Adjusting the world

With more than 1.2 billion people, India is one of the poorest and most heavily populated countries in the world.

With more than 1.2 billion people, India is one of the poorest and most heavily populated countries in the world. Physician ratio is one doctor for every 1,700 people. Nearly 22 per cent of the population or 269.3 million live below the poverty line, according to the Government of India Planning Commission.

Chiropractors and volunteers pose for a photo during the Sant Nirankari Mission in November 2013, where more than 5,500 people received free chiropractic care.   Photo: Indian Association of Chiropractic Doctors Advertisement

Many people would view these statistics as a little discouraging, but not so to a group of chiropractors thousands of miles away in Canada wanting to make a difference in a country that has been home to their ancestors.

Dr. Jimmy Nanda, of Oakville, Ont., established the Indian Association of Chiropractic Doctors (IACD) in 2001, while still a student of chiropractic at Life Chiropractic College West in Hayward, Calif.

Although he was born and raised in Canada, Nanda’s family is originally from India. Growing up, his parents would take him to their homeland to visit relatives and friends. And as a student at Life West in the early 2000, he realized chiropractic was non-existent in India.

“Knowing that one of the biggest countries in the world (did not have) chiropractic was what got me started in looking into why it’s not there,” Nanda recalls.

“I was very disheartened in a sense that there is so much suffering in India with the labour class. There is no option there other than surgery, really, to do anything.”

His opportunity came when he visited India with his family in 2000. When people learned that he was studying to be a chiropractor, they wanted to talk to him and tell him about their back and neck pain problems. Some of them, Nanda recalls, had low back disc problem and were told by their doctors to have back surgery.

“As you know, that is ridiculous,” he says. “But because of the monetary gain for a doctor there, it makes more sense for them to do surgery than to do anything alternative.”

It was during the same visit that he was approached by India’s sports minister upon learning that he was a chiropractic student. Nanda’s family in India is well connected in politics and government. He asked Nanda to help assist in getting chiropractic care for the national cricket team, and introduce chiropractic at least in the sports level.

This started the ball rolling in establishing an Indian chiropractic association, the IACD, which had ultimately one main purpose: to bring chiropractic to India.

Working with the Indian government and other appropriate groups was not the most difficult part of starting the initiative, Nanda says, it was convincing practitioners – many of whom are trained and live in the West – to “take up the cause.”

That was in the early 2000. Today, Nanda says, India is home to eight chiropractic clinics, thanks to numerous efforts spearheaded by the IACD and dedicated doctors who were willing to leave their first-world comforts to start a chiropractic practice in a third world country.

“People now have seen that it is definitely worth going there. And the chiropractors there are also doing very well financially that they are able to make a good living,” Nanda says.

The IACD has made progress over the last decade, not only in bringing in fulltime chiropractors in a country where there never was before, but also in getting international recognition for its relentless efforts in India and other parts of the world. In 2006, the IACD was recognized and granted membership by the World Federation of Chiropractic, the association representing the chiropractic profession in the international community.

Despite these achievements, the advocacy and outreach work continues for Nanda and his group of like-minded doctors. He travels to India four to five times a year, which can sometimes be challenging as he tries to balance his time between his work with the IACD, his fulltime practice in Toronto and his young family.

 “Some people say, ‘What’s the gain?’ There’s nothing, really,” says Nanda. “We don’t make money from this; it’s strictly charitable… you’re doing it because of your passion for chiropractic.”

Open for business
With a doctor-patient ratio of about one chiropractor for every 150 million people, setting up practice in India sounded like an attractive proposition, recalls Toronto native Dr. Natasha Patel. Leaving her $50,000-car and the comforts of an upscale family home behind, Patel travelled east two years ago to set up shop in Baroda, in the Indian State of Gujarat.

Patel is one of three Canadian chiropractors now practicing fulltime in India. The other two are Dr. Shiv Bajaj and Dr. Shailly Prasad.

Patel saw India’s huge population as an open market for her practice, with the majority of the working population engaged in physical labour.

“I just thought they needed chiropractic care,” says Patel. She admits the transition has not been without challenges, some of which she still encounters to this day.

Patel runs the Ananta Chiropractic and Wellness Clinic in Baroda. She also visits three other cities, including Mumbai, to provide chiropractic care to residents there.

One of the difficulties she faced was changing the mindset of people about their health and managing their conditions. Due to lax regulation on pharmaceuticals, the Indian population has had easy access to prescription drugs, Patel says.

“Antibiotic use is out of control here,” she says. “Medicine is not regulated, so you can just get pretty much anything – aside from narcotics – from any person who owns a medical shop.”

Educating the people about overall health and wellness became an important part of her practice. “Just letting people know how powerful they are and how capable they are and their body is.”

Patel admits her patient retention rate has not been very high in the beginning, because people may not necessarily agree or have not been used to the chiropractic way of health care.

“It may not be just their fault, but also maybe it’s the way that I come across,” she says. Language barriers could have also played a huge factor, with 26 languages and thousands of dialects spoken across India, she says.

But work is always very busy and many new patients come to her clinic for care – some even travelling hundreds of kilometers just to see the chiropractor.

Challenges notwithstanding, Patel is having the time of her life practicing in the birthplace of her parents.

In her own way, she is paving the way for other chiropractors to enter the Indian market. Her clinic has been host to several foreign chiropractors who found her online or through another connection and wanted to visit her clinic – some of them volunteering to work on her patients.

“We are gaining more exposure for chiropractic in India on a global scale. Now, some (of the visiting chiropractors) even want to come back and practice in India or open a clinic or start a mission trip,” Patel says.

