Mindful Medicine Worldwide

Posted on Jul 4, 2012

Mindful Medicine Worldwide (MMW), based in Chicago, IL, USA, seeks to bring long-term integrative health care to people of developing areas, domestically and internationally, by establishing and operating integrative health care clinics. In existence since 2008, MMW is currently providing care in Kathmandu, Nepal utilizing volunteer practitioners from various countries who provide Chinese medicine and health care education.


The interview below profiles the work of Mindful Medicine Worldwide (MMW), which seeks to bring long-term integrative health care to people of developing areas, domestically and internationally, by establishing and operating integrative health care clinics. Their professional volunteer practitioners provide medical services and healthcare education to their patients as well as create sustainable health practices by educating local lay people to be integrative health workers within their communities. Mindful Medicine Worldwide is rooted in a practice of mindfulness, education, research and training.   


The interview is with MMW’s Executive Director – Ms. Grainne McKeown, L.Ac., and CIC’s Program Coordinator, Terry Courtney, L.Ac.


CIC: Mindful Medicine Worldwide’s mission statement is to bring “… sustainable integrative health to developing regions.” What does integrative health look like in a developing region?


MMW:  The goal of our organization is to find clinical opportunities that allow Chinese medicine to work alongside various other medical modalitites in order to provide patients with the best care possible.  There are some conditions that need co-management with Western medicine, and some conditions that really do better with one modality or the other initially taking the lead. Our goal is to bring a variety of providers to Nepal including chiropractors, massage therapists, homeopaths and naturopaths.  We are also looking for future clinical opportunities for physician assistants and midwives.


CIC:  What has been the receptivity of the local Kathmandu medical community to MMW’s work?


MMW: Like anywhere else, some doctors are open to acupuncture as a genuine form of healing and some are not. In general, receptivity has been good because they see patients benefitting. When working in an underserved area, you don’t have the luxury to be “picky” about whom, how and where help is coming from. A case in point is a 7-year-old girl who had a kidney infection.  She was resistant to both oral and IV antibiotics so the local doctors were out of options. Fortunately despite the severity of the infection she responded to the acupuncture and herbs and the infection was resolved.


CIC: Is that case typical to what is encountered or what is other commonly found types of medical cases that are treated in the Nepal clinics?


MMW: Common conditions include typhoid, malaria, TB, tumors and cancers. Patients may or may not get western medical diagnoses fairly readily, so we often assist with referring them for further diagnosis. The illnesses we do more commonly treat with TCM is stroke, gynecology, asthma, gastritis, numbness, and pain.Treatment options are very limited. Either people don’t have the money for treatment or the type of care needed is simply not available. There is also wide spread immunity to antibiotics which is due to lack of education about the correct way to take them combined with frequent lack of access to the correct type of antibiotic.  It is really important that practitioners know their western medicine because this knowledge and clinical application will greatly enhance patient care and even save lives.


CIC: How did you identify the particular areas within the Kathmandu area of Nepal to establish clinics?


MMW: My personal path with Buddhism led me to Kathmandu where I lived and studied.   While I was there, I developed a number of contacts and this helped to identify the local areas in need of health care. Early on I began to work at the Sechen clinic and initially I thought I would start a Mindful Medicine Worldwide clinic, which would offer care at one site.  Over time it became apparent that it would be more efficient and a better use of resources to work with established medical clinics where there was already an identified need and connections with local residents were in place. Often times a physical clinic building would be available with plenty of patients, but due to loss of funding, no doctors or supplies were on site. Some clinic sites had been in existence for many years with no services but local residents would still show up regularly to see if a doctor had arrived.

MMW has over the last three years established acupuncture in various clinics around the Kathmandu valley. Despite this number of clinics, we still have people asking us to come to their village to provide care because many people travel for several hours to get to our clinics.


CIC: With more than 90 languages spoken in Nepal, how do you handle the translation needs of patients?


