Newsletter: November 2003

Chiropractic Overseas Relief

Hasta la Vista, Dr. Larry!!!

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Here's some background: As most of you who read this are aware, Dr. Larry has had a very active chiropractic practice in Parksville for the past 16 years and has been very active in the community for a good deal of that time.

But here are a few bits that might be somewhat lesser known: He has also been involved with local sports teams, running clubs, bicycle clubs and many different support groups during that time as well. He was the tournament chiropractor for the Morningstar International Golf Tournament, as well as the "Cops Against Cancer - Tour de Rock" for the past five years. He has completed 12 full 26 mile marathons and over 20 triathlons in the past 14 years and in the year 2000 he ran the Hawaii Marathon for The Arthritis Society's "Joints In Motion" program, for which he raised over $4,000 in pledges. He regularly (sometimes twice a month) gives 'no-fee' presentations to the various clubs, organizations and groups in the Oceanside area promoting wellness through healthy life-style choices. This is a rather brief sketch...but it's background.

So, with this knowledge about Dr. Larry, I hope it may provide you (as it does me) with an insight into the 'inner-workings' of this man. And further, how he came to make this choice.

So here's the "news" that I just had to make public... Dr. Larry is going to Cuba, over the Christmas holidays, to volunteer his time and professional expertise.

As I said in my preamble, in an effort to get all the facts straight, I have chosen to interview him. The following is the result of that interview:

NK: Dr. Larry, tell me how this all came about. What precipitated this trip?

LS: I was looking at our B.C. Chiropractors classified ads to see who was doing what and where. I noticed a classification under "Opportunity" -- it said. "Have a life-changing experience as a volunteer chiropractor in Cuba. Meet and treat the friendly inhabitants of the Isle of Youth for one week or more and then spend a second week on your own exploring this interesting country." I inquired about the opportunity and was contacted by Rupert Molloy from Great Britain. He is one of the Directors of Chiropractic Overseas Relief (aka "CORe").

NK: What did you learn about CORe? What is it? What do they do?

LS: CORe is an organization established for the purpose of bringing chiropractic care to countries and to people where there is none. It is strictly a volunteer organization, run by chiropractors, based on the premise that if enough chiropractors donate one to four weeks of their time in a year, then free clinics can be opened and staffed on a year-round basis.

Presently, they are looking for volunteers to treat patients in Cuba. A CORe clinic was established in Neuva Gerona, Isla de La Juventud, Cuba in April, 1995, and has been received enthusiastically by the health care community.

Although Cuba is a socialist state, CORe has no political agenda either for or against this system. Their soul purpose is to care for the people, this has been made clear to the authorities.

The usual dedicated period is two to three weeks, of which seven to fourteen working days are spent at the clinic and the remaining time may be spent travelling and exploring this sub-tropical island. La Habana, the capital of Cuba, is a UNESCO world heritage site, while the Isle of Youth is the "Treasure Island" of Robert Louis Stevenson fame. There is a wealth of culture, music and hospitality that guarantee to make this a most memorable trip and, above all, it brings chiropractic relief to many people. The Cuban people, I am told, are friendly and open, despite being materially poor, they are most generous.

NK: I understand that there is a political problem and that the CORe project has been temporarily suspended until February, 2004. How will this affect your plans?

LS: Yes, I received this disappointing news the moment I came back from the Victoria Marathon. BUT, I am still going on the trip. However, my mission has now been changed. It appears that chiropractic may become part of a Cuban holistic national health centre, but the National Director has only three members of staff to administer the project. Hence, the delay of reopening the project. My new mission is to maintain the chiropractic profile alive and well amongst the "Pineros" (the name given to the local people from the Isle of Pines). I will meet formally and informally with the local medics who have referred patients to the CORe project in the past and I will also have the opportunity to present a paper at one of their local meetings. I am planning on presenting the "Manga Report" with regards to the efficacy and cost effectiveness of chiropractic for low back pain. By gathering further support from the local medical community, it is hoped that chiropractic will have a greater presence in the Cuban health care system.

NK: What steps did you have to take to prepare for this trip?

LS: One of the most challenging aspects of the trip will come in being immersed in a Spanish-speaking culture. I have thoroughly enjoyed all my attempts at fumbling my way through the Spanish language. I've bought books, tapes and phrase books, practiced with my friend Bev and also have many objects at my home labelled in Spanish. Yo hablo y comprendo Espanol un poco, gracias.

CORe has the use of Ada-Juana, a Spanish-English translator, which does help. But I was told from the beginning that the volunteers who have learned the most and have had the most fun are those who have attempted to speak the language.

NK: I understand that you have had some interesting dealings with the Cuban Embassy. Could you tell me a little about that?

