– The economic conditions that support the development of chiropractic, simply explained.

Occasionally someone in the world experiences a brief moment of creative genius that propels an idea into a life-changing event. That moment happened on September 19th in 1895 when D.D. Palmer made the connection between spinal misalignments and a compromised nervous system. This revelation rapidly developed into the Philosophy, Art and Science of Chiropractic and a new profession was born.

The first fifty years saw this new profession remain almost exclusively in America. Eventually there were foreign graduates and the profession began to spread throughout the world. Interestingly enough, the rate and distribution pattern of this growth occurred primarily in Western Europe like Switzerland, France, Italy, Norway, Denmark or the UK and elsewhere in English speaking countries such as Canada, Australia, New Zealand, South Africa, Hong Kong, Singapore and the Caribbean Islands. What these countries do have in common is a large economic middle class.

There are other characteristics that can be used to explain the profession’s peculiar distribution pattern of growth. The majority of these countries were formerly colonies that did well in the post-colonial industrialization era. Still others also have a geographical advantage that favors strong International trade such as major seaports or highly skilled laborers. Further studies into modern day social profiles of countries will reveal still other identifying factors that have favored the growth of chiropractic in their country but, for the purposes of this article, we will stick to the most basic element, economics. In conducting this type of analysis we find economic profiling as the common element. The string that ties it all together is the size of a country’s middle class.

I was reading an article by a young female chiropractor that opened an office with another woman chiropractor in Costa Rica. One comment in particular stuck in my mind. She said: “At first, we were surprised by the type of patients we saw. Knowing that Costa Rica is a third-world country, we assumed we would be catering mainly to the poor people. But, while poverty exists in Costa Rica as it does in any nation, mainly we’ve attracted the middle-to-upper class population (1).” The doctor does go on to say that they frequently donate their services to the poor whenever they visit outlying villages.

This story actually narrates what is and has been occurring in all developing countries where there are primarily two dominant socio-economic classes and an ever slowly increasing small middle class. In these countries, chiropractic is an imported specialty that is only financially accessible to the middle and upper classes that can afford to pay beyond basic medical care.

There is another report about a chiropractor in the Philippines that admittedly understands this two-class reality. First he has located his clinic in the city’s most exclusive mall to attract the portion of the population that can afford his regular fee. Then, on every other Sunday at his church, he donates his afternoons to hold a free clinic for the poor. Until governments can afford to provide for a larger safety net it seems to be up to the individual doctors to step in where possible. High profile foreign missions are also a part of solving this equation when designed to include the local chiropractors.

In order to truly appreciate the effect of economics on providing a fertile ground for the growth of chiropractic it follows that a review of the economic factors in the United States could well explain much of what has occurred through out the world. Yes, the USA stands heads up above the rest of the world with the highest Gross Domestic Product per Capita (GDP/c) of around $34,000. This compares to the lower GDP/c in Canada ($23,000) and Australia ($22,000) or to the much lower GDP/c in China ($3,800) and India ($1,800). Unique countries like Switzerland ($27,000) and Singapore ($28,000) are in the upper GDP/c ranges because of their small size, highly skilled laborers and globalized societies.

Looking at the United States and referring to a study by Harvard University that outlines four economic sub-groups: the very wealthy (3%), the well off (10%), the average working person (60%) and the underemployed, unemployed or unsuitable for employment (27% – which includes the children), the benefits of a country that has over 70% of the people contributing to the tax base means that there is enough money for everyone to afford healthcare. The taxes support a broad variety of welfare and unique social programs that provide an extensive “safety net” for the entire population.

Our lesson of basic-economics-in-action is like this: the very wealthy invest their money into businesses that are managed by highly qualified and well paid, now well off people. These businesses provide jobs for the average working person in the community who can now afford the services of professionals who are able to charge a high fee and join the well off group. Everyone gets to pay a fair portion in taxes which takes care of the community needs for a high quality of life and leaves enough money left over to provide for the 27% dependant and otherwise less fortunate people.

If you live in America and need or want chiropractic care, you can get it through public and private insurance, workers’ compensation and other plans. For that matter, the same can be said about Canada, England, Australia, Sweden, etc.

However, the same cannot be said about India and China where there are two chiropractors for over one billion people. There is one chiropractor for every one million people in Egypt, Kenya, Argentina, Ecuador, Guatemala, Hungary, Romania, Russia, Turkey, Brazil, etc. If one considers the proportionate economic middle class population of these countries it becomes obvious why it has been difficult to see a rapid demand for chiropractic.

