steelweaver's picture
The Slow Revolution: Community Acupuncture & Social Medicine

The Challenge: 

The Question: 

How do we provide affordable, deindustrialised healthcare to communities?

The Problem: 

Industrial healthcare is costly, tech-heavy and top-down - individuals' and communities' health is not fully served by it.

The Solution: 

Community acupuncture clinics are already providing one strand of affordable, adaptive and socially responsive healthcare to communities.

Channels: 

Fifteen years ago, I wrote an academic paper on the incipient technology of digital advertising screens, the way they were likely to change our experience of urban living and the challenges they posed to our conceptions of self, privacy and the public realm.

At the time, such technologies were the stuff of science fiction movies – part of the classic ‘Blade Runner’ aesthetic of cosmopolitan dystopia. Most people did not anticipate their widespread adoption, and certainly did not consider their subtle social implications; but for those who did, perhaps the most haunting fear about their probable dissemination was the certainty that the social and psychological changes they engendered would quickly become the new status quo, unnoticed and unquestioned.

Passing through Kobenhavn airport this morning, a digital advertising screen promoted this month’s ‘Presidents Summit’ on the topic of ‘Disruption’: “Disruption will change your job. Disruption will change your company. Disruption will change the world. Join our world leading summit and learn how to lead the change and make sure you are one of tomorrow's frontrunners.”

That the idea of ‘disruption’ has moved from the radical edge of digital culture and post-2008 political insurgency to the topic of a plenary meeting of senior executives – featuring speeches by Apple’s Steve Wozniak and arch-Brexiteer Nigel Farage – shows the degree to which the concept has spread through society to become the ‘new normal’; a sign, perhaps, of just how much the pace of social, technological and economic change has increased since I fretted about the novel impact of moving images on the urban populace.

But it also raises the question of how much of this disruption is merely cosmetic – or, rather, how much the very genuine disruption of ordinary lives only serves to bolster the established iniquities of our current economic and political status quo. If disruption is merely another business opportunity from the playbook of ‘creative destruction’ capitalism, if the elite response to it is simply to fight harder to be one of ‘tomorrow’s frontrunners’ (while those who can’t keep up must, presumably, be left behind), then perhaps this is merely another case of plus ça change, plus c'est la même chose.

If so, what would genuine disruption look like? Is it possible that it might look like the opposite of all this? That it might look like a rejection of these kinds of disruption? The stories emerging from the OpenCare initiative suggest that this may be the case. Again and again, the tales that emerge are of a less hierarchical, more empowering approach to health and care; of individualised, human-scale responses to unique instances of wider social problems; of a movement away from the paradigm that measures ‘efficiency’ of care in terms of speed, throughput or numbers discharged – measured, in short, on how fast the system can cease to be in relationship with the citizens who have sought aid.

True disruption, then, might not look like the world-spanning, high-octane revolutions beloved of the senior executives. It might look like slowness; like quietness; like a return to engagement at the scale of the human being. It might just turn out that old is the new new.

My own involvement with OpenCare stems from a very particular form of healthcare, based on something very old, small and quiet – the Community Multibed Acupuncture Clinic (CMAC).

Community Acupuncture is a new version of an old format of providing a very old form of medicine – using traditional East Asian methods, it eschews the one-to-one treatments most common in the West, instead adapting the traditional Chinese model of treating multiple patients at once in the same room. This enables treatment to be offered more cheaply, as well as creating a shared space of communal healing, so that healthcare becomes a site of community empowerment. There are now over 170 such clinics in the US and more than 50 in the UK (you can read about their history and ethos on the websites of POCA and ACMAC).

As I detailed in my original Opencare blog post, I have been slowly evolving a CMAC of my own to serve a small and somewhat dysfunctional market town in the South-West of the UK. Through this process, a number of tough lessons and intriguing insights have emerged, with broader implications for the innovative provision of care in contemporary European societies.

