Chiropractic Helping to Improve Public Health in Buffalo, N.Y.

A long-standing principle of public health and an important concern of the American Public Health Association (APHA) is the provision of health care services to underserved, needy populations, including so-called "inner-city" target areas. Participation in public health programs, particularly when they are multidisciplinary in nature, is an ideal way for chiropractors and the chiropractic profession to provide a valued and much-needed public service while at the same time demonstrating a true commitment to the public health agenda. Community outreach in neighborhood clinics can benefit people who would otherwise never lack the resources to obtain and experience such quality health care.

The Lighthouse Free Chiropractic Clinic, sponsored by the New York Chiropractic College (NYCC), has been going strong for more than one year, helping the overall wellness of the poor, ethnic minority residents of the East Side of Buffalo, NY. The chiropractic clinic is part of a multidisciplinary facility called the Resurrection Health Center, started by Pastor Charles Beigner of the Resurrection Lutheran Church.

The facility handles a variety of health needs for this population. It houses the Lighthouse Medical Clinic, sponsored by the University of Buffalo, where medical students administer free care to the poor. The University of Buffalo Dental School provides screenings to improve the dental health of this patient population. Additionally, mental health needs are addressed here by Samaritan Pastoral Counseling.

The Lighthouse Free Chiropractic Clinic is helping to address the neuromusculoskeletal and public health needs of the poor, ethnic minority population in this area. In its first year of existence, the clinic provided 1,023 adjustments to the needy. Interns from NYCC delivered that care under the supervision of an experienced, licensed clinician (this author), and received credits toward licensure eligibility. Additionally, numerous evidence-based pamphlets and bits of advice were given on topics such as nutrition, cancer screenings, STDs, postural improvement, etc. Providing overall wellness care to this long-neglected population has brought with it a wide variety of challenges and a great deal of very demanding work.

Initially, the goal was to build up the clinic, which was done in a myriad of ways. The Resurrection Lutheran Church promoted our chiropractic services in church newsletters and in sermons from the church pulpit. We conducted numerous direct mail campaigns, spoke at various community organizations, and received referrals from local hospitals and doctors, and the internal referrals gradually increased. A referral base from a local medical doctor, Myron Glick, MD, grew considerably after we were the practitioners who first diagnosed an ACL tear, which was later confirmed on MRI.

As the patient base continues to grow, the interns are being exposed to a wide variety of cases, some of which would likely never be seen in a typical chiropractic office. The cases we have worked on are very diverse and often very acute in nature. One never knows what type of case will walk in the door on a given day in this clinic! We have had patients with C1-C2 instability, cervical fusion, Behcet's'disease and Ehlers-Danlos syndrome. We also have handled numerous cases of common neuromusculoskeletal complaints, multiple disc herniations, facet syndrome, fibromylagia, DJD and lumbar sprain/strains.

Patient management can be an unexpected and unusual challenge. With some cases, it has been difficult to get an accurate or forthright, candid history, which can make diagnosis more difficult. We have had some patients who spoke little English - mostly Arabic and Spanish - making history-taking even more of a challenge. Some patients have mental and social problems as well. Trusting our orthopedic and neurologic testing and chiropractic palpation skills with diagnostic imaging as appropriate has often been the key. Additionally, we have even identified a few malingerers who were apparently attempting to get an exaggerated disability rating or a high no-fault legal payout. Identifying such cases also is a community service, and sharpens our clinical acumen and reputation.

Perhaps most important, the patients themselves are very appreciative of the services provided at the Lighthouse Free Clinic, and often have expressed their hope to see chiropractic care continue far into the future in this setting.

Doctors of chiropractic can learn more about public health concepts, programs and projects, as well as identify opportunities for themselves to participate in their own neighboring communities, by joining and participating in the American Public Health Association, the largest, most influential public health association in the world. Information about the APHA and its Chiropractic Health Care Section can be found at www.apha.org, or by contacting Lori Byrd-Spencer at byrd_l@palmer.edu.