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How in the world is chiropractic?

Worldwide Perceptions of Chiropractic and How Palmer’s International Alumni are Advancing its Acceptance
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In the United States, where chiropractic was founded, the profession and its practitioners have been well-accepted for decades. The same is true in other regions of the world such as Canada, Australia and most of Europe. But what many don’t realize is that chiropractic now enjoys nearly worldwide acceptance with just a few exceptions. And Palmer’s international alumni have been working diligently for many years to ensure this worldwide success.

“Chiropractic is now well-accepted worldwide,” says World Federation of Chiropractic (WFC) Secretary-General David Chapman-Smith, Esq. “There are doctors of chiropractic practicing in more than 90 countries, 49 countries have legislation to recognize and regulate chiropractic practice, and the World Health Organization (WHO) has policy recommendations to all national governments that chiropractic should be included in their health care systems.”

Chiropractic success can be measured by new chiropractic educational programs. Recently, university-based chiropractic programs opened in a number of countries in Asia, Europe and Latin America. “These include six new programs in Latin America—two in Brazil, one in Chile and three in Mexico,” adds Mr. Chapman-Smith.

Making strides in Africa

Chiropractic acceptance is growing in Africa. A recent chiropractic success story was the formation of the African Chiropractic Federation (ACF) at the WFC Congress in Durban, South Africa, in April 2013. “Africa is the last world region to form such a regional organization,” Mr. Chapman-Smith adds. “The AFC was formed by chiropractors from 11 countries and will hold its first annual meeting and seminar in Nairobi, Kenya, April 2-4, 2014. Nairobi’s nine doctors of chiropractic include recent Palmer graduate Dr. Hamisi Kote Ali (Davenport ’12).”

Additionally, Naa Asheley Ashietey, D.C., Davenport ’11, who is currently practicing in Tema, Ghana, has been elected president of the West African Chiropractic Association (WACA). The WACA was created in April 2012 with a mission to unite the chiropractors in Ghana to form a stronger force to work on getting a separate and distinct legislation for chiropractic in Ghana. The new association is also working to create more awareness of chiropractic within the chiropractors’ communities.

African chiropractors at the formation of the African Chiropractic Federation.
Group of African chiropractors

Another international organization, World Spine Care, founded in 2008 through the inspiration of Scott Haldeman, D.C., M.D., Ph.D., Davenport ‘64, is providing access to chiropractic around the world. (For more information, see the article in the Spring 2012 Insights.) Its initial projects are in the village of Shoshong, Botswana, and in Ranthambhore, India. The chiropractic clinic in Shoshong has been serving residents in the community for several years. The first student from the region is expected to begin studies at Palmer’s Davenport Campus this fall through a Palmer scholarship.

International Challenges

But these successes are countered by challenges, especially in Asian countries and small pockets of Europe. “The fight for recognition continues to be difficult in Japan, South Korea and Taiwan, where numerous medical and non-medical practitioners oppose the development of chiropractic, and in central European countries such as Austria and Hungary, where spinal manipulation is restricted to medical doctors by law,” Mr. Chapman-Smith says.

It may be tempting for individual chiropractors to take up the banner of chiropractic in countries where its practice is suppressed or even illegal, but that’s not always the best way for the profession to gain broader acceptance, cautions Mr. Chapman- Smith. “The WFC is working with the WHO and the relevant national and regional chiropractic organizations, and these battles will be won over time,” he says. “It’s sometimes counterproductive for well-intentioned individual chiropractors to take independent action. It’s important that they work through established professional organizations.” Individual chiropractors can, however, encourage people to pursue a career in chiropractic, whether at Palmer or an educational institution in their home country.

Closing chiropractic's cultural credibility gap in Canada

In recent years, the chiropractic profession has seen tremendous success in integration and acceptance into Canada’s mainstream health care system, according to Gregory Uchacz, D.C., West ’92, Calgary, Alberta, Canada.

