 Well, Dr. Adelbridge, thank you so much for joining me on the podcast. I heard about World Spine Care just about a year ago. I was trying to find a chiropractic mission trip to go on, and I really wanted to get out to less developed countries and provide some service. But while looking around, I couldn't quite find anything that fit what I was looking for, and that's when I came across World Spine Care. And I got so excited about it, I had to get involved, and my hope of interviewing you today is to get other students excited and involved. But before we get there, let's just back up, and can you explain what is World Spine Care? World Spine Care is a non-profit charitable organization. It's registered in Canada and the United States. And the mission statement is we are bringing evidence-based, sustainable, interprofessional spine care to underserved communities around the world. Okay, so that's the mission statement. So expanding on that, it is interprofessional in that we're engaged with other healthcare professionals, other doctors on the ground, the nurses, surgeons, evidence-based in that we're using evidence to guide our examination and treatment. And then we are actually collecting data to add to the body of evidence and to also examine the efficacy of our treatments to try to constantly improve the care that we're providing. And then sustainable in that we're hoping that, number one, if we have to exit at any time, then we've left something behind of use. But ideally in the end, that we actually create a long-term spine care program within the existing healthcare system in every country that we engage with. So what communities are you currently in? Currently, we are in Botswana. We have a clinic in the district hospital in Mahalapi in Botswana, in the central district. And about 40 kilometers away, we have a port-a-cabin that is in a small village called Shashong, with about 10,000 people. And that Shashong Clinic was the very first, it's sort of our flagship primary care center because in the district hospital, we act a little bit more as sort of secondary tertiary care. But in the village clinics, we're absolutely primary care. We are the first contact for, I think, about 80% of our patients, we're the first person they're coming to with whatever problem they happen to have. That's incredible. I've been excited to follow and see, I think there are some recent blog posts by one of the volunteer clinicians that went out. What volunteers are you currently looking for and what are their roles? Okay. Well, let me step back because the other clinic we have is in Dominican Republic. I didn't quite answer the rest of that question. And we have a clinic in a rehab facility behind the Mocha Hospital in the Dominican Republic and Mocha Dominican Republic. So in terms of volunteers, yeah, it was Richard Brown from the World Federation, the Secretary General of the World Federation of Chiropractic, who is with us for a month. And his blog post, he's a fantastic writer. His blog posts are excellent and I'd encourage people to at least go and read some of those because you'll get a flavor for what it's like to actually be on the ground as a volunteer. In terms of volunteers that we're looking for, we have two types of volunteers. One is what we call a clinic supervisor and that's somebody who dedicates a year to work full time in the clinic. They live in the community, they run the clinic, they supervise any of the other volunteers who come through. They're the ones who are sort of coordinating everything in the clinic. And then we have what are called volunteer associates for people who come for shorter periods of time anywhere from one month to three months, four months. And those volunteers come and do more or less what a clinic supervisor is doing. They're treating patients, they're helping develop programs. So we have programs like scoliosis screening, straighten up programs. We now have education programs for teaching local healthcare providers, evidence-based care for low back pain. And we're always developing new programs. We have research projects that are ongoing. So the volunteer associates are usually involved with a project, then they're involved in patient care and then they're involved in data collection, data entry as part of our overall ongoing clinical research. So those are the two types of volunteers that we're looking for. Now there's other organizations like the Peace Corps where medical doctors and EMTs can volunteer, there's doctors without borders. How is world spine care compared to those and what niche does it fill? It's really filling the spine care niche because right now low back pain is the leading cause of disability worldwide. Neck pain is fourth leading cause of disability. Spine pain affects over a billion people worldwide and spinal disorders contribute more to the global burden of disease than HIV, malaria, diabetes, stroke, lung and breast cancer combined, traffic injuries. It's an enormous global health burden. And other organizations like Peace Corps and MedCesson Frontier, they don't deal with spinal disorders. They don't have spine specialists on their team. In fact, there is no access to evidence-based spine care in the majority of the world. So what we're bringing to the table is something completely new. There's actually the way this sort of evolved from