Cultural Competence for the Chiropractor: A Conversation with Dr. Charmaine Herman

By International Chiropractors Association

We had the chance to chat with Dr. Charmaine Herman, one of our featured speakers for the ICA 98th Annual Convention – Serving Those Who Served. Dr. Herman is a multi-faceted professional, serving as a member of the ICA Board of Directors, Full Professor at Life University in the College of Chiropractic, and published researcher, in addition to maintaining an active practice in Alpharetta, Georgia, where she specializes in the Blair upper cervical chiropractic technique. She has been recognized as Chiropractor of the Year by the Blair UC Society (2016) and one of the Top Chiropractors in Atlanta by Atlanta Magazine (2018). She was also awarded Upper Cervical Researcher of the Year by the ICA Council on Upper Cervical Care in 2019.

Dr. Herman is an active member of the Title IX Review Board, Conduct Review Board, Research Track Committee, and COC Assessment Council at Life University. She is also the cultural competency trainer for the Office of Diversity, Equity, and Inclusion (ODEI). She supports student chiropractors in her roles as club advisor for the Blair UC Technique Club as well as the Student American Black Chiropractic Association (SABCA).

We are fortunate to have Dr. Herman as one of our speakers at this year’s convention where she will be sharing her expertise on cultural competency with our chiropractors. The following is taken from a conversation Taylor Carter, our Communications Manager, had with Dr. Herman about her experience on the topic in preparation for the convention.

Taylor Carter: I’m glad we were able to fit in a time together because I know you’re super busy. One of our stated values at the ICA is equitability and inclusion and that’s something we’re really trying to focus on, so, number one, I’m glad you’re going to be at our convention to speak about this, and, number two, thanks for having this conversation with me now so we can get people prepared ahead of that. Could you give me a quick definition for what cultural competency is? I know it can be a complicated thing, so just a couple sentences –

Dr. Charmaine Herman: It’s not that complicated, I like to keep it simple. Cultural competence is realizing, appreciating, and educating yourself about your own culture and the cultures of people that surround you. That’s as simple as it is. People seem to think that to be culturally competent, I need to learn everybody’s culture around the world. No, that’s too hard. But what it means is I evaluate and know my culture, so I know the things that may be comfortable for me based on how I was raised – my beliefs, my values – and the things that don’t make me comfortable. Once I realize those things that don’t make me comfortable, for the sake of being a doctor, I learn how to put those things aside so I can treat my patients fairly and provide the services that they need.

TC: I really love that definition – a lot of people hear the words cultural competency or diversity, equity, and inclusion, and they get this kind of kneejerk reaction of, “oh, I don’t know if I want to talk about this,” or they think people are focusing on it too much, but I think when you boil it down to that, just looking at your community and making sure that people at least have a comfortable and safe environment around you –

CH: And being willing to be inquisitive enough to find out more about their cultures.

TC: Yes!

CH: Most people don’t realize their own culture. For me, I’m a black female, I’m a chiropractor, I’m an educator, I grew up in the north, I live in the south, I’m almost 60 years old – all of those things are dynamics that make up your culture. People are a combination of their experiences and their environment. Not just the holidays you celebrate, not just the foods that we eat – all of that is part of our culture, too, but there’s also those underlying things that we don’t see: how people feel about personal space, how people think about modesty, how much of my flesh do I want to show? There are different things that we don’t think about as chiropractors, and those are things that I teach in my class at Life. I get into those topics that people aren’t “comfortable” with but should be addressed, because you don’t know what you’re going to see, you don’t know who’s going to walk in your office, and you want to be able to put yourself aside.

TC: I 100% agree. I am a second generation American – my mom is an immigrant from Hong Kong – and so I have my own cultural mismatch with living in typical American suburban society. Even bringing friends to my house as a kid, I would have to give them the rundown on how to address my parents, here’s some things you shouldn’t do in my house, take off your shoes – it just makes it more comfortable for everybody. And if that’s the prep I have to do for people just coming to hang out, I can only imagine how much more you have to prepare to have anybody walking into your practice.

CH: Mhmm. You know, we all have prejudices, we all have those things we don’t like to admit, but we do. That’s just who we are. And knowing – saying, ok, let me just put this aside because I can’t let that interfere with giving service or care to that individual – lets you feel more comfortable when you’re delivering service and care to them. Even as far as your media, how you advertise, your websites, social media, who do you interact with? People pay attention to all those things when choosing a provider so they’ll know whether they’ll be comfortable to be in your office. It’s not hard, I tell people, cultural competence is just how we live in a society that’s diverse.