MMW: Our translators know several different languages because this is simply what is needed for daily life in Nepal. For example, in addition to English, one of our translators knows several dialects of Tibetan, Nepalese, Hindi, and the neighborhood-spoken languages of Tamang and Newari.

Language needs can be significant. Even if a translator is not totally fluent, knowing some portion of a particular language in combination with the observational diagnosis of Chinese medicine allows for good care to happen. So, you might get an abbreviated translation of a medical problem, but along with pulse, tongue, and palpating the patient, the treatment plan comes together.


CIC: How do the national politics of Nepal affect your organization’s ability to function?


MMW:  Nepal has been without a constitution for the past 4 years, which has made conditions even more difficult than they already are. I hope the elections in November 2012 bring about the necessary changes to allow a constitution to move forward. Daily living conditions are difficult. Most Nepalese don’t have regular daily access to electricity and water which not only makes it difficult to take care of personal needs, it also affects the ability to deliver health care to the people who need it the most. If Nepal’s living conditions can improve, this will be a huge benefit and reduce the amount of stress and illness.  It would be great to have daily life improve to the point where our services are not needed.


CIC: How do you prepare acupuncturists who are volunteers for the cultural immersion and culture shock aspect of working overseas– especially when they may be coming from countries as varied as Israel, Singapore, Colombia and the US?


MMW: One of our organizational strengths is having volunteers from around the world.  In some ways it is easier to have volunteers from outside the US as they may be more used to seeing and experiencing poverty, especially in rural areas.  We have volunteers participate in cultural sensitivity training sessions through Skype since this reduces the costs associated with in-person training. We also do training sessions with groups of volunteers and use role-playing, which has worked really well. Often times volunteers themselves may be multi-lingual and they share how they work with interpreters and a patient at the same time. It is great to have volunteers learning from each other.  In addition, we are also able to provide CEUs for trainings we offer at various acupuncture schools for how to approach treatment in developing areas of the world.


CIC: MMW asks for a 2-5 month commitment from practitioners who volunteer. How are acupuncturists able to take this time from their practices to be in Nepal?


MMW: We have 3 different groups of practitioners who volunteer with us. The first group is primarily new graduates who have not yet started a private clinic.  This is a great experience for them as it provides lots of clinical exposure to a wide variety of conditions, which really helps build confidence. With this experience, they do great when they return to their home countries to start practices, and at the same time they have the flexibility to stay for a long period in Nepal. This makes their treatments very good as they really get to know the patients, gain their trust, and become a source of steadfast care in the community. The second group are people in in mid-life who have been in practice for a decade or so.  They tend to come for the minimum time of 2 months.  This group reports really favorable patient response to their international work and they are usually even busier upon their return. The third group is senior practitioners who are ready to give back.  They may come and teach.  Bob Flaws and Honora Wolfe are good examples of this.

One of MMW’s objectives is to train local people to become Chinese medicine practitioners so we make sure that senior practitioners are able to work and teach with this group as well. There are no schools of Chinese medicine in Nepal at this time, so we provide mentorship style training.


CIC:  How are the MMW acupuncturists working in Nepal able to legally practice in the country?  


MMW: The Nepal government provides permits for people to practice acupuncture as long as you are associated with an organization that has a government license to operate in the country. The acupuncturist also has to be licensed in their home country.  So, people who want to trek in Nepal and then show up on their own to provide acupuncture to local residents are not allowed to do so, as one has to have an organizational affiliation.


CIC: What would you advise an acupuncture student who is interested in working internationally in underserved areas? 


MMW: As a first step, the Mindful Medicine Worldwide website has a recommended reading list. This list of materials plus anything about treating patients in developing countries will help with orientation to this work.  Sometimes we set up long distance internships where students can help myself and our team of interns with the management of the website, various blogs, developing fundraising letters, etc.  This gives them beginning administrative and organizational experience with MMW, which will also help them with future work should they decide to do a service trip with MMW. We have begun a pilot program of having students go and serve at our clinics as assistants, so with further development on our end, this may be another option.