the beginning is Dr. Haldeman and our Vice President, Marguerite Nordin, we're sort of questioned on, well, if we have a problem with spinal disorders in our country, in our community, what do we do? And they sat back and said, well, we don't know. Nobody actually has ever put together a model of care to address spinal disorders. So world spine care, there's two aspects. There's world spine care, which is the clinical program, which is currently delivering evidence-based spine care. And we are constantly working on further developing, further advancing our model to be as evidence-based as possible and as effective as possible. But then associated with world spine care is the Global Spine Care Initiative, which is something you could do another blog post about or a podcast about. And that's a research arm that is actually pulling together leading scientists from the spine care world from all disciplines, surgery, chiropractic physiotherapy, epidemiology, psychology, rheumatology to build a best model for the management of all spinal disorders. So this is, it's really groundbreaking work right now that we're doing. And hopefully over the next few years, we're going to have a very comprehensive model that's been created. Can you explain a little more about the integration? What roles do chiropractors, PT's and orthopedic surgeons play in these types of communities? Sure. So let's talk about primary spine practitioner. So a primary spine practitioner is somebody who can act as first contact for people with spinal pain. And that entity is something that Don Murphy has written a lot about. Scott Haldeman was the first person to sort of introduce the context of a primary spine practitioner. And right now, even in North America, we don't have an entity that really can, that really is seen as this primary spine practitioner. So we are creating a model for a primary spine practitioner as a first contact for people with spine pain. So a primary spine practitioner, I don't think of it in terms of what profession do they come from, but what skills do they require? So they require, they need to be able to screen for red flags, they need to be able to diagnose, they need to be a proper spinal evaluation, examination, be able to treat the majority of what walks through the door. And 90 percent of what walks through the door in any practice around the world in terms of spinal pain needs to be managed through conservative care, which is manual therapies, education and exercise. So they need to be versed in those particular interventions. They also need to be able to read advanced imaging. And so any person, any clinician who has the skill set can act as a primary spine practitioner. It just so happens that right out of school, chiropractors right now are the best trained to assume that role straight out of school. Then so that's that's kind of like the quarterback. You come in, you see the primary spine practitioner, they screen for red flags. They decide whether that patient needs to be referred. If they need to be referred, they're going to be referring to the rheumatologists or spine surgeons or psychologists or psychiatrists, whatever sort of direction they need to go. And then they're going to treat the vast majority of the people in the clinic. So if that gives you an understanding of the types of people who are involved in the sort of comprehensive spine care team. World spine care is still fairly young. It was established in 2008. Is that right? Yeah, it was it was the initial idea started in 2008. In 2000, I think it was 2009, when they first applied for charitable status in the United States. 2011 is when I first went to Botswana to open the first clinic. And it was December 2011. When I opened the clinic in the Mahalapi District Hospital. And then August 2012, when I opened the Shashank Clinic, which was really the flagship clinic. So that gives you a sort of time frame in between 2008 and 2011. When we left for Botswana, that was a real building phase, development phase. And then since then, I mean, we've continued to develop. But that's when the actual on the ground part started was into 2011. And you mentioned it was Dr. Scott Haldeman, who who started this organization. And he's he's pretty he's a DC MD, PhD. I recently was listening to another podcast in interview with the author of the biography of Elon Musk, in which it talked about a family called the Flying Haldemans. Who I guess is is that Scott's dad or his grandfather? No, that's Scott's father. His father. Yeah, for any of the listeners out there, if you ever get a chance to read the biography, it's a fascinating, fascinating read. You know, Scott's third generation chiropractor, his grandmother was the first chiropractor in Canada in Saskatchewan. His father was a chiropractor very involved in chiropractic politics and the chiropractic profession in Canada and was a pilot. And they, when Scott was very young, they took the family, just decided to go to South Africa and and move the family there and started chiropractic practice there. When they arrived in South Africa, he put his plane back together and flew around South Africa, looking for where he wanted to set up a practice. And they ended up landing in Pretoria. And that was where they decided to set up the practice. And so, yeah, long chiropractic history, very colorful, very