Shift Happens

I was once lucky enough to live for a short time on a bluff, in a rusty trailer parked on cinder blocks overlooking the Pacific Ocean. It was a temporary abode at a teaching farm where I worked for a year just after college. It was an idyllic place with eucalyptus trees and goats and chickens, narrow paths through wild fennel and hemlock that ended up at most amazing tide pools nestled in amongst a rocky shoreline. Part of my job when I lived there was to take groups of people, often from the city, to the tide pools to see the variety of sea creatures who lived there, clinging to rocks, pounded by waves. Down there on the rocks we would talk about how these miraculous creatures had adapted to their harsh habitat. Barnacles live in clumps to make it easier to find a mate, even though many of them have sex organs with both eggs and sperm ( they actually can’t reproduce with themselves) and they are able to make their own shelter around their bodies that they can enlarge as they eat and grow. These shelters have doors that open when the tide comes in, and closes to conserve moisture when the water goes out in low tide. But this post is not really about barnacles, it’s about acupuncture. 

Acupuncture, we know, is like noodles, and  noodles are good in soup, so acupuncture is also like soup, which generally is salty, so it follows that acupuncture is also like the ocean. It is vast and unknowable, teeming with life, and capable of making great changes to our physical world; that world mainly being our bodies. Like the ocean, acupuncture cannot be claimed to belong to anyone, but that doesn’t mean that people won’t try to claim it as their own, or forget to acknowledge that community acupuncture in the US continues the work of the Young Lords and Black Panthers, who through their fight to bring justice, partly through healthcare, in the ‘70’s to their communities, provided acupuncture, and acupuncture training.

Our clinics, and our Co-op experience tidal influences grounded in cycles like seasons and moon-phases that are knowable, but ultimately beyond our control. To deal with this unpredictability we’ve learned, taught ourselves and each other how to be more like barnacles. We’ve banded together and figured out ways to hunker down when the tide is out. Like calcified outer shells glued to rocks our clinic and organizational structures give form and function to our individual and group work. Our collective efforts have proven a useful adaptation and POCA and other community acupuncture clinics now deliver over a million treatments annually across North America. Working together, sharing resources, values and goals, over almost 20 years, continues to drive a mission that serves the people of our communities through almost 200 clinics, a multi-stakeholder cooperative with thousands of members, and a school that has already graduated  dozens of new punks, and reached the goal of accreditation all with in its first few years of existence . 

We don’t know the how of why acupuncture works but we do know that it stimulates energy to move around and do stuff in our bodies. Outside of the body acupuncture has the power to move too; it’s a bit like gravity, a force that brings things together. People whose lives might not otherwise intersect come together in our clinics. Organizations and alliances develop as our clinics grow and become institutions in our communities. Like tides, community acupuncture is a force that has the power to shape things, and like gravity it has the power to attract and pull people in. This is how we have a movement that has accomplished so much in a short time, making so much from nothing. Like the Earth’s rotation exerts influence on tides, wind and weather patterns, the axis of community acupuncture being of course in Portland, OR, has meant that Working Class Acupuncture has been a source of power generation in the movement. A global shift in the acupuncture profession started with a couple of punks with an idea, some urgency and drive to serve and survive and then spread out from there, shaping, directing, coalescing resources, bringing together punks and people to collectively envision the acupuncture profession we wanted for ourselves and our communities. Many waves of new punks and clinics have continued to come from this locus that spawned the creation of so much, including so many contributions to our knowledge commons. Without Lisa and Skip and Working Class Acupuncture and all the many people and punks that make up WCA taking so many first steps we would not be where we are today. They have been a core force in get things to move and happen. Of course there’s “the entity”, but that’s more like the ocean.

