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.
