As an acupuncturist, Sonja Sivesind, MSAOM ('08), LAc, has learned to expect certain questions.
Does it feel like getting a flu shot? No.
Does it hurt? Sometimes a little, but not usually.
Can acupuncture treat insomnia? Depression? Allergies? Asthma? Infertility? Pain? Digestive problems? Yes to all, says Sivesind.
She hears one question that's unique to the Community Acupuncture Project, her clinic in a nondescript house in West Seattle: Should I bring my pay stub — or tax records?
No, she says. Like many health care clinics, hers offers a sliding fee scale. But it's based on trust, not tax receipts. The clinic doesn’t ask about personal finances, and patients pay what they feel they can afford, from $20 to $50 per visit. That allows the clinic to serve patients who couldn't otherwise afford acupuncture.
"The No. 1 goal is to try to be accessible to people who don't have insurance, don't have a job, or don't think of themselves as the typical acupuncture patient," says Sivesind, a graduate of Bastyr University's Master of Science in Acupuncture and Oriental Medicine program. "We see a lot of working-class people, low-income people, and people who just don't go to a more boutique-style private experience."
Community Acupuncture Project uses a group setting that emphasizes frequent visits — an approach common in China, where patients often receive treatments several times a week. First-time patients have a private consultation with Sivesind or another practitioner, then move into a quiet room with five recliners. Patients sit and receive individualized acupuncture in the company of others.
They chat and sometimes fall asleep and let their calm influence each other. The open setting is a source of concern for some first-time patients — but a highlight for others.
"People talk about the space feeling calming," says Sivesind. "You're in a room with other people who are all there intentionally healing. It calms you."
There's a term for that energy: Collective qi. Qi is the underlying life force that traditional Chinese medicine seeks to restore (acupuncture is meant to reopen pathways for qi). There is clinical evidence that qi can be cultivated in groups as well as in individuals, Sivesind says.
Community Acupuncture Project opened its first location in Seattle’s Columbia City neighborhood in 2009, adding the West Seattle clinic two years later. It has grown mainly through word-of-mouth, with patients telling their family members and neighbors about their experiences. That helps win over skeptics or those who assume they can't afford acupuncture. It's one thing for a practitioner to tell you about the healing power of acupuncture, says Sivesind. It's even better to hear about it from your bank teller or barista.
The low rates emphasize the importance of frequent visits. Too often, says Sivesind, acupuncture patients stop treatment after the eight or 12 visits their insurance plan covers. By bypassing insurance, her clinic focuses on the evidence suggesting repeat visits are essential to acupuncture's effectiveness.
"People often say they felt pretty good coming in once a week, but when they started coming twice a week it really helped," says Sivesind.
After the initial visit, practitioners have chair-side conversations with patients before offering treatment. Instead of longer, infrequent intake sessions, they communicate briefly at each visit.
"Because we see them so often, there's time for them to say what's different and what's better," Sivesind says.
The setup has proved financially workable for the four practitioners split between the two clinics. Together, they saw more than 7,000 visits over the past 12 months.
Acupuncture leaders remain hopeful that the Affordable Care Act (Obamacare) will expand insurance coverage for their medicine. Meanwhile, the community acupuncture model is spreading among practitioners who want to expand access to low-income patients without waiting for insurance systems to change.
"It's a fairly sustainable business model and it's a socially conscious business," says Julie Johnson of The Pin Cushion, another community clinic in Seattle. "As a practitioner, it's extremely frustrating to have a medicine that's so versatile and can help so many people, but to have it out of reach because it's too expensive. This allows people who are curious about acupuncture to come in and try it without making a huge investment."
Johnson and Sivesind have worked together through the People's Organization of Community Acupuncture to promote new clinics, an effort they describe as more collaborative than competitive. That's been a way for Sivesind to connect her past as a community activist with her work as a health practitioner.
Sivesind grew up in Bellevue, Washington, and chose Bastyr's program because of its emphasis on clinical training. At Bastyr's Seattle teaching clinic, she worked with HIV/AIDS patients, learning to provide immune wellness. At the University's off-site clinics around the area, she worked with immigrants, retirement home residents and other groups who often couldn't afford acupuncture, something she wanted to continue. When she learned about the community model from Working Class Acupuncture in Portland, Oregon, she discovered it could be a viable business model.
"I thought I would need to write grants to provide acupuncture to under-served communities," she says. "This business model is much more sustainable."
In spring 2013, Community Acupuncture Project hired another Bastyr graduate, Emily Paul, LAc, MSAOM ('12), who was also shaped by her time in the University’s off-site clinics. She's been struck by the way patients pass knowledge and encouragement to each other in the group treatment rooms.
"It's a different approach than working with one person for an hour in a room," says Paul. "The group energy reinforces the healing process for everybody. That's been really interesting to see."
For Sivesind, one challenge is that patients often come to acupuncture after they've tried everything else. They come after difficult experiences with conventional medicine and often have layered health problems. Difficulty sleeping is common for them.
"As practitioners, we get hard cases," says Sivesind. "Sometimes it's hard to know where to start. Patients may not get a total cure at once, but they keep coming back because acupuncture makes them feel better."
As they return, they may bring a family member, a neighbor or simply a smile that reveals their newfound comfort.
"It's rewarding to work in a place where everybody is happy to see you," says Sivesind. "There's a transformation that happens when people feel physically better. It affects their outlook and their ability to make eye contact with people, and just makes them feel a little more loved."
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