Together in Wellness: The Promise of Community Acupuncture by Zachary Krebs
Together in Wellness: The Promise of Community Acupuncture
Zachary Krebs
The question “What is health, and how do we create and sustain it?” has interested me for over a decade. After graduating from a community health undergraduate program and later an acupuncture school, becoming a licensed acupuncturist, and speaking with numerous experts, I have settled on the idea that healing is closely coupled and co-produced with biological, environmental, and social influences. Becoming healthy is something that is nuanced and contextual—and oftentimes a radical act—for a person or a community.
I have come to appreciate healthcare options that are simple, elegant, and layered with principles and evidence about how healing takes place. And this is where community healthcare comes into the picture. My experience is with community acupuncture, a healthcare modality that has a long history of providing an accessible way for people to heal together. It comes out of a movement to bring healthcare to disadvantaged and vulnerable communities in need. By creating a space for every socioeconomic class to mingle and receive regular treatment together, many established social norms are challenged and visions of new arrangements for oneself and society can be accessed. The successes and lessons of community acupuncture, along with other sliding scale models found in Western medicine, can serve as an inspiration for how we think about healthcare more broadly.
A Radical, Transformative Approach to Community Health
The history of community acupuncture in the United States is one of necessity and radical action to help heal, transform, and sustain communities in times of need. During periods of social and political turmoil, people tend to benefit from having stable access to community-owned and -operated medical resources that can help keep them relaxed, out of pain, and regulated. At a glance, community clinics are relaxed places to go, hang out, and get the therapeutic and scientifically proven benefits of acupuncture. But they are so much more than that; they are places you can find inspiration to change yourself and the world around you.
By softening your muscles, behaviors, worldview, and most importantly your expectations, everything around you can make space for something new. As we slowly regain our experience of health, our renewed connection and health also affects and helps those in need around us. This is the original method of healing, as it was taught to me: simply by learning how to learn, how to sense the world in a distinctly natural and human way again, we can transform ourselves and everything around us. It is easier and more effective to realize this and maintain changes when you are seen, supported, and integrated into your community. Just like you can relax a muscle in a well-structured posture held for a sufficient amount of time, you can relax into a chair or table in a safe acupuncture session.
This style of acupuncture represents a place where you can be yourself, yet still receive help with dignity. While I am also a proponent of many parts of the Western medical model, the lengthy intakes, high costs (even when insured), and brief conversations with busy and overworked clinicians can leave some of us feeling unheard and stressed—not to mention the racism, sexism, and prejudice inherent in many of the systems available to us.
Public health offices and the biomedical healthcare system are doing this to a certain extent, but they are struggling as well. There is a healthcare personnel shortage that will continue to grow every year. “The Association of the American Medical Colleges (AAMC) predicts a shortage of anywhere between 37,800 and 124,000 physicians in the US by 2034,”[i] leaving us with gaps in coverage. Gaps tend to affect the poor and disenfranchised at a disproportionate rate. In addition to this, recent data shows that changes in eligibility policies will lead to an increase in how many people are uninsured over the next decade to 8.9% from 7.7%.[ii] This is something community acupuncturists are extremely interested in.
Many people struggle to pay their premiums and co-pays, or simply do not receive enough acupuncture treatments from their plans to reach therapeutic efficacy. This gap is what community clinics try to fill, operating as safety nets for people who can’t afford their medication, suffer from side effects, or simply have chronic conditions that respond better to regular acupuncture than other interventions. Also, some people genuinely love acupuncture and just prefer it over other treatment options.
Community acupuncture clinics provide treatments that keep you well and help reverse or slow many existing disease processes. What if we had a clinic in every neighborhood, like a local market or convenience store? Community clinics are like keystone species, an organism that helps hold the system together. They also have a general template for how they operate. In this practice style, one or many practitioners treat groups of patients at once, often in the same room, and charge for the service on an affordable sliding scale. This might seem like a privacy violation to the skeptical, but in practice it makes the clinic safer, because there are more eyes on a given situation than in a private practice setting. Practitioners typically adhere to trauma-informed care standards of safety, cultural respect, and trust and transparency, and they seek to treat everyone as a whole person and not simply a list of symptoms. You get in, pay, and get to receive acupuncture in just a few minutes without a ton of fuss.