Giving back
Aside from the advocacy and political work, the IACD is also instrumental in providing free chiropractic care to the poorer citizens of the country by holding chiropractic mission trips.

Life changing: Dr. Brian Kelly (in black shirt) of Life West and a team of volunteer chiropractors perform chiropractic adjustments and care to thousands attending a massive medical mission in Delhi last November.

Along with a fellow chiropractor from the U.S., Nanda opened up the first chiropractic clinic in India in 2004. Once a week, the clinic would open its doors to provide free chiropractic service to the community. As president and founder of the IACD, Nanda constantly encourages practitioners in India to continue to set aside time in their clinic for pro bono work.

“Our vision is to treat humanity, treat the 1.2 billion people,” says Nanda. “Right now, we have eight doctors for 1.2 billion. That’s not satisfactory. We need more chiropractors, we need more volunteering.”

Through several small initiatives, the IACD and other chiropractic organizations held chiropractic missions in various parts of India. These charitable projects were a way of reaching communities that may otherwise have no easy access to health care.

Last year, the IACD was offered an opportunity to reach a far wider crowd. Through a partnership with the Sant Nirankari Mission, a non-denominational spiritual movement in India, the IACD was given access to a crowd of 1.7 million.

Based in Delhi, Sant Nirankari holds spiritual missions twice every year – one in Delhi and one in Mumbai – that includes a massive medical mission offering free medical service provided by volunteer practitioners. Last November, chiropractic care was offered as part of the free services for the fist time.

Nanda and a small group of chiropractors from Canada and the U.S., including students and faculty at Life West, participated in the mission in November.

“There were 100,000 people per day coming through,” recalls Nanda. “But we could only see 5,500 in three days. That was our capacity. We had about 11 chiropractors there from all over the world.”

The group went back to participate in another Sant Nirankari mission in January 2014. Nanda says chiropractic will continue to have a presence in the Nirankari missions moving forward.

Life West sponsored the November mission trip and continues to support the India missions by sending students and faculty to participate in the free chiropractic clinic. This is not the first time the school has participated and supported similar initiatives, however.

“For many years, Life West has had outreach programs for our students to different parts of the world,” says Life West president Dr. Brian Kelly. These outreach programs touched many countries including Ghana, Cambodia, El Salvador, Peru and Indonesia.

“The notion of ‘service above self’ is part of the college’s DNA,” he says.

Kelly says Life West’s introduction to the India mission is another opportunity to serve and for students to care for people “in all walks of life.”

“It has literally been life changing for them,” says Kelly who personally participated in the November mission in Delhi. “It certainly moved me… to take care of people who not only don’t have access to any health care let along chiropractic, gave me a renewed appreciation for everything we have in life.”

Kelly, who was given an opportunity to speak to the one million attendees at the November mission, says India faces major public health issues, including diabetes and obesity.

“The Indian people resonate with the philosophy of chiropractic and they certainly embraced our message,” he says.

Following that experience, Life West is offering academic scholarships to two deserving students from India to study at Life West. The objective is for these scholars to become chiropractors and return home to practice in India, Kelly says.

The IACD will coordinate the scholarship grants, he adds.

“With eight chiropractors for a vast population of over 1.3 billion people, the first step is to increase the number of DCs practicing. This is one way we can assist this.”

In addition, Life West has also offered an athletic scholarship to a player in the Delhi Hurricanes Rugby Club to study at Life West and play for the college’s newly formed Gladiators Rugby club, according to the school’s president.

End game
All the efforts by the IACD and its supporters have an end goal of institutionalizing chiropractic and the chiropractic profession in India through legislation — and eventually be able to establish chiropractic colleges across the country.

At the moment, the IACD is acting as the governing body for the profession in India. However, the association is actively working towards getting the government to enact a legislation regulating the chiropractic profession.

Nanda admits they have a long way to go before they can finally see a piece of law passed. A big focus for the IACD at the moment is to continue to raise awareness about the developments in India, encourage more foreign-trained chiropractors to practice and volunteer in India and, through scholarship programs like the one offered by Life West, send deserving Indian students to chiropractic schools.

“The reason the legislation is not done yet is because (the government) needs more numbers,” Nanda says. “They are very cooperative of the entire thing; they just need the numbers.”

Kelly of Life West supports the development of more chiropractic colleges or programs in India and other parts of the world where chiropractic has not yet flourished.

He says it is very important to bring the benefits of chiropractic to poorer communities around the world.

“Access to chiropractic care is largely a middle class segment for most populations,” says Kelly.

“This needs to change whether it is in Canada, the U.S.A. or any other country.”

Nanda is optimistic the IACD vision will be fulfilled and chiropractic will flourish in India. For now, he and other IACD volunteers are forging ahead, sacrificing time and money, and racking up frequent flyer miles travelling to and from India, all for the common goal of bringing chiropractic to the Indian people.

It’s not always easy, says Nanda, considering that time and money spent pursuing this advocacy are also time and money taken away from his practice.

“I know that if I don’t do it, no one is going to do it,” he says. “It is busy but I have to balance and I have to sacrifice my time knowing that in the future, if you look 10 years down the road, things will be set and we don’t have to do this again.”

“We just need to get the ground work set up. I just want to make sure it’s done properly from the beginning and after that, it’s smooth sailing.” 

Mari-Len De Guzman is the editor of Canadian Chiropractor and Massage Therapy Canada magazines. You can contact her at mdeguzman@annexweb.com.