Now, there is another important factor to consider… language. As we enter this new century, only 3% of all the chiropractic students in the world are being taught in the 17% of the schools (#6) that are teaching in a language other than English. This is the one single factor, other than the size of the middle class, which has severely hindered the establishment of chiropractic in most other parts of the world. The truth is that until chiropractic is taught in or near that country the profession can almost never become truly established, or enough to reach even the poor in their midst.

Here again, the issue is economics! In third-world countries only the middle class families can afford to put their children through college. The very wealthy families however can afford to send their children abroad for college and that is how chiropractic finds its way into many developing countries today; in addition to the hundreds of scholarships provided through chiropractic colleges in the modern countries. The current challenge is to create the right dynamics that will favor the establishment of new schools in all regions and all major languages like Spanish, Arabic, Russian, Cantonese, Africans, Punjabi, Hindu, etc.

In reviewing the two primary factors that are necessary for chiropractic to have a healthy growth, namely a large middle class and access to affordable chiropractic education, we can better strategize for future growth efforts. Looking at the flip side of this equation we can also see where not to waste our energy and resources and try not to allocate the majority of our focus on the establishment of the profession in countries where the conditions continue to be unfavorable for chiropractic; to do this it may be necessary to create a sliding graph that represents the conditions of each country along this scale; to be able to say in 10 or 30 years that the overall benefit to the people of the world has been good. It’s a matter of priorities.

As the chiropractic leadership begins to absorb these concepts there will be better progress because it will result from clearer intention rather than the more random-type results that are observed. It has been said: “When things don’t change… things don’t change.” It’s not that any change is a good change; but simply, that good people can promote the right kinds of change when they are given access to good information and are courageous enough to act.

(1) A Costa Rican Chiropractic Adventure by Lara Long, DC – The Chiropractic Journal, March 2000.

– Ideas for an updated model of structuring chiropractic missions.

Chiropractic Ecotourism may well be defined as travel related activities that combine a vacation to a foreign country with a humanitarian activity. These missions are value driven experiences that bring great personal gratification for the participating Doctors of Chiropractic.

Short-term humanitarian missions are increasing in both the number of countries served and in the frequency of events in each country. There are two main groups of participants: secular and non-secular. Although motivation may vary from group to group, the common thread is purely humanitarian.

People living ordinary lives with only the occasional extra-ordinary experiences that bring fulfillment and satisfaction are finding themselves attracted to experiences that have the potential to “transform” their lives. Transformational experiences sought by the religious participants help them reach a closer experience and relationship with God through service to the needy. Transformational experiences sought by non-secular individuals help nurture their humanitarian tendencies and possibly also are opportunities to get closer to God.

Short-term humanitarian missions offer both physical and emotional experiences that provoke serious introspection in re-evaluating one’s “purpose in life” or one’s sense of placement in their community. For chiropractors, as in other healthcare and service oriented disciplines, the desired outcome of donating one’s time and money to participate in these missions is also to renew their dedication to the “reasons why they became a chiropractor in the first place.” In all cases we see successful outcomes.

Since we have seen more of these missions in the latter part of the 20th Century it is safe to assume that primary mission goals are being achieved. The question today is: “Do these goals serve the greater good?” What are some of the primary mission objectives?

1. To reach more prospective religious converts through healthcare services.
2. To renew a practitioner’s motivation in their profession by donating their services to the needy.
3. To acquire an appreciation for how good life really is at home after experiencing first hand the world’s poverty.
4. To increase awareness of the benefits of chiropractic care.
5. To participate in the healing of people without financial gain. (Humanitarian service)
6. To get away for a vacation that has greater personal satisfaction.
7. To visit new places and become exposed to different cultures.

As you can see, existing short-term missions are successful in achieving these personal objectives, but the questions of lasting benefit to the people served and the chiropractic profession as a whole also needs to be raised. Do short-term missions really help the intended target population? How can these missions be designed to produce a greater benefit to the establishment of the profession; which ultimately translates into more and better care for the patients?

It is always heartwarming to hear the reports from mission doctors about their renewal in the simple, beauty of chiropractic and, in particular, about some of the spectacular and miraculous results received by some of the individuals following their first chiropractic adjustment, especially the children. As doctors we have learned to personally appreciate the value of lifetime chiropractic care so it must be heartbreaking for the participating doctors to leave a population without care once the mission is over.

Short-term missions are just that… of short duration. What can be done to raise the outcome of missions to create more regular access to care? In answering these questions, several inspired DCs have attempted to create a network of some sort where a number of doctors could rotate into a permanent clinic location. They are finding this goal very difficult to accomplish and have to settle for scattered return trips with often, small groups, and admittedly, a hard task that is financially and emotionally depleting.

