Teaching Chiropractic on the Other Side of the World, Part 2

By the end of 2012, the first cohort of chiropractic students will be entering clinic to commence their clinical education. Before this happens, International Medical University will hire several more doctors for both the clinic and academic departments. I recently completed the floor plan for the second chiropractic clinic (to be started this year); this will be larger than the existing clinic, with up to 7,000 square feet and room for five chiropractors. Between this and the main clinic, we will have sufficient facilities to train entering students.

IMU will also be building a series of satellite clinics around Kuala Lumpur and eventually throughout the entire country. One of the goals is to provide employment opportunities for graduates after they finish their educational requirements.

One of the ways we measure the success of the IMU chiropractic center is by the number and diversity of referrals we receive. Through a series of favorable circumstances, a patient was referred by one of our students for chiropractic care. This patient traveled 4 ½ hours each way from Johor community in southern Malaysia, which is very close to Singapore. After experiencing one chiropractic adjustment, this 65-year-old female was able to go back to work in her garden again for the first time in more than two years. All of her neighbors, friends and relatives were surprised and pleased by her sudden recovery – and wanted to know her secret. Long story short, I now have over 100 patients who travel, sometimes in caravan, to KL for chiropractic treatment on a weekly to monthly basis. They actually make it their chiropractic travel day, leaving the house before dawn, driving 4 ½ hours to KL, receiving their chiropractic care, staying for lunch, and then traveling 4 ½ hours back home.

As our reputation has increased, so have referrals. Patients come from the extreme north of Malaysia, as well as the south and even from east Malaysia, Borneo. In addition to these, we now have patients from Singapore, Thailand, Brunei, Indonesia, Australia, and New Zealand. What makes this even more remarkable is that IMU does very little advertising. We have a fully staffed marketing department with close to a dozen staff who promote IMU education and health care by arranging public talks and health educational fairs.

For the chiropractic clinic, the main focus is on educating people about chiropractic spine health. Several times a month, the marketing department arranges for a series of free open public talks in one or more of the school's four auditoriums. Each educational program takes a turn at providing speakers for these well-attended informational talks.

About every three months, one of the doctors in the chiropractic program is asked to give a one-hour talk on different aspects of chiropractic care. In the past 18 months, I have presented six of these talks, with attendance ranging from 50 to upward of 300 people. However, even with the great attendance at these talks, more than 90 percent of our new patients are referred from existing happy patients, showing there is no substitute for word-of-mouth advertising. I cannot tell you how many times I have attended to three or even four generations of the same family in a treatment room at the same time. What a thrill it is to see the tree of chiropractic growing in a new country.

IMU is first and foremost a medical university and when first I visited here in 2009, I was extremely interested in seeing what kind of acceptance I would have as a treating chiropractor in a medical setting. I had heard a number of chiropractors in the U.S. report about the success of the Veterans Administration chiropractic program and was hoping we would receive a similar level of acceptance.

I am happy to report that all of my fears are gone and integration of chiropractic within IMU's health and education programs is beyond my greatest expectation. This does not mean there is no resistance from some in the medical community; just that the support and approval far outweigh any negative issue. I treated more MDs and their families in the first six months at IMU than I had in my previous 40 years of practice in California. One recent new patient is the director of a major hospital in KL. He is in the process of negotiating with the administration of IMU to set up a chiropractic program at his hospital, where 5th year students will be able to participate in their housemanship. This is just one of three requests we have received for chiropractic participation in hospitals in and around KL.

We are also receiving requests from some of the well-established chiropractic clinics in Malaysia to allow our graduating students access to work within these chiropractic facilities. Keep in mind that the first graduating class will almost double the number of chiropractors in Malaysia, and in a few years, our graduates will make up close 75 percent of all the chiropractors here. Of the 35 chiropractors currently practicing in Malaysia, less than a handful are actually from Malaysia. These job opportunities are very exciting and we look forward to a future of sustainable professional growth.

As we work to establish chiropractic education and health care at IMU, our next focus will be establishing chiropractic licensure within Malaysia's Ministry of Health. Currently there are no licensing laws for chiropractic as a separate healing art, and we are grouped within complementary and alternative medicine. Malaysia only has two healing art boards: one for medicine and one for dentistry. (Interestingly, to obtain a license to practice medicine or dentistry, one must also belong to the respective national association, ensuring a strong presence when it comes to dealing with political issues. This model may serve our profession well.) As our profession grows and becomes established within the existing health care system, our goal will be to have our own licensing and examining board.

There are many important issues that need to be addressed as our profession grows. One that comes to mind is that currently only a MD or dental physician can order radiographs. Although we have a well-equipped radiology department adjacent to the chiropractic center, it is illegal for me to directly send a patient for radiographs. If I have a patient who requires radiographs, I must fill out a "Musculoskeletal Radiograph Request" form, and send it with the patient to the IMU medical center for MD review and approval. Then the patient is brought back to the radiology department, radiographs are taken, and then brought back to the MD for final review and approval. Finally, after one to two hours I will have the chance to review the radiographs.

Besides the frustration for the patient, probably the most frustrating part of this ordeal is the fact that all the chiropractors here have advanced training in ordering and reading musculoskeletal radiography. In the first few months, prior to creating an appropriate form for this process, it was not unusual for the MD to deny the radiograph request completely on the basis of "unnecessary" or "not indicated." There was an instance in which the MD wrote on the request form, "Request denied, there is no fracture and no dislocation, so no indication for X-ray." My response was to ask, "How can you say there is no fracture if you did not allow the X-ray?" Fortunately, we are educating the MDs on our diagnostic knowledge, and recently had a prominent DACBR chiropractic radiologist from Los Angeles guest lecture.

IMU prides itself on the quantity and quality of its research. It seems not a week goes by that one or another department receives an international award for research or a grant for specific projects, or recognition for ongoing departmental research. A recent award went to Dr. Rebecca Shin Yee Wong as first-place recipient at the Asian Congress on Biotechnology for her research on insulin production. She was one of more than 70 international finalists and received her award in Shanghai, China, earlier this year. Rebecca is one of the biology professors at IMU and teaches biology to the chiropractic students. The chiropractic program is currently involved in one research project, with plans for several more as the number of chiropractors with research education and advanced degrees increases.

IMU is actively searching for qualified doctors of chiropractic for teaching and clinical training positions. If you are interested in participating in the growth of chiropractic in Malaysia, please visit IMU's Web site (www.imu.edu.my), where you can view the employment requirements. And if you ever travel to Kuala Lumpur, by all means visit the campus and health center. We would love to have you.

Author's Note: Special thanks to Michael Hubka, DC, FCCS(c), Associate Professor, Faculty of Medicine at IMU, who contributed substantially to the content of this article.

Part 1 of this article appears in the March 12, 2012 issue of DC.