The desire to create our very own community acupuncture school has been a massive effort, a painstaking process, and the result of an outpouring of both financial support from Co-op members and people connected to the Co-op through our clinics. It’s difficult to count just how many people have participated in this effort, but we know that it’s in the thousands: ranging from circle and board volunteers, away faculty,and the many, many patients who participate in bi-annual membership drives, and of course the students, facutly, staff and adiministrators of POCA Tech. Working Class Acupuncture and the Community Acupuncture Network, started and seeded a mission and vision that has manifest as POCA/POCA Tech and all of the many clinics of the movement and beyond. This force, bigger than all of us, has steadily emanated change, reshaping our work and the lives of our patients, and of course the acupuncture profession. All of these actions have involved some level of risk; at one extreme people have staked their savings, their homes, their partnerships, have uprooted and moved to be part of this movement. For anyone still reading, my guess is that community acupuncture has not just shaped or changed your ability to earn an income from acupuncture, or your health, or your career, but your life. Acupuncture has that power and it reminds us that we also have that power.  

Power needs channels to divert effort into useful action and that channel can come from so many people who like rocks by the sea that shelter and create tidepools, or rocks that can be made into soup, have pitched in to create shelter and habitat. POCA Tech was conceived of as a seed-bed of the movement, and it requires careful and constant tending to sustain it. Since 2014 POCA Co-op has shared in the commitment to seeing POCA Tech realized by donating well over $100,000 to POCA Tech (in increments of ~$20K per year over the past 5 years.) The volunteer work that made raising this amount of money possible, while keeping the rest POCA’s work/projects happening is often unseen: circle work to plan and execute membership drives twice a year, many weeks of teaching by volunteer faculty, boxes of books shipped to Portland to make an accreditable library possible, board meetings, advisory committees, and so many hours of un-paid work donated by POCA and POCA Tech’s modestly paid employees.Then there’s WCA’s contribution of its clinics for practical training, including taking the risks to open clinics expressly for this purpose. Power without direction is a swirling eddy, with direction the Grand Canyon. 

A common theme in volunteer driven organizations (POCA has just 4 part-time employees) is the need to continually attract and onboard volunteers, and in the instance of POCA,  all of that work is also done through and by other volunteers, which creates a mechanism by which the effort can at times begin to swirl like water around a drain when this constant effort to recruit outsizes retention. Jeff Levin referred to this in his recent POCA Fest Keynote address. Jeff said:

I’ll let you in on a little secret about your coop. POCA people are burnt out. The ones wearing the masks are tired of it. We are stalled in succession planning, because the effort to create the infrastructure for succession, like the effort for every extra thing we need to do, has to be scavenged from the actual running of our clinics and people running clinics are burnt out too. You need to step up and get involved. This is your coop. You are the succession. You are the next keynote speaker. You are the next pocafest coordinator. You are the next teacher for an online CEU. And one of you out there is going to step in and help organize a solid governance structure for POCA. Another of you has the solution to our dwindling membership and revenues. This is YOUR coop and if you want it to thrive and not just survive, you ALL need to step up.

Jeff’s not kidding; it’s hard to keep forward movement in Circle work with only 2 or three active members. And it’s been challenging to attract and engage new Circle volunteers because we all have busy lives, and busy (hopefully) clinics to attend to. POCA  was conceived of to work with lots of people participating as both producers and consumers. The basic operations of POCA requires volunteers to create membership drive materials, administer micro-loans, create an annual budget, run an annual BOD nomination and election process, generate a monthly newsletter, and to work with the 4 paid POCA staff who oversee Finance,Tech, CEUs and Membership functions to insure that there’s enough revenue flowing into POCA to keep it functioning. Beyond basic operations we need member participation like attending a POCA Fests, organizing a regional node gathering, writing blogs, creating new CEU content, doing a membership drive, organizing a legislative effort, or creating a new circle to keep an endless need for ideas, projects, and resources flowing and vital. 

