Russia is undergoing tremendous change, politically, economically and socially and its health care delivery system is similarly affected by these changes. In the mid-1980s there was growing concern on the part of officials and the public over the serious decline in the country's health and the low quality of medical services available to the general populace.

Reforms in the 1980s called for eliminating over-bureaucratization of medical services, improving medical training and salaries, expanding fee-for-service care, and significantly increasing funding to improve the quality of health care nationwide. As Russia undergoes this metamorphosis in health care, chiropractic will be there as an integral part of this change thanks to the combined visions of Mr. Valery Shegnagaev and Dr. Harold McCoy.

This project to bring chiropractic to Russia began a little less than two years ago after Mr. Shegnagaev, a prominent Russian businessman, received a life- changing adjustment from Dr. Harold McCoy. Shortly thereafter, a delegation was formed to begin what would become an historic project.

In a letter to his partner, Mr. Gennady Katkov in Russia, Mr. Shegnagaev said that the goal of the project would be to send chiropractors to Vladivostok "to train the Russian counterparts and cure the sick people." Dr. Matthew McCoy, who has been living in Vladivostok for more than a year remarked: "Reading Mr. Shegnagaev's letter excited me more than you can imagine. He had a keen sense of the potential chiropractic held for his people, and throughout the project he has remained committed to the goals which were originally discussed."

One of the short term goals was to build, in Vladivostok, a world class chiropractic treatment, teaching and research center to: a) serve the people of Far Eastern Russia; and b) to attract patients, scientists and clinical experts from around the world. The first part of this goal has been achieved as the Clinic is now completely licensed and fully functioning.

The Regional Center for Chiropractic -- "Spine" -- is located on the sixth floor of the Center for Motherhood and Children's Health in downtown Vladivostok. Chiropractic's preventive, wellness and family nature makes this an excellent location with access for women and children. "Spine" will become a world class center for chiropractic and spinal health and, in the near future, the Russian staff in Vladivostok will become the teachers for expanding chiropractic care across Far Eastern Russia.

"This is so exciting," remarked Dr. Harold McCoy. "I've been involved in many international projects and I always wanted to do something in Russia. Now, it's finally happened."

The city of Vladivostok, with a population of nearly 700,000, is the capital of Primorski Region. A "Region" is analogous to a state and Primorski is Russia's Far Eastern Gateway. Each year Primorski's ports receive about 1,000 foreign ships and they send approximately the same number of Primorski-based vessels to more than 400 of the world's ports.

Well-developed mining, fishing, manufacturing and transportation industries make Primorski one of Russia's principle economic regions. Primorski handles about one quarter of Russia's import-export and transit freight. Primorski fishermen account for 20% of Russia's annual catch.

Vladivostok is linked by direct air flights to Nigata, Toyama, Seoul and Anchorage. Vladivostok is known as the consular capital of the Russian Far East, having seven foreign consulates and 51 registered offices of foreign firms.

The entire Russian Far East is home to eight million residents. As of January 1, 1994 there were 2,286,900 people living in the Primorski Region.

The largest and most developed of the Region's scientific communities is based in Vladivostok which will add greatly to the Center's success. The city's 14 research institutions employ about 5,500 people including nearly 1,500 professional researchers.

Industries in the Primorski Region are labor- intensive. Heavy industry is the most highly developed sector of the economy. Fishing, shipping, mining, lumber, ship repair and defense make up the bulk of the Primorski's economy and these industries entail a great deal of physical labor. This type of labor invariably leads to serious injuries, human suffering and resultant loss in productivity. The economic implications of spinal injuries and instability are significant in this region of Russia.

The Clinic

The Clinic's Director is Dr. Kirill Anisov, a Russian neurologist with post graduate training in manual therapy.

"Kirill is a chiropractor at heart," according to Dr. Matthew McCoy. "He thinks, talks and acts like one. This became evident from the very beginning during the long talks we would have into the early morning hours about chiropractic, manual therapy and health. His favorite topic is 'the nature of the mental impulse.' We'll be in the middle of a busy day and he'll pull me aside to share a new thought about it that he obviously sat up all night thinking about."

Some of these innate chiropractic qualities obviously come from Kirill's father who, now in his 70s, has spent his entire life practicing a type of folk medicine which includes manipulation of the spine, joints and viscera as well as nutritional and herbal remedies.

The Clinic has support staff including: Dr. Katerina Molakova, a pediatrician with certification in manual therapy who heads the Diagnostic Department; two "interns" who are working and training in the Clinic; and a radiologist, Dr. Tatiana Masanena.