LS: Ah, yes. The Embajada de Cuba en Canada. In previous years, members of the CORe group were able to enter Cuba on a simple visitors visa. However, the Cuban immigration authorities have recently toughened up their regulations and we are suppose to enter the country on a business visa. This is where the fun started. I found out that the only Cuban Embassy in Canada is located in Ottawa and that I had to send in an application to the embassy along with a cheque for $104.00. I knew something was not right when I had not received a reply after one month -- as I had been told the waiting period was supposed to be 14 days. I made a few futile attempts to reach the embassy by phone. At one point, I was 'put through' to a busy signal...another time to an answering machine. Finally, I spoke to a human being who said he would put me through to the person-in-charge. But, of course, that person was on a break and I had to leave another message. At that point, I passed the task on to my assistant, Nancy, who courageously, and with a great deal of patience, got some results.

(Note from Nancy): I must, at this point, pass on my story about "Vladamira and Yulexi of the Cuban Embassy". I know it sounds like an episode from "Rocky and Bullwinkle", but it is a true story. My first contact at the embassy was to inquire as to the status of Dr. Larry's business visa application which had been sent with payment some five weeks prior. I am told that they are very sorry, but the Chief Counsel, Vladamira --who is apparently the only person who looks after these things --is away on vacation -- where? Where else? "Koo Ba", of course. But that he would be back in September and I could get an answer at that time. So, come September, I called again. This time I speak with Yulexi Sebasco, who tells me that, yes, Dr. Larry Smith's application has been received, but as he did not send a pre-paid courier packet along with his application, they cannot send it. I countered with the suggestion that perhaps they could either send it by courier "collect" or even put it in the mail. To which he then enquired, "Could Dr. Larry Smith come in to the embassy to pick it up?" I then suggested to Yulexi that that might be a little difficult, seeing that there is a rather large country between our two offices. That particular conversation was left at him promising to "look into it" and get back to me. (I truly hoped he was not away with "Natasha" somewhere, plotting big trouble for moose and squirrell!)

As I had given Yulexi Larry's email address, our next contact with him was when Larry received the following email: (Hope you find it as delightfully amusing as we did! Please take special note of his title at the end of his message.)

"Good Morning!!! I was calling you in the morning but then I realize that it was like 5:00 am there in your place. I would like to contact, Mrs. Nancy concerning the Visa of Larry Smith. Could it be possible to reach her. She can call me at .....Thanks

Sincerely

Yulexi Sebasco - Translator of the Embassy

(Larry's comment on it was: I wish I could speak Spanish as well as he does English!)

We did manage to actually get Larry's visa, and I got to know Yulexi quite well. It was a fun little trip to "Koo Ba" for me.

NK: Does CORe pay for your travel and accommodations? Where exactly will you be located?

LS: I'll answer the second question first. I will be staying in the town of Nueva Gerona which has a population of 30,000 people. It is located on La Isla de la Juventud (Isle of Youth) which is about a half-hour flight from Havana. All participants are responsible for paying their own way there and back.

When the project is up and running, the accommodation is handled through the Public Health Authority in Nueva Gerona. They look after accommodation, meals and transport within La Isla. Quarters and meals are offered in the Visitors' House which is spacious and comfortable. The bedroom is air-conditioned although the bathroom is only served by cold water! The lounge has a large colour television and VHS video, also a stereo radio/CD hi-fi. For anyone who wishes to bring their family, then the Public Health Authority generously will accommodate them too. The youngest guest has been two and a half years old. The Cubans love children and put great store in the youth of today but never fail to show respect for the elderly too.

NK: What support staff do you expect to have?

LS: When the project is running, patients come to the clinic via physician referral and direct contact. The nurse, Lourdes Gay Perez, provides excellent assistance as the Project Nurse.

NK: Will you have time to sight-see?

LS: Isla de la Juventud's primary attraction is its scuba diving. I plan on spending at least a few days exploring the underwater world as well as checking out some of the most elaborate and best preserved indigenous cave painting in the entire Caribbean basin. Another site in Nueva Gerona not to be missed is the Model Prison or Presidio Model. This is the prison where Fidel Castro and his crew were sent following their unsuccessful Mancada raid. I also understand that I may run into mutual friends of Bill W. and Doctor Bob on the island. ( That would be a very welcome treat!) Of course, there will have to be some time spent in Havana on the mainland. I am trying to find time to read some of Hemmingway's books and embrace the feeling of being in Habana Vieja.

NK: Do you have any knowledge or expectations regarding the Cuban medical system?

LS: I got the following information from the website: A recent article in "The Guardian" newspaper (2nd Oct. 2000) told us how the British Government had sent one hundred doctors to Cuba to study their healthcare service to find out how a poor country like Cuba could provide such an effective healthcare system at such a low cost, only 7 (pounds) per head. Their healthcare and education systems are the most amazing achievements of the 1959 revolution. It is indeed a remarkable story and I would recommend Theodore MacDonald's book, "A Developmental Analysis of Cuba's Health Care System Since 1959", which is available through CORe for those who would like a more in depth analysis.

