The Heart of the Matter

Valentine’s Day approaches and depending on whether you’re a sentimental person, if you are currently partnered, or perhaps chasing the winter blues with any number of online dating adventures, you may or may not care. Sometimes “occasions” whether created by Hallmark, or an actual passing of a date of significance serve as a place to gaze backwards from. I’ve found it to be true for myself that much of what has been good to gain from relationships-gone-by, ones that ended poorly, as well as those that ended okay (it’s called a break-up for a reason), is often found in looking back at it having allowed time to create a bit more perspective.

On a side note: these days Valentine’s Day is supposed to be about a winged infant shooting arrows of mushy sentiment into our hearts. But going back a couple millennia, Eros, Cupid’s Greek counterpart was one of the primordial gods. In 400B.C. so and so writes about Eros in this way:

Earth, the Air and Heaven had no existence. Firstly, blackwinged Night laid a germless egg in the bosom of the infinite deeps of Darkness, and from this, after the revolution of long ages, sprang the graceful Love (Eros) with his glittering golden wings, swift as the whirlwinds of the tempest. He mated in the deep Abyss with dark Chaos, winged like himself, and thus hatched forth our race, which was the first to see the light.[9]

This is no vapid cherub with well wishes, but the source of humanity. 

Back in November, at the one year anniversary for our second clinic, which we actually closed back in August (I’ll say more about that further down) I sat down and tried to write about the experience. I half-wrote a blog, but then put it aside, as I often do, because other work took priority and it just didn’t seem finished. When I bumped into our main champion out there unexpectedly this past week, I got thinking about this unfinished blog and what part of PCA’s experience with this project might be useful to anyone else considering options and partnerships with other organizations. I hope the punks, patients, and receptors of PCA, or anyone reading this who has had some thoughts or experiences that relate to our short-lived second clinic will also chime in here. 

Really if you don’t feel like reading this very long blog I’ll summarize the 2 main things learned:

  • The impacts of what we do and how we do it are far reaching in terms of our effectiveness in getting treatments to lots of people, and the sustainability of our model. In other words testing the model outside of our typical setting indicated that the setting has a lot to do with it all, in part because it allows us to connect to the clinic, and ultimately each other.
  • Working with other organizations, in an effort to broaden our reach is doable, but certain boundaries must be seen (uncovered if not known from the outset) and respected. Collaboration then looks like two distinct organizations; speaking for us, our culture and foundational ideals cannot be removed from what we do.

Part of our agreement with THC was that we would collect data, to be exact, every six visits. This data, we were told, would help the medical doctors and grant providers understand what, if any effects acupuncture was having; the main focus would be on acupuncture’s effect on chronic pain. For a bunch of reasons: an increased reliance on prescription pain meds, here in a state where this year we saw a whopping 72 deaths from opiates and pain meds in the first  3months of 2014, that community health centers like THC are looking forward to new pay structures based on outcomes rather than services delivered, and because THC provides care to a whole bunch of people in chronic pain, many who have all but exhausted effective treatment options, measuring in this way was important.  As a provider within our healthcare system, THC uses data of all kinds to justify treatments, and to qualify for various forms of funding and aid. As a small for-profit entity, solely dependent on treating lots of people to make our operation work, I feel relief at the fact that we don’t have to measure outcomes in this way in order to keep justifying our existence. Instead the measure has come time and again from people who after anything from a single treatment to a series of treatments over months, says something like: I can’t believe I have my life back in these ways (fill in the blank) thanks to acupuncture.

It turns out that during our time at THC we only administered a single survey to capture feedback from those who had completed their 6 visits. We mailed the survey to everyone who we figured out had had or was approaching 6 visits. Our front desk staff handed out written copies and/or had people take the survey on an ipad at the front desk. It was a very small sampling of people, but overall everyone was very happy with their acupuncture treatment and said they were likely to continue coming. Below I’ve included a few of the comments from the survey; the column on the left are responses to the question “what helps your condition?,” and the column on the right are responses to “what makes your condition worse?” 

relaxation, recliners (that you have 2 of) not the chair ones you use, and music

loud noise like doors slamming

acupuncture and movement (yoga, etc.)

being still

coming at least once a wk.

