I've been working on materials for the Big Damn Clinic workshop and an analogy occurred to me. Having coworkers in a CA clinic (owners, employees, punks, receptionists, all categories) is a lot like treating patients in a CA clinic. Whether you are the owner or the employee, the punk or the receptionist, there is a lot of overlap to working in a CA clinic and receiving acupuncture in a CA clinic. In fact, there is a lot of overlap generally between working anywhere in the CA movement and being a CA patient.
The community acupuncture model only works if everybody involved *gets it*. What do we mean by that? Everybody involved has to understand the goals, the context, and the limitations of the model. And those three elements are all woven together and influence each other.
Let’s start with the goals. Basically, we are trying to make acupuncture available to people on their own terms. We want to make it so that people use acupuncture the way they want to use it, the way that fits their needs best, as opposed to the way some insurance company says they can use it or the way some acupuncture guru commands them to use it. We try to treat ordinary people as if they were authorities on their own bodies and their own lives. Furthermore, we are trying to make acupuncture equally available to a really wide range of people. As another community acupunk described it recently, we are trying to “level the playing field relating to the economic status of people interested in getting acupuncture without drawing attention to the fact that some people might be poor”. (Thanks, Nate Mohler!) We’re trying to empower people and we’re trying to include people — a LOT of people; that’s the essence of the community acupuncture model.
We are doing this in a larger social context of inequality, disempowerment, and consumerism. So we are constantly swimming upstream and jumping rapids; we’re like salmon trying to go home. It takes an awful lot of effort, but like the salmon, we do it because on some level it’s our nature to do it, and also, this kind of effort is the fulfillment of our lives. The currents of inequality, disempowerment, and consumerism in this culture and at this time are intense. Part of the reason I think that acupuncture in general has had such a hard time integrating into Western culture, and why the community model works so well, is that acupuncture itself is inherently equalizing, empowering and creative. It’s not like the rest of the healthcare system, so it doesn’t fit in well. Part of what we’re doing with POCA is building a different foundation for acupuncture, and we’re doing such a good job, sometimes I think it’s easy to forget how hard the larger social context is pushing against us. Salmon don’t forget because they don’t have abstract minds; they don’t build multi-stakeholder cooperatives, they just keep hurling themselves upstream, feeling the push of the current in every moment. Some of what can go wrong with coworkers in a CA clinic has to do with forgetting about the current, because we’ve built these structures that to some degree allow us not to feel it.
Just because it looks easy and it’s going relatively smoothly, don’t forget that we’re all still swimming upstream.
The limitations of the model have a lot to do with the context. If you really want to treat a lot of people who are only able to pay $15 a treatment, and you also want to be an employer, you are going to run a very lean operation. Sometimes it will feel like a stretch to make ends meet; other times, it’s easier. But as long as you are committed to treating a lot of people who have limited financial resources, though, your clinic will also have limited financial resources. You will always have to be clear about what your priorities are, because you’ll never be able to do everything you want to do all at once. CA clinics teach their owners to be careful and patient and frugal.
Community acupuncture doesn’t work for every patient. It works for the patients who understand and accept the context. It works for the patients who don’t need us to tell them what to do every step of the way; it doesn’t work for the ones who want us to tell them exactly where to sit, how to breathe, what to eat, what to think, and what every single acupuncture point does. It works for the patients who are grateful that somebody wants to try to give them as much acupuncture as they need to get better. It doesn’t work for the patients who are mad that we can’t give them acupuncture the way that their private-room acupuncturist who charges $100 per treatment does. It works for patients who can basically get along with other people well enough that they can be treated in a context where they are sharing space and sharing an acupuncturist’s attention, and be happy about it. It doesn’t work for patients who are very needy, very demanding, very self-centered, or oblivious to what’s going on around them. The patients that it does work for are why our jobs are not only doable, but fun. Everybody who works at our front desk comments at some point on what nice people 98% of our patients are. The other 2% just don’t stick around long.
It’s very similar for the people who want to work in the CA movement itself.
1) Coworkers need to appreciate that everybody has to work pretty hard to make the whole thing work at all. Everybody’s job is demanding and everybody is trying: owners, punks, receptionists. We need to give people room to do their jobs and give people the benefit of the doubt whenever possible. We need to try to be aware of all the elements that our coworkers are juggling in order to do their jobs. Don’t get in their way unless you have to. Just like most patients are aware that their acupuncturists are juggling a lot of people’s needs in the treatment room and are appreciative and calm even when they have to wait, we workers need to have the same attitude with each other. Punks need to appreciate receptionists. Owners need to appreciate employees and vice versa.
2) We all wish that everybody could get paid more, just like we wish that so many of our patients were not working grueling minimum wage jobs and dealing with awful chronic health problems. A lot of people who don’t like community acupuncture, both acupuncturists and patients, basically argue that the real solution is to make the government pay for unlimited private-room style acupuncture for everyone, so that all patients can get as much massage, moxa, and lifestyle counseling as they want, while acupuncturists get paid upper middle class wages plus great benefits — and until that happens, we shouldn’t accept anything less! Yeah. Right.