The concept and practice of people receiving acupuncture together in a room at a low cost or for mutual aid originates in China and was brought to the US by the activists at the Lincoln Detox Clinic at the Lincoln Hospital in the South Bronx in the 1970s. There they used a simple and effective five-needle ear protocol to help reduce withdrawal and craving symptoms, alongside other community services.[iii] In addition to this history, many pioneering Chinese-born and Chinese-American herbalists and acupuncturists like Dr. Ing Hay and Miriam Lee brought Chinese medicine and acupuncture to their communities at their own personal and legal risk,[iv] before the acupuncture profession had implemented the regulation of the filiform needle and the education and testing system we now have.[v]
Inspired by the work of the Young Lords and the Black Panthers at the Lincoln Detox clinic, Lisa Rohleder and Skip van Meter, founders of Working Class Acupuncture, began to adapt the group treatment model to the wider American audience in the 2000s by utilizing La-Z-Boy recliners instead of massage tables in their treatment rooms. This allowed them to work with more patients, eliminate barriers to care, lower the cost of treatment, and fine-tune the financial model.[vi] They were guided by the idea that we should use what is available to us to help people. They taught around the country (and still teach at POCA Tech, which offers a three-year, master’s-level program),[vii] sharing their insights with people wishing to help their communities. Also, interestingly, their model closely matched the understanding in the science of acupuncture that treatment frequency is a large and important variable in a patient’s recovery.[viii] What is the use of the best acupuncture in the world if someone cannot afford it, get it regularly, or gets hurt in the process of doing so?
The volume of community clinics exploded in the 2000s and peaked as COVID-19 struck in late 2019–2020, and they have been adapting and evolving ever since. There are hundreds of clinics providing this style of medicine across the country, each with its unique flavor and nuance. For instance, many of my favorite clinics also offer Japanese acupuncture, herbal medicine, facial rejuvenation acupuncture, massage, reiki, hypnotism, and group exercise classes in addition to community acupuncture. The economic shift after COVID caused many clinics attached to the traditional business model to shut their doors or change the way they operate.
Healing Ourselves, Each Other, and Our World
I see community acupuncture as a beautiful innovation and a balancing act that brings other forms of Chinese medicine to people in the community at affordable rates. Community clinics provide a way to help people regularly access healthcare and oftentimes meet other people struggling with similar health concerns. Many health conditions can be so chronic and debilitating that depression and other mental health problems accompany them as comorbidities, leaving many people stuck and unsure of what to do next. Barriers to care can be extremely high, and even higher for people in constant pain. But in this model, healthcare is something we all participate in together, and we are not seen as failures for experiencing illness, nor for needing help to recover. There is a purposeful reduction of barriers to care, to make it easier for you to come in and come back. The reality and basic assumption that underpins the philosophy of many clinic owners is that we live in an illness-producing and oftentimes toxic economic system that triggers, exploits, and harms us—and it is far too easy to blame ourselves for everything that has gone wrong in our lives, especially our health. In the back of our minds, we may guiltily ask ourselves: If we’re not healthy and productive, do we have any value?
There is a desperate need for community-based healthcare options in the US that recognize the social determinants of health are a major factor in our health outcomes. Pain is felt more in isolation and mitigated in community and shared spaces. While our choices influence our health outcomes to an extent, we live in a greater ecosystem and experience the advantages and disadvantages of the terrain. We inherit the powers and poisons of the world around us. As many of my friends from the biodynamic farming and gardening world tell me, the farm is a living organism that responds to the influences from above and below. Likewise, we as humans exist between the influences of heaven and earth, with an interchange and connection between all three. In other words, the things that are going around inside and outside of us affect us, all of us. Having access to a form of medicine that can allow us to regain function and participate in our lives again gives us all a better chance to heal and face the issues coming our way.