Dr. Anatoly Belyaev, the president of the Far Eastern Association of Manual Medicine and head of the Post Graduate Department of Vladivostok State Medical University was recently provided with an office at the Clinic.

"Spine" also employs a full-time interpreter for Dr. McCoy, Olga Volkova, who is also involved in overseeing the translation of documents and literature for "Spine." The Clinic employs a receptionist and an accountant as well.

Educational exchanges

The cultural, educational and scientific exchanges which began in April 1996 were also part of the initial goals of the project. They have included four additional exchanges, the last one having been held in November of last year in Seattle. Invited lecturers from outside Russia (primarily the United States) spend from one week to one month working and teaching at the Center and, at this time, all invited lecturers have graciously agreed to cover their own expenses.

The lecturers have included Dr. Kenneth Stillwell, who lectured to a group of manual therapists at a children's outpatient rehabilitation center in November 1996.

"Our Clinic wasn't completed yet so we weren't on our 'turf' and there was one 'Doubting Thomas' in the group of about 25 manual therapists," recalled Dr. McCoy. "He had apparently heard some things from European manual therapists about chiropractic and was very suspicious of us. This changed dramatically when Dr. Stillwell adjusted him after the lecture. His eyes lit up, he hugged Ken and invited him to a sauna. After this, all the other MTs loosened up as well."

The next exchange was held in July of 1997 with Dr. John Gerhardt and Dr. Harold McCoy. Dr. Gerhardt spent a week teaching and lecturing on objective range of motion measurement and Dr. McCoy discussed computerized manual muscle testing.

The lectures were very well-received, however, the best part of their stay was apparently the two-hour boat trip to a remote island for swimming, bar-b-queing and sun tanning with the Clinic staff.

Remembering the trip, Dr. Matthew McCoy said, "It felt surreal, being in this paradise, in Russia, sitting on the beach with Dr. Gerhardt and hearing from him how important he felt this project was. He underscored the responsibility that went along with it which meant a great deal coming from a man who has devoted his entire life to his work."

The next exchange took place at the end of August 1997, with Dr. Donald Mears presenting the Mears Upper Cervical Technique, which had been developed by his father. He was again accompanied by Dr. Harold McCoy and they spent two weeks lecturing and treating patients in the Clinic.

Before Dr. Mears arrived, a book on the Mears Technique, which his father had written, was translated into Russian. Dr. Mears recalls the moment when he first saw the translation: "I was suddenly struck by the realization that my father's work was the first material dealing with cervical spine analysis and adjusting to be published in the Russian language." Dr. Mears plans a return trip next year.

The last trip occurred in October of last year, with Dr. Harold McCoy returning to Vladivostok to discuss the coordination of a five-year plan developed by Dr. Matthew McCoy and Dr. Anisov of The International Spinal Health Institute.

Another reason for Dr. McCoy's trip was to escort Dr. Anisov to Seattle for the first of ongoing exchanges which will occur in the United States and include Russian doctors from the Far East.

The overall goal is to expose the Russian specialists to the clinical methods, clinical management, technology and protocols utilized in chiropractic and to find the most efficacious combination of treatment and preventive strategies leading towards the goal of subluxation reduction and optimum spinal health.

The next exchange in Russia is scheduled for this month. Dr. Malakova and Ms. Volkova have been invited to Seattle by the International Spinal Health Institute for another exchange in the spring.

In addition to the exchange program's objective of exposing the Regional Center's staff to chiropractic principles and practice, the intention is to promote cultural, scientific and educational exchange through top notch international collaborations. Besides the visiting lectures by international experts, educational programs have begun at the Center on a daily basis. They include a diverse array of approaches including "Grand Rounds," lectures, case presentations and round table discussions. "We started with the basics of vertebral subluxation and went from there" stated Dr. McCoy.

The educational programs will soon be coordinated with the Vladivostok State Medical University, and other institutions that participate in the project as it unfolds, such as The International Spinal Health Institute. In addition, collaborative research between "Spine," Vladivostok State Medical University, and other research institutions in the region and world will be undertaken.

The primary focus will be outcomes research and will include evaluation of the short- and long-term efficacy of chiropractic care utilizing structural and functional outcome assessment tools. The data from two retrospective studies are now being evaluated, one on scoliosis and another on children with cerebral palsy.

A unique aspect of "Spine" is that it has brought together chiropractors and other conservative authorities specializing in a wide array of techniques with one goal: spinal hygiene. This includes specialists in scoliosis, rehabilitation, corrective techniques, radiology, outcome assessment technology, diagnosis, pediatrics, research, biomechanics and clinic management. Also included are manual therapists and physicians specializing in orthopedics/orthopedic surgery, neurology/neurosurgery, physical medicine and rehabilitation.

