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Community Acupuncture: Making Buckets from Ming Vases

Journal of Chinese Medicine Number 98 February 2012

Community Acupuncture: Making Buckets from Ming Vases

Abstract
Community acupuncture as practised by self-styled acupunks is a radically different vision and philosophy for the practice of acupuncture in the West. Patients are seen in a group setting, which allows for treatment to be conducted via a high-volume, low-cost sustainable business model. Spa settings and excessive Chinese medicine theory are unnecessary with such a model of treatment, as the needles do all the necessary work. This article describes the vision, aims and underlying philosophy of the community acupuncture movement.

ommunity acupuncture1 has a curious problem. It is a controversial subject among acupuncturists, admired by some for its lively idealism and despised by others who accuse it of degrading Chinese medicine. At this point in time, the community acupuncture movement in the United States is still very much a work in progress, but has developed significant momentum. It owes this momentum to a variety of factors, including the Great Recession, the increasing inaccessibility of healthcare for people with ordinary incomes, and the undercurrent of populism that is currently surfacing in the Occupy movement - community acupuncture seems timely. But the vigour of community acupuncture also comes from a careful and conscious rejection of the professional acupuncture culture that has developed in the US in particular and in Western countries in general. Possibly the greatest challenge to the success of the community acupuncture movement is not acupuncturists who hate the thought of community acupuncture, but rather acupuncturists who love community acupuncture in theory, but misunderstand how to do it in practice. This misunderstanding sometimes comes from an inability to reject the professional culture of acupuncture acupuncturists tend to like to keep their options open, and try to have it both ways by practising community acupuncture and simultaneously striving to be respectable examples of the acupuncture profession who get along well with their peers. This does not work. Genuinely successful community acupuncturists have to refuse to act like acupuncturists, think like acupuncturists even think of themselves as acupuncturists. The movement has come up with a useful shorthand: we call ourselves acupunks, or often just punks. Upstanding representatives of conventional acupuncture culture in the US are more than happy to agree with us about that: we are the troublemakers of the acupuncture world.

Acupuncturists and acupunks

Community acupuncture has spread as far and fast as it has in the US in large part due to the fact that I was able to write a column about it for the publication Acupuncture Today, but after a year the editors fired me as a columnist because they thought the column had, in their words, dangerous potential. This article is about the difference between an acupuncturist and a community acupunk. I hope it will be useful to acupuncturists who are contemplating practising community acupuncture. Since you cant have it both ways, you need to decide whether you are, at heart, a punk. An online dictionary (dictionary.com) defines punk variously as any prepared substance that will smolder and can be used to light fireworks, fuses, etc, something or someone worthless or unimportant, a young ruffian; hoodlum and a style or movement characterised by the adoption of aggressively unconventional and often bizarre or shocking clothing, hairstyles, makeup and the defiance of social norms of behavior, usually associated with punk rock musicians and fans. An early reviewer of this article was concerned that using the term punk throughout this article would lead some readers to prematurely dismiss its arguments. Such people might share the values of community acupuncture, but would be turned off by the call to become a punk. It is therefore worth clarifying that turning off acupuncturists who think that they share our values is a conscious goal for us: we do not want to persuade people to do what we do - they need to want to do it enthusiastically, without persuasion and in the face of opposition and difficulties. Furthermore, it is a good thing for community acupuncture as a movement to be dismissed by acupuncturists who do not want to get dirty and disruptive, because the odds are high that those acupuncturists would be unable make community acupuncture a living reality anyway. It is bad for community acupuncture as a movement to be embraced by acupuncturists who love it in theory but who are too well-socialised to make it real.

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Community Acupuncture: Making Buckets from Ming Vases

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Community acupuncture needs people who are able and willing to smoulder, who can light a fuse and stand the heat. Community acupuncture needs people who are untroubled by being unimportant and glad to take care of other people who are unimportant. Community acupuncture needs people who are happy to be seen as ruffians by other acupuncturists, who can defy and shock the social norms of the acupuncture profession. Community acupuncture needs punks.

If conventional acupuncture in the West is an orchid a delicate and exotic epiphyte we are dandelions: not much to look at, but tenacious, nutritious and challenging.
it and display it so that other people can admire it. It is valuable to them because it is exotic, ancient and refined. They are resentful when other people dont admire it sufficiently, because it is a rare and precious antique. Its their rare and precious antique, which they believe entitles them to all kinds of social recognition. However, they have little intention of doing anything objectively useful in society with it. Acupuncturists define themselves by what they know; community acupunks define themselves by what they do. Community acupunks take the Ming vase off the shelf and use it like a bucket. We are not interested in venerating its ancient elegance, because we know people who need water. If there were the acupuncture training equivalent of a bucket that allowed us to pour the water of relief over as many suffering people as possible with as little fuss as possible, we would be delighted, since we do not care that much about knowing everything there is to know. In the US, however, you can only get an acupuncture licence if you have a Ming vase an education that is devoted to the theories of Chinese medicine. So we acupunks go about devaluing the Ming vase by filling it up and pouring it out over tens - maybe even hundreds - of thousands of people. These people do not even notice that it was a Ming vase that brought them relief; they only notice that their pain went away. This offends many acupuncturists, who have no desire for acupuncture to be so commonplace, so unremarkable, and so unremarked.