Not coming or not being able to afford

yoga and this

my bad habits

yoga

tension

meditation/acupuncture

certain food/stress/ weather

Learn how to relax and taking time for me to recover from negative in rest of life

Not taking time to express myself, taking a lot of thing in that don't apply, learn how to let go

One thing I love about community acupuncture is how our patients are actually key into what it is we are trying to do. We are trying, maybe more than delivering acupuncture, to create spaces where people can come together, or alone, to be still, to relax, or to do nothing, which for many is new. We are creating sanctuaries of quiet where people contact their health, or vice versa. What we do isn’t us doing it, it’s the opportunity unfolding for people to do it themselves, together, again and again. And to me when I look at even the smallest sampling of part of a survey CA patients get CA; they may not know about the fractal, but they show how it is there.

I am glad about the work we did with THC to build bridges between 2 organizations that share some similar goals, and more importantly more people got acupuncture. But needling groups people in recliners clustered together in dimly lit rooms; that really is the easy part, it’s also the most enjoyable, most rewarding, most flowing part of what we do. It’s the part that feels like going on a walk in a beautiful place on a warm Spring day where the conversation flows, and every little thing falls into place beautifully. The other part, just to entertain the metaphor a bit more, is more like agreeing to go to a family gathering (yours or someone elses) or school reunion(yours or someone elses); stressful and exciting, lacking a familiar context and requiring a lot of superficial interaction that may leave you wishing that you had stayed home and watched a movie. Interfacing with our medical system can be a lot like that too, feelings of isolation, waiting around for something to happen, a sense of “does anyone here really see me?” but with much higher stakes and expense. Obviously many worthy endeavors don’t feel like a walk in the park, but an awareness that something feels like a continuous uphill climb indicates to me that if a different path is an option it’s a good idea to consider it.

Getting acupuncture for the first time can have similar nerve-wracking effects that meeting an online date in person for the first time does. With CA clinic treatments hopefully the fear and excitement of novelty can quickly move to a more stable state of domestic bliss. Relationships with a solid base of trust and communication are generally more resilient, and more satisfying. Trust and communication are basic to effective relating and these two things build on one another in a way that as each increases it allows for the other to increase, ultimately allowing greater challenges to be approached and resolved satisfactorily. In CA clinics a large part of the heavy lifting for the work that happens is done through establishing clear communication around expectations for treatment, and what is required from patients and clinic staff to work towards our common goals of lessening pain and suffering, and increasing peace and contentment. We pare down what we say, and systemize how we move through and between seeing large volumes of patients to keep static lowaround communicating. For many who use our services, they come to trust the experience of getting acupuncture both in how they can predict their bodies/emotions/energy will respond, and also what their interactions around the clinic will be like. Because this predictability factor weighs in high in importance to what we do, when we agreed to “start dating” THC we were very clear that we would ultimately want a dedicated space for our clinic. It wasn’t possible to have this from the outset, but there were possibilities, options further down the road if the program took, we were told.

I’ve been reading some fascinating stuff from the Institute of HeartMath (IHM) in Boulder Creek, California.  Poking around their website there are  a few simple, free, DIY tools they’ve developed and researched that to me connect to community acupuncture, and specifically to some thinking I’ve been doing about our 2nd clinic at THC.  Sadly, we closed the clinic within 12 months of opening it because we lost a punk during that time and could not find another person to bring on. This staffing loss meant that we could not run 2 clinics in a sustainable way. Looking at this project and future partnerships between health care organizations and CA clinics through this lens of HeartMath has given me some ideas of what will help these partnerships to be more sustainable and more satisfying in the future, and what might help a larger cultural shift around healthcare in general to keep driving momentum towards more access and more just delivery and care.

At the core of the HeartMath philosophy is that the heart, physically and metaphorically, is the key to tapping into an intelligence that can provide us with fulfillment. Science has shown that the heart communicates with the body and brain on various different levels.