“In so many aspects of the Canadian system, chiropractic has gained access and acceptance as an equal partner,” he says. “We’ve experienced this in the delivery of services, in research opportunities and in policy-making decisions. Virtually all of these were opportunities presented because of greater integration of chiropractic.”

Despite this progress, challenges remain for chiropractic in Canada. “In the past two decades we’ve made incredible gains in chiropractic acceptance, and many chiropractors have tremendous personal credibility and are excellent ambassadors for the profession,” Dr. Uchacz says. “However, the profession is still hindered by a lack of cultural credibility. Chiropractic as a profession needs to gain greater cultural credibility in order to gain a higher level of public access.”

A closer look at chiropractic in Australia
magnifying glass over Australia

How well-accepted is chiropractic in Australia? Australia is one of the countries in which the use of chiropractic is substantial and its popularity increasing, reports a recent article, “Chiropractic in Australia: A Survey of the General Public,” published in the September 2013 issue of Chiropractic Journal of Australia.

This most recent survey of chiropractic, which included 757 respondents, found that “Chiropractic is a thriving profession in Australia … A considerable number of Australians already utilize chiropractic services. Encouragingly, the vast majority of these consumers are satisfied with the service provided. … A more active approach should be taken by chiropractic practitioners and institutions to improve the general public’s knowledge about chiropractic.”

This research demonstrates a widespread acceptance of chiropractic in Australia, though there are some hurdles to overcome. “There’s now national legislation covering chiropractic in Australia, which was formerly state-based,” says Dennis Richards, D.C., Davenport ’78, the president of the World Federation of Chiropractic and a practicing chiropractor in Tweed Heads, New South Wales. “The Chiropractic Board of Australia is one of 15 health profession registration boards that are part of our federal government’s Australian Health Practitioner Regulation Agency. This means chiropractic is now ranked on the same level as these other professions, legally at least.”

Recent successes aside, chiropractic in Australia, as in most other countries, has its detractors. “Recently chiropractic has been attacked by pro-medical groups, which have been able to generate biased coverage in the media, including on several TV programs,” Dr. Richards says. “The attacks are particularly related to efficacy, safety and chiropractic care of children. The Chiropractors Association of Australia has responded and it’s not clear whether these attacks hurt or help chiropractic. Some chiropractors report increased inflows of new patients after this 'bad' publicity.”

There also is continuing concern among Australian chiropractors that the principles of chiropractic philosophy are not well-taught at some Australian chiropractic educational institutions. “It’s important that Palmer alumni promote the passing down of this philosophy to students, so they understand who they are as chiropractors and what they exist for,” he says.

Palmer alumni have a long history of leadership roles in Australia at the state and national levels, as well as internationally. “Since 1998, there have only been two years when the presidency of the Chiropractors’ Association of Australia (CAA) has not been filled by Palmer graduates,” Dr. Richards says. “Dr. Laurence (Laurie) Tassel, Davenport ’85, served in that position between 1998 and 2002; Dr. Andrew Lawrence, Davenport ’80, between 2002 and 2005; I served between 2005 and 2009; and Dr. Tassel assumed the office again in 2011. Dr. Joe Ierano, Davenport ’97, is president of the New South Wales state branch of the CAA. I currently serve as president of the World Federation of Chiropractic and Dr. Tassel and I are both on the WFC Council.”

With all of this progress, what remains to be done to advance chiropractic in Australia? “From my perspective, the task and my goals are always the same,” Dr. Richards says. “The lives of the people of the world will be better if they have access to quality chiropractic care. Chiropractic’s safe, gentle, effective and natural approach truly promotes health. We should be playing a leading role in simplifying and spreading the understanding that health mainly comes by living healthy lifestyles. D.D. Palmer described chiropractic as a philosophy, science and art. We need to be the best we can be at each of these, and to pass on that understanding, knowledge and skill to the next generation.”