Those of us who work in the community acupuncture movement need to be willing to work with reality as it is. Patients with limited resources minus magical government solutions equals clinics with limited resources to pay workers. The only part of that equation that you can change is the patients. If you really want more money, you need to accept treating a much more limited range of patients. If you can’t accept that, you need to accept what our culture defines as relatively low wages for your work (though if you’re an acupuncturist, of course, any wages are kind of a miracle). Only you can decide what inclusivity is worth to you. Our patients, by and large, get that paying $15 for a treatment and sharing a space with other people means that they can bring their grandmother in with them. If we paid ourselves substantially more, there would be substantially fewer grandmothers coming in, and the whole clinic would feel different.
3) We don’t give out cookies and gold stars. In general, we don’t give patients rewards for referring their friends and family members, or for long-term loyalty, or for coming in frequently. We need them to do all those things as a matter of course, if we want to stay open at all, and most of them know this and don’t expect cookies. We can’t give workers rewards for enthusiasm or passion or loyalty, because we depend on them to have these qualities if we are going to operate at all. These qualities are not “extras” in this business. This goes for owners as much as employees. Salmon don’t get gold stars, they just get over the rapids — or they don’t.
If you don’t love doing this for its own sake, don’t do it. If you need cookies and gold stars to feel valuable, you will probably not be happy here. Nobody is going to be in a position to give you those things in the form of bonuses or merit raises or even pats on the head, because everybody else is working flat-out themselves, and the operation is so lean. Mostly, we need people to get their rewards from the work itself. We hope that people regularly express their appreciation to each other in informal, spontaneous ways, just like patients often express their appreciation in the clinic.
4) Just like the benefits for patients of getting treated in a community acupuncture clinic often have a lot to do with the relationships that they build, the benefits for workers are also about relationships. Working together in a CA clinic is intimate. Sometimes it’s too intimate. Just like patients deal with each other’s snoring and noisy crutches and smelly socks, coworkers deal with each other’s imperfections at close range. You may learn a lot more about your coworkers’ human failings than you really wanted to know. In a big clinic, it can feel like you’re married to a whole bunch of people, and all of them can drive you crazy the way a spouse or a partner can drive you crazy. Intimately.
On the other hand, you have genuine relationships where you can genuinely grow as a person. It doesn’t mean that you are friends with everybody you work with; that’s not only unlikely but probably inadvisable, just like being friends with all of our patients. What you are, though, is connected. In a big clinic, you depend on each other for your jobs to exist. The point of a Big Damn Clinic is to make those relationships as stable and as long-term as possible.
5) CA clinics and jobs in the CA movement don’t fall out of the sky. Somebody — or more accurately, somebodies — worked their asses off for them to be there. People need to appreciate what is available and understand how hard it was to create it, even if it isn’t their personal version of perfection. The majority of CA patients get this; they don’t complain that the fleece covers on the chairs are not their favorite color, and they don’t insist that every treatment be to their exact specifications. They don’t expect the clinic to be a spa or the acupuncturists to act like servants. Patients who do want the clinic to be something it’s not are not patients for long. Similarly, workers who want a CA clinic to look more like a resource-intensive, traditional middle-class organization and less like its bootstrapped, handmade, experimental self are not a good fit. If the workers in question are the owners, the clinic itself isn’t going to be around for long, if it ever gets off the ground at all.
As Voltaire said, the perfect is the enemy of the good. CA’s good, but it can’t survive perfectionists. Especially selfish or unrealistic perfectionists.
Everything in the movement — the clinics, the jobs, POCA itself — didn’t happen by accident and you can’t take it for granted. No matter what your role is, you need to really get that. A successful CA clinic is the result of a lot of people — owners, employees, patients — acting selflessly without acting martyred. POCA is also the result of a lot of people acting selflessly without acting martyred. That kind of behavior creates an environment that has, overall, made a lot of us very, very happy. But that kind of behavior in a capitalist culture does not get a lot of encouragement; in fact, happy or not, you can end up feeling like a freak if you pay too much attention to the current you’re swimming against.
But we’re not freaks any more than salmon are freaks. After they swim miles and miles upstream, leaping waterfalls if they have to, they spawn the next generation and then they die. Their bodies are like fertilizer for the new salmon and for the river itself. Salmon aren’t trying to get ahead personally. Despite all that effort, they can’t win as individuals and they don’t try. Community acupuncture is about responding creatively and transparently to a number of situations where we can’t win as individuals: illness, suffering, loneliness, inequality. We don’t promise patients that they will defeat their illnesses and win at life; we do offer the hope that acupuncture will give them a better quality of life. It’s the same for us. Having coworkers in the movement is about having a better quality of life, while we have it.