By Dr. Geoff Outerbridge
Spine-related disorders are the number one cause of disability globally and every year result in the loss of billions of dollars through healthcare costs, diminished individual incomes, and loss of productivity in the workforce. Populations in most areas of the world, especially rural populations, have no access to conventional healthcare resources to care for spinal conditions.
Unlike many other diseases, there are no comprehensive protocols or models of care available for the treatment of the wide spectrum of spinal conditions and disability. The result is that individuals have to contend with pain and an inability to carry out normal activities of daily living without any hope for help.
When a person cannot work or provide support for their family due to back, neck, or other musculoskeletal disability, the result may be a catastrophic chain of events, the implications of which can be particularly devastating for populations that depend on manual labour for survival.
World Spine Care
In 2008, Dr. Scott Haldeman launched World Spine Care (WSC) to fill this healthcare gap in evidence-based treatment of musculoskeletal and especially spinal conditions found in under-served areas in the world.
Before long, nine academic institutions had signed on to become collaborating research institutions. Now there are more than a dozen organizations from around the world financially supporting WSC. The number of organizations and the level of support continues to grow.
In 2009, I became the WSC Clinical Director tasked with developing the clinical program and projects. Working closely with Dr. Haldeman, our team developed the WSC clinical toolkit (documentation and data collection) and the model of care.
WSC has now grown to become a large, international organization with a solid track record, an ever-expanding body of research and international recognition as a leading model for the implementation of spine care programs around the world.
The Organizational Model
The WSC‘s mission is to improve lives in underserved communities through sustainable, integrated, evidence-based spine care. The goal is to develop a comprehensive model for the primary care of spinal disorders. Each clinic aims to be fully integrated with the local healthcare system and to build capacity until the entire program is locally run, sustainable, and scalable.
The WSC model of care follows the priorities set out by the World Health Organization (WHO): attaining the highest available standard of health, improving access to care (with a target of universal healthcare), provision of evidence-based care, and offering care providers who are people-centred and integrated with other health services. WHO recognized WSC as a promising practice in 2016 and included its profile online for educational purposes and to indicate an opportunity for potential collaboration.1
The WSC team involves surgeons, physiotherapists, chiropractors, researchers, rheumatologists, radiologists, and many other stakeholders in the spine care world. Elements of sustainability that are incorporated into each site include local cooperation, interim foreign volunteers, local capacity building, and spine specialist training.
The Role of Spine Care Specialists
On the ground, we advocate for a primary spine care specialist within the healthcare team — a role that has been embraced by all of the participating health ministries. WSC clinicians increase local practitioners’ knowledge of evidence-based, integrated, people-centred care and WSC clinicians learn the local beliefs, customs, unique health challenges and diseases of the area.
WSC uses the best available evidence to guide clinical care. Using data collected from the clinics, WSC is adding to the growing body of research on spinal conditions in underserved regions. WSC has a robust research agenda and, to date, has published eight articles in peer-reviewed journals with more research papers in the pipeline for publication this year.
There are currently six WSC clinics in four countries: three in Botswana, and one in Ghana, India, and the Dominican Republic, with more in development.
Each location is unique in language, culture, and political climate. WSC takes these into consideration in adapting to local needs, while maintaining the principles and elements of the spinal care delivery model.
In 2011, my family and I moved to Botswana to establish the flagship clinics in Mahalapye and Shoshong, Botswana. The country was chosen not only because it is safe and beautiful, but also for the government, local healthcare network and community support.
Our arrival in the country was anything but ideal. The government-rented house for this fledgling project required considerable work to remove the chickens, clean out the snakes and scorpions, and fix electrical problems and leaks during the rainy season.
In March 2018, Dr. Stefan Eberspaecher spearheaded a WSC clinic in the main referral hospital in the capital, Gaborone. The Ministry of Health and Wellness offered a full endorsement and financial support to expand the spine care program to every district hospital in the country.
In the Dominican Republic, WSC opened a clinic in collaboration with a local charity in November 2014. The clinic has been welcomed by local healthcare practitioners and politicians who have secured local funding to ensure its sustainability. The Canadian Memorial Chiropractic College had been sending students to the Dominican Republic for short-term clinical experience under the supervision of Dr. Patricia Taveras, who proposed the WSC program in that country.
In 2016, Ghanaian medical doctor and chiropractor Dr. Afua Adjei Kwayisi founded the WSC at a regional hospital in Ghana. The same year, Dr. Margareta Nordin, vice-president of WSC, partnered with Dr. Rajani Mullerpatan from the Mahatma-Gandhi Mission University, to establish a WSC program in India.
Although they did not directly engage the government’s healthcare system, the Indian WSC clinic was established in a local hospital, giving clinicians full access to imaging and referral to medical professionals and specialists, and the opportunity for interprofessional collaboration.
A second clinic in India is under development in a local health centre in a rural village, bringing the spinal care closer to patients unable to travel hours to reach hospitals.
WSC is almost completely driven by volunteers. Many are actively involved despite holding full-time jobs. Without this selfless commitment from so many, WSC would not exist.
Since its inception, over 100 volunteers from 16 different countries have contributed to the WSC. Their roles have ranged from clinic supervisors, clinical associates, researchers, executives, and WSC board members to yoga instructors, clinical and scientific advisors, communications officers and fundraisers.
It is inspiring to see so many well-trained clinicians, researchers and other healthcare professionals willing to offer enormous amounts of time and expertise to keep WSC alive the thriving.
The WSC is continually updating our model of care, developing new projects, building capacity, and soliciting support from organizations, institutions and individuals.
The WSC has been so successful that we are now being approached to help create spine care programs in other countries.
We hope that more chiropractors get involved in fundraising and volunteering to ensure the success of WSC and chiropractic on the global stage.
To learn more about World Spine Care, its supporting associations, and how you might be able to contribute, visit worldspinecare.org.
Reference 1. Creating a sustainable model of spine care in underserved communities in Botswana. WHO Collaborating Centre for Integrated Health Services based on Primary Care website. August 17, 2016. www.integratedcare4people.org. Accessed February 13, 2018.