This article is the first in a series of interviews covering the practice of acupuncture internationally. We welcome input from readers who have experience or knowledge of global projects to contact us.

Ananda Nagar, located in northern India near the border of West Bengal and Bihar, is the site of an acupuncture clinic and school that welcomes international volunteers. Although it is situated in a poor rural area, the rolling hills, rivers and small villages are home to a vital acupuncture community founded by a Hindu spiritual group dedicated to outreach and service. [Editor's note: see "Acupuncture in Ananda Nagar: A Place That Has Captured My Heart" in the February issue, or online at www.acupuncturetoday.com/archives2003/feb/02martley.html.]

Alison Quiring, a Boston-based acupuncturist, spent five weeks working at the clinic and shared her expertise using Japanese-based clinical techniques. She learned about the community and one of its organizers, Charles Fallick, through their Web site, www.acuindia.org.

The acupuncture clinic and school are approximately 11 years old and are part of a large health care facility that includes a Western hospital, veterinary clinic and school; medical training for India's version of "barefoot doctors" is also provided. All services are available for children and adults. Ananda Nagar even has an emergency rescue team that mobilizes during natural disasters to offer care and supportive treatment. The acupuncture school offers a three-year curriculum, and a nearby school offers training in homeopathy.

Economic support comes from international donations of funding and supplies. Services at the acupuncture clinic are available at no cost to the patients. Currently, three acupuncturists are based at the clinic; their numbers are supplemented by volunteers who come to Ananda Nagar for up to two months. Most of the clinical staff speak at least some English.

Clinical sessions are held every morning and extend into the afternoon until all patients are treated. Intakes of new patients usually take around 10 minutes, and treatments last about one hour. Because some patients have to walk for hours or take the train from great distances, clinicians endeavor to treat everyone who arrives at the door. Although between 20 and 30 patients are seen on an average day, there are days when over 100 patients arrive at the clinic for treatment and medical advice.

Alison described the clinic setting as follows: "People wait outside the clinic on benches or the 'porch,' some sitting on the ground or along the garden wall outside the clinic. Treatments are provided in two rooms of the clinic; women are usually treated in the smaller room, which has three beds, and men are treated in the larger room, which holds six beds. These beds are wooden cots with thin mattresses on them. A few curtains provide privacy during treatment."

A clinician conducts intakes with student assistants; this process takes between 10 to 20 minutes. The acupuncturist then writes the treatment on a piece of paper and gives this to the students who do the needling, under the supervision of the acupuncturist. TCM treatments are commonly administered, although Alison was able to teach some Japanese and Five Element theory and practice.

Although acupuncturists encounter many of the same disorders that we treat in the U.S., such as musculoskeletal problems, headaches, digestive problems and menstrual irregularities, patients in India also have conditions such as leprosy, malnutrition and malaria; children are often diagnosed with problems related to failure to thrive.

Acupuncture treatment was helpful in treating people with leprosy, who often had wasting of the limbs or missing fingers or toes. Alison described the favorable effects patients experienced with treatment, including reduced pain and numbness. For children failing to thrive due to cerebral palsy or other neurological conditions, acupuncturists provided treatment and physical therapy, along with education about helpful exercises. In a situation where there are so few resources, parents are desperate for help in dealing with their children's health.

The acupuncture clinic and Western hospital enjoy an amicable and collegial relationship, often referring to each other's services. Acupuncturists frequently perform valuable triage by identifying incipient illnesses such as tuberculosis and other infectious diseases. Early detection and intervention can sometimes mean the difference between severe morbidity or a timely cure.

While working at the clinic, Alison had the experience of actively collaborating with a gynecologist in her busy practice. This rich partnership offered the valuable experience of being part of a team that shared information and resources, and an opportunity to contribute to improved quality of life for hundreds of people.

Alison stated that she "volunteered for the experience at Ananda Nagar because I was interested in how Chinese medicine can be integrated into the care of people who have almost no access to other care. Acupuncture is an inexpensive, effective option for people with few other options."

The differences between "alternative" and conventional medicine are blurred in many international settings. Physicians trained in allopathic medicine often use both approaches in their work, offering treatment or referrals as appropriate. Thus, barriers to care can be eroded by the elimination of boundaries or designations that are sometimes meaningless or irrelevant.

Alison also appreciated the opportunity to work in a situation with people who had a different belief system regarding health and the body. Cultural differences play a major role in people's attitudes toward self-help and valuing health care traditions that are based in human relationships, not technological intervention. At Ananda Nagar, for instance, patients receive health care that is comprehensive, often consisting of advice on ayurvedic principles of health and nutrition, vitamin B12 injections or available Western pharmaceuticals. Using acupuncture to provide relief for conditions such as arthritis, bronchial or pulmonary disorders and pain is an important element of the full-service concept. The camaraderie that exists between physicians and healers benefits patients and the community as a whole.

This seems to be the essence of public health, whether in the context of the local or the global service arena. Overcoming differences to arrive at excellent care that includes prevention is a goal that is worth striving for, wherever and whatever type of medicine we practice.

Click here for previous articles by Elizabeth Sommers, PhD, MPH, LAc.

Click here for more information about Kristen E. Porter, PhD, MS, MAc, LAc.