·      The heart sends neurological information to the brain and the rest of the body.

·      Through the pulse, the heart sends energy in the form of a blood pressure wave. Researchers have seen that changes in the electrical activity of brain cells occur in relation to the changes in the blood pressure wave.

·      The heart communicates on a biochemical level, releasing atrial peptide, a hormone that inhibits the release of other stress hormones.

·      The heart communicates electromagnetically. An EKG measured in the doctor's office is actually an electrical signal produced by the heart. This signal can be picked up anywhere on the body, and permeates the space around us.

From https://www.pbs.org/bodyandsoul/203/heartmath.htm

IHM supports a theory of emotion

“first proposed by Pribram in which the brain functions as a complex pattern identification and matching system. In this model, past experience builds within us a set of familiar patterns, which are maintained in the neural architecture. Inputs to the brain from both the external and internal environments contribute to the maintenance of these patterns. Within the body, many processes provide constant rhythmic inputs with which the brain becomes familiar. These include the heart’s rhythmic activity; digestive, respiratory and hormonal rhythms; and patterns of muscular tension, particularly facial expressions. These inputs are continuously monitored by the brain and help organize perception, feelings, and behavior. Recurring input patterns form a stable backdrop, or reference pattern, against which current experiences are compared. According to this model, when an input pattern is sufficiently different from the familiar reference pattern, this “mismatch” or departure from the familiar underlies the generation of feelings and emotions….It is through practice and experience with outcomes that inputs become appraised as relevant or irrelevant, hopeful or hopeless. As we encounter new situations, experience new inputs, and learn how to gain or maintain control, we expand our repertoire of successful outcomes. The more repertoires available, the more likely a new input will be assessed as optimistic with a high probability of success in maintaining control. It is the organization of sequences of input patterns and behaviors into hierarchically arranged programs that gives a person flexibility and adaptability.

Community Acupuncture has created a new set of inputs around acupuncture and its delivery, and these innovation, these inputs are something others are interested in generalizing to the delivery of other services, including education and health care. Public health and social service organizations, private medical and health practices, and educators are looking to the systems and culture of community acupuncture to see how they might influence new outcomes. What are these inputs and what effects do they have on care and why? Let’s look at the role of patients’ in our clinics as one example. We ask patients to participate in our systems in order to keep costs low, but also to engage people in their own care in small, but significant ways. By being asked to participate and to learn the basic systems for getting treated in a CA clinic patients can clearly see that their role is a key part of what we do or why we even exist. Punks and staff alike re-iterate the importance of this role; we know that the clinic runs better with everyone playing a part.

By contrast, the bio-medical model delivers care in a much more stratified way, that separates patients from care givers with a more clearly defined hierarchy of doctors, PAs, NPs, etc. Professionalism paired with a culture of expertise is driven by demands for profit for increasingly complex and high input treatment options. In the bio-medical realm these things are mostly critiqued through the lens of science and evidence, although qualitative research looking at patient and practitioner satisfaction is more common now than before. In the POCA-verse we talk about these things as they relate to economics, race, gender, class, and social justice. It’s not that people working with many community health centers don’t care about these things. Instead there are just much higher demands on their time and energy away from patient care and toward administration, funding, regulations, etc. Our smaller decentralized structures and our relatively simple and straightforward care and business models allow us to focus more on seeing and strengthening our mutual dependencies. This transparency helps bring the parts of the systems, the various interests, and stakeholder, together and focused on our common goals. This level of resonance, held with a common vision, is what I think can change our health care system.

We had a hunch that not having a space of our own would have a big impact. Even though the community room that THC generously offered use of at no cost to us was VERY nice, the “container” that is our clinical setting, which is really a lot less clinical and a lot more like a“third-place,” does a tremendous amount of the work in helping people to go inside to that place where healing can happen more easily. Though our packable 10-chair clinic, complete with white noise, ambient music, dim lights and homey hand-lettered signs, was really a cool thing to be able to pull out of a closet, we still couldn’t quite create the type of environment we have in Providence at our main shop. I think of the clinic as a living organism, and our Thundermist clinic seemed to be on life support. We knew that in order for it to serve long-term, it would have to get off life support and breathe on its own and having a space of its own would have gone a long way toward achieving that. The novelty of packing and unpacking the portable clinic wore off in time, and required payroll time and that added to the difficulty of breaking even (part of getting off life support.)