Reaching across borders, oceans, great distances and cultural differences presents many challenges. It takes resources and reserves of money, people, time and opportunities. We will likely continue to see an increase in foreign missions. How can these dedicated DCs meet the demands of today’s mission needs? Networking and sharing experiences and resources is a good place to start. Adopting an updated mission structure is the next step to take, one that addresses the deficiencies of older models and also takes partial responsibility to be a stakeholder in the establishment of the profession of chiropractic in the target countries.

Today’s researchers and businessmen and women have learned the value of “outcome based” designs for their work. If we really want to bring chiropractic to other countries it will require designing a mission structure that places patients’ needs first, the professional needs second and personal needs third. Since we’ve already established that personal needs are being met, let’s look at the other two areas.

Patients’ needs are pretty simple: They want access to a doctor when they need one. A doctor who is affordable and who is willing to become a part of their community. It’s really no different than what patients expect of their doctors where chiropractic is established.

The profession needs six things from short-term chiropractic missions:

1. Attract qualified doctors who may become permanent additions to the country’s roster. Let the DCs know that they are welcome to come back and become a part of the pioneer effort in that country.
2. Attract prospective students to the profession from the attention and PR produced by the event. Schedule regular “special student sessions” at local universities or have people return after the day’s clinic hours for a student talk.
3. Local DCs need to be included in the planning stages and their clinic advertised to the patients who are treated by the mission team. (So patients will have a place to continue care.)
4. Respect the authority of the local DCs and tap into their contacts but mostly use the “dignitary” status of the mission to further the cause of establishing the profession in a more formal or official capacity.
5. Only bring licensed doctors to treat people and be fully documented at all times. The only exception is when a DC schools structures a clinic environment within the mission group and even then, only senior interns who qualify and receive school clinic credits.
6. Make the mission a series of highly publicized events in each location. High profile events reach more people and have the best results across the board.

Humanitarian missions have left many of the existing practicing DCs with mixed feelings. If we are to extend the concept of outcome oriented activities, there could be special consideration made for the doctors who are pioneering chiropractic in the developing countries targeted by mission groups.

Chiropractic is only regulated or officially recognized in about 30 countries. These are largely “northern countries” with an advanced industrialized economy. In the other 65 countries, where chiropractic is not legislated, there is nothing to stop anyone from misrepresenting themselves as chiropractors. This is why mission participants need to be documented.

Understandably, pioneer DCs may not feel entirely comfortable with receiving too much attention since they actually live with the fear or the risk of sanctions by the local government should a chiropractic group create undesirable results. Always include the leadership of the existing DCs in any activities where chiropractic services are being delivered to the local population. They may have no interest in participating in the mission or it’s planning; being tied up with their own practice and families. Or, just the opposite, they can be a valuable ally and a primary contact. Either way, they are entitled to be notified and invited.

The New Chiropractic Pioneers – Part 1

By Michel Tetrault, DC – Chiropractic Diplomatic Corps

*** A series of articles designed for chiropractic students and others interested in foreign practice.***

As we observed the turn of this century, we find around 15,000 students enrolled in chiropractic schools and 69,000 Chiropractors in practice worldwide. The USA has 13,000 of the students while there are only 400 students enrolled in the 6 recognized schools located in non-English speaking countries. 85% of the DCs are in the USA and only 5,000 DCs are located outside of the United States and Canada. There are more DCs in practice in the state of Indiana than in all of Asia, Africa and Latin America combined.

This is the first of a multi-part article on “Practicing Abroad.” It is our desire to inform you, as students, of the opportunities and responsibilities of a foreign practice. Undoubtedly, it is hoped that these brief articles will either stimulate in you an interest in practicing outside of the USA and Canada, or strengthen your resolve, if you already plan on practicing abroad. There are many opportunities in chiropractic during the next century to be found outside the USA. Under the current global economic standards, the world can support upwards of 350,000 chiropractors and we have met only 20% of that total.

The Chiropractic Diplomatic Corps, a humanitarian, non-government, international organization, has set up an Internet based “Foreign Service Registry.” Some 500 DCs and students (10%) have registered their desire to practice abroad in 65 different countries. The majority expressing interest in Europe (43%) with the balance requesting Asia (27%), Latin America (28%) and the last 2% looking at Africa and the Middle East. Fifty percent of the registrants have been in practice less than three years or are still in school. Thirty percent have been in practice 4 to 10 years and the remaining twenty- percent in practice over 10 years.

Imagine being a DC in the early 1900’s? That same opportunity to pioneer chiropractic is just a plane ride away, offering you the chance to be a leader and to nurture the growth and development of chiropractic. See yourself respected as a drugless healer and treated according to the degree of education and social position you could earn as a valuable player in the future of chiropractic. If you don’t think these are tangible goals in your hometown, think again, think differently or think abroad.