TC: Would you mind sharing in your own words some of the things that led you to chiropractic, to upper cervical chiropractic, and specifically focusing on cultural competence and diversity, equity, and inclusion?

CH: Well, I was not a chiro kid. My parents raised us to be healthy, but if we had to go to the doctor, we were in a doctor’s office. My family is from Jamaica, and we moved to New York when I was about three years old, so I grew up in Brooklyn, New York. I didn’t know anything about chiropractic, never saw a chiropractor, never knew what a chiropractor was. I do remember seeing some of the offices, but never looked into it any more than that. I ended up at the University of South Carolina and started working after school in environmental labs and things like that. I worked for the Department of Environmental Health in South Carolina. For 10 years, I was a laboratory evaluator, so I traveled around the state evaluating wastewater labs.

So again, nothing about chiropractic on my radar until my minister was using my bike in my apartment and something happened to her hip. I took her to urgent care and they gave her some muscle relaxants. When I took her back the next day, the doctor looked at her and just gave her more pills. She was down for about two weeks and could hardly walk. I went to a store that we normally frequent – a health food store – and a nurse asked me how [she] was doing. I said, “Well, she’s got this thing in her hip and her back and I don’t know what’s going on.” So she said, “Have you taken her to a chiropractor?” and I looked at her like, “Huh? What is that?” At this time, I had a master’s degree, two bachelor’s degrees, had managed my own laboratory, and I had no idea what a chiropractor was. She gave me a card for her practice, so I took my minister to her chiropractor. Two adjustments later, she started moving, and the next visit she was up and going. I was like, “Oh my gosh, what is this?” That started me thinking and as my journey through life went on, chiropractic was always on my mind. I couldn’t stop thinking about this way of helping people by moving bones and without medication, so when I made up my mind – and I’m so thankful I did – I went back to that same chiropractor’s office, but he had moved on. But a Sherman chiropractor had purchased that practice and he and his wife would talk to me about chiropractic. He gave me an application to go to Sherman.

Around my 5th or 6th quarter, something started to happen. I had just turned 40 around that time and I had developed a hip pain that would not go away. I went to my intern, I went to doctors on campus, and it was not going away. I was really at the point where I said, “You know what, maybe chiropractic isn’t going to work for me, so how can I tell other people that it’s going to work for them?” Thankfully Dr. Susan Hooper came on campus to teach the Blair elective, but at 5th quarter I couldn’t take it yet, so I asked her if I could be the patient. She took my x-rays and said, “Oh, you’re perfect for this module, so I’ll get you adjusted today.” In my mind I said, “You know what, if this does not work, I’m going to do something else because I can’t tell people something works if it doesn’t work on me.” So, Dr. Susan took my x-rays, got me down on the table for an adjustment – and again, this is an upper cervical adjustment so she just adjusted me at the atlas – once she did the adjustment, I kid you not, the first place I felt heat was in that hip. It was like someone set it on fire. It was just burning up. She rested me for about 30 minutes on one of the benches in the clinic. I laid there and I rested and went right to sleep. When I woke up, I promise you my hip pain was g-o-n-e.

TC: Wow

CH: I felt nothing in that hip. I stood up and I was like, oh my gosh, you adjusted me here and this went away? I said thank you, now I know what I want to do. I know exactly what I want to do. I’m going to be a Blair Upper Cervical chiropractor because I know it works. So, I tell my patients I’m not only someone who has learned this technique, I’m also a beneficiary of this technique. But I’m so thankful that a hip pain led me – and God took me – to the Blair technique. That’s what I do today.

TC: That’s incredible. I mean, I deal with so many chiropractors day to day with our membership and there’s a lot of them where it’s a family business, so I love hearing stories from people who, like you, found it a lot later in life,

CH: Oh yes.

TC: And you felt called to it in a really meaningful way, so I love hearing your story, thank you for sharing. Joining chiropractic a little bit later, you’ve already had a whole career in a different field and a bunch of degrees under your belt, did you notice things in the way that you were treated or the people around you were treated in chiropractic that led you towards this focus on cultural competency?