I subtitled my initial post “An Ongoing Mutation” both in reference to the overall development of the approach in the West and to my own experience of developing a clinic. This experience has been one of trial and error, of creative response to practical and bureaucratic challenges, and of constant adaptation to feedback from – and through ongoing relationship with – the community; as I learn more about their needs and perspective, I have changed the way I am treating, the way I interact with patients, the hours treatment is offered and the venue it is offered in.

To ask, as a state bureaucrat convinced of the usefulness of CMACs might, “how can we replicate this so that we can roll it out across the country at an official level?” rather misses the point; it is precisely by being embedded in the community that this process of creative mutation can occur, and precisely by meeting patients outside the usual structures of state-sanctioned medical authority that a more horizontal trust and respect can be created, and a more creative approach to healthcare provision enacted.

Like many of the other projects featured in OpenCare, the flexibility of Community Acupuncture – light on infrastructure, expensive medical equipment or architectural requirements, reliant instead on the portable diagnostic and treatment skills of the practitioner – makes it well-suited to navigating a disrupted present and an uncertain future. Quite aside from its effectiveness at treating unexplained and chronic conditions (the kind mainstream Western medicine does not excel at curing), having the ability to treat without reliance on fragile, resource-intensive and environmentally-damaging industrial supply chains may well prove to be a great asset in the near future. Indeed, the worth of this is already being proven through the work of charitable foundations like World Medicine, who have set up successful CMACs in poor, rural areas of India, Palestine, Nepal and Sri Lanka.

Problems still remain, not least with the institutional resistance to acupuncture – often based on little more than ill-informed prejudice against ‘alternative’ medicine. There are clashes within the acupuncture community, as well, on how best to treat, and issues with providing quality-assurance and redress to patients whilst working outside the usual channels and institutions of healthcare.

Nevertheless, the popularity and effectiveness of CMACs speak for themselves. All too often, the state-established institutions of care remain locked into a post-imperial perspective, treating the body, the patient or the polis as the passive subject of a homogenised, top-down intervention.

It is a little like a digital advertising screen, broadcasting a single, one-way message to a public who have no choice but to receive it. Just like a digital advertising screen, this kind of healthcare can seem cutting-edge, innovative and technologically impressive, but its values do not respect the uniqueness of individual or place, nor do they promote communal solidarity and empowerment. So long as this is the case, communities will continue to vote with their feet, seeking out new forms of adaptive Open Care that address their real mental, physical and social needs.

 

***
 

I would love to see Community Acupuncture being integrated with some of the other projects and approaches detailed in OpenCare; to hear suggestions about how the CMAC model could be further improved and evolved; and, as ever, I am keen for people to educate themselves about acupuncture, to help fight against the misguided myths that have arisen about it, and to spread the word about this affordable, effective, environmentally-friendly and humane form of medicine!

Steve Wheeler, Lic. Ac., MBAcC - steve@whiteoakhealth.co.uk

The production of this article was supported by Op3n Fellowships - an ongoing program for community contributors during May - November 2016.

Comments

CPH

Rune's picture

@steelweaver, I really enjoyed your article. Your reference to denmark made me think of the The Emperor's New Clothes. Are we just renaming old stuff?

Id like to discuss Acupuncture more,  could it be integrated in a OpenCare - WeHandU approach?

collaborative acupuncture

steelweaver's picture

Thanks, @Rune.

Yes, I think there could be some very interesting cross-over with the WeHandU-type approach. Notwithstanding what I said in reply to @Alberto below about the need to retain a degree of 'expert-pateint' hierarchy, I am very interested in exploring the prospects for more collaborative healing.

Indeed, the nature of Traditional East Asian Medicine is very collaborative already - patients can be given exercises to do, dietary changes, self-moxa kits, or herbal teas that all supplement and reinforce the acupuncture treatment, meaning that they are far more involved in their own journey back to wellness.

One idea I had was to supplement the clinic with a once-a-week 'Moxa Club' where people could come and learn to safely use moxa on each other. Many more people could be treated simultaneously than is possible with just one acupuncturist; if partners, friends or family came together, they could then continue treatments at home; and the overall message - that people should be learning the skills to keep themselves healthy - would be inherent in the model.