Your thinking decides your success in life. If you go back to hometown USA and accept the status quo or practice where everybody else wants to be, you will create one type of reality for yourself. On the other hand, when you step “out side this box”, when you go where very few have gone and little is familiar to you, this foreign environment breeds creative and adaptive traits, evoking your noblest efforts. You are literally forced to think differently and, in so doing, create a different future for yourself. Up to the challenge? Three challenging areas come immediately to mind: language, time and finances.

The first major subject to consider is language. Chiropractic needs to be communicated to people in their own language so you should determine if you have the aptitude to learn another language; and one language in particular. Some of you already speak this “particular” language because of family heritage, previous travels or personal interest. The next two major challenges are time and money. That is: “When will be the best time for you to move abroad (or back home) and when will your finances support the move and the new practice?” Speaking to the “back home” crowd, statistics sadly report that only 30% of the foreign students who were provided full chiropractic scholarships returned home to set up practice after graduation. Until there are schools that teach chiropractic in every major language and in every region on earth, American Schools will need to see a greater percentage of their graduates establishing a foreign practice. If you are a foreign student or here on an international scholarship, please recommit yourself to your people and bring them chiropractic the way only you can. Are you willing to let foreigners decide how chiropractic is to be developed in your country (in your absence)? Besides, America is not the land of golden opportunities it once was. The opportunities for chiropractic are beginning to see a rising potential in less serviced countries.

The next upcoming sections will discuss the needs for humanitarian services and thoughts on future planning which include you and your family semi-retiring in your favorite country, for those who wish to wait before practicing abroad. Later, detailed steps involved in setting up a foreign practice will be outlined. If you wish more information, you are invited to further check this Chiropractic Diplomatic Corps’ web site. The current global statistics on the state of chiropractic are available there, along with links, articles and much, much more.

 

The New Chiropractic Pioneers – Part 2

This article focuses on available humanitarian programs and other things you can do in the future about bringing chiropractic to under served countries. It is completely understandable that you wish to practice in your home state or other location in the USA or Canada. Many doctors have a successful experience in practice for 15 to 25 years, then find inside themselves the desire to “reach-out to do more” for their personal fulfillment and are now looking to start over in a foreign country. Many of you reading this article right now will be in exactly such a position, years down the road. Here are a few suggestions to keep that spirit of “service” alive in you over the years:

Mission programs.

There have been many, many chiropractic mission programs where several DCs fly into a country and provide humanitarian care to the indigenous people. Some are exclusively comprised of chiropractors and others are medical missions, which have added a DC or two to their team. Life University’s “LAW: Life Around the World” and Palmer College’s “CAP: Chiropractic Abroad Program” have on-going, short-term missions that involve students AND graduate doctors. This trend will increase in the years-to-come; so, you can always plug into these schools for the experience. Coping with State Law issues, insurance issues, competition issues, IRS and other business-related issues, etc. can turn off a “turned-on” Chiropractor. The personal gratification reported by those who have participated in humanitarian missions is beyond words and will keep that giving side of you alive, as you maintain a regular Western practice.

The Christian Chiropractic Association has been very active for many years with their ongoing missions in Poland, Ukraine, Nigeria, Mexico, Bolivia, Columbia, Costa Rica, Jamaica, Hungary, Haiti, El Slavador, Ecuador, and the Dominican Republic. Also, there are also several privately organized expeditions that go to such places as El Salvador, Panama, Peru, India, Nepal and the Philippines. So, there will always be opportunities for you to participate with a variety of organized humanitarian efforts. This is an excellent way for you to visit and experience the cultures and consider where you may wish to return and establish a permanent practice down the road. It is recommended that you keep on file the Internet resources of the Chiropractic Diplomatic Corps’ web site address so you can inquire into the listing of Chiropractic Missions.

Humanitarian help begins in your neighborhood.

Another way to serve the needy, without the costs associated with travel, is to look in your own community. There are several ways to provide humanitarian care in your practice by dedicating one or two slower mornings per week as “community care”, “free clinic”, “children’s clinic” days on a “sliding scale” or “low fee” basis. You can consider donating several hours weekly at a homeless shelter, battered women’s shelter or Migrant Worker Center in your community. As you get involved with local service clubs and your local Chamber of Commerce, you will develop the contacts that will expose you to the needs within your community.

Travel and learn another language.