Recently the Ear Circle and Movement Building Circles have been central to new and energizing work  happening around the POCA-verse. POCA needs both operational and productive Circle work to keep things fresh and engaging for members; it’s hard to compete with the lure of engagement on other platforms and to counter the onslaught of the daily news cycle. POCA’s circles and structures are meant to be flexible enough to allow what interests people, in the service of the mission, to create and do all kinds of things, and when Co-op members feel excited and engaged they create new things that excite and engage other members. This helps keep POCA alive. 

But as Jeff mentions above many of the folks who have been volunteering for some time are feeling done, burnt out, or for various reasons need to step-back and attend to other areas of their lives, including focusing on their clinics. Finding punks to hire is still difficult, low clinic numbers is something that many are experiencing. Business costs have increased and so has a general and pervasive sense of anxiety in many communities and families that continue to face hardships, some levied by political, economic, and social currents. POCA Tech is a bright spot in all this: enrollment is up! New punklings continue to enter the workforce. We need a strong Co-op to help insure that clinics can weather low-tides, and to help buoy new practitioners and clinics, the way CAN did when so many of the first CA clinics started. We need to do more than change the LOC guidelines or raise our prices for the first time in decades. And contractions to operational budgets only whether at a clinic or organizational level, makes sense for the future of the community acupuncture movement, if those can eventually expand again. Sticking together is how we do that. It always has been.

Recently Working Class Acupuncture launched the WCA Builders Project in order open more clinics that serve both their community but also the needs for clinical training sites for POCA Tech’s students. Along with the POCA Tech Sustainers Program, and ongoing and increasing enrollment, POCA Tech has a plan for its continued existence. This shift in focus and fundraising strategy creates a chance for POCA to shift modes as well. For example, long overdue updates to POCA’s website require tens of thousands of dollars in both labor and updates/upgrades to functionality, which could help with member retention (auto-renew anyone?) and engagement of more members. We need tools and resources that bring us together because this work is best done together. But we also need to look at what that work is, and how it is shaped, and directed. Our decline in Circle volunteers and membership overall,  is an opportunity for not only new bodies, and new ideas, but also new leadership. A recent proposal from the Movement  Building Circle  to do an organizational equity audit, as part of groundwork to re-energizing governance and participation has been hotly debated by the General Circle and so a survey has just been launched to ask you, yes YOU!  What are the projects and work that you want to see done by POCA? Is an equity audit one of them?

To continue the force of our movement we need to be clear on direction. POCA’s focus is shifting away from the necessity and urgency of getting POCA Tech off the ground, though both the Builders and Sustainers programs still need POCA members to contribute!  Concurrently, leadership and core volunteership has shifted. To continue to have a co-op, we need and want  more people to wade in and get wet. We need to know what work will inspire and motivate people. We need to consider how our structures help or hinder this flow. We need to know how do you want to get involved to sustain and shape POCA in whatever comes next? How has POCA been helpful to you, your clinic, your healthcare, your work, your life? What new projects do you want to see seeded? Which of these can you commit to tending? Whether you have volunteered with POCA before, or never been sure of how to begin, if you value POCA as a resource we need you as a member, we need you as a volunteer, we need you as producer of POCA resources, and we need you to be part of directing the flow. Please comment below on what you want to see and do- and please fill out the survey!

Author: crismonteiro

I've always thought that I would live to be 100 years old and now that I have an actual idea of what it might be like to inhabit this body for a century I want to be damn sure that Community Acupuncture is around to help me through my days and in the end, on my way. In the meantime, I am passionate about getting shit done, and also having fun.

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


  1. I first learned about Trauma Informed Care, and other really great concepts like fractals, Liberation Theology/Psychology, and Tungsten, from POCA. When we put TIC into practice at our clinics, we connect with each patient understanding that they have most likely experienced some form of trauma in their lifetime. What would POCA be like if we practiced TIC with each other? How would that shape our interactions in meetings and in online discussions? How would it affect our membership numbers and our goals to make acupuncture affordable and accessible to as many people as possible?