"The one thing I demand is cooperation," Dr. McCoy remarked. "If someone thinks they have the answer to spinal health problems, I know they don't belong being involved with this project."

In addition to all this, patient programs have been introduced to promote chiropractic wellness care and foster patient education.

No one wanted "Spine" to be a place for "back and neck problems" so the focus is on family care and the achievement of health through a nervous system free from interference to its fullest expression. This has allowed the Clinic to take care of a wide range of patients including people with cerebral palsy, mental illness, seizures, Lou Gehrig's disease, brain tumors, etc. If a patient has a subluxation, The Regional Center for Chiropractic can help.

And help they do. The clinic has agreements with several of the Region's hospitals to accept patients who fall into the category of "the worst of the worst" -- those for whom doctors have run out of options and who cannot afford to pay for care.

According to Dr. McCoy, "We get patients from everywhere! In the States I always tried to keep track of where my patients came from, but here, it's nearly

( ( since word of the Clinic has spread on its own. We get people who come several hours by train, people who come from villages in the Region and spend a month in the city to get chiropractic care. We take care of volunteers from the American Peace Corps, people from Korea, Japan, Europe. It amazes me sometimes, the diversity of people we take care of."

School of Chiropractic

Another goal is to establish a chiropractic curriculum within the University system in Far Eastern Russia which will ensure the continued training of qualified Russian citizens in the practice of chiropractic. This will create the doctors who will staff future chiropractic centers and create the seeds for the establishment of chiropractic as a separate and distinct profession in Russia. Russian citizens will also study at American Chiropractic Colleges and return to Russia to practice.

Chiropractic is not licensed or regulated in Russia and -- according to a decree issued by the Minister of Health in July 1996 -- chiropractic, along with osteopathy, is considered part of the practice of manual therapy, hence, the practice of medicine.

Dr. Matthew McCoy stressed: "Our biggest challenge is going to be to legislate, license, define, and establish chiropractic as a separate and distinct profession in a country that has only one primary health care profession -- medicine."

Comparatively speaking, chiropractic in the United States, Australia, Canada, and Europe is highly integrated into the existing health care systems and the profession and educational systems are highly organized. The goal is to encourage the same in Russia, the Asia Pacific and Far Eastern Regions. This includes establishment of legal definitions regarding chiropractic practice, establishing standards of care for chiropractic and the establishment of licensing standards for chiropractic practice.

Nevertheless, the stage has been set for this achievement as discussions with local government officials have led to preliminary plans to begin the process of establishing chiropractic as the first primary health care profession apart from medicine in Russia.

At a recent meeting, Mr. Katkov remarked that chiropractic "will sweep across Russia from the Far East" and he renewed his and Mr. Shegnagaev's commitment to open additional centers in Primorski Region and after that move into Khabarovski Region. Planning for the next center will begin before the end of 1997.

The Regional Center staff will begin to train other teams of specialists to staff newly developed facilities in these other Russian cities. Careful documentation of patient outcome assessment and publication of research from clinical studies conducted at the Regional Center will serve to attract public and private interest and will focus worldwide attention on "Spine," thereby encouraging further clinical and scientific exchanges with other trade partners in Japan, Korea, China, Australia, Canada, United States, Europe and other parts of Russia.

The International Spinal Health Institute

In order to help accomplish the goals of "Spine" and this project, a non-profit institute has been formed in the United States called "The International Spinal Health Institute." Presently, there are 14 members, including a Board of Directors, Board members and an Advisory Board.

The Board of Directors is comprised of Dr. Harold McCoy, president; Dr. Matthew McCoy, vice president; Dr. Terry Rondberg, secretary; and Jonathan Hatch, J.D., treasurer.

Board members are: Dr. John Gerhardt, Dr. James Robinson, Carol James and

Don James.

Making up the Advisory Board are Drs. Donald Mears, Stephen Renner, Kenneth Stillwell, Veronica Gutierrez and Kirill Anisov and Mrs. Josephine Legan.

The Institute's vision is to ultimately serve as a worldwide center for the dissemination of knowledge regarding advanced methods of achieving optimum spinal health. The vision will be accomplished through international education, research, training, and cultural exchanges. Widespread effects on health of an optimally functioning spine and nervous system will be the Institute's cornerstone.