Enormous potential in Eastern Mediterranean and Middle East
Dr. Stathis Papadopoulos addressing delegates at the multidisciplinary meeting at the Jordanian University of Science and Technology on April 25, 2010.
Dr. Papadopoulos speaking from podium

There are relatively few chiropractors practicing in the Eastern Mediterranean and Middle East region, and no educational institutions at present. It will take time for the profession to attain the level of acceptance it enjoys in either the U.S. or Europe, says Efstathios (Stathis) Papadopoulos, D.C., FFEAC, FICC, Davenport ’81, Lefkosia, Cyprus. Dr. Papadopoulos is the president of the Eastern Mediterranean & Middle East Chiropractic Federation (EMMECF), formed in 2010. “The potential for expanding the chiropractic profession in our region is enormous,” he adds. “We’re still at the pioneering level.”

When Dr. Papadopoulos was elected regional representative to the World Federation of Chiropractic (WFC) Council in 1991, there were only a few well-organized national associations in the region, and in most countries there were only one to three individual chiropractors “practicing quietly and keeping to themselves,” he says. “I decided to personally visit each country, find the individual D.C.s and convince them to form national associations to have someone representing the profession on the ground. I also encouraged them to apply for membership in the WFC to have access to its support and specific advice when contacting their government or facing medical or other opposition.”

Efforts continue to create an educational institution in the region. In 2010 there was a major undertaking by the Jordanian Chiropractic Association, supported by the EMMECF, the WFC and Canadian Memorial Chiropractic College, to create a chiropractic program at the Jordan University of Science and Technology (JUST) in Irbid, Jordan.

“We had good cooperation from the university and all involved, but unfortunately due to political instability we could not get the program started,” Dr. Papadopoulos says. But some good came out of the effort as the EMMECF was formed by representatives from 11 countries at JUST on April 25, 2010. “It was a historic decision,” Dr. Papadopoulos says. Founding members were Bahrain, Cyprus, Egypt, Iran, Jordan, Lebanon, Palestine, Saudi Arabia, Syria, Turkey and the United Arab Emirates.

“Palmer College of Chiropractic helped us significantly by sponsoring the EMME meeting in Egypt in 2008,” he adds. The meeting featured a two-day extremities and imaging program presented by Dr. Ed Feinberg, West Campus professor, and Dr. Tracey Littrell, assistant professor, Davenport Campus. “Here I must express our thanks once more to the Palmer Board of Trustees for its much-appreciated support,” Dr. Papadopoulos says. “Conditions are now maturing for a chiropractic education program to be started in Turkey and possibly also in Dubai.”

A noteworthy milestone for the EMMECF, the WFC and the profession was the 5th Annual SPINE Conference (SPINE is the regional affiliate of the North American Spine Society, representing spine surgeons and other orthopedic specialists in the Near East area) in Beirut, Lebanon, in June 2012. It was jointly sponsored by medical spine societies from the Middle East, the North American Spine Society, the EMMECF and the WFC. “Following this successful meeting, the two chiropractic organizations were asked to sponsor the 2013 SPINE Conference, and a number of surgeons received their first chiropractic assessment and treatment,” Dr. Papadopoulos adds. “Chiropractors also have been invited to become members of SPINE member societies.”

European Leadership

Generally speaking, chiropractic is more accepted in Western Europe than in Central and Eastern Europe, mainly because there are no chiropractic colleges in Central and Eastern Europe. “In Western Europe, national associations of chiropractors got together as early as 1932 to establish the European Chiropractors’ Union (ECU) as a regional body—initially Belgium, Denmark, the United Kingdom and Switzerland,” Dr. Papadopoulos says.

He adds that the ECU “is the prime example of a well-organized regional organization. It acts as the nervous system for its 20 member countries. We need the three levels of organization for the proper development of the profession: national associations, regional bodies and global ones such as the WFC. The main purpose of the ECU, and all other regional bodies, is to unite the profession, promote university-based chiropractic education and research, uphold the professional standards, and promote chiropractic legislation and regulation in their region.”