Not everyone is interested or motivated to have a foreign practice purely for humanitarian reasons and that’s perfectly fine. Taking a break from the practice by vacationing and traveling abroad is a fun and fulfilling experience. You will get more out of your travels by also learning the language, getting you close enough to the locals to enjoy their culture in greater depth. It comes as no great surprise that you will probably find yourself attracted to a particular country and culture. Eventually you may desire to bring chiropractic to one of the countries you visit when you find yourself ready for a foreign practice.

Chiropractic is a wonderful profession, full of diversity and personal gratification. The bottom line: “We need more DCs in foreign practices and we will coach anyone who is willing to go forward with this endeavor.” Those who feel they have the personal integrity and commitment to bring chiropractic to the under served will find inspiration in the next sections. The next article discusses criteria useful in making a proper country selection.

 

The New Chiropractic Pioneers – Part 3

It may come as a shock to our young or new people to the profession that chiropractic is only established in a handful of countries (USA, Canada and Australia and a few in Northern Europe). Although there are one or more DCs in some 90 countries, only 30 have laws that recognize chiropractic as a legitimate profession. Yet 65 countries have only one DC for every 100,000 to 2,000,000 people. There are 160 countries without DCs of which 120 are too poor, too small or too dangerous to try and establish practices.

Needless to say, making the right choice in selecting a country to open a practice is a serious matter. How do you select a country that is ideal for you?

Putting things in simple terms, the greater the familiarity and the genuine affinity between the doctor and the patient, the better the choice. Blood and heritage hold the strongest bonds between people. Familiarity includes language, physical similarities and common interests. Ask yourself this question: “What group of people do I hold dear to my heart?” Unless you have actually traveled to a country or have personal experience with that culture it is difficult to know if you can genuinely care about them.

Once you can honestly say to yourself that there is a love for the people of a particular culture or country you will have begun to narrow down your choices. The next question to ask yourself is: “Can I make a decent living in that country?” The demographics (population and economy) will indicate your potential for success if you are willing to work hard.

How do you determine these facts? Go to a local bookstore and buy a travel book on the country(ies) of interest. There is a wealth of information there to familiarize you with many facts. Another source is the CIA World Book on line. You can access this link on our website at  under the section called TOPICs (Topics On Practicing International Chiropractic). Be sure to use Internet Explorer as your browser and scan the TIP BOX that can be accessed on the menu page of 24 topics.

Next, take the opportunity to travel or even volunteer in a mission to your country of interest. This will either make or break your decision because it replaces fantasy with facts. It really is your “gut feeling” that will ultimately decide if all the facts are right for you.

Language is also an important factor min your decision-making. Here the question to ask yourself is: “Can I speak or learn to speak the local language?” In some countries like Norway, the Netherlands and Germany you are required to speak and write fluently in their language before being permitted to establish a permanent practice. Many countries are accustomed to having professionals who only speak English, but a doctor must rely on translators. Obviously, it is important for doctors to effectively communicate with their patients. This has always been especially true for the chiropractic practitioner. You will have to be the judge on how critical this issue plays in making your selection.

Let us look at these questions again:

1. What group of people do you hold dear to your heart?
2. Can you make a decent living in that country?
3. Can you speak or learn to speak the local language?

Once you can fully answer these questions to your satisfaction it will become easier to narrow down your choices. After all, you can only be in one place at a time. Why not make a solid decision and plant some deep roots; your future patients deserve that. So does the profession and so do you!

In the next article we will discuss the different opportunities available in foreign practices.

The New Chiropractic Pioneers – Part 4

As a chiropractic student you carry a full plate between classes, studies, clinic, work and what’s left for your personal life. Thoughts about the future are overshadowed by the demands on your time in the present. Besides, it’s kind of hard to envision what you have not yet experienced… being a doctor in practice.

Whatever motivated you to enter the chiropractic profession may or may not be enough to feed your passion. As a practicing DC of over 20 years I am thankful for the ever-consuming love for my patients that continues to sustain me; even stronger today because the dream of a practice has become a reality and a lifetime purpose. As you think about graduating there is a sense of anticipation and even some trepidation. The unknown, “will I make it?” is sometimes a little scary.

Fear if the unknown is easily conquered with knowledge and experience. If you do not have a close relationship with your field doctor, the DC back home who encouraged you, find a local DC whom is willing to be your mentor, or at least let you spend a little time in a real clinic and observe what it’s all about.  See yourself in that role and visualize your ideal practice… a day in the life of Dr. (you). It’s important to dream because it gives meaning to your work and raises your commitment to strive and do your best. So, do a little day dreaming.

OK, stop right here! Before we go any further. In that daydreaming, where are you placing that clinic… in your hometown or in another location? If you see yourself in a practice outside of the United States or Canada, the rest of this article will be of particular interest to you. (If not you’ll still get something out of it.)

