British-born shiatsu instructor Shuddhabha Lannen, AOBTA-RI, of Montana and I recently brainstormed her creative game plan to initiate the first fully AOBTA-compliant shiatsu program in Montana under the umbrella of Sacred Roots massage school. I encouraged her to plan ways of setting up future offsite opportunities as a way of introducing shiatsu to Missoula.
Shuddhabha described some of her unusual offsite clinic experiences in the U.K. before she moved to the U.S. In Manchester, Shuddhabha organized a group to give sessions to the unhoused in a nonprofit resource and counseling center, Big Issue North. During the HIV crisis, the group went to St. George’s House HIV charity to help teach mainly refugees from Africa to work on one another. All of which inspires Shuddhabha to craft unusual offsites in Missoula.
Our chat prompted me to review the shiatsu offsite clinics I initiated during my years on AOMA’s faculty. We briefed centers on exactly what to expect: freestyle chair shiatsu in a fun circle, or individual sessions on tables we carried into an integrative medical setting. We also had to give proof of our insurance coverage.
Outreach Is an Art
Colleagues always ask, “How do you initiate such clinics?” Rattle the cages of your contacts in the community as a first line of approach, I advise. I created a series of offsite and volunteer clinics for ABT and acupuncture at a local hospital, as my spouse was a nurse manager there.
My former TA, Charlie Love, MS, LPC, LMFT, who is also a licensed therapist, reached out to colleagues who directed a residential substance-use rehab center, and, in a different part of the city, a haven for survivors of domestic abuse. Both centers welcomed our offsite clinics.
The mother of one of my students lived at a retirement center, so it was easy to organize evenings of chair shiatsu there in a friendly circle in front of a blazing fire. Our introduction to the state school for the blind (to work on the staff) was through our visually challenged student while she completed her ABT and MSAOM training.
Prepping
Prepping is vital when students are dropped in the deep end of unfamiliar sites. Former student clinic supervisor Billy Zachary, LAc, DAOM, says, “I would advise new supervisors to focus on a first day orientation” and to involve staff – to avoid a situation such as at the People’s Community Clinic, for example, where a student told a low-income client to access high-quality grocery stores.
Charlie Love briefed us for the rehab center and the safe haven by cautioning: “Many clients have experienced therapists who don’t even know how to ask about past trauma.” She added, “Some enter treatment after living with instability, including physical abuse, and family abuse. Explain to them what they will experience with shiatsu. Let them know it’s OK to say if anything feels uncomfortable.”
“Many simply disassociate from their bodies,” Love says, reminding everyone, “The objective is to create a safe healing experience. Make eye contact in a welcoming way. Focus on a gentle touch. Patience is important. Practitioners need to be part of the healing, not another disconnected experience.”
Caution?
Students were also urged not to drink or party the night before any clinic in case – as in one unfortunate situation – clients could smell alcohol on a student’s breath.
Former supervisor of a range of student clinics, Claudia Voyles, LAc, DAOM, offers an additional cautionary note: “Students can get triggered by working in a substance use rehab center because of a family member or even their own personal experience.” All of which requires careful and sensitive supervision.
Offsite Clinics at a Hospital
My most comprehensive sequence of offsite clinics involved St. David’s North Austin Medical Center, spanning several years. Initially, I supervised a group of students in chair shiatsu one evening in the cafeteria, where we were on display in an atrium open to several floors; which meant we attracted nursing crews between shifts, surgeons needing a quick tune-up, weary security guards, and even the cleaning crew as they spiraled down the circular stairways. We also worked on patients’ family members, who appreciated care in stressful moments. All it took was 15 minutes of shoulder, upper back, and neck work.
On a different occasion, my colleagues, graduates and I gave volunteer ABT and acupuncture sessions during the hospital’s pain week in that same cafeteria – an invaluable way of sharing our unique approach to pain with the pain management team.
Such experiences made it easy during the COVID crisis for us to set up groups of LAcs and ABTs volunteering AcuDetox, tuina and shiatsu in morning and night sessions in the ICU waiting room. ICU nursing and respiratory therapy crews joined our treatment circles for moments of calm during breaks. Connie Randolph, LAc, MSAOM, also added her tuning forks to the lively mix of techniques, to the fascination of the groups.1
Connie’s extensive offsite and volunteering experience, and mobile AcuDetox five-needle protocol practice, has inspired her to become a trainer for the protocol. Looking ahead, she hopes to be approved to be able to offer CEU classes for nurses, licensed counselors and social workers. She is equally keen to create a mini-training in beads and tuning forks especially for “people in marginalized communities.”2
Isabelle Chen-Angliker, MD (Switzerland), LAc, MSAOM, once volunteered at a Swiss orphanage and at a summer camp for physically and mentally challenged folks of all ages. As an acupuncture student, she said the offsite time at Seton Northwest Hospital’s walk-in $5 clinic in Austin was a “humbling and rewarding experience,” with a wide range of clients including “addicts and construction workers.”
Off-the-Beaten-Path Clinics?
Liz Ross, MSAOM, whose first degree was in theater, used her contacts to initiate acupuncture, tuina, and guasha student offsite clinics at the ASHwell Sexual Health and Wellness3 Community Clinic near the UT Austin campus. “It was immediately popular,” sys Liz. “A great opportunity for students to learn about healthcare needs around the LGBTQ+ community, including documentation offering slots for a chosen name, and pronoun options.”
Also, given the homophobia many of the clients met at other clinics, ASHwell offered a “sex positive, body positive, colorful and inclusive” experience, says Liz, along with a chance for her to develop a future specialization into the side effects of hormone therapy and reproductive health care.
Suzanne Rittenberry, LAc, MSAOM, is currently supervising Texas Health and Science University students in an offsite clinic at the Texas Harm Reduction Alliance4 in downtown Austin. They offer acupuncture and AcuDetox in recliners to both clients and stressed staff.
As a strong believer in offsite clinics, Suzanne says, “Working with an unfamiliar population opens students’ eyes to a different set of problems. It helps them to develop empathy and compassion for folks who are unhoused, trans, and maybe suffering from mental illness or drug addiction. It’s so rewarding when one witnesses a very agitated person relax, and allows their spirit to settle back in their body. My students love this clinic.”
Offsite Into Employment?
As a result of supervising offsite student clinics at the Austin VA, Claudia Voyles, LAc, DAOM, and Billy Zachary, LAc, DAOM, AOBTA-RI, were subsequently hired by the VA as acupuncturists.
Says Dr. Voyles: “Working here is very different from private practice. It’s team-based integrative care involving a diverse population in terms of age, ethnicity and experience.”
When Dr. Voyles supervised the VA offsite clinic, their focus was mainly on pain, and how important it was to teach students “how to bring our medicine into other medical settings.” All students and supervisors had to go through screening and background checks beforehand. Dr. Voyles also mentioned that in order to set up such clinics, “there has to be a formal relationship between the VA and the school.”
On the value of offsite clinics, Dr. Voyles says, “Students who have done offsites are better prepared for working in conventional healthcare systems.”
Notes Shuddhabha Lannen: “Being in an unusual context, you have to be really centered and rely on your skills to deal with what is in front of you.”
Adds Connie Randolph, “Community style clinics are economical and socially empowering and an efficient way of bringing our healing into medically deprived neighborhoods. It’s a win for the school too, to be out in the community.”
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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