interesting, exceptionally adventurous family and and sort of Scott, Scott obviously then grew up through that. And Spine was, you know, his life from a very young age and pursued extensive education and just continue going on and on, learning more and more, always with an exceptionally evidence-based background. And so he just reached this sort of status where he became the only person who really could create something like world spine care because he bridges the medical profession, the chiropractic profession, researchers, clinicians. He sort of can do it all and not just that he can do it, but he has an enormous reputation in each of those professions and has led, been the president of North American Spine Society and has read written multiple articles and books and I think two over 250 research articles now. So, exceptionally prolific researcher and there's really nobody else in the world who could have made this happen. Number one, world spine care. There's nobody else who could have pulled together this group of people and make this happen and bring the legitimacy that's required to gain the sort of support from the people that we're getting support from. And also the Global Spine Care Initiative, he's pulled together all of these leading spine researchers from around the world. And there's just nobody else who could do something like that. It's impressive and intimidating. And as you were talking before, he mentioned in another podcast that he's reading research 10 hours a week and thinks that we all should be doing that. And that's something I aspire to, but I've not been able to to even get one paper a week, which was my goal for a long time. I think aspiring to that is about as good as you can get. Well, so less than 10 years in, have you guys been able to measure the impact that you've had so far? In a qualitative way, yes, in a quantitative way, not yet. Because one of the problems we ran into was we needed to evaluate the outcomes of our interventions and we worked for a while using existing outcome measures and found that they weren't adequate for the population, certainly in Buckswana that we were looking for. So we had to develop a novel outcome measure for us to be able to not just measure the outcomes in Buckswana, but the outcomes across all our clinics around the world and going into the future. So these are the outcome measures that we learned in school, such as the visual pain score and the activities of daily living. Is that the type of stuff that it doesn't work in Buckswana? Yeah, and Roland Morris. And I mean, if you look at all the outcome measures, there are hundreds of outcome measures that you can use for all kinds of different purposes, and even just within spine pain alone, you've got neck, one for neck, one for low back, one for general musculoskeletal. There's a Bournemouth questionnaire, the keel start back, and all of these have our exceptionally good instruments, very well validated in certain populations for certain purposes. So we had a series of requirements that were very unique. So we had very low education level in many of our patients. In Shashong, some don't even have a primary school education. And so using certain language doesn't work. There's certain language that can't be translated effectively. We needed to ask questions that were that related to universal experiences around the world, so we couldn't ask people about getting in and out of a car or even going up and downstairs, because some people never go up and downstairs throughout a week. So we needed to ask about universal experiences. We needed language that was easily translated. So we have sort of searched through all the existing outcome measures and found that there are questions that are appropriate, but not full outcome measures. So we've had to create our own and we're in the midst of we've done our pilot testing on that. We've collected a lot of data on it. And we're at the point we're about to write up an article introducing that outcome measure, and then we have to work in the validation study. So until we have that done, we won't actually have quantitative measures of the outcomes, but certainly qualitatively we're getting a good idea of how things are going. Are there any particular patient cases that you've been involved with that are pretty inspiring? There's a lot that are a lot that are inspiring. As instead of a specific case, in generally a lot of the cases that we treat or I shouldn't say a lot, some of the cases that we treat have literally been unable to work for years and are sitting around and have to be cared for by other people. And within a very short period of time and sometimes just one treatment, they're back up and able to go back and do the kind of work to have to do. It's different in developing countries. Often when somebody has back pain, it means they can't work. And if they can't work, they can't put food on the table. And now that family may descend into poverty. They may start to because they can't get food on the table. They're issues with nutrition. So it can have very catastrophic effects. And because low back pain is the leading cause of disability worldwide, that's usually what's really driving people into that state of poverty or inability to work. So the impact we can have is quite significant on those lives. And that is not an atypical story that we hear