    Years ago, my husband was really enthusiastic about Stephen Covey’s book, Seven Habits of Highly Effective People. We were a new couple at the time. As the inseparable couple monster that most new couples are, we read the book together. We never actually finished the book, but sometimes we discuss some of the concepts in the first few chapters. Covey teaches that love is a verb. He describes a story where a man confesses to him that he is no longer happy in his marriage and he is not sure he loves his wife anymore. Covey’s advice to him was to go back home and love his wife.

    Covey also writes about the Aesop’s fable with the farmers and the goose that lays golden eggs. The farmers get impatient and want more golden eggs. Instead of working collaboratively with the goose to help it lay golden eggs, they killed it and searched inside it’s dead body hoping to find more eggs. The moral? No more goose and no more golden eggs.

    I did theater in college. I worked with two different directors in those four years. One of the directors taught us the value of unions by enforcing a 15 minute break for every 45 minutes of rehearsal time. He was an avid smoker and this guaranteed him regular cigarette breaks. The other director created a culture where we routinely thanked each other. After every class, rehearsal, and pre-show meeting we would individually thank other cast and crew members for their work. “Thank you for your work.” “Thank you for your work.” “Thank you for your work.” Until we’d thanked everyone. It was contagious. It became part of our lives. When the theater nerds sat together in the dining hall, we would part ways by saying “thank you for your work” instead of “see you later.” We ended conversations and said goodnight this way, too.

    Gloria Jacobs, in Portland, Oregon, writes our POCA newsletters. She always needs content. I regularly send or create content for her. We started working together in 2016. Gloria always thanks me when I send her something worth publishing. That makes me feel good. So I keep sending her more content. If you want to feel good and be thanked for your work, you can work with Gloria, too. Send her a photo of the new plants in your clinic or let her know when your clinic is voted the best place to get acupuncture in your town. Community clinics always get voted best place to get acupuncture in town.

    Lisa spoke about positive feedback in her 2013 Keynote speech in Rhode Island.

    I want to thank the POCA members who took the time to put together the survey together. I also want to thank them for the time and energy it will take to process all of our feedback.

    I hope this is helpful. I am glad to see discussion about how we work together as a co-op and how to get more golden eggs for POCA, preferably with artisanal New Zealand sea salt.

  2. Very well said, Roppy. It really lands, for me. All any volunteer wants is to know that their work is valued and appreciated, and they are contributing to something that is bigger than what they could be contributing simply as one person.

    I will forever be grateful to CAN, and to POCA for giving me the path to the career of my dreams. I served on the BOD for a bit, and was part of the Welcome Wagon as well. I also spent a few months putting 100% of every new patient’s fees into POCA by way of membership. However, having my clinic membership unceremoniously yanked not long after that (while I was on the BOD) really took the enthusiasm out of my sails, and I’ve never really felt the same about POCA since.

    There is an anger and hostility within this organization that I’ve never really understood, especially when it gets directed at its own members. There are many good people still working the CA groove, but who no longer members of POCA once they became a target of that hostility. It’s something to ponder.

    These days I feel very fulfilled mentoring acupuncture students, and giving them the opportunity to learn in my clinic all the facets of CA, and giving them the tools to one day open their own CAP. I’m still working the CA groove, and will maintain my punk POCA membership as long as I’m welcome to, but can’t see throwing myself back into that fire again any time soon.

  3. Roppy, I agree that explicit acknowledgement is not something that has been part of POCA culture, and thanking people is a very easy and effective way to do that. It’s something we all can easily do. In very early organizational planning we had discussed having a sub-circle of Membership that would help the circles assess people’s needs/experiences and to acknowledge/thank people for their contributions. I think Welcome Wagon’s role was in part to thank and acknowledge people for participating by paying dues. But why hasn’t a larger culture of thanking and appreciating taken hold? I think simply for lack of people to take on that role. As individuals I surely hope that we do express our appreciation to one another, I think that’s part of the glue that keeps us together. Greater effort to make sure people’s work is seen, shared, appreciated, acknowledged organizationally would be a cultural shift for POCA, but it sounds like it would have lasting and positive effects. Thanks for sharing your experiences and ideas about this.