But, as the WFC’s David Chapman-Smith points out, some challenges remain in Europe. This was reiterated by Dr. Papadopoulos: “In some European countries, such as Austria and Hungary, chiropractic is restricted to medical practitioners by law,” he says. “This is where our profession needs total unity, good organization and capable leadership to face these issues nationally as well as at the European Union and global levels. I’m confident that with the recent decision by the ECU to create the post of secretary general, and the appointment of Dr. Richard Brown, who’s both a chiropractor and a lawyer, in that position, the ECU has strengthened its organizational ability and the future is much brighter for the European countries. In fact, I can confidently state that Europe is a step closer to becoming the leading force in the profession.”

Some examples of European successes include:

  • Switzerland has the highest level of training for chiropractors in Europe with a six-year program at the University of Zurich followed by a two-year mandatory graduate education program. Switzerland also has the widest legal and reimbursement rights in Europe.
  • In 2011 the ECU succeeded in achieving a European Standard for chiropractic awarded by CEN, the European equivalent of the ISO. The CEN/TC 394 acknowledges chiropractic educational competencies including preparation for diagnosis and primary care practice.
  • The 2012 SPINE Conference in Beirut opened the way for Eastern Mediterranean chiropractors to join their national spine societies as full members, which, if handled properly, will open the door to closer cooperation with M.D.s and others in their health care systems.
One Alumna's perspective of chiropractic in Peru
Dr. Emily Broniak (center with spine) and Dr. Lindsay Mack, Davenport ’12, (back row, second from left) with volunteer firefighters in Trujillo, Peru.
Drs. Broniak and Mack with volunteer firefighters

Emily Broniak, D.C., Davenport ’06, began working with a group of chiropractors led by Liam Schubel, D.C., in March of 2006, just five days after her graduation from Palmer’s Davenport Campus. She’s a chiropractor with Centro Quiropractico Schubel (CQS) in Northern Peru. CQS now has 14 offices in Peru and two in the Dominican Republic.

“There are so many people who need help,” Dr. Broniak says. “More than 30 million people live in Peru and there are probably less than 50 chiropractors.” She began working in Lima, Peru’s capital, and stayed there for two-and-a-half years. During that time she cared for many patients who had traveled more than 10 hours by bus to reach the capital city for chiropractic care.

She and her colleagues soon realized they needed to bring chiropractic centers closer to the people. During the past five years, Dr. Broniak has been closely involved in opening CQS chiropractic offices in northern Peru. “We now have four offices in three cities—there are two offices in Trujillo, one in Chiclayo and one in Piura.” In all of these areas, the chiropractors work hard to educate community residents about chiropractic, including talks to groups of every size, and appearances on national and local radio and television programs.

Dr. Broniak was inspired to go to Peru “to serve those without access to chiropractic care” after a Palmer Clinic Abroad Program trip to India in 2005. “I wanted to be able to practice like that all the time instead of taking time off and traveling to a distant place in order to do it,” she says. “I’ve started partner programs with orphanages in every city where we have offices. In Trujillo we’ve been adjusting children in two different orphanages since 2008. It is so fulfilling to know that taking care of a child’s nervous system can give them the ability to think, function, feel, grow and develop to be the best person they possibly can be … and this can mean the difference between a marginal life and an outstanding life where they contribute to society.”

The group cares for all types of patients, from children to senior citizens, and those from all walks of life, including volunteer firefighters. “In Peru there are only volunteer firefighters; the country doesn’t have the infrastructure or resources to pay them for their services. About three years ago we began offering free chiropractic care to any volunteer firefighter in Trujillo in order to appreciate what they do for the community.

Dr. Broniak says they are always looking for more chiropractors to join them in Peru or the Dominican Republic. Visit schubelvisionworldwide.com/associate.html if you are interested in working with CQS.

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