Acupuncture in the West is fundamentally out of context it floats unmoored from the culture that created it, and is as yet unrooted in the US, the UK, Europe or Australia.2 If acupuncture were a plant, it would be a fragile epiphyte - precariously attached to foreign structures and living mostly on air. How can acupuncture root itself in the West, and what might those roots look like? Community acupuncture has a vision of what acupuncture would look like if it were truly grounded in the West, and we are fixated on the rooting process. Root in Latin is radix. Not only are we punks, we are radicals. If conventional acupuncture in the West is an orchid a delicate and exotic epiphyte we are dandelions: not much to look at, but tenacious, nutritious and challenging. Our radical perspective on conventional professional acupuncture culture is that it is too passive and selfabsorbed to survive in any meaningful way. In the US at least, acupuncturists as a group are not really a profession; they are merely dedicated, long-term consumers of the acupuncture education profession. There is a notable, uncritical emphasis on accumulating and consuming knowledge, as opposed to simply using what we already know to help real people. Many of us became acupuncturists because we were fascinated with the concepts of Chinese medicine; we were motivated to hear someone else talk about those concepts. Once we graduate from school, it becomes our turn: we go out looking for patients who we hope will want to listen to us talk about those same concepts, and attempt to locate another tier of acupuncture education consumers below us. But we have trouble finding them. Community acupunks believe that this is because most potential patients of acupuncture are actually looking for something quite different than fascinating concepts. They want something that is less romantic, less abstract and more personally meaningful: they want relief from pain. Acupuncture can provide relief from pain, with or without the theories of Chinese medicine to support it. A lot of acupuncturists treat their acupuncture training as if it were a Ming vase; they like to have

Orchids and dandelions, Ming vases and buckets

A low-cost, high-volume business model

Community acupuncture is not really about acupuncture - at least not the acupuncture that is defined by concepts and theories. It is a means of delivering something else altogether. The only hope of rooting acupuncture in Western soil, we believe, lies in recognising that the worth of acupuncture lies in the solace it offers, not in its theoretical underpinnings. When I first opened my community acupuncture practice ten years ago, other acupuncturists repeatedly told me that working-class patients do not want acupuncture, as they are not refined or educated enough to appreciate it; they do not value their health enough to pay for acupuncture, because they spend all their money on beer and cigarettes. Thanks to such helpful advice from my peers, I had no difficulty rejecting professional acupuncture culture (rage can

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Community Acupuncture: Making Buckets from Ming Vases

Journal of Chinese Medicine Number 98 February 2012

The only hope of rooting acupuncture in Western soil, we believe, lies in recognising that the worth of acupuncture lies in the solace it offers, not in its theoretical underpinnings.
be a great source of clarity, not to mention motivation). Now that my practice provides some 700 treatments each week, it is hard for anyone to claim that workingclass patients do not want acupuncture. But it is still hard to get acupuncturists who think that they want to practise community acupuncture to understand the difference between orchids and dandelions, Ming vases and buckets. It is very sad to hear, as I do from time to time: Well, I tried to offer affordable acupuncture, but nobody wanted it. When I first opened my clinic, I spoke with the director of a prominent local affordable acupuncture practice that focuses on treating patients with serious diseases such as cancer but who have few resources. He told me flatly, Affordable acupuncture clinics dont grow. Ours hasnt grown at all in 11 years. His clinic is a non-profit business with other funding sources besides patient fees. In the years since that conversation, my clinic has grown some 10,000 per cent with no significant funding sources other than patient fees. Why is this? He was trying to grow low-cost orchids. I was cultivating dandelions. The core of community acupuncture as we define it is that it is a low-cost, high-volume business model. The cost is lower than most acupuncturists can stand, whilst the volume is higher. The business aspect is critical. Early in the US community acupuncture movement we defined what we meant by low cost and high volume, and set parameters around the business model (see http://www.pocacoop.com/ join-POCA). Many acupuncturists were outraged by our definition, because a cornerstone of their identity as acupuncturists is being able to do whatever they want, however they want. But we wanted community acupuncture to survive. We deliberately chose to discourage the would-be orchid growers. As a result, we were called divisive, polarising, and worse. Our little plot of dandelions, however, is fairly healthy, and so we think it was worth it.