CIC: How does MMW work with other international relief organizations?   How do you network as an organization?


MMW: Networking is casual but very effective. I have a many friends who work in a local Nepal non-profit and also know many people in the Buddhist community.  Half the population in Nepal is Tibetan and the Tibetan Buddhist community has foreign NGOs already set up.  Therefore, connections can get made fairly easily and opportunities get identified. For example, the Sechan clinic has a foundation, which provides the fundraising necessary to help pay for the day to day needs of the clinic including management and Western medical supplies, rent, etc. We have also worked with a small US based non-profit called The Himalayan Medical Foundation and through this connection we are able to use a small clinic at one of our nunneries that was set up by this Foundation and are looking at other collaborations with them. This opportunity for MMW came about over coffee one day with a Doctor who treated Tulku Urgyen Rinpoche in his last weeks of life.  So, networking is truly casual but with focused intention great things can happen.


CIC:  What do you tell volunteers about how to take care of their own health while on location?


MMW: With this type of travel and work, people typically get sick with food born illnesses.  We educate our volunteers about various prevention strategies that will help them.  This includes assuming that all patients have TB and having volunteers wear masks as prevention. We stress the importance of extra sleep, utilization of a daily meditation practice, resting, not travelling on weekends and as few extracurricular activities as possible. It probably helps our volunteers that Kathmandu’s electricity shuts down each night at 9:00 pm! We encourage volunteers to travel and do trekking after their clinic rotation with us has been completed.


CIC:  What makes Mindful Medicine Worldwide unique as an organization? 


MMW: Our organization incorporates meditation and other mindfulness practices into our healing work.  Some type of mindfulness practice is a very important way for practitioners to be grounded in their work and reduce daily stress.  So, we require that volunteers do some type of meditation retreat prior to starting their service.  This really helps reduce the stress of working in a fast paced environment with many people needing medical services. It is a great way for practitioners to stay fresh and focused. MMW is happy to help get people started with meditation practices.  Our website lists beginning resources for people to use.  Mindfulness practice can also include yoga or developing a Qi Gong practice.

The second thing that makes us unique is that we see our work as about creating sustainability by helping local people become trained in Chinese medicine. Our goal is to have local people trained in order to ultimately take over the clinical care of their neighbors.  We also strive to have a full time presence on location, as we believe that consistency of care is incredibly important for improving patient outcomes. With this goal in mind, we were able to staff a clinic every day in 2011.

The last area that makes us unique as an organization is that we don’t want our volunteer practitioners to have to pay a lot of money to come provide care and we didn’t want to have to charge a lot of money, either. We wanted the MMW volunteers to have an experience that was as easy and as low of a barrier as possible.  So, we ask volunteers to raise the money for their plane tickets and for a donation to MMW of $750.  We help with fundraising support and strategies.  One volunteer did her fundraising by asking for a modest donation of $25 and she would send the donor a hand made postcard from Nepal.  That simple strategy was wildly successful for her.


CIC:  Anything else you would like to add?


MMW: I would like to share a case study that really highlights the work of our volunteers and the difference they make on a daily basis.  I had the opportunity to treat a 50 yr old male stroke patient who came in to the clinic walking on his own.  When I reviewed the treatment notes I saw that he had started acupuncture 7 months before after arriving in a wheelchair.  Then I saw that after the next volunteer took over, it was noted that the patient arrived at the clinic walking with assistance.  Then, after that volunteer rotation was completed, I saw that the next volunteer noted that this patient was now walking by himself with a cane.  Then, the next volunteer noted that he was now walking independently. This is such a beautiful tapestry of skills being woven together by various volunteers all of which is leading to an incredible patient outcome.  If this man had remained wheelchair bound he would not have been able to work and support his family.  This care is not only life changing for the patient, but it also becomes life changing for the practitioners. We welcome volunteers who are ready for life changing work!