The Chiropractic Diplomatic Corps is an organization that encourages doctors to establish foreign practices. We want you to seriously consider pioneering chiropractic in another country or to join the growing number of DCs in the countries of your heritage or interest. Not everyone can go straight from graduation to a foreign practice; so, we would like to help those who can to find their way.

There are two topics that we will cover here: 1. Seeking opportunities and 2. Making contacts.

If you already have a pretty good idea of which country you’re heading for, all you need is to know what opportunities are available. There are three types of opportunities:

1. Temporary or locum assignments that last 3-6 weeks or months.
2. Associate with an established practice for a few years.
3. Starting a practice from scratch (or purchasing an established one).

There are very few requests for a DC right out of school to come and take over a practice while the regular doctor takes a leave. There are a growing number of countries that require 1-2 years of internship before qualifying for licensure. We have heard of a few situations where a doctor places a new DC in an established satellite office. These are great opportunities to gain experience in exchange for a subsistence salary, but not enough money to meet student loan payments in US currency. The good locum positions generally go to a semi-retired DC and that makes a lot of sense from the resident doctor’s perspective.

An excellent choice is to seek and associateship for 2-5 years. You could be an additional DC in the clinic or the doctor in a satelite clinic. At the end of your term you may take over a clinic, buy another one or be able to start your own from scratch. As a new graduate you stand a better chance of getting hired if you are willing to stay for several years and if you apply in person. Yes, that means go to the country and meet the doctor in a personal interview. Actually, this becomes a two-sided interview and you get to see for yourself (not sight unseen) what you’re getting into and with whom.

If you have a personal relationship with a DC in practice in your country of interest you could discuss some arrangement that is mutually beneficial. If you have no contacts you need to make inquiries with the local DC representatives. Our website has this information on every country with an established National Association and can be found in the section called Global Statistics.

yuNew graduates who can financially start on their own have either been in business before and can rely on their past experience, or have a lot of support from family and friends to guide them in those first years. Starting your own clinic doesn’t mean “going it” alone. In closing, it is important to realize that the question of experience is not a casual topic since new doctors inevitably make more mistakes. When you are the only DC in the area… YOU are Chiropractic!

Students and doctors that are listed with our Foreign Service Registry are now able to receive a monthly bulletin on International Topics.

By Michel Tetrault, DC

– A brief editorialized review of the recent WHO publication “Legal Status of Traditional Medicine and Complementary/ Alternative Medicine.”

The World Health Organization (WHO) has released its 2001 “Worldwide Review” of 124 countries and their efforts at recognizing the value of healthcare services that fall outside the recognized and highly regulated Imperial or western medicine. In this work they elected to include the current status of the chiropractic profession in each country, wherever information was available.

A notable quote from the publication can be found on page 4, where it states: “The World Health Organization encourages and supports Member States to integrate traditional and complimentary/ alternative medicine into national health care systems and to ensure their rational use.”

We are thankful for the efforts of the WHO to objectively report the representation of chiropractic in the world today in its publication. Although there may be sound arguments against including chiropractic in these other classifications, nevertheless, the WHO has elected to include the information it has received on chiropractic in its Traditional Medicine (TM) and Complementary/ Alternative Medicine (CAM) report. Chiropractic is unavailable in 160 countries and so when one looks at the lack of chiropractic presence in the majority of the world’s countries, it is understandable for the WHO to lump this emerging and growing profession at this time in history within its existing administrative capabilities. Credit is due to the major contributing organizations, in particular the World Federation of Chiropractors (WFC) and Life University for their persistent presence at the WHO over the past two decades.

The following table is a snapshot of the 189-page document outlining to what degree we find TM, CAM and Chiropractic integrated, included, tolerated or unrecognized by the respective countries in each of the 6 major regions of the globe. What does stand out is the sheer lack of exposure there really is for chiropractic in comparison to the other non-medical healthcare systems we find throughout the world and something to take serious note of.

