The #getSHARP Ear Seed Project: Implementing TCM for resiliency

1. Identified Domain: Community: Black, Brown, and Indigenous People of Color (BIPOC)

2. Problem Identification

Acupuncture and Traditional Chinese Medicine (ACM) is an under-recognized and underutilized medical resource in African American social resiliency groups and recovery efforts. There's an increase in the use of mind-body techniques in the African American community as there is a greater understanding of the need for stress management, including yoga, meditation, and Tai Qi. These therapies are being offered individually and concurrently in a variety of healing settings. However, ACM is not a sought after resource; despite the evidence of ACM's ability to help the body deal with the effects of chronic stress. Acupuncture has been documented to be effective for conditions like anxiety, depression, trauma, anger management, cardiovascular health, reproductive health, metabolic disorders, and more.

3. Culture-Specific Application

•    What role has 'racial socialization' played in the non-use of ACM.

African Americans have a history of neither complaining about nor investing in their health. Precedence for this behavior can be observed in the way slaves were often accused of malingering when ill and the expectation that one would quite literally work till they died. In the modern era, descendants of slaves expect themselves to be able to tough it out through anything simply because their ancestors survived everything with "no help." (3, 10, 11)

Iatrophobia, an abnormal or irrational fear of doctors, is a known attribute of African American communities. Racially based medical discrimination and a history of medical atrocities performed on black and brown bodies have fueled mistrust of doctors. Acupuncture suffers heavily from this bias in the African American community, being a "foreign" medicine involving multiple needles. One example of the African American community attempting to deal with iatrophobia can be found in the Free Panther Clinics of the 70s. Lay people learned to perform simple medical diagnostic procedures like monitor glucose levels, sickle cell testing, blood pressure, and others. (2, 8, 11)

There is also the idea that self-care is for other people, specifically white people or the affluent. Participating in such otherness is enough to be labeled as "acting white." The perception of ACM is that it is a foreign medicine that is predominantly utilized by wealthy white people in the US. Acupuncture can be cost-prohibitive with the average appointment cost around $100 out of pocket. There is also a stigma around the use of community acupuncture clinics as being "not as good" because of the open style, limited services, and significantly lower price typically $15-$60 sliding scale. The sliding scale conjures up justifiable fears of social programs with an overabundance of paperwork needed to verify a person's identity and actual need, even though neither is the case. (3, 10)

•    What role has "Serial Forced Displacement" played in this situation? 

One effect of serial forced displacement on the use of ACM means that there has been a lack of community cohesion and passing down of positive experiences amongst African American groups. If ACM had been introduced into a stable community, there would be a safe, trusted voice from the "village" to verify its efficacy. However, there is no "Ms. Susan and Mr. Joe" going to their Tuesday acupuncture treatment, receiving benefit, conveying this positive information to the community, and encouraging others to do the same. (5)

Instead, serial forced displacement ensures that there is a disruption to the extended and immediate family units usually due to imposed distance (gentrification) or incarceration. If the groups of communities that mobilized the free Black Panther medical clinics had been able to stay cohesive, then more positive medical outcomes could have become the norm.  A bit of lost history that is slowly being illuminated is the involvement of the Black Panthers and Dr. Mutulu Shakur and Dr. Tolbert Smalls with using acupuncture in the 1970s. I hope the illumination of this information will have the effects of making African Americans more comfortable with the role of ACM being a safe, reliable, natural source for primary care. (11, 4)

•    How might enlisting the "village" in the ways below help put pressure on the "groups?"

According to the work of Dr. Joy DeGruy, the ability to effectively activate the community, or "village," and build up interpersonal relationships is the key to healing the trauma found in the African American community. This is in part because the highest value in the African American community is placed on the interpersonal relationships according to "The Philosophical Aspects of Cultural Difference." If so, then multiple members of the village having a tool at hand to be able to help mitigate the effects of toxic stress would help to strengthen those interpersonal bonds. If the village is armed with a treatment tool that can effectively and painlessly assist anyone in the community, it should be a well sought after resource. This arming of the village mirrors the goals of the Free Panther Clinics of the 60s and 70s. (8, 12, 14)

One of the main components of the work done with the Free Black Panther Clinics is that they were staffed by local community volunteers, "the village." These clinics put medicine in the hands of the local people, leaving the village safe from re-injury from white individuals providing medical care. This solution deals with both the appropriate fear of western medical providers and the lack of access to regular quality care. (8, 11)

Unfortunately, ACM is not a quick, easy skill to learn, and there are many barriers to being able to practice (minimum of an MS to practice, cost of licensure, opening a business, etc.) However, there are components of Chinese medicine that can be learned quickly and easily, used safely, and puts the tools of the medicine in the hands of the village independent of an acupuncturist. One example of effective integration of self-administered acupuncture techniques includes tapping. The downside of tapping is that it is predominantly active when you're performing the tapping; a session can take upwards of 15 minutes to complete. (9)

A different example of evidence-based ACM tools is acupressure with ear seeds. Ear seeds have been proven effective in several applications, including increasing parasympathetic activation, easing anxiety, and helping to manage stress and pain. ACM treatments like ear seeds combined with other mind-body modalities bring about a profound healing effect. A few advantages to using ears seeds include; supplies can be purchased online, it's easy to learn, it's safe to perform in any setting, and the effects continue for as long as the ear seed is in place. (1,6,13)

If there were programs that taught the layperson how to use tools like ear seeds safely and competently, it wouldn't require the expense associated with hiring an acupuncturist, and it wouldn't trigger iatrophobia. More importantly, it means that anyone in the village who had taken the class could administer the treatment. Parents, aunts, uncles, preachers, nurses, police officers, teachers, yoga instructors, therapists, counselors, trainers, teens, and older children would be able to administer treatment in real-time whenever needed. Such therapies could and should become a cornerstone in resiliency and recovery session that actively use other mind-body techniques or as a part of daily life maintenance.

