Liberation Acupuncture, Part One
When you have a small business -- or in our case a nonprofit that runs like a small business -- it’s all about making good choices. Your time, your energy and your resources are limited and so you need to be thoughtful about how you spend them. Any opportunity to solve several problems at once — any elegant solution — is a lifeline.
Awhile back I mentioned that WCA gets a lot of questions related to, “but why do you do it like that?” Or as one of my coworkers wrote: Sometimes people seem to feel like there’s a better way of running this business than what we’re doing, whether it’s related to how much we charge, how we schedule, or how we decorate the clinics. I often hear people say well why can’t you just see fewer people per hour or why do you let people show up whenever they want to or each room should have its own special decorative theme according to the Five Elements, etc.
That’s what you get from a fan base, right? Lots of opinions.
Many things that are hard for us to explain originate in the same place, though, so I thought it might be useful to just go there. Let’s talk about Liberation Acupuncture.
Back in 2002, we didn’t have a descriptive term for what we were trying to do other than “acupuncture” because we didn’t really need one. I think the first person to use the words “community acupuncture” to describe what we were doing was an acupuncturist from Colorado named Mary Saunders, who reached out to us sometime in 2004. (She opened a community acupuncture clinic herself in Boulder.) That term stuck, no pun intended, and we used it to good effect for another ten years or so.
When we opened our own school, though, “community acupuncture” wasn’t descriptive enough. For one thing, by that time so many acupuncturists were using those words to describe such variable practices that its meaning had become extremely squishy. The bigger issue, though, is that most acupuncturists thought what WCA was doing could be boiled down to a low-cost, high-volume business model, otherwise known as “lots of people + cheap”. Which was a bad thing from their perspective, and also, you can’t base an acupuncture school just on a business model. It needed to be grounded in something more academic.
The very first thing I learned about the economics of healthcare, I learned when I was five years old or maybe younger, when I asked my mother why my father walked with a limp. I don’t think the answer I got was age-appropriate (possibly there is no age-appropriate answer); she told me that when he was a boy he was hit by a car and nobody took him to a doctor, because they didn’t have enough money.
The long version of the story is that my father and his brothers spent portions of their childhood in the 1940s equivalent of foster care because their mother was in and out of mental hospitals and their dad was a deadbeat. There were all kinds of scars from those years, not just his limp. Poverty wasn’t the source of all of them, but it was intertwined with chaos, neglect and abuse that continued to roll down to the next generation. Lots of acupuncturists are not bothered when people can’t afford their care, but not me. I can’t stand it, so here we are.
The idea of Liberation Acupuncture comes from liberation studies, which in turn originate with Liberation Theology. I grew up Catholic at a time when Liberation Theology was a big topic of discussion in the church due to the murders of Archbishop Oscar Romero and U.S. nuns in El Salvador. Liberation studies represent a deep rabbit hole so let’s just summarize the basic idea: you can gain insight into an institution or a system by looking at it from the viewpoint of people who are poor and marginalized. Or, “the cry of the poor rises to the heavens”, according to the Latin American bishops who defined Liberation Theology.
So one way to understand healthcare is to consider it from the perspective of people who can’t afford to get the care they need, or people who are otherwise marginalized and treated badly by the healthcare system. People with chronic pain are a perfect example. Also people who are “high utilizers” of the healthcare system, like the clients of CareOregon’s Regional Care Teams. Atul Gawande wrote the groundbreaking article on high utilizers in 2011, in which he described how the patients who access the most healthcare (particularly through the ER) typically also get the worst healthcare, which tells us a lot about what’s wrong with our healthcare system in general. Liberation Theology would say these insights reflect “a preferential option for the poor”.
Going back to where we started, when you have a small business with limited resources, it’s all about making good choices. Through our relationship with the caseworkers and clients of CareOregon’s Regional Care Teams, WCA learned that the systems we created for the purpose of treating a high volume of people were also effective at including people who were otherwise marginalized and unwelcome in other parts of the healthcare system. Some of the “difficult” patients that other providers didn’t want turned out to be no more difficult than anybody else for WCA, and sometimes our favorite people. So the converse is true as well: the things we do that make it possible to include the caseworkers and clients of the Regional Care Teams in our clinics are the very same things that make us able to treat lots of other people, from all walks of life. When we’re not sure what WCA should do in any given situation, we can figure it out by considering what would work best for the clients of the Regional Care Teams. They’re like a litmus test.
The academic term for that is Liberation Acupuncture.
Our energy is limited so we can’t necessarily spend it on, say, redecorating the clinics to align with Five Element theory. (True story: one of the rooms in our Cully clinic used to have an impressive cascading water feature, and maybe that was beneficial to any patient with a Water Element imbalance? But it went away when the landlord finally fixed the roof.) WCA’s decor won’t make much difference to someone with chronic pain who’s worried about getting evicted.
On the other hand, we offer a lot of flexibility in terms of when people show up for appointments, because we want to include people who depend on (notoriously unreliable) medical transportation services. And we treat a lot of people per hour because some of those people are paying below the sliding scale or not paying at all. Those choices take energy but they’re worth it. It’s not that we don’t like money (more about that in a future post) — it’s just that we value our relationships with people who don’t have much of it.
Liberation Acupuncture is an organizing principle for WCA. It’s an elegant solution. It doesn’t mean that we can include everybody, unfortunately, or that we can provide care for everyone who needs it. But we can try. We believe in a preferential option for the poor and we back that up with any action we can take, within the limits that we have. Practicing Liberation Acupuncture is sometimes inconvenient, but it’s rarely unclear. Everything we do makes sense to us. And we love that.