A very big refresher course in Myanmar (Burma)

In January 2010 I was privileged to be part of a small team of TCM practitioners who travelled to Sagiang in Myanmar (Burma). This was part of an ongoing project that has been teaching acupuncture to doctors of traditional Myanmar medicine (TMM). John Hamwee one of my colleagues has given me permission to publish this article detailing our time there.

This article first appeared in the spring 2010 copy of the acupuncturist the magazine of the British Acupuncture Council

JOHN HAMWEE MBAcC

Acupuncture Practitioner: Cumbria and Oxford

About 20 years ago a young American sat in meditation for long months in the hills of Sagaing, an important centre for Burmese Buddhism, overlooking the Ayeyarwady river near Mandalay. One day he came down to the village and a woman, a perfect stranger, seeing this westerner and apparently taking pity on him, gave him a bottle of C

oca-Cola. He was deeply touched by the gesture and thought, I must give something back. He found many ways to do so, and one of those ways was to institute an annual visit of western acupuncturists to the nearby hospital. This was the tenth annual visit. There were five of us, four from the UK and one from the USA. For one of our party it was her fourth visit, for another the second. It was my

first time, though it won’t be my last. I worked harder than I have ever worked in my life, I paid all my own expenses to get there and back, and I can’t wait to go again.

The set-up was that we worked for a week in the hospital where there are two rooms given over to acupuncture, one with about twelve beds in it and the other with about ten. Then we moved to work in a village where there were no beds, strictly speaking, so we worked on raised platformsin the monks’ dormitory, or outside. I didn’t count but I suppose there were about the same number of spaces available to patients.

And we needed them. There were almost 100 people the first day, more each day afterwards and, we were told, nearly 500on the last day. That may have been an exaggeration but the patients certainly came in waves and we did have to findnew spaces to work. That last day was all abit of a blur, partly because we were sobusy and also because we were all verytired by then, but as far as I can tell I treated 26 people myself and I supervised a further 40 or so treatments.

Which brings me on to how we worked. We had with us three local acupuncturists who had been qualified for some years and about sixteen young practitioners, in their twenties, who had qualified recently. It was a big part of our remit to act as teachers to the young people, mainly in

the clinic but also with a lecture each day.

They were all pretty good, so by the time the

numbers really hit the roof we westerners were

able to spend as little as five or ten minutes with each patient. We’d agree a diagnosis and treatment plan with one of the students and then leave it to her or him to do the treatment, coming back to check the pulses at the end. In that way, the five of us managed five or six patients at once all day long. Although some of the students were delegated to crowd control, and the senior people were usually otherwise occupied, there were still about twenty of us, each treating, say, three people an hour for about seven and a half hours. So that’s how we made up the numbers. Naturally, there were translation problems.Huge numbers of patients complained about ‘numbness’ for example but were normally sensitive as far as we could tell.We never really got to the bottom of what they were trying to tell us. More generally, because we couldn’t take much of a case history, we had to work with a simple diagnosis of the state of the patient’s energy system; it was refreshing to see how much we could do with very few words.

It was a very steep learning curve for me. Normally I have one-hour appointments, and rarely see more than eight people in a day. Also, in my own practice I tend to use zero balancing rather than acupuncture for musculo-skeletal problems, of which there were many, but it wouldn’t have been any use to the students if I had done so there. So I struggled to remember bi syndromes and shoulder points and was pretty rusty for the first day or two, which the students noticed and charmingly forgave. It felt like learning acupuncture all over again. All this reaffirmed my deep respect for this system of medicine. It really did work on conditions for which I would normally use zero balancing or recommend osteopathy. It also seemed to work on conditionswhich I never see at home and which, as a result, I had to treat simply

from first principles. After nearly 20 years in practice I hadn’t realised that I hadbecome very limited in my thinking about acupuncture, assuming, in a rather lazy way, that it was good for what I used it for and a few specialisms like pediatrics and obstetrics but not much else. Wrong! Secondly, it taught me, as if I needed to learn, the value of having to explain a

treatment before doing it. At the beginning of the work the students wanted to know why I was planning to do what I was planning to do. Sometimes, in explaining, I came to understand my rationale; one which I’d never spelt out clearly to myself and which I could then apply to other patients and other conditions. Very satisfying. And sometimes, of course, when pushed to

explain myself I found that my thinking was woolly or inadequate, and it was a

pleasure and a relief to be made to think again and to come up with a better treatment than the one I first thought of. By the end I made the students write

down their proposed treatments before I would tell them what I would do, and I learned a lot from seeing two different but equally plausible sets of points. I often let the students do what they proposed, even when it didn’t seem to me ideal, and it was instructive to see the results of those treatments which, of course, I never do!

Finally, there was the whole process of working in a multi-bed setting. I loved it. I loved the noise and the bustle. I lovedglancing up at one of the students taking pulses on the opposite side and seeing inher eyes an agreement about what we were noticing. I loved people coming round to have a look at me needling Liv 14, Lu 1 (not a treatment they knew) and their

interest in the resulting pulse change. I loved calling a colleague over to assess a hip joint which moved, or rather failed tomove, in a way I’d never felt before. I liked having to talk less (it was tedious to wait for long translations) and having to senseqi more. And I liked the whole idea of seeing more people, more often, more quickly, for less money.

The whole experience has made me a much better practitioner and it will change the way I work from now on. I recommend it to those of you who feel like taking a very big refresher course.

Thanks to all at the Watchet JivitadanaSangha Hospital, especially U Win Ko and U Aung Min, and the students; to Kirsten Germann for leading us, and my colleagues Richard Graham, Dudley Kent and John Renna; and to Oxford Medical for their generous gift of supplies.

The hospital is run as a charity and receives no financial support from the Government. The programme I describe is run under the auspices of the MettaDana project which provides funds to local initiatives, including the hospital.

Contributions welcome

http://www.vipassanahawaii.org/mettadana_projects.php