(TM and CAM disciplines)                                         (Chiropractic Recognition)

REGION  (T#)	IG	IC	TO	UR		0	A	B	C
Africa  (44)	19	15	2	8		38	0	3	3
The Americas  (19)	9	5	3	2		12	0	3	4
E. Mediterranean  (12)	1	3	1	7		9	0	1	2
Europe  (21)	1	17	2	1		10	3	4	4
SE Asia  (9)	7	2	0	0		9	0	0	0
W. Pacific  (19)	5	14	0	0		13	1	2	3
Totals	42	56	8	18		91	4	13	16

TM & CAM:   IG = Integrated         IC = Inclusive              TO = Tolerated             UR = Unrecognized

Chiropractic:  0 = Nothing Official    A = Included in CAM      B = Partial Registration  C = Fully Protected

The majority of the non-western countries that comprise 2/3rds of the world’s population are poor and can little afford Imperial medicine and as such is where the poor see their traditional healers. In looking at the regions with the greatest utilization and acceptance of TM and CAM services such as SE Asia, W. Pacific and Africa, TM and CAM are strongly accepted by their governments and integrated in national healthcare policies. This is in direct contrast with the European and E. Mediterranean regions where laws continue to allow the monopolization of Imperial Medicine at the exclusion of all others.

One of the significant values of this report for the chiropractic profession is the specific information provided about the existing non-medical services available to the average citizen in their own country. Even though there is no duplication of chiropractic services by any other provider, we have to realize that in the absence of chiropractic services people have to go somewhere for care and when they do they frequent their TM and CAM providers. Having the knowledge of what services are already available certainly is important to know, as more and more chiropractors are willing to pioneer their profession abroad.

One difficulty faced by the pioneer chiropractors is the trend to lump chiropractic as just one more manual therapy and the challenge to educate the community about the difference offered by chiropractic care in contrast to local manual healers… i.e.: that DCs are college trained Primary Portal of Entry health care providers that utilize non-allopathic, non-drug methods of assisting their patients in regaining and maintaining their health.

The publication “Legal Status of Traditional Medicine and Complementary/ Alternative Medicine” may also serve as a useful reference text in the development of a country strategy by the chiropractic leadership. This can go a long way to understand where the prospective allies and opposition may exist in planning efforts to legitimize the chiropractic profession in a given country. There is sufficient information reported to better understand where new chiropractic patients have been accustomed to seek care and to direct further studies on these local health care providers.

An excellent example is the study of the Filipino hilots by John O’Malley, DC, PhC extending from 1992 to 1996. His thesis has meticulously detailed the folklore and techniques of these traditional healers who continue to serve their communities today. This study was distributed to the hand full of DCs now in practice in the Philippines, to aid in their understanding of the roles played by the hilots and to foster respect for them. This type of study needs to be repeated in all counties where there are traditional healers and the WHO report does an excellent job of indicating this presence.

Out of the 258 separate countries in the world, 191 have joined the United Nations and the World Health Organization. The fact that 124 countries, about half of all countries, were able to contribute to this report one can attest to the relative value of this document. In developing better ways to effectively nurture the development of chiropractic for the many pioneers that are out there it calls for the chiropractic leadership to maintain a “satelite” perspective. When there are chiropractors in 100 countries today, in comparison to just 20 or 30 just 30 years ago, it becomes important to understand the bigger picture. Thankfully, through continued involvement at the highest levels in global healthcare we are beginning to see the fruits of years of seemingly frustrating efforts.

As readers find themselves attracted to the issues in the globalization of chiropractic it is recommended to also become familiar with the “Global Strategy for Chiropractic” that has been developed by the Chiropractic Diplomatic Corps. You are invited to read this book only available online at www.ChiropracticDiplomatic.com in Adobe format. Copies of the book “Legal Status of Traditional Medicine and Complementary/ Alternative Medicine” is available from the World Health Organization, publication #WHO/EDM/TRM/2001.2.

By Michel Tetrault, DC

The Chiropractic profession has been developing a gradual and progressive relationship with the World Health Organization (WHO) since before 1985. Initially through Dr. Gary Auerbach and at his invitation, there have been dozens of chiropractors during the past two decades who have attended the WHO’s Annual Assembly, referred to as the World Health Assembly (WHA). An even smaller group has been attending regularly over all this time and these individuals have become known and trusted by the WHO in Geneva, Switzerland.

The 1988 World Chiropractic Congress in Sydney, Australia resulted in the organization of the World Federation of Chiropractors (WFC). Now, the profession could speak with one voice on behalf of the membership of the National Chiropractic Associations at International gatherings.

There are to date only a few chiropractic non-government organizations (NGOs) that have developed affiliation with the United Nations: WFC, Life International/Life University and the World Chiropractic Alliance. There are also other NGOs that serve the international communities in varying capacities but have not sought or received official sanctions of the UN. These NGOs are primarily involved in organizing humanitarian missions to developing countries or meeting some other needs of the profession as it slowly expands into non-English speaking countries. (Currently, over 95% of the world’s chiropractors practice in primarily English speaking countries.)