The BAcC is actually moving funding towards Proof-of-Concept studies for 2017; there might be some scope for creating a project that combined different aspects of Opencare in this sort of way.

What else is mutating?

Alberto's picture

Hey @steelweaver – thanks for this. I went back to your original post: it does explain how you changed your pricing model to adapt it to the CMAC's community. But here you are saying you are also changing the business hours, and even the way you treat.

Could you be more specific, especially on the subject of the way you treat? 

changes

steelweaver's picture

Sure - the venue I was in had a lot of character, but also a steep staircase and difficulties in heating it sufficiently. Turns out there is a community centre on the other side of town that already has a lot of people passing through doing interesting community things. So I'm moving there for ease of access, easier parking and the synergies with other projects.

I was doing the clinic during the day, but a lot of people had problems getting childcare or said they could not come because of their working hours, so I am thinking I will run it from the afternoon into the evening instead, to give people a chance to come along who otherwise couldn't. The other option would be Saturday morning, which would certainly get people in.

There's also a good chance I will be combining forces with a western herbalism school, who will ahve student herbalists prescribing herbs under supervision in the same venue.

How my treatments have changed is a little more subtle - one unexpected area is that I was previously attempting to be very 'collaborative' in my treatment style, not pushing people to commit to treatments unless they were self-motivated to do so, leaving it open for them to decide how deep they wanted to go with lifestyle changes etc.

But it turns out that people actually want a bit more guidance / authority than that - perhaps this is just the legacy of hierarchical healthcare, that they feel more comfortable with a model that they are familiar with, or perhaps it is actually a greater part of being a therapist than I previously considered; that the nature of therapy is such that you need to have a degree of authority for the patient to productively assimilate the treatment. This obviously raises interesting questions about some of the 'horizontalist' projects featured in Opencare!

Great insight from your treatment change experience.

Noemi's picture

Talk about a slow revolution! It makes sense to me that we're hardwired to take univocal instructions more seriously, it shows that the doctor is not doubting his approach.

Patient-doctor dynamics in healthcare is probably cultural too - we've heard stories from China where ambivalence or open endedness in medical consultations inspired fear more than confidence. 

 

 

Authority in health care

WinniePoncelet's picture

I enjoyed reading your well written post @steelweaver ! I have a rich medical history and although I had a brief run in with acupuncture, I never really went for it. I'd still like try it out when the opportunity presents itself.

It's an interesting remark on the authority of health practitioners @steelweaver and @Noemi . I think the reliance on guidance by an expert is in large part the result of the patients not being as familiar with acupuncture as the expert. Yet patients are there for a reason: at some level, they believe in the positive potential of the treatment. This common belief of both parties is the base for authority and lends you, or the practitioner, as an expert the authority to give direction. Authority governs the interaction and when nobody (or nothing) assumes it, confusion arises. To be clear: authority is different from power.

I can complement this with my personal experience in the standard healthcare system in Belgium. For a little over 5 years I had a series of serious physical afflictions, which didn't ever seem to heal or resolve themselves and only got worse over the years. At the start I always left the clinic with a smile, which always disappeared in days, weeks or months as the situation deteriorated again. I experienced first hand that I was just a number, and that treating symptoms is faster and easier. Good thing for pharma companies, because endlessly treating symptoms sells more drugs. Finding the real cause takes longer, is harder and is more expensive, at least in the short term.

I got pretty skeptical about the system by going from doctor to doctor and spending more time in physiotherapy than with my friends or family. Gradually I lost belief in the system. It was after I ultimately found the cause and cure (very simple ones at that) that whatever remained of my belief vanished. With that gone, there was no more common belief between me and the doctor, so the authority vanished. My language can't hide it: I found the solution, not a doctor or a system. For this specific illness, I will not lend authority very easily anymore either. I'm lucky, as I have a general idea of healthcare through my studies and know my body well by now, but this is clearly problematic for the general population when you hear similar stories with unhappy endings.

Also interesting that (at least for me) a big part of the authority of the health practitioner is due to belief in the system, rather than a belief in the knowledge of the doctor (which I never really doubted). I think that might be a western thing, linked to what surfaced in the discussions with @alkasem23 about differences in care with Syria: in the west we put our trust in and rely on systems rather than other people. In some other cultures, people probably put their belief mainly in a person, the doctor.

