Doctors of chiropractic find themselves in a moral dilemma when it comes to meeting the need for chiropractic care in so-called Third World or developing countries. A strategic plan for the profession would need to incorporate creative and innovative public health ideas to satisfy this dilemma, with the wisdom to plan and the courage to act at the core of the professional development.
Pioneer DCs have found themselves setting up clinics in or near First World pockets inside Third World cities. Other than foreign tourists and expatriates, the only people who can afford chiropractic care in poor countries are the wealthy and the budding middle class, which together, usually make up less than 5 percent of the country's total population. DCs are torn regarding the lack of access that the average working person has for chiropractic: "Do I charge less for the poor than I do for the wealthy?" Often, the answer to that question comes to about 10 percent of the usual fees, just to be affordable.
There is no perfect answer that fits every DC facing this dilemma, but as a profession, we have left these pioneer chiropractors with little options or support, and even less guidance. The challenge of developing a pioneer chiropractic professional strategy has not been taken very far, but a good place to start is to incorporate the concept proposed by the World Health Organization (WHO) in its 2006 publication: Guidelines on Basic Chiropractic Training and Safety.
One section in particular (Part 1, Section 9), on primary health care workers (aka, community health workers or CHWs), can be viewed as an opportunity for the chiropractic profession to seize a leading role in public health advancements in non-communicable diseases (NCDs) for the poor. The truth remains that in Third World countries, the working poor have minimal access to chiropractors, and the absolute poor never see the inside of a chiropractic office. So, where do they turn for conservative care to manage their common NCD issues? They have little choice but to seek out their local lay healer, bonesetter, herbologist, etc.
Unfortunately, what happens today is that young people are not attracted to assuming the traditional role of a CHW. As the aging lay healers die off, these poor communities face a growing health care crisis that will become critical in just one generation. Chiropractic, as a growing profession new to these poor countries, certainly has something to offer.
So, you ask yourself: "What on earth can a DC do in these situations?" The answer is: "Very little as an individual, but as a part of a well-thought-out plan of action, a lot more than you may have imagined!"
Why do young people shun centuries of tradition in the local communities' healing arts? The absence of a formal education that provides a certificate and official recognition for most CHW vocations is the reason offered. Hueseros, curanderos, albularyos and hilots are but a few names for these barefoot healers, but there is a diminished perception of value and social recognition for pursuing these vocations.
Since we know there is little or no chance that a DC can actually reach the entire community, the profession has a moral obligation to consider what it can contribute to helping these poor folks, even in some diminished capacity. The WHO suggests we contribute to the training of local manual therapists. The Chiropractic Diplomatic Corps has studied this option with great detail and feels strongly that the profession should confront its natural resistance to offering or supporting this type of CHW training. In fact, this could possibly be the magic bullet that will speed up official recognition of chiropractic and the DC degree, while at the same time resolving this moral dilemma faced by our pioneer DCs in a plan that is mutually beneficial.
What Should This Course Look Like?
First, it would never teach chiropractic's high-end and trade-specific icons, namely palpation and spinal adjustments. Second, it would have to incorporate, in addition to massage techniques and other bodywork, the traditional healing methods that have been passed down from generation to generation. Preserving time-honored and relied-upon methodologies must be given a foothold through this program. Third, it would have a public health component, so the average citizen could be safely serviced by the CHW and be properly referred when conditions call for that action. Basic sanitation, nutrition, oral and spinal hygiene, etc., are also important aspects of chiropractic's preventive health philosophy that can be infused. Fourth, it would incorporate special chiropractic views on naturalism, holism and vitalism. And of course, it would teach personal responsibility and common everyday lifestyles for better health and physical activities that have long been hallmarks of chiropractic's holistic approach to care.
The CDC has outlined such a course for the Philippines and is calling the graduates of this 500-hour training certification course Spinal Health Therapists (SHT). The topics of this course are:
Electives
The Filipino government has already expressed interest in and support of the certificate course through its Technical Education and Skills Development Authority (TESDA), which provides skill development of the labor, local government units, and technical/vocational institutions of the country's human resources. The government also would be responsible for eventually licensing the SHT. The Canadian government is considering financial support as part of its international aid commitments, and the chiropractic profession gets credit for initiating the work and supervising the development of the training program. Instead of a dozen practitioners from a still-unrecognized profession pressing the government to "please give us a law," we could become partners in resolving long-term public health issues. This approach is not only wise and meaningful to the people of the country, but also will likely have a more profound effect on gaining the respect and eventual recognition of chiropractic, since it will have first earned public trust.
A decade ago, this could have never been done or considered and probably wasn't even on anyone's drawing board. The World Federation of Chiropractic (WFC) has helped to see the "WHO guidelines on basic chiropractic training and safety" come into fruition and can now help to encourage its national association members in Third World countries to evaluate how this concept might apply in their unique and sovereign circumstances.
Incorporating public health objectives in non-communicable disease areas is within the chiropractic community's responsibilities. Taking a patient-centered, vertebral subluxation, profession-centered approach has always been mutually beneficial. The SHT training program is a good example of creative and innovative public health ideas. For more information on the Spinal Health Therapist program, visit the Chiropractic Diplomatic Corps Web site at: www.chiropracticdiplomatic.com/advocate.
The American Public Health Association (APHA) is a member of the World Federation of Public Health Associations (WFPHA), which works collaboratively with the WFC and WHO on common international interests. Within the APHA, there are many opportunities for chiropractors to learn more about international health opportunities and for working with multidisciplinary groups on international public health issues. Both the WFPHA and the WFC are members of the WHO and send delegations to attend the WHO World Health Assembly in Geneva, Switzerland every May. For more information, visit the following Web sites: www.wfc.org, www.who.int/en and www.apha.org.
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