Diversity in Chiropractic Care

May is Asian Heritage Month. It’s an opportunity to celebrate the contributions Canadians of Asian descent have made, and continue to make, to Canada’s growth and prosperity.1

During Asian Heritage Month and throughout the year, we’re proud to celebrate our members of Asian descent, their contributions to their patients’ and team members’ lives, as well as their communities and the profession. Our diverse members also bring a unique capability to understand how their culture’s norms and values align with their patients’ preferences.
¹ Canadian Heritage, Government of Canada, Asian Heritage Month.

2023

Highlighting stories and insights of members of Asian descent for Asian Heritage Month 2023.

2023 marked the 21st annual Asian Heritage Month (AHM), a time for all of us to come together and recognize the incredible strength, determination, and accomplishments people of Asian descent have made across Canada. Initiated by the Government of Canada, this month provides an opportunity to highlight and celebrate the many contributions of our members to the chiropractic profession and patient care. The theme for 2023 was “Stories of Determination.”
Throughout the month of May, we spoke with a few of our members about what Asian Heritage Month means to them, their vision for inclusive chiropractic care, and how acknowledging diversity and patient preferences enhances patient care.
Dr. Ellen Chin
Dr. Ellen Chin — AXIS Chiropractic, Uxbridge

For me, inclusive chiropractic care requires an understanding that all patients and their chiropractors have unique perspectives, including differences in language, culture, race, ethnicity, ability, and gender or sexual orientation. These unique perspectives and differences must be acknowledged and accepted to provide barrier-free care.

Also, inclusive chiropractic care means understanding that past discrimination and implicit biases have led to inequities for different groups and knowing that discrimination and biases still exist in health care. The first step to proactively removing barriers and prioritizing the time and commitment to providing inclusive care is acknowledging and understanding the issues that different groups face.

Communication is always important in patient care, especially while taking patient histories, communicating assessment and treatment options, and during every patient visit. With any patient, it’s important for the chiropractor to fully understand what the patient is experiencing and for the patient to understand the chiropractor’s questions, diagnosis, treatment options, and plans. If there are language or cultural barriers to understanding, I find that giving patients relatable day-to-day examples allows them to better understand what is trying to be communicated.

If I am unfamiliar with a patient’s cultural norms or beliefs, I think it’s important to ask them to help me understand them. Typically, patients are happy to educate me on their culture or religion and appreciate the initiative and open-mindedness. I also reach out to other health care professionals with the same cultural beliefs to help me learn how to give better care and understand preferences from a chiropractor’s point of view.

There can also be differences in understanding health and illness. Both health professionals and patients are influenced by their respective cultures. Awareness of a patient’s culture can promote trust, and better health care, leading to higher acceptance rates of diagnoses and improved treatment adherence.

I find that giving patients relatable examples and having them answer “yes” or “no” is more helpful than asking them to answer in English. Using visuals, pointing to body parts, and showing patience and understanding are always important. It’s also important to offer opportunities to contact you afterwards once information has been reviewed. This gives patients the opportunity to look up information in their own language and discuss it with loved ones before asking the health care professional more questions.

It’s important not to generalize Asian backgrounds and be aware that each culture is unique. From my experience, I find that in the Chinese language, there are many adjectives that in English has grouped together as one adjective. This makes it difficult for someone who usually communicates in Chinese to find the right words in English to express themselves.

As another example, in Chinese culture, reverence for the elderly is valued. Caring for elderly family members as they had cared for their children is essential. The elder family members may expect their adult children to care for them, and they commonly live together. It’s not uncommon for adult children to bring elderly parents, so it’s important to for the health care professionals to have consent from the elderly parent to discuss openly with their adult child about their care.

Living and working in a small community for the past twenty years, I’ve have seen young patients grow up through the years and have their own families. I feel so proud when they are excited to introduce their loved ones to chiropractic care. I love seeing this cycle of chiropractic through the generations. I also enjoy seeing my elderly patients age gracefully through their years of treatment. Another achievement would probably be that I’ve recently been selected to help peer assess and/or mentor other chiropractors. Mentoring and peer assessment allow me to give back to other chiropractors by helping them reach their goals and the profession to grow stronger.