and its consequences

The average payment for an acupuncture treatment in my clinic is about 18 dollars (11.41 British pounds). Many people pay at the low end of our sliding scale, which is 15 dollars (9.51 pounds). The goal in setting our fees was to try to be accessible to people who have jobs that are paid at or the near minimum wage. Our decision to create a business based on fees this

low has had all kinds of consequences (as well as being vilified by other acupuncturists for devaluing the profession). The first consequence was that we had to radically simplify what we did in the clinic. If patients could only afford 15 dollars per visit in order to get a full, clinically sound course of treatment, then we had to find a way to give at least six treatments per hour if we wanted to keep the lights on in the clinic and take home a paycheck that would let us buy groceries. This was not a theoretical dilemma. If we could not figure out a way to treat quickly, simply and inexpensively, then patients would not get acupuncture and we would not eat. Other acupuncturists told us repeatedly that there was no market for this kind of stripped-down, non-verbal kind of acupuncture, in which practitioners spend no more than three minutes or so talking to the patient before inserting the needles. What those acupuncturists forgot, or never knew in the first place, is that acupuncture - all by itself - really works. If the treatments are frequent enough and regular enough, the results speak for themselves, and there are enough patients of modest means who want pain relief as opposed to a lecture on Chinese medicine for a business like ours to thrive. Therefore the first consequence of setting fees at rates that working class patients can afford is that treatments have to be simple and fast. No matter how compelling the theory or philosophy behind treatment, if patients cannot afford to pay you to do it and you cannot do it six times an hour, then it cannot be done. Many acupuncturists are unable to accept this consequence. The second consequence of a low-cost, highvolume business model is that as a practitioner you depend on your patients for your livelihood. If you work in a public-health treatment centre, parole officers or social workers or psychiatric nurses will ensure that patients come in for treatment, and you can rely on them to keep your schedule full. If your job is supported by charitable donations or government funding, you can rely on wealthy donors or the government itself for your income. If you are providing acupuncture as a volunteer, in a humanitarian context, your livelihood has nothing to do with it at all. But in a community acupuncture clinic in a working-class neighbourhood, your livelihood depends entirely upon one patient after another walking through your door and paying you what they can afford. You have to have good social skills, be willing to provide first-rate customer service, and you also need a healthy dose of humility. The people who make your job possible are the same people that your colleagues think are spending all their money on beer and cigarettes.

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Community Acupuncture: Making Buckets from Ming Vases

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Some of them know that acupuncturists and other medical providers think this. If you think this, they will pick up on it, and if you believe that you are better than they are because you own a Ming vase, they will not support your practice. You are directly accountable to them. Many acupuncturists find it difficult to accept the consequences of being directly accountable to, and dependent on, patients. Whether they admit it or not, they chose acupuncture as a profession expecting some kind of secure and privileged position in society. In the US, in fact, many acupuncturists are vocal about wanting to be recognised as doctors. Acupunks can live with the consequence of having no security other than solid relationships with individual patients and with their community as a whole. We have found that punks can make a living by providing fast, simple, effective treatments and by being directly accountable to patients. Not necessarily an extravagant living, but a decent living, which results in thousands of ordinary people having access to as much acupuncture as they want or need. Acupuncturists who are thinking of providing community acupuncture need to ask themselves if this is really what they want.

Acupunks can live with the consequence of having no security other than solid relationships with individual patients and with their community as a whole.
acupunk means setting aside your identity as an acupuncturist in order to concentrate on this - because such an identity can be cumbersome or even crippling when you are trying to be useful out in the world. This is our challenge to the acupuncture profession in the West: do you want to be acupuncturists, or do you want to help people?
Lisa Rohleder has been a licensed acupuncturist in Portland, Oregon since 1994. She is a co-founder of Working Class Acupuncture (www.workingclassacupuncture.org), the Community Acupuncture Network and the Peoples Organization of Community Acupuncture (www.pocacoop. com).

Endnotes
1 We define community acupuncture as the practice of acupuncture: 1) in a setting where multiple patients receive treatment at the same time; 2) by financially sustainable and accountable means, whereby community acupuncture clinics are directly supported by the patients who receive acupuncture in them, rather than by grants, donations, or other funding; 3) within a context of accessibility, which we create by providing consistent hours, making frequent treatment readily available, offering affordable services, and lowering as many barriers to treatment as we possibly can for as many people as possible while continuing to be financially self-sustaining.

2 This may also apply to Israel. I regret that I am unaware of the cultural context of acupuncture in Latin America. 3 Since words cannot adequately describe this, community acupunks in the US produced a 35 minute documentary about community acupuncture which can be viewed online at https://blip. tv/community-acupuncture-network/ community-acupuncture-the-calmestrevolution-ever-staged-5287533.

A final, critical distinction between acupuncturists and acupunks is that punks want and need jobs. At least in America, many acupuncturists have given little thought to what it really means to work as an acupuncturist, day in and day out, year in and year out, with regular hours and prosaic demands like payroll taxes. For many it is far more interesting to ponder the routes of the transverse and longitudinal luo. For too many acupuncturists, acupuncture is an exotic hobby. Being a community acupunk is not designed to be intellectually entertaining. Any longterm clinician who is honest with herself will admit that the same strategies mostly work over and over. There are occasional exceptions, of course, but many of the patients who seek care are not suffering from anything fascinating, and what will help them is not particularly complex. As a community acupunk, I do a lot of the same points and point combinations over and over. My treatments are rarely thrilling. What is thrilling are my patients in their amazing diversity, and the clinical outcomes that occur when people have access to as much acupuncture as they want for months or years.3 This is how we believe that acupuncture can take root in the West: by practitioners concentrating on what ordinary people want and need from acupuncture, and what structures we need to create in order to make it available to them. Being a community

What do you want?