Easier interactions through the internet, powerful search engines, a lot of people sharing experience and stories online, easy access to second opinions (in my country anyway)... Though they don't always provide correct information, these factors also lead people to challenge the authority in terms of knowledge of the practitioner in the classical doctor's office. I think both this challenging of knowledge and the failure of the system will inevitably lead to some fundamental changes in healthcare.

Importantly, authority cannot simply disappear, the common belief has to shift to something else. Most stories of experimentation with new methods in the stories here on Edgeryders share some sort of community aspect. This illustrates a shift to lending authority to a collective rather than a system or a person. The collective can consist of patients, doctors or other caregivers and is likely a mixture ideally. In Syria the collective is mainly the family, according to Alkasem.

Looking through this lens of authority is interesting and can be applied to many aspects of our daily lives. The matter is fresh in my head from a Dutch book I just finished reading, which I hope gets translated to English. If anyone is interested: the book builds on work by Hannah Arendt that you can certainly find :-)

Separating authority from power

steelweaver's picture

Thanks for the comment, @WinniePoncelet, and glad to hear you found the cause of the problem in the end.

Your distinction between authority and power is very useful. The point about different cultures reifying the system vs the person is also very relevant here - the problems around regulation and recognition of traditional acupuncture in the west can basically all be traced back to the original error of accepting the setting of the terms of debate around the technique 'acupuncture' rather than the practitioner.

Indeed, I call myself an 'acupuncturist' because people are familiar with the term - but a doctor or physio who has done a few weekends training in the technique can also legitimately call themselves an acupuncturist.

In reality, I am a 'traditional medicine practitioner' who uses a variety of techniques, including acupuncture. The main point of coming to me is for my knowledge of chinese medicine theory, my diagnostic skill and my years of training in using the needle [or cup, or hand] to effect change in the body.

And there is an additional hurdle to overcome; I am using an unfamiliar medical paradigm and technique that people do not necessarily have trust in [at first] - and I am doing so outside of the usual recognised channels of 'medical authority'.

So I have to simultaneously convince a patient of the soundness of the medical approach as a whole and of my own competence - when they may be used to thinking in terms of trust in the system and not the individual.

This is why I was keen to have patients provide some of the impetus for engagement themselves - if they waver in their trust of me or the medicine there is no institutional push for them to remain in treatment as there is in mainstream medicine.

But evidently part of keeping them engaged is providing that sense of medical authority that they want.

So now I'm thinking about how I can generate the kind of reassuring authority I need without falling into the established patterns of power relationships we are used to in the west.

Using vs creating community

steelweaver's picture

Just linking in @Noemi's post on running from a failed medical system in Romania. https://edgeryders.eu/en/when-do-you-decide-that-running-from-a-failed-medical-system-is-no

One thing it has brought into stark relief for me is the interplay between using Opencare projects to try to build community [as well as make people healthier], as is often the case with Community Acupuncture projects, and the sort of thing that is possible when strong bonds of solidarity [being poor, being Amish] already exist.

Unfortunately, in much of Europe, it seems like many people have used rising living standards as a way of stepping out of engagement with community and society - and it is only when economic or other disasters strike that they are forced into connection with one another once more.

The best way to deal with the uncertain futures ahead would be for people to start building those localised, horizontal connections beforehand - but the cynic in me suggests that they will always wait until necessity forces their hand.

Not acupuncture but an interesting find about community

trythis's picture

https://youtu.be/3hwR6vQHiUY?t=1217

With an anthro perspective it turns out that the most important thing after a hear attack are your friends!

This story slowly contributed to changing my views

Noemi's picture

I'm reminded of this take on medicine every time I read others acknowledging alternative therapies - somehow mediated by different values (human treatment, social medicine, flexibility, group therapy..): "Success really came for me through trying alternative therapies such as bio energy, acupuncture and reiki." @steelweaver, meet @Sharon Kinnane !

 

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