Dr. Ellen Chin with Axis Chiropractic Team
Dr. Chadwick Chung
— Canadian Memorial Chiropractic College (St. Michaels Hospital)

Asian Heritage Month is important to me because it allows for a special time to reflect on our origins. And all the efforts and sacrifices that previous generations made for us today. Being a third generation Asian in Canada, my identity is mostly Canadian. However, my culture is mixed with Chinese and Caribbean heritage. This to me demonstrates the beauty of Canada today, which is inclusive of diversity and multiculturalism. A place where my Asian heritage is embraced along with the Caribbean heritage of my parents.

Inclusive chiropractic to me means being accessible to all cultures, races and identities. It means treating people with respect despite the colour of their skin or where they’re from or how they may identify. As a clinician in a public setting that sees a lot of inner-city health as well as in a community-based clinic that serves the general population with a focus in chronic pain, I see patients of various demographics and needs. In the public setting, it is extremely rewarding to see those who may be new to our country and may not have the resources to access chiropractic care in a similar way to those patients that are able to afford community-based care.

To effectively incorporate patient preferences and cultural norms or beliefs, I believe it is important to approach each patient with respect and humility. I acknowledge that each patient will have their own experiences throughout their life journey and that this may impact how they experienced their health issues. It would not be fair for me to impose my beliefs or experiences on them, but  rather to listen to their story and to try to understand their perspectives. By doing this, I believe that we can adapt the way we discuss things or educate our patients so that they can be a part of their health decision-making process as we provide them with chiropractic care.

When communicating to patients with Asian backgrounds, it is important to consider that they may not have the same vocabulary to describe their health issues or may not conceptualize their health issues in a similar way to what’s typically expressed. In many cases, I think this leads to frustration among both the patient and the practitioner which can impact the overall experience. My advice is to take your time and use various methods of communication concurrently such as typing through a translation device and using images. You could also consider using relatable examples or analogies, different computer applications, or even a translation service.

2022

In 2022, we asked a few OCA members several questions to reflect on their Asian heritage, their growth as a chiropractor and how their diverse background enriches their patient care.
Dr. Aksa Ahmed, Dr. Ayla Azad, Dr. Adrian Chow, Dr. Hera Khayyam, Dr. Oishi-Stamatiou (Dr. Ailin Oishi), and Dr. Moez Rajwani have graciously opened a window into their experiences. Their stories show us how their culture shapes their identity, enhances their care delivery, as well as contributions to their community.

I self-identify closely with second-generation Asian Canadians. The Asian Canadian community is a mix of first and second-generation South Asian Canadians. In other words, those born in Canada versus those that immigrated to Canada. Those born in Canada are most likely to self-identify differently from South Asian Canadians that immigrated to Canada due to their mixed ancestry and Canadian influences.
– Dr. Aksa Ahmed, Toronto, Ontario
I’m proud that I’m South Asian but I have certainly pushed the boundaries with some cultural norms. It’s the beauty of Canada that allows this fusion of cultures to happen.
For my kids, there’s no questions. With a heritage that’s third generation South Asian, they identify as Canadian with South Asian roots.
– Dr. Ayla Azad, Ajax, Ontario
One of my family’s core values is to be there for each other no matter what community you’re from. There’s an old saying in Chinese culture, “When you wed, you marry the family not just the spouse.” When you’re a chiropractor, your patients become like family to you. I want my patients to know that their chiropractor is dependable and caring. This is how my family treats each other, so why would my care be any different?
— Dr. Adrian Chow, Markham, Ontario
My parents made sacrifices to help shape who I am today. For example, they come from a culture of gender roles. However, my family encouraged women to take on a larger role within their own family dynamic, to be an equally independent, well-rounded, and a strong partner, as compared to the traditional divisional gender roles of generations before.
— Dr. Hera Khayyam, Newmarket, Ontario
Part of my identity is the fusion of my Asian heritage with North American customs. My family values passion and respect for all cultures and being the best version of yourself. I see myself as I am today, serving the Japanese Canadian community through my work and volunteering. For example, my clinic forms are transcribed in Japanese to serve my community, and I offer education and seminars at the Japanese Canadian Cultural Centre.
— Dr. Oishi-Stamatiou, Toronto, Ontario
As part of her volunteer work, Dr. Oishi is a contributing writer to Nikkei Voice and submitted this article as part of our 2022 initiative to celebrate Asian Heritage Month, which you can also read here on our website.
I am Ismaili Muslim, a branch of Shia Islam. My father was born in India and ancestrally I am from an area in India known as Gujarat. I was born in East Africa and immigrated to Canada at the age of five. My culture and faith have provided me with a moral compass that guides my life. It has allowed me to develop a set of values that govern how I live my life and interact with others. The values are universal and all me to focus on patient care with a sense of compassion, integrity and always trying to learn to improve my abilities and skills to be the best I can.
— Dr. Moez Rajwani, North York, Ontario