    Jessica, I know that there are people who share your experience of being both in the CA groove, and feeling discontented and disconnected from POCA for a bunch of different reasons, including personal conflicts with other members. I have my own experiences of that, and in some instances I am not clear what issues stand in between me and others. At the same time I am open to looking at what isn’t working, I am aware that I don’t have limitless energy to address everything. As a barnacle my focus on clinging to the rocks happens twice a day even though I have so many other desires and ideas for other things I’d like to see come to be. If there were a beach clean up circle, or a way for people to vent their dissatisfaction and seek remedy where possible I’d think it could do a lot of good. It’s been tried before, but did not stick.

    In striving to build so much, stopping to assess where things haven’t gone well hasn’t been a strong point for POCA governance or process. Perhaps this is particular to this group of people, or maybe it is part of group dynamics especially in larger groups. In addition to our shared mission, our cohesiveness has been built on survival at the level of clinics/punks as well as as a profession. That doesn’t mean we can’t or shouldn’t attend to conflicts. Building ways to do that could be a next step for the co-op if people want it.

    The shift that is happening now, where POCA Tech and POCA’s resources are becoming less intertwined, creates an opportunity for new structures to be built within POCA. I’m grateful for the MBC’s push for members to self-assess via the survey link above. Participation and input in what comes next for POCA presents the possibility to reshape how this imperfect ecosystem works. My hope is that this will re-engage people like yourself who have been part of the Movement for a long time, or attract and engage people who are new to POCA and CA, because we’re going to need folks stepping up. There’s a lot already that needs to happen to keep the POCA functioning as well as much more that we collectively want to get done.

    So thanks for sharing about your experiences here. I hope that more people will comment here, respond to the survey, and share the link with people who might not see it here at PPP.

  4. I just realized that I responded to the wrong person at the wrong clinic- apologies to Jessica.

    Jean-Paul, welcome back. Your clinic set-up at the time your listing was removed from LOC now meets the revised LOC guideline, assuming you still do private and group treatments. Thanks to you and everyone who has ever volunteered in any role with POCA. One particularly hard volunteer role has been to be the LOC hammer, especially when LOC guidelines were more narrowly defined; I tip my hat to the many hammers have taken on the particularly challenging role of boundary keeper. In instances where LOC listings were removed there has always been a process of back and forth and often times deliberation with one or more circles including the General Circle. It sounds like this all happened while you were fundraising via an ongoing clinic membership drive and volunteering for the Board so understandable that there was some awkwardness.

    To me this is one of the tricky parts of working in groups. How do people attend to their own needs and feelings about how things work out or don’t especially in interactions with “the group.” When we take on roles to act on behalf of the mission or the entity, and that bumps into each others individual needs or wants or reasons for being here, it can feel challenging for sure. Navigating back toward the mission is a big part of the way forward I think. It’s why people stick around, or come back around.

  5. Just so we are clear, if a POCA member has a board position, or some other leadership position yanked from them, that is a systemic organizational issue. It is not an interpersonal conflict. If an organizational leader chooses not to follow sociocractic process, that is also an organizational issue.

    Welcome Wagon is about welcoming new members and answering questions. I ran it for two years. Most volunteers that I worked with gave it a few months and tend to get tired of it quickly. I tried to show appreciation for whatever time they could put into calling people they don’t know. After two years, I passed on the torch, just as the torch was passed on to me.

  6. “But why hasn’t a larger culture of thanking and appreciating taken hold? I think simply for lack of people to take on that role.”