What is so significant about the WHO and the WHA? Every member country of the United Nations is also represented at the WHO and sends a delegation from their Ministry of Health to the annual assembly, held every spring. These assemblies bring together the representatives who are responsible for developing their country’s health care policies and programs. These are usually the same individuals who need to be contacted and informed when it is the chiropractic profession’s intention to seek legal recognition, protection and regulation. Attending the WHA is a very cost effective way to meet several Ministers of Health in a “neutral environment” to make introductions and possibly arrange for a more formal meeting back in their office with the chiropractic representatives working in their country.

The chiropractic contingency does more than simply make contacts at the WHA. As representatives of NGOs which participate in forwarding better health care for the world, these individuals are also active in developing alliances with other healthcare NGOs and bring that “unique perspective” only found in chiropractic to the healthcare discussions.

It is wonderful to see that the WHO has taken issue with the ravages caused by tobacco in our societies by establishing a Tobacco Free Initiative currently in the framework developing stages. The intention is to draft a legally binding treaty between countries to curtail the spread of tobacco usage internationally. In the year 2000, there will be 4 million deaths attributable to tobacco usage with the projections placing that number closer to 10 million by the year 2010. Tackling life style choices such as tobacco usage is an area of “common ground” where chiropractic fits in well and can more easily build relationships with other healthcare providers. The more direct contact there is between chiropractors and doctors of other disciplines, the easier it becomes to have productive face-to-face discussions about the unique role chiropractic can play in serving our respective societies.

Fifty years ago, little was known or said about computers. Today, the number of people employed and benefiting from this industry is staggering. Chiropractic has been on this planet as a separate profession for over twice that length of time. Where will chiropractic be as a profession after a second century of existence? In spite of attempts at destroying this valuable service to humanity by organized entities, chiropractic continues to grow.

Take the United States as a measuring stick for the rest of the world. Factoring in a country’s population, economy, employment and humanitarian policies, it has been estimated that the world can currently support over 360,000 chiropractors… today. The latest statistics show a total of 81,000 DCs practicing in the world, meeting only about 23% of the profession’s potential and leaving some 150 million people without access to care they need and can afford.

The profession has finally evolved beyond the survival stages and can now look forward to a century of rapid growth; but this will take leadership and support for that leadership by the entire profession and by the patients who personally benefit from the services. Vision, commitment, coordinating resources, etc. are all qualities essential to good leadership. Willing and able bodies are also needed to take their place in delivering the services to new populations and exposing entire societies to the benefits of chiropractic care: doctors who want to care for people of other cultures; teachers who can speak more than just English to build the faculty for new schools; patient advocates who can organize humanitarian efforts and keep an eye on the profession’s actions.

If you feel compelled to step forward and offer your talents in service at the international level, it is suggested that you become acquainted with the organizations which are already on the front line. The Christian Chiropractors (www.frii.com/~cca) and the Chiropractic Diplomatic Corps (www.chiropracticdiplomatic.com) are just two NGOs who have an international presence and can open some doors for prospective DCs to investigate their interest in foreign practice. Life University (www.life.edu) has several foreign programs requiring faculty and seasoned practitioners. Palmer’s successful Chiropractic Abroad Program (CAP) exposes senior student interns to servicing foreign populations (www.palmer.edu). The WFC (www.wfc.org) lists the contact information for each member association if you are looking to research a particular country as well as formal gatherings where many countries are represented. Dynamic Chiropractic (www.chiroweb.com /international) has articles that give a brief representation of chiropractic in many countries. Today’s Internet technology makes it so easy to gather quite a bit of resources and information by computer and in the privacy of your own home.

Consider this analogy. Ever notice how driving a vehicle in first gear or second gear does not allow much momentum. In fact, NOT changing gear will keep down the speed. When a person only drives on small side roads they can never get into higher gears because of all the curves and corners to negotiate. For most of the past century Chiropractic has been maneuvering the small roads. Chiropractic has now found the on-ramp to the freeway and is approaching that speed and momentum where it needs to be prepared to shift gears and really take-off! Where is this on-ramp? It is in the International arena.

Technology has made the world a lot smaller. Travel has become more affordable making it easier for people to visit foreign lands. Organizations who are paving the way for the future growth of chiropractic need your support. The Chiropractic profession is positioned to assist and support individual DCs who wish to be a part of the pioneering efforts of chiropractic’s second century. If you cannot be a player in the international scene, you can help in other ways such as donating older equipment or visiting DCs when and where ever you travel and encouraging their work. The above organizations can make good use of your gifts.

The momentum is building and pressing for the shift into the next gear. If reading this article has made you feel a little anxious and excited, it is a good indication that your heart is trying to lead you into foreign service or even to pioneer chiropractic in another country. Opportunities to serve are just a “click” away.