I’m sitting in my kitchen looking out the window at the three little raised garden beds in my backyard. The beds are empty, the trees are bare, and the row cover I had put out to try to extend the life of my green onions this winter has blown into a corner of the yard, where a feral neighborhood cat is napping on it. I am wondering again, as I do each year at this time: what will I plant in my garden come spring? For some reason I plant a garden each year even when I know that the majority of my produce will come from the farm I volunteer at, and the local farmers market. I care a lot about buying local, seasonal stuff whenever I can, and even though organic is also important to me, I would rather eat a non-organic apple grown here in RI, than an organic one from across the continent. My commitment to having some sort of garden, and its commitment to me, is to bind me to this place I live in. Part of that commitment is an ongoing process of understanding the conditions in my yard: soil, pests, new seeds, new varieties of plants and all the different things that affect what will grow and how well. It’s not enough for me to just want a garden; I also need to learn about the climate and landscape, and even with a lot of understanding gained over time, there are still no guarantees that I’ll succeed.
Starting a garden is similar to starting a community acupuncture clinic, with both there is a difference between wanting to do it and understanding how to create optimal growing conditions for any particular landscape or climate. Wanting to provide lots of treatments to lots of people, to have a stable practice, to work with others, and to develop clinical skills rapidly and in many areas: these are necessary conditions for a successful community acupuncture clinic, but they are not sufficient. The number one “growing condition” that any thriving community acupuncture practice requires is realizing that at its heart, community acupuncture is not about pleasing ourselves; it is about doing what needs to be done. Providing acupuncture to people who otherwise would not have access to it at all, tens of thousands, maybe millions and millions of them is what needs to be done.
In this way community acupuncture is like a victory garden, and the rest of the acupuncture profession, by contrast, is like a botanical garden. The acupuncture profession botanical garden is concerned with the preservation of exotic species, and with the distinctions between “true species” and cultivars. This garden requires funding from philanthropists, and foundations, and connections to universities with research grants; these relationships are part of what makes this botanical garden special, and unique. The botanical garden charges admission, and its mission combines education, enjoyment, and preservation. A victory garden, by contrast, is designed to enable citizens to provide food for themselves when resources are limited or diverted. During WWII an estimated 20 million victory gardens in the U.S. were able to produce the same amount of food as commercial growers would have. Communities pulled together to work these gardens, with some even forming their own cooperatives. Ironically, after the war ended very few gardens were planted and food shortages were experienced.
It is in this same spirit of pooling resources, crowd-sourcing labor, and doing what needs to be done that community acupuncture has emerged. Until community acupuncture arrived, the only route acupuncturists in the US could see for more patient access to acupuncture was through insurance coverage. The profession surmised that gaining access to the insurance system would require that acupuncture prove to be on par with allopathic medicine, with some sort of parallel educational standards, or through “legal” status as independent medical practitioners of a stand alone system of medicine (this was attempted through legislative maneuvers.) Neither of these strategies have worked, despite considerable expenditure of time and money; perhaps because they prioritized connecting to doctors, schools, lawmakers and the insurance industry over connecting with actual and potential patients. Community acupuncture provides an answer to the foundational question that any practitioner trained in a healing modality wonders: who am I serving? Community acupuncture is a call to immediate action. There are clear steps to take. It quickly begins producing effects: on practitioners, on patients, on clinics, on communities. A solution that requires legislation, legitimization, and funding is a long way around compared to a solution that immediately starts providing care for people who need it and won’t otherwise get it. Community acupuncture effectively harnesses the work of individuals to meet the needs of the collective.
Sometimes practitioners decide to try community acupuncture because their private boutique practices are not able to sustain a living for them. Most acupuncturists in the US are in private practices, working as sole proprietors, and most of their income derives from a combination of treatments given and products sold (though some of them supplement this with teaching at acupuncture schools, or teaching CEU courses). According to surveys done by a national professional organization, most acupuncturists are working fewer hours than they want to, and making a lot less money than they thought they would. Navigating the pressures and pitfalls of a solo business is challenging. A community acupuncture practice, while still challenging, is much easier to scale up, and there is evidence that the bigger a community acupuncture clinic is—the more acupuncturists that it employs and the more patients it treats—the more stable the operation through the normal ebbs and flows of any business (and therefore the more stable the income). But simply wanting this kind of stability for yourself cannot sustain a community acupuncture practice; you have to want that stability for the community, and at some point the clinic really begins to belong to the community. It takes less energy to let that happen, and to simply steward what gets set in motion, than to force a clinic to conform to an ideal in your mind. It’s like gardening; you have to be open to changes that you never planned on.