    This shouldn’t be something that requires a Circle to be formed. I think that misses the point entirely. We need to rebuild a culture of appreciating each other, seeing each other, supporting each other, and thanking each other, full stop. Not a Circle of people whose job it is to write thank-you notes, but engaging with one another in a sincere and gracious manner. It feels to me like the desire to create more structures removes the personal concerns that people do not feel appreciated or valued as individuals within the community.

    Roppy’s point about theatre is apt and fitting. When you practice the act of self-care (that director’s smoke breaks were self-care in an unhealthy way, but still) through rest and expressing genuine gratitude – both values that should be associated with POCA and CA clinics! – then you create a good energy that feeds everything else.

    Cris, thank you for writing such a personal and deep blog post. It shows me more about you as a human and as a punk, and also shows me the connection we have to being folks who love the beach – something I didn’t realize before!

    Roppy, thank you for sharing feedback, which helps build our community. I always forget that we both have a college theatre background and am tickled to find new ways that our friendship has common ground.

    Jean-Paul, thank you for bravely sharing that you were hurt, how you were hurt, and seeking resolution. That isn’t always easy, and it takes courage to show that vulnerability.

    See what I did there? That was all genuine. These were all my real thoughts. I didn’t delegate those replies to a Circle. I didn’t put “reply with gratitude to the blog post” in my planner. I took a moment, in the moment, to express my appreciation to each of you. Yes, that is second nature to me (maybe a theatre thing, maybe a teacher thing, maybe a woo-woo empath hippie-dippie thing), but it makes me feel good to make connections. Making connections is what we should be about in POCA – connecting our disparate clinics over the common ground of our work to serve our communities.

    It’s Thanksgiving week. Let’s make thanking people and showing gratitude our mantra for the rest of 2019 and carry it into the future.

  7. This blog is wonderful, Cris– more barnacle facts, more of the time, please. We create energy and possibility and make the unimaginable real when we collaborate and grow new nodes of connection: POCA has demonstrated that time and again and I hope to be a part of continued iterations that expand what we think is attainable.

    I think there are so many things that go into creating a functional and as-healthy-as-possible-in-an-unhealthy-world group culture. Roppy, I think your questions about what would it look like to implement TIC with each other are worth getting deep and real with. I’m also thinking about this article of shifting from trauma informed care to healing centered engagement: Anyone else read it? It’s pretty awesome.

    I get that people like to feel seen and valued for their work, that’s a basic human need (4 levels up on the hierarchy of needs), and I think that happens in lots of different ways for different people. Sounds like some people wish that they were thanked explicitly and have been doing some of that. For myself, I feel like I’m making a meaningful contribution in a way that is seen and valued when I see projects that I’ve dedicated a lot of time and energy to start to take flight (ie as someone who has been involved in the Ear Circle since the beginning, watching AATs go out into the world and make ear acupuncture more accessible to more communities fills that need for me).

    I am able to support myself doing this job that I love because of POCA, and the people who trained me in ear acupuncture at Lincoln Hospital, and the people on the frontlines I’ve had the honor to fight beside who have taught me about community, risk, and healing, and many other people that I will never meet including the revolutionaries in the BPP and Young Lords, and Miriam Lee, and so many other ancestors of liberation acupuncture, known and unknown. To me, I thank them (and you) with my feet, my hands, my brain, my heart, my work. I’m not saying expressing thanks directly is a problem– it’s just not a central issue for me in terms of how we make POCA a more equitable, welcoming, strong, and growing place. I’m part of 2 circles that are active and busy and based on relationships of interdependence, complementary skills, and shared passion/vision– in my experience with the Ear Circle and the MBC, people get thanked and validated in their workin all kinds of ways that aren’t always explicit.

    I’ll just say, because a Thanksgiving aka Thangstaken reference got made, that this is a time of year that illustrates the problems with gratitude taken out of context very clearly. It’s so problematic that the day that many people give thanks is actually based on a history of genocide and theft from indigenous peoples. Let’s be grateful by getting our feet wet and building the world we want and need, one org/community/clinic/project at a time.