The John A. Sweaney Lecture: Gold Coast, Australia, October 2023, given by Mufudzi Chihambakwe: The light we carry: Chiropractic as a public service

Abstract

The following is the John A. Sweaney Lecture delivered by Mufudzi Chihambakwe at the Biannual Meeting of the World Federation of Chiropractic in Gold Coast, Australia, on October 11, 2023.

INTRODUCTION

Thank you to everyone here. This is a special honor to be here in the room with so many passionate leaders in the chiropractic profession. I honor you. I honor all the work you do for the profession. It is an amazing honor to be up here delivering the John A. Sweaney Lecture as others have before me.1–7

I recognize that Australia is the country where Dr. Sweaney was from. It is incredible to come full circle. The last time I was at a [World Federation of Chiropractic] WFC Congress was in 2013, when I was a second-year chiropractic student. As important as this recognition is to me, I also want to recognize my amazing wife, who is here for the first time. There are a lot of firsts here today (Fig. 1).

Figure 1.

Mufudzi Chihambakwe presenting the John A. Sweaney Lecture on October 11, 2023, to the World Federation of Chiropractic Assembly.

PRESENTATION

Picture this. It is Summer 2019, which is December where I am from, and it is a hot, sweltering afternoon in a small place called Gutu in Zimbabwe (Fig. 2), a place that many might call the deepest darkest Africa. This is a place where people speak a lot about nature and the climate but not about the people there. This is a forgotten place. This place is where my father was from, where my grandfather was from. A place where people come from but rarely ever go back to.

Figure 2.

Gutu, Zimbabwe. Source: https://gadm.org/maps/ZWE/masvingo/gutu.html. Accessed April 15, 2026.

But it is in this place where I saw a light. It is the same place in Gutu that my father spoke about. This is the area where my father grew up and where my grandfather’s compound is. My father used to tell me how he herded cattle after school and carried his books in the fields. He went on to study engineering and later raised his family in the city.

A generation later, I was in Gutu, Zimbabwe, on a mission trip, bringing the gift I had gained from the world back to our fathers and grandfathers. The gift of providing spine care. A friend and I founded a nongovernmental organization during my final year of chiropractic school. It was called Spine Health Africa.

Here is when things changed for me. It was our second year doing the mission trip. We had been there for 2 weeks. On this day, which was the very last day of the mission trip, we were tired after a long shift seeing patients. And it was then that I saw something jarring, somewhat easy to dismiss as idealistic yet also an impulse for health care I had only sensed, never quite gotten to touch. It was a sign that I just could not ignore. It was a light that I did not know I needed to see.

The sign said, “This is a health center. No fees are to be charged at this facility.” And what caught my eye was the section written in my language, Shona. The sign said “Vanhu vanorapwa pano havabhadariswe mari.” This has the same meaning but with greater nuance. It means that anyone who needs care and comes to this facility will receive it (Fig. 3).

Figure 3.

Sign at the health center.

That sign was essentially making a promise to help anyone who needed it. This sign was inspiring but also deeply disturbing. It was inspiring because this is the way health care should be provided. But it also brings up questions, such as “What quality of care will be provided here?” or “Will there be care provided here at all?” A lot of people around the world rely on promises like this in locations such as this, but unfortunately, all too often, those promises are broken.

A World Health Organization report described how steps towards Universal Health Coverage have stalled and that over 50% of the world’s population still lacks access to essential health services.8 We are in a situation where many promises have been made, yet many people still have limited access to good health care. For me, signs such as the one in Gutu forced me to consider the question: What are the factors keeping health professionals in general and chiropractors in particular from being available in places such as this?9,10 One possible explanation is the Inverse Care Law, which posits that those with the greatest burden of disease often have the least access to care.11 This is not a result of health practitioners not caring but rather of market forces dominating the way health care is delivered. The result is that we end up in a situation where so many people are left in the dark and with broken promises.

I would like to teach you an African word that has great meaning to me. The word is sawubona. Sawubona is a Zulu greeting commonly used in South Africa that loosely translates to “I see you.” Can the chiropractic profession say “I see you” to all people?

For the millions of people across the world who are suffering from spine-related disorders12,13 and have limited access to care, can we say as a profession, “We see you”? There is an aspect of this that is particularly challenging for people living in places where there is still a significant burden of communicable disease: the fact that spine-related disorders are mostly invisible. Patients in our clinics often express how invisible their pain seems as they often find themselves in health care settings that are often not well-equipped to effectively manage their pain or condition. Working in these places, it has become increasingly obvious to me that this is exactly where we need to be as chiropractors. As individual chiropractors and as the chiropractic profession, we need to, in a sense, sawubona them.

I have been blessed to work in a context where people take the service of the underserved seriously. I have been mentored by amazing people at World Spine Care, who have taken the initiative to provide sustainable spine care to people in need.

Noteworthy are Dr Scott and Joan Haldeman, who came to Gaborone earlier this year. They visited our facility at the Broadhurst 3 clinic (Fig. 4). Dr Scott Haldeman is a hero of spine care and the chiropractic profession and a personal hero of mine. It was a great honor and a privilege to have him visit our clinic. The Broadhurst 3 clinic was established under unique circumstances, and I have had the privilege of working with World Spine Care for most of my career to date. It has been a world of learning about how to make a sustained effort in the service of the poor. During their visit, we had the opportunity to speak with the matron at our facility. She described how, with just over 30 health practitioners, including nurses, medical doctors, and myself, who is a chiropractor, the facility sees over 33,000 patients monthly. This makes for a busy public practice.

Figure 4.

Scott and Joan Haldeman visit to Broadhurst 3 clinic, Gaborone, Botswana.

There is a serious need for greater musculoskeletal care in primary care settings such as this. There is a significant burden of spine-related disorders limiting people’s capacities to live full lives. I often sit with this knowledge and wonder how to make spine care more sustainable. With such a large burden of disease, it is not sufficient to rely solely on volunteers, donations, or mission trips to serve people in these communities. A more sustainable and organized pathway is necessary if we are to make a significant dent in this burden. Service to the underserved needs to not be a charity issue but instead a priority for our profession. Viable multiyear career pathways need to be created in these spaces to this effect and to make this a reality.

I believe that as chiropractors, we carry a light, that we can do more than acknowledge the darkness but actively push against it. I wrote a poem that embodies this thought (Fig. 5).

Figure 5.

Poem: The Light We Carry (reprinted with permission, Chihambakwe).

CONCLUSION

Aiming to help the poor and serving them is expensive.

It is going to take a lot of effort to figure out how to work sustainably in these spaces. We are not seeking to be a brand; instead, we are seeking to be of service. We can shine a light in these very dark spaces, and I hope you can shine it with me.

DECLARATIONS

Competing Interests

The author declares no competing interests.

Artificial Intelligence

Artificial intelligence was not used to prepare this paper.

Contributorship

Concept development: MC. Design: MC. Literature search: MC. Writing: MC. Critical review: MC.

Funding Statement

Funding No funding was received for this paper.