CH: Well, you know, cultural competence actually came out of my career working for the state Department of Health. We had issues where people were not being treated fairly. It came up, for example, that we were issuing citations for people in the mountains for burning rubber. In South Carolina, people have been burning rubber in the mountains for generations and generations, but here comes the “government” saying that they can’t do that anymore and issuing citations, so a lot of our agents were met with rifles, buckshot, and gunshot. Another example is that the nurses would go out for home health care – they would go to people’s houses and call an elderly person by their first name, and some people complained that the nurses were disrespectful. The state government started issuing a directive for cultural competence training. All of the departments had to send someone to be trained, and then go back and train their colleagues. I was the cultural competence trainer in my department, so I saw on the state level how much of a difference it made in how we treated people, how we did our job.

I’ve noticed I’m a minority, no matter where I go – whether I work for federal government, state government – wherever I am, I am always female, a black female, I am always a minority. That’s something I was used to, but in chiropractic, I noticed that as well. We were blessed at Sherman that our president at the time was Dr. Jerry Hardee, who is maybe the second African American president of a chiropractic school. At that time, Sherman also had a very large African American population. There was a lot of recruiting being done at historically Black colleges and universities, so a lot of students were coming on campus. I would hear comments from faculty about what was happening to the school and the different students, so I started doing some research. I found some really good articles that had been done back in 2012 talking about this same issue with chiropractic in the US. I actually did a research project looking at where we are as a profession and what we’re missing as a profession in order to better serve the communities as they change, because there’s always going to be changing communities. You’re always going to get an influx of people who “don’t look like you.” As a chiropractor, you don’t know who’s walking in your door, you want to serve the community that needs to be served. I found growing up in New York, as much as I thought that we were pretty much in a mixed community, I don’t remember seeing a chiropractor’s office. What I’ve found is that for most people who are minorities in this country who learned about chiropractic, it’s usually though trauma – a motor vehicle accident – and no one’s trying to tell them to bring their family to get care. So, looking at cultural competence, looking at which communities chiropractors open in and how often chiropractors go into other communities that aren’t theirs, and who they market to, those were the questions I was looking at. I was looking at the numbers, and I mean, [long pause] it was very disappointing, but also challenging, which is why cultural competence is so important to me. So, I started doing some research here at Life and putting out some numbers, and that’s what got me onto cultural competence in our profession.

TC: So, you research, you teach, you do all these things, but you do also maintain a very active practice. Within your own practice, how are you carrying out your commitment to serve a diverse population, and, also, how have you seen in other offices how cultural competency affects chiropractic?

CH: In my office, I am very particular about how my website is set up, I try to put up all my information and have different people’s faces on the website so they can find me. In my reviews, things like that, I don’t want anyone to feel like they’re not welcome. The Bible says do unto others as you would have them do unto you, and that’s how we treat our patients when they come to our office, like they’re family. I can’t help it if some people don’t realize I’m a Black chiropractor – sometimes they don’t feel comfortable, but after a while we have a conversation, I’m still a doctor, so they calm right down, and they feel comfortable, and they refer family members. I go to the ends of what I can do as a person who wants to be culturally competent and if I don’t understand the culture, I will take some time to look it up. I ask questions, I want to know, I’m always inquisitive about my patients, because they want help but they’re still people, they’re not just an atlas that walks, or a sacrum that needs readjusting. They’re actual individuals wrapped in a whole lot of skin and a whole lot of emotions, a whole lot of feelings, a whole lot of experiences. I try to make myself open to that.

Because I teach students, people come back and report to me things that they see in other offices since I do talk about cultural competence. I had a student come back two or three quarters ago who went to shadow a doc. She said it was really interesting, but she was very disturbed. It was a Caucasian male doctor, a recent graduate, and she stayed all day with him and watched him adjust patient after patient. She said something changed when he had one patient come in, and he turned out to be an African American male. She said every time he adjusted the patients, he would wipe off his hands on his legs. I mean, I get patients sometimes that are a little, you know, dirty, and sometimes a little odor-y, but she said, no, he came in a suit, he looked like a businessman, but every time he adjusted him, he wiped his hands off on his clothes. She said it made her feel very uncomfortable watching that. He probably didn’t even know he was doing it. It was deeply ingrained, and he probably didn’t even think about what he was doing. I asked her, “No other time?” and she said, “No, that’s the only time he did that.” So, cultural competence is people being aware of their own biases and prejudices and understanding that they do have them so they can put them aside. A lot of people don’t think about that, these unconscious thoughts, unconscious attitudes.

