic in the form of socialized medicine. I think that if we combine our efforts, and are given enough support, we could really make a universal name for chiropractic.