Here is another submission about the Cuban health care system from one of the CORe volunteers:

"I started work on the Monday morning at 8:30 a.m., there were about 20 patients booked in. The Clinic runs every day from 8:30 till 1:30 or until the queue of patients has finished. The Clinic will try to accommodate to the volunteers needs, so I kept my afternoons free to enjoy the Caribbean climate. By the end of the second week, word had spread that there was a chiropractor back on the Island and I was seeing over 30 patients each morning. It was a wonderful relaxed way to practise, sometimes there were eight people in the adjusting-room talking, laughing and always so appreciative of us going there to provide chiropractic care, as evidenced by the many gifts of grapefruit and plums I received. Many doctors came to observe and discuss chiropractic in an open-minded way. I was invited down to the hospital to check their spines in the ER. The interesting thing I noted on talking to the Cuban doctors is that they recognise the problem facing modern medicine is due to an increasing reliance on drugs and high tech intervention, which simply is not sustainable.

"The US blockade means Cubans have not been exposed to many of the excesses of modern medicine. Cubans have to prioritise their limited resources and concentrate on well-being and prevention of disease; this starts with hygiene and nutrition education in their day-care centres which are available to all pre-school children and as good as anything that can be found in this country, the UK. Health promotion is emphasized right through their education, literally from the cradle to the grave. Health sciences need to be more concerned with the maintenance of health and wellness rather than just treating the symptoms of disease. When we talk about philosophy and health Cuban doctors have much to teach us about healthcare and education. For example, when you enter the polyclinic there is a quote on the wall from a famous Cuban nationalist, Jose Marti, "The most valuable medicine is not the cure but the prevention."

"The Cuban philosophy of health is demonstrated by the Family Doctor programme. The GP lives in the area and knows most of his practice members (patients) personally. If treatment is required patients are sent to the polyclinic where all kinds of specialist treatment is freely available including dental treatment of which I had to avail myself during my stay. Yes, people may have to wait a few hours, but they will be seen, tests and examinations are performed at the polyclinic on the same day. Patients are also responsible for keeping their own x-rays etc. to reduce costs and eliminate beurocracy.

"During their recession in the early 90's after the collapse of the Soviet Union, Cuba did not reduce spending on health or education but slashed its military budget. They have more doctors and teachers per head of population than any other country in the world. They have more doctors working abroad in poor countries than the whole World Health Organization put together. The doctors and teachers I met and worked with are a shining example to us all, their motivation is their love of their work. Yes, some of the doctors are motivated by money, they leave and take jobs waiting on tables in the tourist hotels; a reason for not tipping."

NK: Do patients who come to the clinic have to pay for the service?

LS: There is no fee for any of the patients receiving chiropractic care.

NK: When do you leave? When do you come back?

LS: I am leaving Vancouver on Friday, December 12, 2003, and returning home on Saturday, January 3, 2004. The office will be closed during this time period, but arrangements for patients who need help will be made with the local chiropractors in our area.

NK: Now the big question...Why do you want to do this? Why would you expend, what must be a rather substantial sum to go 'work without remuneration', in a place from which many people have paid dearly to 'get out of"?

LS: I suppose I could answer this question with other questions -- and I think I will. Why would I choose to be a chiropractor in the first place? Why would I spend my spare time training for and competing in marathons and triathlons? Why would I still cheer for the Toronto Maple Leafs? :>) An individual has to have a deep and strong belief in what he or she is doing. I believe that when an individual has great passion combined with faith, confidence and belief -- then one is truly following his or her true path and enjoying the journey at the same time.

In the early 1980's, I made the final decision to become a chiropractor, even though I had thought it about it since I was 11 years old. I knew it involved going back to school for another five years, although I already had my degree in physical education. I knew I would likely be 70 to 80 thousand dollars in debt during my first few years of practice. I knew there would be super long hours of study and work and toil. I had tremendous support from my family and friends throughout these years, but there were also many people who questioned my sanity on practicing in a profession that was frowned upon by " traditional medicine." BUT, I knew what I wanted to do and I felt very strongly about it.

There was also a great sense of adventure when I was embarking upon that journey. I feel the same way about going to Cuba. This is a way for me to give something back to other people through my profession. It is an adventure and it is going to be fun even though there may be some conniptions along the way. I have tried to help spread the chiropractic word in our community and I now I have a chance to do so in Cuba. What a blast!! This is a great opportunity to experience life and see how other people on this planet live.

NK: Are you planning to share your experience in Cuba with others? Have you thought about how you might do that?

LS: I would love to be able to share the experience with others. I love to journal my experiences whenever possible and this trip would be a great opportunity to do so. I also have a digital camera (albeit a temperamental one) and I can basically take up to a 150 shots without having to worry about wasting any of them. You just download the pictures to the PC, keep the ones you want and discard the others. A PowerPoint presentation is not out of the question. BUT I am not making any promises either!

"And I also have faith that the Toronto Maple Leafs will once again win the Stanley Cup. (There is a rumour going around that Pat Quinn is coaxing Davey Keon, Allan Stanley and Johnny Bower to come out of retirement to help them in the playoffs".)

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Contact the office:
Dr. Larry Smith D.C., B.P.E.
Chiropractor

P.O. Box 307
255 Island Highway
Parksville, British Columbia
Canada V9P 2G5