I wouldn’t say that being an Asian Canadian specifically played a role in my decision to pursue chiropractic. My decision was based on my personal experience as a patient receiving treatment for a sports-related injury from a chiropractor. I was intrigued by the profession and as I delved into the realm of conservative therapy I decided to explore the option of studying chiropractic. That said, I find many South Asians are not aware of the chiropractic profession and do not utilize chiropractic services. The hope is that this changes as there is more awareness on the benefits of chiropractic care.
– Dr. Aksa Ahmed, Toronto, Ontario
As a high school student in the 1960s, my father went on an exchange trip to the United States and was hosted by an American family. The family’s father was a chiropractor, and my dad learned a lot from him. He developed a lot of respect for the profession and suggested I pursue a career in chiropractic. When I first read about chiropractic I knew that is what I wanted to do because it was such a unique way of looking at the body.
– Dr. Ayla Azad, Ajax, Ontario
I first got bitten by the chiro bug when I was playing sports and had injuries. It was at this time that I was referred by a friend to a chiropractor. I thought how great it would be to be able to help people achieve their optimal health.
– Dr. Adrian Chow, Markham, Ontario
In my community, there is a cultural understanding of the importance of natural healing and overall health. I grew up understanding the importance of Western medicines along with natural Eastern ones. It was during this time that I developed an interest in the musculoskeletal (spine, muscles and joints) part of our body. As a teenager, I wanted to pursue both parts of care: Evidence-based and a natural approach to helping people feel better.
– Dr. Hera Khayyam, Newmarket, Ontario
In the early 90s, my family immigrated to Canada to escape the economic bubble collapse in Japan. I thought I was going to be a marine biologist, but when I developed low back pain, my doctor sent me to a chiropractor. This changed my career choice. I always had an interest in science, so chiropractic was a natural fit.
– Dr. Oishi-Stamatiou, Toronto, Ontario
When I entered chiropractic school there was only one chiropractor that was from my community that I knew so I didn’t have too many role models. I always wanted to be a health professional but was not aware of chiropractic. It was a car accident that I was involved in that led me to the profession. As with many chiropractors, I was a patient and my chiropractor became my mentor, a role model and encouraged me to apply to be a chiropractor and here I am!
– Dr. Moez Rajwani, North York, Ontario

South Asian heritage is taught as essential to my kids. They need to appreciate their culture. Learning and appreciating your traditions are important but it’s not just your particular heritage, you need to respect all cultures. This is what makes multiculturalism beautiful.
— Dr. Ayla Azad, Ajax, Ontario
I grew up in a non-Asian community. Being different made it difficult to fit in but my family taught me, “We are all different.” Understanding that there are many different communities in Canada allowed me to be more open and aware of my heritage.
— Dr. Adrian Chow, Markham, Ontario
Yes, family traditions were and are particularly important to me. In Pakistan, anybody who your family has a good rapport with — from the neighbour down the road to close friends of your parents — becomes part of your “family!” You even refer to them as your aunt or uncle. Everyone is connected through this strong belief of looking after each other and keeping close. I bring this sense of “family” to my practice. I care for my patients as I care for my family. By providing care to my patients, I close the loop on ensuring my “family’s” health needs are met.
— Dr. Hera Khayyam, Newmarket, Ontario
Yes, I am blessed to have a multi-racial family that is Greek, Russian, Taiwanese and Japanese. One big happy melting pot! I’m glad Canada has pride in our multicultural heritage. We need to pass these cultures to the next generation.
I bring this multicultural and diverse acceptance into my work by embracing all of our differences. The beauty of celebrating diversity is through each cultural mosaic.
Get to know the culture first before you make a conclusion on what that community is all about. The more open you are, so are your patients. They won’t be hesitant on sharing their ailments with you as their chiropractor.
— Dr. Oishi-Stamatiou, Toronto, Ontario
Yes, and it was even more evident during the pandemic. The family when united is a sense of strength and comfort during times of difficulties and investing in family is so important. I learned from my parents and my wife how important it is to invest time in family. As I reflect on the last two years, it was the family unit and our traditions that kept us strong and allowed us to persevere.
— Dr. Moez Rajwani, North York, Ontario