Climate zones, topography, soil quality, drainage, rainfall, season: all of these are external factors that affect what will grow and how it will grow. I’ve been thinking a lot about the acupuncture profession, and life and culture in general, here in the US and around the world. In the UK, where a community acupuncture and multi-bed clinic movement is also growing, there are very different growing conditions. The UK has a nationally funded healthcare system. College and university education is much less expensive in the UK, much of it subsidized by the government as well. Studies show that people living in countries that provide more equitable and inexpensive access to healthcare and education are generally more satisfied with these systems than we are here in the US. I wonder if this general level of satisfaction has an effect, like climate or landscape do, on the growth of the community and multi-bed clinics in the UK, or on the overall goals for the acupuncture profession.
The cost and inequitable access to healthcare and education in the U.S. also affect the growing conditions for acupuncture and community acupuncture here. In a sense, the cost of acupuncture education and the cost of healthcare together form a pinnacle of dissatisfaction for the average American trying to either get treatment, or to join the profession. The community acupuncture movement in the US was born from leaping off this pinnacle and into action If the same conditions for dissatisfaction to not exist in the UK (or not to the same degree), what motivates acupuncturists in the UK to make the shift to the multi-bed model? What goals are multi-bed practitioners seeking to meet? Who are they seeking to treat? Do these different “growing conditions” mean that different things will grow? Only those working in place, can really determine what is needed; but I still wonder what the two movements will end up looking like in ten years.
In its first six years, the community acupuncture movement in the US, used the downward momentum of the leap from the pinnacle of dissatisfaction to fuel a robust movement of clinics, some 177 of them thus far, that in 2011 delivered 500,000 treatments and grossed $4.5million. Perhaps the community/multi-bed movement in the UK has not grown as fast because the overall level of dissatisfaction is lower – that is, that there is less far to leap, and therefore less momentum. There are other growing conditions that differ from the U.S.; for example, how the multi-bed acupuncture movement situates itself in the landscape of the National Health System, as an un-regulated practice. If and when the regulation changes, I imagine that the community and multi-bed practitioners could well be at the fore of leading acupuncture into the NHS, with their experience of scaling up and treating many more people than the typical private practitioner—though I don’t know if that’s a goal of either ACMAC or the broader UK acupuncture profession. But even in the UK the healthcare climate appears to be changing, with increased use of vouchers and reliance upon private sector services for specific needs or conditions.
The community acupuncture movement in the US is not just moving away from a pinnacle of dissatisfaction; the downward movement is also characteristic of its grassroots goals. Community acupuncture is a movement that has deliberately stepped away from the usual trappings of professionalism in healthcare. Instead, community acupuncturists (or punks, as many of us call ourselves), are cultivating a new professionalism, one that reflects values of inclusiveness, and collaboration with our patients, rather than unnecessary status-mongering and information hoarding. You see these values reflected in the way our clinics are set up, what they are named, where they are located, how the punks dress, speak, and interact with patients and each other. By rejecting many of the values of the professional class, the community acupuncture movement has been able to create a new culture that appeals to a much wider range of people, primarily those in the middle and working classes. This “downward mobility” has not just brought with it a refreshing challenge to the assumptions previously inherent in our profession; it has made acupuncture a lot more relevant to a lot more people.
There’s a farmer I know who started growing ginger here in New England a few years ago. Each year that he’s grown it, he’s been able to increase production and yield, as he learns how to provide these tropical plants what they need in this temperate climate. Why does he grow ginger? Is it because it’s novel, and creates a niche market for him? Is it because he loves ginger? or because he’s concerned with how much petroleum is burned to bring ginger to New England from the tropics? Is it an economic reason, an esthetic, or a whimsy? I don’t know the answers for this farmer, but I think that questions like these need to be considered when undertaking an innovative and potentially risky business choice, one that may very well change one’s entire perspective of everything, including the task at hand. Who knows what will grow best with changing planetary climates and access to resources once thought to be infinite? The most meaningful work provides us a means to put values into action, and these values directly shape the work sometimes despite growing conditions, and sometimes with them. Although arguably not essential, growing ginger in New England requires a vision of what is possible. I admire the farmer for his innovation, and I admire him equally for the knowledge and skills he has that help him produce crops like potatoes, leeks and squash. But I admire him most of all because he feeds people.