Community acupuncture—with the elegance of gentle medicine, the low cost, the ubiquity and availability of the offering, and the ability to connect and rest with your local community—is a boon in a world that can feel isolating and painful to connect with.
If you’re interested in learning more about acupuncture, and especially community acupuncture, the POCA Coop website (https://pocacoop.com/) is a wonderful resource. If you were inspired by this article and want to have a try at becoming a community acupuncturist, please check out my alma mater, POCA Tech, where Lisa Rohleder and Skip van Meter still teach (www.pocatech.org).
------------------------------------------------------------------------------------------------------------------
Zachary Krebs is a Licensed Acupuncturist at White Phoenix Acupuncture in Portland, Oregon, as well as Co-Director of the Biodynamic Association. He enjoys spending time in nature, practicing Chinese martial arts, and drinking as much Taiwanese oolong tea as possible. His belief is that a truly integrated health model needs to combine science with tradition and cultural competency to fully uplift a population to sustained wellness.
SIDEBAR 1:
“Community acupuncture, to me, is making acupuncture accessible. So many times during a shift, people tell me they couldn’t get it if they hadn’t found this model or my clinic. It does create some unique challenges, though. We need bigger spaces, more supplies, and the ability to communicate and schedule a lot of people per day. It can also be physically demanding. I think that, working within the pandemic and economic challenges that we face in 2024, clinics need to be able to adapt and change some things while maintaining the core values of keeping things affordable.” — Mayo Mercedes Wardle L.Ac, Owner and Acupuncturist, Herbalist at Phoenix Community Acupuncture, Arizona
SIDEBAR 2:
“Our patients love community acupuncture, as it is an affordable way to get amazing healing! Everyone can afford it and thus come frequently enough to actually get completely well, as opposed to getting their pain levels low enough to tolerate it and then stop due to expense. They also like spending time in a calm and healing environment where they are not judged in any way.” — Allyndreth Stead, MAcOM, L.Ac., owner of White Phoenix Acupuncture in Portland, Oregon
[i] Kristen Moon, “Solving the Global Healthcare Providers Shortage,” Forbes, accessed June 18, 2024, https://www.forbes.com/sites/kristenmoon/2023/12/01/solving-the-global-healthcare-providers-shortage/?sh=78e9fc04508c.
[ii] Amina Niasse, "Rate of US uninsured to rise to 8.9% in the next decade, Congressional Budget Office says," Reuters, last modified June 18, 2024, https://www.reuters.com/business/finance/rate-us-uninsured-rise-89-next-decade-congressional-budget-office-says-2024-06-18/.
[iii] The history of Lincoln Detox Center is covered more in-depth in the 2020 documentary “Dope Is Death.”
[iv] Phan, Tyler. "American Chinese Medicine." PhD diss., UCL, 2017. https://discovery.ucl.ac.uk/id/eprint/1571107/1/American%20Chinese%20Medicine%20-%20FINAL.pdf.
[v] Kevin Chan; Henry Lee (6 December 2001). The Way Forward for Chinese Medicine. CRC Press. pp. 349–. ISBN 978-1-4200-2423-4. Archived from the original on 21 August 2016. Retrieved 5 October 2016.
[vi] POCA. "Our History." Accessed June 21, 2024. https://pocacoop.com/our-history/.
[vii] Working Class Acupuncture, https://www.workingclassacupuncture.org/poca-technical-institute/the-school/, accessed June 18, 2024.
[viii] Bauer, Matthew, John L. McDonald, and Natalie Saunders. "Is acupuncture dose dependent? Ramifications of acupuncture treatment dose within clinical practice and trials." Integrative Medicine Research 9, no. 1 (2020), 21-27. doi:10.1016/j.imr.2020.01.003.