There are two things that particularly intrigue me about my South Asian heritage. First is the vast diversity. South Asian culture has a lot of diversity in language, ethnicity, and religion. Second is the strong importance of family, kinship, and community.
– Dr. Aksa Ahmed, Toronto, Ontario
What brings me joy is the knowledge that many people are recognizing the cultural make-up of their communities.
There are many diverse cultures in Canada, and each can provide their own unique approach to how they embrace being Canadian. This to me is fascinating! What a way to learn about your fellow Canadian.
– Dr. Adrian Chow, Markham, Ontario
To answer, I’ll reference the amazing book, “Like Water for Chocolate,” which welcomes the idea of “magical realism” to explain the importance of food in culture. It describes the connection between food and how it holds a “magical response” to how those close to you relate to eating food of distinct cultures. Nutrition is not just consuming protein, fats, and calories. It’s about feeding the soul too!
When we feed our souls with both emotional and nutritional sustenance, we thrive. To me, the joy of cooking is equal to the joy of helping others lead healthier lives.
– Dr. Hera Khayyam, Newmarket, Ontario
Joy for me is celebrating my mixed heritage as it uniquely provides me with a multi-sense of belonging.
Helping Japanese seniors and giving back to the community is my current focus. Take chronic pain in older adults as an example. These patients will share their wisdom and life lessons with you if you are receptive. It’s a positive cycle. I help them understand how to live successfully with chronic pain.
– Dr. Oishi-Stamatiou, Toronto, Ontario

One of the major challenges I find is preserving my culture and identity.
– Dr. Aksa Ahmed, Toronto, Ontario
There were moments when I was questioned about, “How I spoke such good English,” or, “How come you know so much being South Asian,” but overall, the community I served embraced me as a chiropractor.
It’s ironic that some in my own culture wondered why I chose to become a chiropractor. This of course comes from a lack of awareness as to what chiropractors do. I still get questions at family events about chiropractic! As a profession we have a huge opportunity to help educate people from different cultures about chiropractic and its role in the health care system.
– Dr. Ayla Azad, Ajax, Ontario
I think everyone faces challenges when they first come to Canada. It’s not specific to their line of work. Growing up, I felt proud to learn multiple languages as a second-generation South Asian.
— Dr. Hera Khayyam, Newmarket, Ontario
As a woman and a visible ethnic minority, I have faced adversity from society. It has made me work harder and smarter to prove myself. We need to ensure that gender, race and diversity are equally represented in the chiropractic profession and leadership to better reflect the patients and professionals we serve. That is our future.
— Dr. Oishi-Stamatiou, Toronto, Ontario
Like many minority communities I have faced challenges of inclusion in the early years, whether it was at school or working with other health professionals. The last few years I have seen more interest in learning about each other and embracing our differences. As a profession and a country we have a long way to go but I am seeing the openness to learn more about each other.
– Dr. Moez Rajwani, North York, Ontario

The most common cultural norm I come across is the misunderstanding of ‘hurt verses harm.’ The majority of the time this is due to the belief that if there is pain, movement and exercise will cause damage. This is not necessarily true and it is important to understand that not all of our aches and pains cause tissue damage. My awareness and ability to identify cultural norms like this is extremely valuable in clinical practice. I make it a point to discuss these concepts with my patients to better inform and educate them and this in turn improves their recovery and restoration of function.
– Dr. Aksa Ahmed, Toronto, Ontario
There are many cultural norms to be mindful of when treating patients from the South Asian culture. These include a multitude of religions, languages and rituals – from women wearing a hijab to a Sikh man carrying a Kirpan.
We need to have cultural agility to understand everyone’s beliefs and values, which I believe is a key component in addressing diversity, equity and inclusion (DEI). As health care providers, it is our responsibility to ensure we have this skill as we treat all people from all cultural backgrounds.
– Dr. Ayla Azad, Ajax, Ontario
My heritage impacts my delivery and communication with my patients. A large aspect of South Asian culture includes respect for elders and respect for women, including their comfort during a physical examination. If for example, I’m treating someone wearing a hijab (scarf to cover their hair), I will explain why it needs to be removed if they complain of pain in the neck region, but also when it doesn’t need to be removed. So, they are able to keep it on and stay comfortable while I treat everything else. It is a sign of respect and acknowledgment that it is a part of them. Just as you wouldn’t remove a shirt until working on skin in that area, the hijab can stay on until if and when it needs to be removed for skin contact.
In terms of communication, some people may feel they are able to describe something better in their own language or use a saying in their culture to describe the ache they are experiencing. This is something I like to highlight and translate as best as possible, as it signals to the patient that I am interested in what their understanding of their pain is but also how they would usually treat it.
— Dr. Hera Khayyam, Newmarket, Ontario
I think respect and sensitivity are key here and making your patients comfortable enough to lower their barriers and trust you with themselves. When delivering primary care as a clinician, I can better connect with my patients in a welcoming and safe space.
In my culture, patients are reluctant to question and disagree with their doctor’s recommendations because it may be seen as disrespectful. The patient may refrain from asking questions, even if they do not understand the doctor’s instructions because they don’t want to waste the doctor’s time. To avoid confrontation and keep a harmonious patient-doctor relationship, the patient may leave their doubts and real opinions ambiguous or unspoken.
To overcome this barrier, I am the first to ask questions to demonstrate that it is not embarrassing to clarify. I tell my patients it’s normal to have questions and doubts. It’s better to clear any potential misunderstandings and fears before they become something more. If you show others that you can be vulnerable by asking questions, they feel they can also be open and less hesitant with you. This creates an open dialogue with shared decision-making rather than a top-down conversation. You want an equal partnership with your patient regarding their health.
– Dr. Oishi-Stamatiou, Toronto, Ontario
First there is language. For a small subset of my patients, expressing their health issues in English is difficult. My ability to speak the language (Gujerati) allows them the comfort and ability to explain their issues.
Secondly there are activities of normal life that I understand because of my culture that others may not. Examples include attending congregational prayers, the role of extended family and parent/child relationships. It allows me to understand barriers to recovery that other chiropractors of a different cultural history may not be as familiar with.
– Dr. Moez Rajwani, North York, Ontario

