When I set up Resurgis Acupuncture a central pillar of the business plan I wrote was making acupuncture more accessible within my local community. I had some ideas about how I might achieve that, ideas that, despite my stumbling efforts, I’ve been unable to turn into reality. A failure that left me feeling somewhat despondent toward the end of last year. And then I came across an American organisation, POCA (People's Organization of Community Acupuncture) and a book written by its founder Lisa Rohleder. The book is called ‘Punking: the Praxis of Community Acupuncture’ and reading it I found myself inspired, realising that what was being described was exactly the sort of practice I’d imagined myself creating. But until I read Rohleder’s book I simply hadn’t known how to go about creating it.
So what is Punking? I guess in part its simply a provocative name that the pioneers of the community acupuncture movement gave themselves, both to differentiate themselves from the mainstream of the acupuncture community but also to describe a practice that was firmly focused on the practicalities of delivering healthcare to patients who lacked access to healthcare, either conventional or complimentary. Of course in the UK everyone should have access to healthcare via the NHS and acupuncture might be seen as a luxury for those that can afford it. However coming from a culture where ‘healthcare free at the point of need’ is deeply ingrained, its hard for an advocate of acupuncture not to want acupuncture to be similarly available. Well its very unlikely that acupuncture is suddenly going to be available on the NHS but the community acupuncture model does offer a route to making it more widely available.
There are a number of aspects to making acupuncture more widely available but perhaps the most obvious is that community acupuncture clinics lower the cost of treatment dramatically. They do this by treating a number of people simultaneously in a communal space, while taking care to ensure everyone’s privacy and dignity is protected. For some this idea of having treatment in a communal space is off-putting and I might have found it so myself but for my experience of a chemotherapy ward. Several years ago my partner underwent treatment for breast cancer and every few weeks we went to the chemotherapy ward for her next round of treatment. The patients sit in chairs with drips feeding their medication into them. There’s enough distance between patients to feel there’s no need to interact with others if one doesn’t wish to but patients are close enough to chat if they want to. What comes about is a mutually supportive atmosphere that takes away some of the loneliness of struggling with a serious illness. In fact Rohleder talks about community acupuncture clinics in just these terms; as supportive containers within which healing can occur.
There’s much more in the book, about the barriers that stop people accessing acupuncture and about how they might be overcome. There’s a chapter on what Rohleder calls ‘Liberation Acupuncture’ that draws on the ideas of Liberation Theology. There’s a discussion of what she terms ‘Accompaniment’, the idea that the acupuncturist accompanies patients on their journey toward health rather than taking a more directive role in which the acupuncturist acts as ‘expert’ in relation to the patient, who plays the passive role of a consumer of ‘health services’. Accompaniment is more egalitarian. She talks about the politics of the professionalisation of acupuncture, an issue perhaps more pertinent in the United States where, in an insurance based medical system, being recognised as a professional doesn’t simply confer status but opens the door to getting paid. For Rohdeler such considerations warp our understanding of what acupuncture is and how it should be taught and practiced. For me this was really interesting, to suddenly discover that I had all sorts of beliefs about what I do that shape how I practice and of which I wasn’t really aware. I might not agree with her about everything but I’m grateful for the opportunity the book gave me to think a little deeper about what I do and why I do it as I do.
Rohleder herself comes across as somewhat strident and combative. She wrote an article in the Journal of Chinese Medicine which was somewhat disparaging of how acupuncture is conventionally practiced in the West and of acupuncturists working in that way. Perhaps that attitude came as a reaction to how her clinic was received when she first started it – she was accused of devaluing the medicine, of undermining it and ‘Acupuncture Today’, one of the largest acupuncture magazines, cancelled her column after just a few articles citing similar reasons. But despite such opposition the community acupuncture model has spread and there are now quite a few such clinics in the UK, mostly working under the auspices of the Association of Community and Multibed Acupuncture Clinics (what a mouthful). While community clinics in the USA often have patients in large reclining chairs and almost exclusively treat using points on the lower arms and legs such clinics in the UK seem to offer treatment that is closer to the sort of treatment you might get more conventional acupuncture clinic. Many clinics have a sliding scale of fees with patients paying what they can afford, some offer free drop in auricular acupuncture, some have herbalists or run short courses on a similar basis. However these things are structured the idea seems to be the same; to be a resource for the community, a resource that that community can use to improve its own health.
So I’m inspired again. Obviously such a thing isn’t going to suddenly materialise and there’s a lot of learning to be done. I’m having to think about how I need to change how I work and I’m getting the training necessary to make those changes. I’m visiting existing clinics to see how they make this work. And I’m asking myself hard questions about whether this is really the way I want to work, because there are aspects of seeing patients individually andgiving them time and attention, that I enjoy and which may be lost in a community clinic setting. But I also know that there are patients I’m no longer seeing because, as the cost of living has rapidly increased, acupuncture treatment that was barely affordable has now slipped out of their reach. So I’m back to rewriting the business plan and trying to work out, as far as is possible, just how I can take this model and make it work here in my community. Hopefully there’ll be a part two to this post where I can write about, if not a community clinic itself, at least a more detailed plan for one.
Bruce Bell is a traditional acupuncturist working from clinics in Midsomer Norton and Keynsham.