We are so appreciative of all the e-mail questions we receive as a result of our column. Your interest in public health, access to care, specialty populations and health center integration warms our nonprofit hearts and further inspires us in our work.

To address the many questions we receive, as well as share some of what we have learned through our practice, this month features a Question & Answer Column. To have your question included in a future Q & A, please send e-mail to . Identifying information will not be used, and questions will receive personal response.

Q: I came across your column as a result of searching for information on the treatment of transgendered clients. Your article on this subject appears to be the only holistic publication. How might I consider getting more knowledge and connecting locally to reach out to this population?

A: We applaud your interest in working with this population. Our first article in Acupuncture Today (two parts) on this subject was printed May and June 2003, titled " The Dance of Yin and Yang: Transgender Health." Reviewing these articles will provide a good context for understanding what being transgendered means.

To let your local community know your doors are open to transgendered clients, here are a few suggestions:

• Learn all you can about this community including terminology, culture and the effects of hormonal and surgical interventions. This will prepare you to articulate the benefits acupuncture and herbal medicine might have to offer. A Web site with educational resources is www.gendercrash.com/101.shtml. For health-related information, check out www.trans-health.com
  
  
• Contact your local Gay, Lesbian, Bisexual and Transgendered (GLBT) agency. A statewide directory can be found at www.hrc.org or Google your home state and GLBT (i.e., "Massachusetts and GLBT") for additional sources.
  
  
• Ensure your office is a welcoming place. Make registration/intake forms inclusive. List sex with a blank space, or include male, female, transgender and other.
  
  
• The transgendered population has been historically marginalized in traditional health care settings. Therefore, these folks really are searching for providers who will be sensitive and welcome. Reach out to transgendered support groups and to endocrinologists in your area working with this population. Provide free educational workshops. Have your name added to provider lists.
  
  
• Consider financial policies that will provide access. Employment issues are not uncommon for transgendered individuals due to societal norms, so cost might be prohibitive.

Once you are engaging in treatment relationships, your patients will be your greatest teachers. Ask individuals how they would like to be called, which pronoun to use, and if any body areas might be sensitive. Show transgendered patients the same respect and compassion you demonstrate with others, and you might find new opportunities for healing will flourish.

Q: I'm just finishing up my last year of school and am very confused about whether to set up my office as a private practice or a community room. As you provide both in your practice, how do you think I should start out?

A: Congratulations! You are exactly where you should be - in very good company with hundreds of other soon-to-be-graduates in the same quandary. We know the uncertainty can feel really uncomfortable, but the payoff often results in growth and development as practitioners and as business people.  

Why the need to pick only one practice style or business model? Many successful practitioners embrace the start of their practice as an opportunity to sample various opportunities, styles, office arrangements and collaborations to experientially discover where their vocation wants to take them. It's a chance to discern what resonates with you most passionately, where your skills are best matched, if a specialty develops and with which patient populations or colleagues you most enjoy working.  

Loving what you do is one of the most profound practice builders, and taking the time early in practice to dive into new relationships and sample models is well worth it.

Q: I would love to get involved in some of the international acupuncture projects you have featured in your articles. I'm having a hard time figuring out what my first step should be.

A: Most programs are actively seeking volunteers willing to fund their own travel to provide care in these settings. So, the first step would be for you to figure out if it's feasible to take the necessary time off, whether you can take this time unpaid, and if you can afford the expenses (which could make a beneficial tax write off)? If the answer is "yes," you are probably over the biggest hurdle.

Next, we'd recommend you update your resume and write a cover letter. Your resume should have a major focus on your clinical experience. Include assistantships, internships, volunteer acupuncture experience, your style of practice, continuing education and your current practice info. If you don't have a current practice or are a student ready to be licensed, don't shy away. This will be a great opportunity to hone your skills, treat a high volume of people in need and douse yourself in inspiration!

Check out the program Web sites for information on how to become involved. Send a letter of inquiry or e-mail with your resume. Many of these programs are one-person operations, so be patient waiting for a reply.

Once you receive your confirmation, ensure you have a valid passport and check to see if you'll need a work visa. Allow several months to get these in place. While you wait, read what you can about the culture of the area to where you'll be travelling, appropriate dress and likely symptoms you might encounter. Learn some of the language, if possible, even if only greetings or other salutations. Consider whether health precautions such as vaccinations or preventives against malaria are a factor. Doing your homework here will allow you to better prepare for the journey and international experience.

If possible, communicate with other acupuncturists who have already been involved in the programs in which you're interested. Find out whether certain styles of practice will be more or less useful. Assess your tolerance for busy clinical schedules and settings, as well as how well you function with minimal amenities and comforts.

Some of the sites you can check include:

• PanAfrican Acupuncture Project (www.panafricanacupuncture.org)
• Guatemalan Medical Acupuncture Project (www.GUAMAP.org)
• Acupuncturists Without Borders (www.acuwithoutborders.org)
• Acupuncture Institute at Ananda Nagar (www.acuindia.org)

Even if you aren't able to immediately travel and volunteer at any of these programs, it's important to build your understanding of these international efforts. You can demonstrate your support through making donations of monetary funding or supplies, as well as helping to promote a cultural of international healing and understanding.

We are inviting acupuncturists to join us at the International AIDS Conference in Mexico City, Aug. 3-8, to provide treatment in the Traditional Healing Zone we have been asked to coordinate. This zone is part of the Global Village and provides a peaceful respite to participants and community members to receive free, chair-style community acupuncture, as well as to experience a variety of other forms of indigenous health opportunities. The Global Village promotes cultural and artistic interchange between people from all the countries. If interested, contact .

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

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