My role models/mentors have been some of the educators that I have come across over the course of completing my chiropractic degree. Interestingly enough, although they are not of South Asian heritage, many of them are either first or second-generation Canadians themselves.
— Dr. Aksa Ahmed, Toronto, Ontario
I grew up in Dubai at a time when there were no chiropractors. When my dad went on an exchange program to the United States, Dr. Herschel Stanford was the host family’s father. He had a huge influence on my dad’s life. If it wasn’t for Dr. Stanford, I would have never known about chiropractic. He was a Palmer University grad and that is why I also went to Palmer College of Chiropractic.
– Dr. Ayla Azad, Ajax, Ontario
As a CMCC student, I was working at Dr. Alan Horowitz’s clinic. He helped guide me towards becoming one of his associates.
My parents also really set the bar for overcoming hurdles in life. The barriers they both faced coming from Hong Kong and immigrating to Canada were significant. This showed me the perseverance needed to succeed — not just as a chiropractor, but as a Chinese Canadian.
– Dr. Adrian Chow, Markham, Ontario
I consider Dr. Ayla Azad a mentor from my time at CMCC. Especially as she is a woman of colour and knows what it takes to rise within our profession. Also Dr. Patricia Tavares, who I knew I needed to learn from when I sat in a guest lecture from her years ago. They have found thriving careers, while dealing with multiple hurdles. The gender issue is getting better but still has a long way to go.
At CMCC, Dr. Dominic Giuliano was a great support as I navigated my way through being a petite woman in a profession dominated by larger males. In addressing this contrast, I asked “How am I supposed to do this?” and his response was “You’ll have to work harder than them.” His reply was a stark reminder of how women, and even more so, women of colour have many hurdles in their pursuit of being a chiropractor. My reply was definite, “O.k. I will!”
— Dr. Hera Khayyam, Newmarket, Ontario
I am inspired by others in the chiropractic community. Our OCA award recipients have done so much for our community. Look in the mirror and accept that we are all works in progress.
Making human connections is both in the community and in your clinic. The whole body is our responsibility as chiropractors. By accepting other cultures, we put the human factor into play.
— Dr. Oishi-Stamatiou, Toronto, Ontario
My first chiropractor, Dr. Guerriero was the one that guided me to be a chiropractor and is still a role model for me today. He was always so passionate about his work and the critical role chiropractors should play in the health care system.
He made me believe that our profession has so much to offer and that with hard work and excellent patient outcomes, other health professionals would see the effectiveness of what we do. As I fast forward my over 25 years in practice, his vision has become a reality and we are more integrated in the health care system than ever before.
– Dr. Moez Rajwani, North York, Ontario
Note: Our original banner art for Asian Heritage Month 2022 is comprised of textile patterns and traditional designs from a variety of Asian countries, including Indonesia, Korea, Japan, China, India, and Malaysia.

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