TC: That’s so unfortunate! But it’s good to see that with the work that you do in teaching students and working with the next generation of chiropractors coming up, they’re able to spot those things, so the fact that the student is able to see that this is an inappropriate way to be handling your patient and then can use that as a learning opportunity to make sure that their patients are handled better, I think if there has to be an upside, at least we have that.

Speaking of all the things on your plate, coming up in April we’ve got the ICA 98th Annual Convention and we’re so excited to have you. The theme for this year’s convention and throughout our whole year is Serving Those Who Served – so it’s a focus on veterans and their families, their particular needs, and how we care for them. I think what I’ve learned from our talk together today is that cultural competency covers a lot more than just the aspects that I would have typically considered, and I think I think cultural competence obviously includes the special care needs that veterans have.

CH: That’s exactly right.

TC: So, can you elaborate a little bit on how your presentation, how your topic, how cultural competence in general ties in with the theme of serving those who served and caring for veterans?

CH: Well, veterans have a separate culture all their own. Whether they were in the Army, Airforce, Marines… it’s still different cultures. And working with veterans, it’s important to understand that they have some stresses that come out of that culture. They have some different challenges. I think as chiropractors, we need to take that into account. I love when people say, oh, we just need to adjust. No, you can’t just adjust everything. You have to also be willing to talk and listen and hear and realize that people’s experiences can definitely shape how they come to your office. So, I think as chiropractors we should be more mindful of that separate culture because it is a separate culture. I’ve never been in the military, so all I can do is hear what they have to say and have an understanding ear and a willingness to learn – it’s always about a willingness to learn – what they’ve been through, what things are important to them, so when they’re on my table, I’m paying attention to things that are also important to them and just taking the time to get to know them. I think that’s a big part of any time we work with anyone, but especially our veterans. Some of them have experienced some horrible things in their life and you want to be that person that’s not adding more stress but helping to relieve not only the subluxation, but maybe a lot of what’s going on mentally.

TC: Thank you. That was a great preview and I’m looking forward to your entire presentation coming up in April. As we wrap up, we’re in February now – obviously, that’s Black History Month. It’s a great time to reflect on how we as individuals and how we as a society interact with the Black and African American members of our community now and in our history. Having that context in mind, can you speak a little bit on the importance of diversity and inclusion within the chiropractic profession, especially as it relates to recognizing and celebrating Black chiropractors?

CH: Here at Life University, the Student American Black Chiropractic Association Life University chapter does an annual Black History Month gala. It’s a big event, and because we’re chiropractors and chiropractic students, we honor the folks in chiropractic who people don’t know about. We talk about the first person to be ever adjusted, Harvey Lillard. We give honor and credence to him because he didn’t have to let DD Palmer adjust him. We talk about all the unsung heroes. I think we need to have an understanding of where African Americans fit in chiropractic history, looking at what BJ Palmer taught, and how he did support African American chiropractic colleges –  because students at Palmer wouldn’t allow them to come there – by being willing to help support smaller chiropractic schools that were just for minorities. We need to talk about those unsung heroes: [Dr. Fred] Rubel and all the others who have come into the profession who have done great things. The American Black Chiropractic Association was established in 1985 to support and help African Americans in chiropractic school because there was such a dirge of people helping each other. So that’s why we do what we do. You know, there were so many more people than just the ones we talk about all the time when we talk about chiropractic history. We always say we want to take chiropractic to the world, we want to serve the world, we want to serve everyone, but we need to take a look and appreciate those around us who are chiropractors. I am so glad that Dr. Deborah Little is the first African American female of the Georgia Chiropractic Association. I’m so proud of her and I’m so happy for her and pay tribute to the work that she’s done. She’s a Life graduate and those things we really need to pay more attention to and not ignore. And I do think if it’s not on your radar, you don’t think about it. But there’s so many unsung heroes. I think I’m the first African American Board Member of the ICA. Those are things that look like small things, but in making headway and breaking through some barriers that have been there for a while, I think that’s an important thing to celebrate.

TC: Absolutely! I have a thousand more questions I could ask you, but I know that you’re very busy and we’re out of time, so thank you so much for taking time out to talk with me and to share things with our chiropractors. This is such an important topic that I think they’re not getting to interact with enough, so thanks for bringing that to our organization, for all the communities that you already deal with. It really is such a blessing to be able to speak with you today.

CH: Thank you.

Dr. Herman will be speaking at the ICA 98th Annual Convention – Serving Those Who Served, to be held April 11-13, 2024 in Dallas, Texas. To learn more about the Convention and to register, please visit

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