World Spine Care: Continuing to Provide Evidence-based Care In Under Served Communities

The most recent World Spine Care (WSC) visit to the India project was once again eye-opening and motivating. The project is a clinic operated by Mahatma Gandhi Mission School of Physiotherapy, constituent unit of Mahatma Gandhi Institute of Health Science (MGM), Navi Mumbai, in collaboration with World Spine Care. WSC volunteers were able to witness the impact spine pain can have in developing countries and the reason our vision - a world in which everyone has access to the highest quality spine care possible – is so important.

Members of the WSC team gathered with our Indian counterparts for a week-long trip which opened with the Spine Conference hosted by the WSC-MGM India team. This enterprising event brought together a host of professionals and students, to learn and share best practices for tackling the challenge of spine pain in vastly differing cultural settings. It was unlike any event I had attended before, firstly in the calibre of individuals brought together, secondly in the work these individuals are doing every day.

Keynote speakers included Manohar Panjabi, whosebiomechanics books many of us have studied. We listened intently to a number of physiotherapists who offer care and rehabilitation to those with severe spinal cord injuries, in incredibly remote, poor regions with very limited resources. Their commitment to serve their patients was awe-inspiring. Often the spinal cord injuries were caused by falls from trees, ladders, or when navigating difficult mountain passes. We heard from Professor Rajani Mullerpatan, who presented unique research into the movement range and muscle activation experienced by the body during yoga, and how it’s implementation may prove useful in the care of low back pain patients.

Professor Scott Haldeman, joined by members of the World Spine Care Europe Board of Directors, introduced conference attendees to the Global Spine Care Initiative (GSCI), and the work being done to introduce a triaging system that would be universally appropriate and applicable to all professionals intervening with back pain patients. Dr Pradnya Girdhar, PT (Clinic Supervisor, WSC Clinic India) advised that the clinic in India had treated 100% more patients than the previous year and continues to provide an effective, low cost treatment at less than $0.50 per consultation.

Dr Bang presented a model of delivery of healthcare in remotest tribal region of Maharashtra State. Dr Varma presented their surgical spinal programme, that works in remote regions of India, with a goal to help those individuals in rural communities who are suffering from spine pain. This admirable programme struck a chord with the WSC team. Surgeons attend to hundreds of patients, and triage as needed. Only the minority of patients actually require surgery, and collectively, we wondered, what happened to the vast majority of patients who require non-invasive care? WSC's vision and model to provide an all-encompassing, sustainable, integrated care was brought into sharp focus.

The second half of the trip was spent investigating potential rural outreach spine clinic sites. Preliminary research from villages surrounding Navi Mumbai found the reasons for some in rural populations not seeking care for spine pain include: being unable to miss work, the cost of travel, or the lack of doctors available to consult and provide care. Instead, many individuals rely on home remedies. A popular self-treatment for back pain is to heat a brick on a fire, allow the brick to cool a little and then apply as heat treatment to the painful area

.Our team visited the village of Dhamani which is located one hour from Navi Mumbai. On the journey we passed by towers of bricks, moulded by hand, drying in the sun. There are approximately 70 homes in Dhamani with up to 10 people living in each home. The roads are narrow dirt tracks. Stacked tree branches formed a simple goat house. A woman squatted, effortlessly, to wash her dishes. A small fire settled with a cooking pot nearby. Slowly, a small cluster of individuals arrived at the carefully maintained community centre, our clinic venue for the day. Our team of physiotherapists spent the morning screening for red flag, providing exercises and advice or for those requiring further investigation or medical care pathway referral was made to the visiting community medical doctor.

Dr. Pradnya Girdhar addressing the India Spine Care Conference

Later in the week, together with Dr Pradnya Girdhar, PT, we spent time reviewing the data and systems in place at the clinic in the MGM Hospital in Kamothe, the site of the India World Spine Care clinic. An enjoyable session was spent with students in an open forum, reviewing topics and cases of special interest, and discussing best-practice and management in each case.

It is always the stark juxtapositions that you are undeniably faced with in India that leave a lasting impression. Extravagant malls; remote rural populations without access to regular electricity. Smart businessmen travelling by train; sari-clad women carrying baskets of rice overhead walking for miles. Luxury hotels; woven mats to sleep on the floor. A bustling business district; those who cannot afford a day off work to seek medical advice.

The overall message for me, was one of re-focused perspective. I was once again reminded of just how great the burden of spine pain is, and in some cases, how profoundly life changing that pain and disability can be. The social and economic burden this condition places on families, communities and a country at large cannot be underestimated. The WSC-MGM collaboration is a testament to the changes that can be made in people’s lives as we strive together to provide the care they require.

Only with collaboration from all angles, do we have the potential to make to make our greatest impact. Clear communication between health professionals, employment of best-evidenced principles in care and support from policy makers and stakeholders in relaying simple, effective public health messages are paramount. Collaborative ventures between WSC and MGM provide wonderful insight into what can be achieved and following my latest adventure in India I continue to remain convinced that our mission – to improve lives in under served communities through, sustainable, integrated, evidence-based spine care, is more important than ever before.

“For most people in the world, it’s not about performance. It’s not about relief. It’s about survival.”

To learn more about World Spine Care’s programs, to make a donation, or learn how you can get involved, please visit www.worldspinecare.org