I have worked with other acupuncturist and modified the "Ear Seeds for Peace Project" to be applicable to the African American community. My program is called the #getSHARP initiative (SHARP= Self Help Acupuncture Resource Project) and is taught as a 4-hour class. #getSHARP class participants will learn how to; accurately identify auricular anatomy, the neuroscience behind the treatment, sanitation, how to find auricular acupuncture points, protocols that are treatment specific, how to utilize ear seeds, where to purchase materials to be able to continue to use this method, and provides a certificate of completion after demonstrating mastery of the technique.

Education will be a crucial component. The general public is naïve to the uses and benefits of ACM as an option for primary care and much less for trauma care and resiliency building. Educating and empowering the public at large with the #getSHARP methods is critical. A thorough understanding of the benefits of this medicine will allow the gatekeepers of the community to disseminate the information with confidence.

4. Action or Intervention

•    Utilize public social media with the tag line #getSHARP to provide webinars, information, demonstrations on the issues allowing a larger audience to learn and ask questions.

•    Extend an invitation to community leaders and organizers to discuss the merits of incorporating ACM using the #getSHARP methods into healing circles through the use of ear seeds, Tai Qi, and self-administered acupressure.

•    Invite parents, teachers, African American local and national community leaders and activist, local black business owners, public officials, religious leaders to a sponsored training using #getSHARP methods that details specific practices empirically proven to help reduce stress and is reproducible in their groups and activities.

•    Provide testimony, data, research, and tangible efficacy to the invited parties

•    Invite local media to a training session of #getSHARP methods

•    Create a way for ACM to be available in local schools instead of detention using #getSHARP methods

•    Create a route for ACM to be available for other large organizations like prisons, shelters, and drug treatment centers using #getSHARP methods

5. Evaluation

Ask participants how they feel about the information, implementation, and effectiveness. Was the #getSHARP strategy easy to duplicate and bring about desired results? How do extended community members feel about the intervention? Use exit questionnaires to determine how or what participants would add, change, or improve as next steps to accomplishing the goal of bringing ACM to the community as a standard of care.

Bibliography

1.    Arai, Y. P., Sakakima, Y., Kawanishi, J., Nishihara, M., Ito, A., Tawada, Y., & Maruyama, Y. (2013). Auricular acupuncture at the "shenmen" and "point zero" points induced parasympathetic activation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687596/

2.    Armstrong, K., Ravenell, K. L., McMurphy, S., & Putt, M. (2007, July). Racial/ethnic differences in physician distrust in the United States. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913079/

3.    Black & African American Communities and Mental Health. (2017, April 03). Retrieved from http://www.mentalhealthamerica.net/african-american-mental-health

4.    Dandridge, T. (2019, February 27). Unusual Tale of Acupuncture, Racism, and African American History in the USA . Retrieved from https://everyones-place.com/2016/10/04/unusual-history-of-acupuncture-in-the-usa/

5.    Fullilove, M. T., & Wallace, R. (2011, June). Serial forced displacement in American cities, 1916-2010. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126925/

6.    Kao, C., Chen, C., Lin, W., Chiao, Y., & Hsieh, C. (2012). Effect of auricular acupressure on peri- and early postmenopausal women with anxiety: A double-blinded, randomized, and controlled pilot study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358095/

7.    Nauert, R. (2018, August 08). 'Racial Battle Fatigue' Seems to Fuel Anxiety Disorder Among African-Americans. Retrieved from https://psychcentral.com/news/2011/03/04/racial-battle-fatigue-seems-to-fuel-anxiety-disorder-among-african-americans/24132.html

8.    Nelson, A. (2011). Body and soul: The Black Panther Party. Minneapolis: University of Minnesota Press.

9.    The Manual Stimulation of Acupuncture Points in the Treatment of Post-Traumatic Stress Disorder: A Review of Clinical Emotional Freedom Techniques. (n.d.). Retrieved from https://www.liebertpub.com/doi/abs/10.1089/acu.2017.1213

10. Ward, E. C., Wiltshire, J. C., Detry, M. A., & Brown, R. L. (2013). African American men and women's attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279858/

11. Washington, H. A. (2008). Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. New York: Anchir Books, a division of Random House.

12. “Cultural Diversity Seminar with Dr. Edwin Nichols.” Find in a Library with WorldCat, 11 Nov. 2018, www.worldcat.org/title/cultural-diversity-seminar-with-dr-edwin-nichols/oclc/31822725.

13. Wang, Yu-Jen, et al. “Auricular Acupressure to Improve Menstrual Pain and Menstrual Distress and Heart Rate Variability for Primary Dysmenorrhea in Youth with Stress.” Evidence-Based Complementary and Alternative Medicine : ECAM, Hindawi Publishing Corporation, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3876699/

14. DEGRUY, JOY. POST TRAUMATIC SLAVE SYNDROME: Americas Legacy of Enduring Injury and Healing. AMISTAD, 2017.