from patients. In terms of the types of conditions we see, I mean, we'll see things in the clinic that you would not be exposed to in North America, mainly because most of them end up in the medical system. We've seen hemorrhagic ovarian cysts, kidney infections. Gosh, they're not they're sort of I can't think about a lot of them now. But we have a I think I read a couple of case studies that you wrote up on tuberculosis. Yeah, we have. So we had the case series that was written on tuberculosis. That's on our website. So we saw TB fairly often. Lots of vertebral body compression fractures. There's lots of osteoporosis. Again, nobody's done any measures on the prevalence of osteoporosis, but we do see a lot of that. So suddenly we're constantly keeping in mind. We've seen hemivertebrate, sprinkles, deformity, other congenital deformities, hydroceals, gosh, all kinds of stuff. So your your your sort of radars are constantly up. It's more you're really working hard to try to rule out those pathologies before you continue on with care. So being able to take a really good history from somebody who doesn't speak the same language and equals you through an interpreter takes quite a bit of time and you need to be really patient and you really need to think and try to put yourself in the patient's shoes. And that's very difficult when they come from an exceptionally different background and lifestyle that you do. And so trying to get in to as much into their head as possible to be able to ask the appropriate questions takes a little bit of time and experience. So it sounds like the students listening this should really pay attention to their radiology courses, their pathology courses that well and their interview skills. I would I mean, this is something I learned from from Richard Brown. I always thought I had pretty good history taking skills, but he takes it to another level. His history taking is exceptional and listening to him talk with a patient before he's even going into his physical examination. He has a pretty good idea of whether there's some pathology he's got to look for or not. And in a way that I've never seen anybody else. So I can't emphasize for students, I cannot emphasize enough how important the historical information is, how much time you need to take and how patient you need to be during the history and not rush through the history. We were told that in school, but it it really, really strikes you when you're doing this type of work. It is exceptionally important. And now coming back to North America and doing the same type of work back home again, I realized what I wasn't doing, even though I thought I took a pretty darn good history. I it's it's way better now. So yeah, keep that in mind. Well, this so World Spine Care is not quite like the other chiropractic mission trips that are out there. I went to Haiti, the Dominican Republic, a lot of classmates have gone to Peru. Palmer has a yearly trip, I think, to both India and to Brazil. How is World Spine Care different? But also how can students be involved? The main differences is the long term presence. That's the main difference. So we're setting up clinics and creating a permanent presence on the ground so that the volunteers coming in are coming in and participating on something that is continually ongoing. So that's what's really, I think, empowering to what we're doing because patients can be treated continuously until their problem is resolved. So mission trips still have a role. I still think they're very important. They they can be very evidence based, but they're just they're not continuous. So I think that's the the principal difference. And by having that long term presence, we're able to develop models and approaches and learn all sorts of things that we can share with with the Spine Care community that is different from what a mission trip can gather. So how can students get involved now or plan to get involved in the future? Students right now, we don't have a program for for undergraduates or people who are still in school. So once you graduate and are licensed, then you're welcome to come and volunteer. So to gather more information, you can go to the volunteer information page on our website or you can email me and ask more questions. And if you're interested, then we can and you're truly interested and you have dates that you want to go, then we can start getting you set up with a time to go and all the information you need and application procedure and everything else. Well, I encourage everybody to check out the website, worldspinecare.org. You can follow on Twitter and on Facebook. And I believe we've got coming up in October is World Spine Day, which is last year we did Spine Selfies, I think was the social media campaign. Yeah, I'm not well, that was World Spine Day, which is a separate organization from us, but we do collaborate on a lot of stuff. Yeah. OK. So both trying to bring awareness to the same problems throughout the world. Absolutely. Well, Dr. Adderbridge, thank you very much. How can students get in touch and follow what's going on? Well, info at worldspinecare.org is the email. Or if you go to our website and click on getting involved, you'll see volunteering and you can get information and then click to to connect with us on email. All right, great. Thank you. All right. Thanks a lot, Nathan.