The Institute's mission is to -- on a global basis -- introduce and develop progressive, conservative modes of analysis, correction, reduction and prevention of spinal disorders. The chief mode will revolve around the science of chiropractic and other conservative measures. The primary entity addressed will be the vertebral subluxation and its effect on health and well being.

The immediate purpose of the Institute is to foster the creation of a world class spinal health center in Vladivostok which may serve as the model for similar centers throughout the Far East, Russia and the world.

The Institute intends to bring together expertise and guidance from a wide array of disciplines in order to accomplish these goals. Participating professionals will include: chiropractors, manual therapists, physiotherapists, rehabilitation specialists, neurologists, orthopedists, traditional (oriental) medical physicians, and surgeons. The expertise will be found among practitioners, researchers, academicians, hospital administrators, government leaders and consumers of health care.

In order to bring the world community together and share knowledge about spinal health, the Institute's scope is intercultural. One goal is to establish a framework for workable international guidelines for spinal care involving objective, outcome-oriented protocols.

"International Spinal Health Symposium"

The International Spinal Health Institute (ISHI), in conjunction with "Spine," is planning an "International Spinal Health Symposium" to be held in Vladivostok during the next year. ISHI and "Spine" will involve the Medical University, related governmental departments and the private sector in this undertaking.

This Symposium will draw on the talents of both regional and international lecturers. The Symposium's goal will be to provide a balance of basic science and clinical programs in order to reach the broadest possible audience and also bring together researchers and clinicians from a variety of fields. Additionally, it will allow the attendance by researchers and clinicians from several countries close to the Russian Far East, thus further strengthening and adding to the goals of a regional alliance for spinal care and research.

Technology

Technological infrastructure related to health care is lacking in the Russian Far East and the beginning stages of a computer network is being set up within the Center with plans to connect it to other parts of the Regional hospital system and the United States. This will allow for seamless access to information concerning patients and the ongoing activities related to research, diagnosis and education.

This network will be linked to participating locations in other parts of the world, primarily the United States, Japan, Australia, Korea and Moscow. Doctors and researchers will be able to exchange information freely and at reduced costs. The network will set the stage for telemedicine linkages and for implementation of the electronic patient record which will be necessary to keep pace with other parts of the world in the near future.

Doctors in the Clinic are being educated about literature retrieval, research databases and other tools of research. They will need this access in order to perform literature reviews, obtain research articles, keep abreast of the latest developments in related fields and become skilled regarding research and its technological tools.

Equipment

Additional equipment which will be added to "Spine" in the near future includes: radiographic digitizing, videoflouroscopy, and spinal diagnostic ultrasound. The Clinic has a complete Diagnostic Department with computerized manual muscle testing, surface electromyography, thermography, range of motion and radiology. All of the original diagnostic equipment was donated by chiropractic companies who understood the importance of the project. Additional donations were recently made by Dr. Leander Eckart who donated four adjusting tables.

Recent discussions have been held with officials here to establish a "Magnetic Resonance Center" in Vladivostok. There are currently no facilities for magnetic resonance available in the Region. The nearest facility is located in Khabarovsk, a neighboring Region, which is 12 hours by car and an hour by plane.

Consultations have begun to assess the present skill level of technologists and radiologists here and ascertain their future capabilities. Information gathering is being performed regarding space requirements and other factors associated with the installation and use of an MRI scanner. This endeavor will be a joint project involving government, the MRI industry, private organizations and the scientific community.

Literature

In order to accomplish the goals related to this project, chiropractic needs a literature base in the Russian language. When there are no words to describe what you do or the profession's identity, it creates roadblocks to development. This has led to the translation of a number of pieces of chiropractic literature including Dr. Terry Rondberg's book "Chiropractic First," technique- related material, definitions, research articles, and assorted information regarding the vertebral subluxation.

Speaking of translation and terminology, Dr. McCoy relayed an interesting story about the word "adjustment." He hadn't thought about asking how the word was being translated, as he assumed there was a word in Russian that meant adjustment.

"I don't use the term 'manipulation' to describe what chiropractors do," he emphasized, "and one day I asked my translator what the word for adjustment was in Russian. She told me there really wasn't a direct translation, and that she was using the word 'correction.' I couldn't argue with that. It reminded me of the way upper cervical chiropractors describe an adjustment, so the term has stuck."

Dr. Matthew McCoy was originally scheduled to leave in October of 1997 after spending one year helping to establish the Center. However, he was asked to stay longer and has agreed to remain until May of 1998.

"To be honest, I don't think I'm ever 'leaving' Russia," he admitted. "It has become a second home for me and I have an adopted family with all the wonderful people I have become so close to."