PanAfrican Acupuncture Project

Posted on Dec 2, 2012

HIV/AIDS has depleted the Uganda’s labor force, reduced agricultural output and food security and weakened educational and health services. The incredible number of AIDS related deaths amongst young adults has left behind over a million orphaned children. Women represent 59% of those infected with HIV/AIDS in Uganda. Malaria is the leading cause of morbidity and mortality in Uganda and is responsible for 40% of outpatient visits, 25% of hospital admissions and 14% of hospital deaths.

The PanAfrican Acupuncture Project (PAAP), based in Boston, MA, USA, trains healthcare workers in Africa to use simple and effective acupuncture techniques to treat the devastating and debilitating symptoms associated with HIV/AIDS, malaria, and TB. In existence since 2003, PAAP has provided trainings in 2 Kenyan and 13 Ugandan districts with over 200 trainees who are local doctors, midwives, nurse-midwives, nurses, physiotherapists and traditional healers. PAAP has provided 20,000 treatments during the trainings alone. Thousands of additional treatments have been done as local personnel return to their clinics to continue their practice.

The interview below profiles the work of the PanAfrican Acupuncture Project, which utilizes professional volunteer acupuncturists who work to train local health care providers in basic acupuncture protocols, directed at the debilitating symptoms associated with HIV/AIDS, malaria and TB. This is in addition to providing direct patient care.


The interview below is with PAAP’s Executive Director – Mr. Richard Mandell, L.Ac. and CIC’s Program Coordinator, Terry Courtney, L. Ac.


CIC: The Ugandan HIV/AIDS statistics described in the introduction are devastating. With 1 million children orphaned, and the adult population profoundly depleted, is this one of the main reasons that PAAP focused its training efforts on Uganda or are there additional reasons?


RSM: From my experience in Boston co-creating and working at The AIDS Care Project (now Pathways to Wellness), I already knew of the significant benefits HIV+ individuals received from acupuncture. When it became clear to me that I needed to do something to help address the epidemic on the African continent, I developed the basic idea of PAAP and began emailing those already involved with HIV/AIDS work across Africa. I received many responses, most of which were very positive and encouraging. Then one day I heard from Dr. Margaret Mugwana in Uganda, who stated that she would be our contact person there. I wrote back to her, providing more information, and two weeks later she sent an email stating that she had put together a team to operationalize the project. Soon thereafter, Beth Sommers (Boston area acupuncturist) and I traveled there to meet the team and work out the details. Uganda was the perfect place to begin PAAP. As you stated, the numbers there were terrible, and people from the Ugandan president down to grassroots organizations were doing what they could to stem the spread of HIV. PAAP fit into this wide net of intervention, which in itself was very holistic by nature.


CIC: At its worst point, the Ugandan HIV positive rate was almost 30%. It is currently estimated at 5.4%. Since Uganda has been recognized for its comprehensive and timely HIV/AIDS campaign, how would you summarize the public health initiatives that were taken to decrease the rate of infection?


RSM: As I mentioned, Uganda was very committed to doing everything possible to survive the epidemic. There was a very broad view of which interventions would make a difference. This included making HIV testing more accessible, free condoms, educational programs, dissemination of basic foods, individual and group counseling, as well as singing and dancing. At the heart of this broad initiative was the desire to eradicate the stigma associated with HIV/AIDS. It also included, perhaps a bit later, adopting the ABC approach (Abstinence, Be faithful, use a Condom).


CIC: What has been the receptivity to PAAP’s work by the local indigenous healers?


RSM: We had the privilege of training a group of 23 traditional practitioners through an organization called THETA . Some conventional medical providers were skeptical that these traditional healers would be capable of learning and practicing acupuncture, but they proved otherwise. Although some of these trainees had little formal education and limited written language skills, they worked extremely hard to learn the material. In a way, these practitioners understood acupuncture at a level the western practitioners we’ve trained did not. They had an intuitive sense of Qi and the manipulation of Qi. So, needless to say, they have been extremely receptive and very committed to acupuncture.


CIC: After viewing the PAAP video on your website, it was interesting to note that acupuncture is truly a new and unique form of healing for the Ugandan people. Given your understanding of Ugandan indigenous healing practices, do you see connections between Chinese medicine and local practices?


RSM: I think the connection is related to a visceral sense of energy and healing, an overall respect of the healing capabilities of the human body supported by both Ugandan healing practices and Chinese medicine. Observing health and illness and formulating views of the body that reflect these observations are the foundation of both medicines.


CIC: Given that PAAP’s clinical training program works with patients struggling with malaria, dengue fever, elephantiasis and TB, what options do you have for connecting these patients with western medical care?


RSM: A great question. When we are in Uganda to conduct trainings, word gets out, and hundreds of individuals come for acupuncture. Frequently, people will not travel to a clinic or health center when the rumor is that there is no pharmaceutical medicine available. However, acupuncture is seen as a viable treatment option and people travel from miles away. During the trainings, we are very clear about what acupuncture can treat and when conventional medical interventions are necessary. Because of the popularity of acupuncture, it serves as a gateway to all types of interventions. Since our trainees are all medical providers (e.g., nurses, midwives, and nursing assistants) working in medical facilities, they understand the referral process. Our trainees refer many patients before, during and after trainings. Thus, acupuncture is provided concurrently with western treatments, but never solely if allopathic treatments (such as antibiotics, antimalarials, or antiretrovirals) are needed.


CIC: Of all the thousands of patients you have met over the years, is there a particular case that stands out?