I know that space is also a challenge for healthcare facilities in general, Thundermist being no exception even in their newly renovated 14,000 sq foot facility in W.Warwick which is only 1 of their 3 facilities in the state. So just recently when another community health center approached us with the hopes that we could set-up (another) community acupuncture clinic in (another) non-dedicated space I felt confident in saying that I thought it would be better for everyone if we could just figure out a way for their patients to get vouchers to get treated in our dedicated clinic space (in Providence). Transportation seems to be a common and persistent barrier to care for many of the patients served by either of these two community health organizations (the 1st and 2nd largest in our state). We’re not immune to this either, and so as we begin a search for our next dedicated space (our lease in our current Providence space is up in less than a year) being on a main bus line as well as amidst the communities we hope to serve remains a priority.

The Institute of HeartMath’s (IHM) mission is to help establish heart-based living and global coherence by inspiring people to connect with the intelligence and guidance of their own hearts. Some of IHM’s research that shows how the heart’s rhythm helps lead multiple sub-systems into coherence where the actual frequency of oscillations in these systems come into a state of resonant alignment. The results have both physiological and mental/emotional consequences that optimize function and good feelings. Sounds a bit like what we witness time and again with needle naps. And if this is happening inside individuals getting acupuncture, might it also be what happens between a group of individuals getting acupuncture together in the same room? And how about between groups getting acupuncture in one part of the country at the same time as groups in other parts of the country? And how about the continent? See where I am going with this?

This relates to our experience in opening a clinic inside a community health center because here is yet another organization/organism, with a similar mission to provide access to care to those without, with whom we can create some resonance. If we can create enough resonance between various systems that are looking to serve similar purposes, then it’s possible to create new outcomes. The resonance must be both intrinsic (people getting treated, providing treatment) and extrinsic (systems, structures, priorities focused on the intrinsic.) [Reverse the two if you believe that corporations are people.]

Can we change our healthcare system solely through extrinsic forces, new laws dictating how the health insurance industry and big pharma behaves, or do we need some kind of intrinsic force to guide us as well? What is the at the heart of healthcare that really cares for people and communities more than for the bottom line? Could it just simply be people? Could something like HeartMath help us find that because it, or practices like it, can help us tune in to what fulfills us, what allows us to see ourselves in others and vice-versa? What if you substitute the words Community Acupuncture for the words HeartMath above? Community acupuncture’s part in changing the world, or at the very least unjust healthcare and economic systems, lies in the connections we both build and uncover between the parts of our systems, and the people serving and served by it as well.  If patient care is the true heart of all health care, then it follows that patients’ needs would set the pace. This really is the Heart of the Matter.

Love to All!

crismonteiro
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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Responses

  1. I love this whole blog but I especially love this sentence: Our smaller decentralized structures and our relatively simple and straightforward care and business models allow us to focus more on seeing and strengthening our mutual dependencies.

    That’s so subversive. Most of our culture is about denying mutual dependencies, because they freak us out the way that illness, death, weakness and vulnerability freak us out. It makes so much sense to cultivate cooperation instead in the face of pain and suffering and all the things that scare us.

  2. “What is the at the heart of healthcare that really cares for people and communities more than for the bottom line? Could it just simply be people?”

    Yes, in all our vulnerability, and striving and failing and trying again. In our trust as patients and our openness as providers. In our willingness to work for something more. In our surprising recognition of one another, over and over. And in our deep dedication to a sometimes seemingly impossible vision of recreating what we know we really need.

    Thanks for writing this, Cris, for helping to process the feelings and understandings from our THC collaboration. I think it’s made us stronger and closer to the vision of what we know we need to do again and again. Thanks for sharing the vulnerability and love.