Acupuncture at the Mae Tao Clinic

I fled winter in China for northern Thailand, where I was volunteering at the Mae Tao Clinic. MTC was started in 1989, BY refugees from Burma, FOR refugees from Burma’s civil war, and it’s still going strong. Its beginnings were simple, as concerned people — Dr. Cynthia Maung and others — just tried to find solutions for an overwhelming number of underserved people, mostly refugees from the Burmese civil war. It grew from nothing to its current status of a combination community clinic, birthing center and in-patient ward with multiple departments, somehow serving 115,000 people annually! As specific needs have become more prominent, the clinic has done more to meet those needs, an example being the recent shift towards offering reproductive care, so 3-15 babies are born every day in the Clinic.

Located down an unpaved dirt road a short distance away from the long-distance bus terminal and about 1.5 km from town, without a sign to mark its entrance, the old clinic has several shambling buildings which housed its multiple departments. Patients registered near the entrance, and after being seen at the outpatient Consulting rooms, referred to other departments as needed. Volunteer health professionals come in from all over the world to assist the MTC clinical staff (medics), as well as nurses and midwives, who deliver most of the care. The care — medical examinations, lab tests, minor surgeries and medications — is delivered for free. The clinic is a nonprofit, which pieces together its support from many different private agencies and individuals.

The Clinic has a training program for its medics and other health-workers; some of the graduates later deliver care at the refugee camps in Thailand or in communities back in Burma. The certification isn’t officially recognized, but their skills are gained from didactic classes and massive practical experience of checking vitals, cleaning teeth, sewing up wounds, giving injections, delivering babies, etc.

The clinic is not actually a legal healthcare facility here in Thailand; and most of the patients do not have legal status here  — those who are staying at the clinic’s Patient House can’t safely stray far from the grounds. The same applies to many of the clinical workers, and even the clinic founder, the famous Dr. Cynthia, is without legal status in Thailand. Because there is little available healthcare in Burma, many residents just cross the river at unsanctioned spots for their needs. The border area between Thailand and Burma is well-populated with refugee camps, where many of the staff officially reside.

The Mae Tao Clinic’s Acupuncture Department was started in 2010 by foreign practitioners. At the old clinic, it was sandwiched between the Dental and Eye Care departments — so it was actually not even a room, but occupied about 1/4 of the Dental department, separated from it by thin boards nailed to the room pillars — not quite  reaching the ceiling. Throughout the work day we could hear the relentless verse of the dental drilling and refrains of screaming children.

In this narrow space there are 4 platform beds, on which lie thin mattresses and mats. The platforms are wider than the mattresses, which allows the medic to hop up and needle. Supplies are housed on narrow tables against the jerry-rigged wall.

A few years ago, the Acupuncture department was averaging about 50 patients/day — now it’s more commonly about 15-20/day, and also the department. I don’t understand all the why’s and wherefore’s of how patients are referred or not to Acupuncture from the other departments, but patients are mostly seen complaining of back pain & other musculoskeletal issues, post-stroke recovery and other neurological problems. Stroke incidence is just crazy amongst the Burmese — one staff member told me that the average age for a stroke in this population is only 35!! A referral to acupuncture treatment is usually for 7 continuous days. As many patients are traveling from within Burma to Mae Sot for medical treatment, the course of treatment is arranged to provide patients maximum treatments during this short period of time. I think this is true for most of out-patient departments.

What I found during my time there was that these patients are the dictionary-perfect definition of stoic, even too stoic! In addition to the language barrier, I found that the Burmese patients tend to tolerate discomfort to such a greater degree, that I had to carefully watch their faces and body language as I treated them. I found myself using moxibustion to a greater degree than in the US (where I am accused of over-using it), which is beneficial. I found that tongue diagnosis is EXTREMELY difficult in a patient population that almost universally chews betel nut — the tongues are all stained sanguine or red-brown! I also found myself free-needling much more than usual, which made for a bit of learning curve. Much like other shared-room clinics in other parts of the world, there’s a lot of talking back & forth, and very little privacy. But the Burmese tend to be very kind people, who watch others not in a judgemental way, but to see if someone needs help. Plus, they universally demonstrate a refined politeness, which was a real pleasure to experience.

At this clinic, I was a volunteer-teacher, so while I certainly did treat quite a few people, my roles was more to be on hand to offer encouragement, tips, & suggestions to the medics who do the lion’s share of the work. This is true for all the volunteers, because we are coming & going, but the clinic & its medics are remaining and providing patient care, so our best contribution isn’t by treating patients, but teaching others to do so. At one point, I worked up a small training booklet, combining some basic theory and specific treatment suggestions. I really do like to teach, but think I’m usually not so clear when giving explanations in clinic, but at the Mae Tao Clinic, I was really able to be much more clear in my explanations — and that’s satisfying!

The Acupuncture Department has received international support in the past, as well as organized trainings (most recently from a Hong Kong-based group).

Unfortunately, time and again, I could see that at MTC, the Acupuncture Department was very far from being integrated into the work of the other departments. There were few new referrals from the intake department, mostly former patients who were returning. Some physiotherapists (P.T.s) from Australia and Europe have been creating a department there. During my time, they didn’t actually have a space of their own, but were going from department to department, offering their expertise, and certainly the foreign volunteer M.D.s were more inclined to work with them than us. I also found that our work was largely ignored in the patient chart folders — like improvements in stroke patients. Before i arrived, i had dreams to establish more cross-department efforts here, but I  can see that the Acupuncture department is only somewhat tolerated.

MTC moved this year to a new clinic space some kilometers away .. . except for the Acupuncture Department and the Prosthetics Workshop, both managed by the same staff-member. The Acupuncture department was scheduled to be moved into the former Child Outpatient Department, which was quite close to the clinic entrance, which is good but it’s unclear how MTC will be referring clients to Acupuncture.

The Acupuncture Department operates  on a budget of $16,000/year in operating costs. It actually receives only a small part of the overall Clinic budget — even the earnings from the donation box in the Department are pooled amongst all departments of MTC. It is possible to send a donation earmarked for the Acupuncture Department via Paypal, or just to support the Mae Tao Clinic in general, at this link. I also recommend volunteering your skills to the clinic — MTC usually asks for a 3 month commitment. They don’t provide housing, or even visas (most volunteers are there on tourist visas, which need to be renewed every 1-2 months). The application process involves some paperwork (the usual sort of thing: a resume and proof of licensure).

One very interesting wrinkle in my work there is that I was training (or helping to train) para-professionals (the medics) in providing acupuncture treatments. It’s interesting because in the developed world (the U.S., etc), there is a big struggle  with the growing number of under-trained acupuncture providers (P.T.s and their “dry-needling”). Is it hypocritical of me? Actually, it seems a no-brainer to train para-professionals working among underserved communities in some basic and generally helpful skills — it’s completely different than the creation of under-trained needlers (dry needling practitioners) alongside licensed experts (Acupuncture Physicians/Licensed Acupuncturists/East Asian Medical Practitioners or whatever they’re called), as in the more developed world.

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