RSM: There really are so many cases. And, the remarkable thing is that we have witnessed quick and dramatic changes in so many people—far more than one ever observes here in the States. A woman who hadn’t spoken in years began to speak and laugh during her course of treatment. We have seen hugely enlarged spleens (splenomegaly) from malaria shrinking and patients becoming pain free. I also recall a young man suffering from seizures reporting that the seizures stopped after his treatments. There are so many.


CIC: What steps do PAAP volunteers take to stay healthy while on location, particularly in relation to malaria, dengue fever, elephantiasis, and TB?


RSM: We have a local coordinator, a mother of six, who takes very good care of us. We stay in clean, safe hotels, sleep under treated mosquito nets, drink bottled water, and eat healthy food. Given that acupuncturists have a very wide range of philosophies and practices when it comes to allopathic medicine and prevention strategies, PAAP’s approach is to provide information and let individuals do what makes them comfortable. Some readily take western prophylactics, while others use herbs or homeopathic remedies. I believe we have a very good record of helping our volunteers stay healthy.


CIC: What does PAAP look for in a volunteer application that will help the applicant to be successful as a trainer? Are there particular personal and professional skill sets or attributes that makes one successful to work in Uganda or Kenya? What is the time commitment you ask for?


RSM: We look for individuals who are compassionate and receptive, who are open to learning as well as teaching, who are good listeners. There are certainly cultural differences, some subtle, and some not so subtle. One needs to be accepting and supportive. Although being an experienced practitioner is certainly an asset, it is not a guarantee that this in itself makes for the most successful trainer. For some, there is a moment of tension when first confronted with the simplified nature of what we teach. For most practitioners, this ultimately gets transformed into respect and awe for the power of acupuncture, even when applied very simply. But one must be open to seeing this. So, flexibility is probably the most important attribute.


CIC: How do you prepare volunteer acupuncturists for the cultural immersion and culture shock aspect of working overseas?


RSM: We provide volunteers with written material and the opportunity for voice and email conversations prior to leaving for Uganda. Once there, we meet as a group to provide further orientation. Although cultural norms and behaviors are different, we work in somewhat more urbanized areas, which helps with the cultural adjustment. We do not work in the more rural, isolated villages that would demand significant adaptation and acceptance.


CIC: Given that the PAAP volunteers need to be able to pay for the round trip air fare to the host country plus $3,000 to cover other expenses, what are some of the various ways that volunteer practitioners have done successful fundraising?


RSM: I introduce the need for volunteers to do fundraising by describing this aspect of their volunteerism as taking on the role of being temporary fundraisers for PAAP. This takes it out of the realm of asking for donations for purely personal use and instead focuses the fundraising efforts on teaching and empowering local practitioners to be able to reduce pain and suffering and improve quality of life. Using keywords such as Africa, HIV/AIDS, malaria, TB, and acupuncture usually elicit compassionate giving. Volunteers have provided free treatments in exchange for donations, set up benefit concerts, and used Facebook. However, the bulk of the donations come from the use of direct asking, letter writing, and email.


CIC: How are the PAAP acupuncturists working in Uganda and Kenya able to legally practice in these countries?


RSM: PAAP always coordinates with the Minister of Health in the country in which we work, and so permission is granted through them. In Uganda, there are no acupuncture regulations. One must also remember that PAAP acupuncturists primarily volunteer as teachers, not practitioners.


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


RSM: We have had a number of student volunteers from the New England School of Acupuncture in Boston, MA and the Pacific Rim College in Victoria, British Columbia. It is an opportunity to share what they have already learned as well as see acupuncture make a huge difference in people’s lives. I frequently say that in Uganda, one sees acupuncture at its best—relying on the power and simplicity of this medicine to promote dramatic, positive change. For students, it is an opportunity to learn how to be better observers and listeners, to practice openness and acceptance, selflessness and compassion. So, my advice is to join us for an experience that will enrich themselves as aspiring practitioners and gain an even greater respect for acupuncture.


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


RSM: In Uganda, developing ongoing collaborative relationships with other relief organizations has been a challenge. I believe this is due to many issues, including turf wars and ignorance. But we have had the opportunity to interface with the United Nations High Commissioner for Refugees (UNHCR) in two ways. A few years ago, a number of PAAP trainers traveled to the Nakivale Refugee Camp in southwest Uganda, where they provided treatments. In fact, they were overwhelmed by people wanting treatments. More importantly, we have trained a number of health providers who work at Nakivale to now provide acupuncture. This has been a very successful way to bring acupuncture to a large group of people who have significant medical issues, including HIV/AIDS, malaria, TB, and PTSD. Although this is a great achievement for PAAP, working with the UNHCR has been very difficult, and we have come up against a great deal of resistance. However, we continue to work to address this and expand within this area.


CIC: What makes PAAP unique as an organization?


RSM: The most important aspect of our work is that we provide training to the local practitioners, thereby supporting the possibility of fully integrating acupuncture into the local health-care system. Our focus is to make acupuncture theirs as opposed to importing westerner practitioners to provide short-term, time-limited treatments. We have always wanted to avoid the pitfalls that so many NGOs (non-governmental organizations) have fallen into, when they have created paternalistic relationships and nonproductive dependencies that do not promote long-term growth and self-sufficiency. I think PAAP contributes to empowerment and independence. Acupuncture itself breaks down boundaries and creates deep connections and community. When the locals treat one another, their own communities benefit.


Update: This past October, 2012 Richard Mandell was the recipient of the New England School of Acupuncture’s Alumni Community Advocacy Award. This award honors NESA alumni who have made an outstanding contribution to public health and advocacy for acupuncture and whose accomplishments have impacted access to acupuncture care.