Abstract
ABSTRACT
My background is in nursing, midwifery, and acupuncture. In November of 2021, I came across a blog post about volunteering as an acupuncturist in a rehabilitation clinic for migrant refugees and asylum seekers on the island of Lesvos. With experience in the National Acupuncture Detoxification Association (NADA) protocol and trauma training provided by Acupuncturists Without Borders, I decided to apply to the nongovernmental organization Earth Medicine rehabilitation clinic. I stayed for 2 weeks in January 2022, and went again in September 2022 for 2 weeks, but that time, I was based inside the camp. On returning home from my first trip, and while giving a talk about Lesvos to our regional group, a fellow acupuncturist suggested that we could do something closer to home. Thus, we set up a project in our city, Exeter, in the United Kingdom. Thanks to a willing team of volunteers, asylum seekers and refugees are offered free acupuncture treatments weekly on Saturday mornings. This takes place in a community center in a group setting, using the NADA ear protocol, as well as other acupuncture points and occasional full-body treatments when the circumstances allow this. Although the work on Lesvos was hard, it was also very rewarding. Working there has had a profound effect on me and I plan to go back. At our local project, we receive very positive feedback from the people who come to us. Using acupuncture to address post-traumatic stress disorder is very worthwhile, and I encourage others to consider doing the same.
INTRODUCTION
The blog that I read was written by a practitioner named Sandra Arbelaez, MSc, CHM, Dipl Lic Ac, Dip ITEC, based in Bristol, UK.1,2 It was very inspiring, so I looked up the organization she had been working with: Earth Medicine (EM), a non-profit organization created by a group of physical therapists and health professionals. * Early in 2020, I had volunteered to go to Cambodia by invitation of a nongovernmental organization the Les Mains du Coeur pour le Cambodge (MDC). † This mission was to teach acupressure and acupuncture for obstetric care to midwives and doctors there. To prepare for this I had trained in the National Acupuncture Detoxification Association (NADA) protocol. I knew this would also be useful on for my planned work on the Greek island of Lesvos (also known as Lesbos). With my nursing and midwifery training—and my many years of working in a hospital and having qualified in acupuncture in 1988—I felt ready to give humanitarian work a try.
As a member of Acupuncturists Without Borders, ‡ I was able to access that organization's training on trauma prevention and recovery, to prepare myself better—and I consider this essential for this work.
Fabiola Velasquez, BSc, the director of EM, established this organization in 2018, with the aim of providing physical rehabilitation for refugees in the camps with musculoskeletal disorders, chronic illnesses and post-traumatic stress disorder (PTSD).
LESVOS FIRST TIME
Lesvos, where I set my sights on for my next mission to work with a group of volunteers, is in the North Eastern Aegean Sea, very close to Turkey. The Lesvos clinic was in a building near the center of the island's capital, Mytilini. Most of the people treated there had been victims of violent terrorist attacks, torture, and physical and sexual abuse. Their journey to Lesvos often involved fear-filled days and nights, hiding in freezing temperatures before they could even start the hazardous crossings by boat. Many were separated from their families at this time.
In the clinic, refugees who could speak English, came from the camp and translated what we said into Farsi and Arabic. We worked alongside physiotherapists and other manual therapists.
Our working day started at 8.00
The main issues we treated were:
Lower back ache, usually from hard work (sometimes associated with slavery) and coldness, although sadly also due to torture (Fig. 1) Anxiety and insomnia., which was not surprising, considering their histories of violence and wars, but also due to their poor living conditions that were exacerbated by the cold weather and their uncertain futures Digestive problems were very common, especially constipation, abdominal pain, and poor appetite Extreme fluid retention was common, especially among the women, due to trauma PTSD and its associated symptoms were commonly present in all patients, and I noticed a lot of disturbing scarring from bullet, shrapnel, and torture wounds.
Acupuncture and Moxibustion on needles for elderly female refugee with severe low back pain following emergency surgery.
Our treatments varied from just using needles to, more often, adding cupping, bleeding, massage, tui'na, Gua Sha, and Plum Blossom needling. We used a lot of moxibustion, and I usually started all the treatments with the NADA protocol, often replacing the needles with magnets that the patients could take with them. I am pleased to say we got very good results, especially in terms of reduced pain levels and much-improved sleep. It was very rewarding to see the patients' mobility improve and their faces looking more relaxed.
Case Examples
Case 1
Ms. S, 19, from Afghanistan, saw her mother killed in a bomb blast when she was only 6 years old. Since then, she had been moved from place to place, sometimes being trafficked and having deeply traumatic experiences at a very young age. She was unable to sleep; was feeling extremely vulnerable at night; and had several physical problems, including irregular painful menses, poor appetite, constipation, and abdominal pain.
I used NADA on her, before inserting needles in Yintang, SP-6, ST-36, LR-3, LR-13, HT-7, Ren-4, Ren-6,and Ren-12. Some of these needles were used with moxibustion. These treatments varied according to how she was feeling on each treatment day. We treated her most days, and she began to look quite different, communicating and smiling more, and sleeping much better.
Case 2
Mr. B, 22, from Syria, had previously been treated by Sandra in December. It was so important that we picked up where she left off. He had been in the camp for 2 years, was alone with no family, his father having been assassinated. Like many other young refugees in the camp, he had been refused asylum twice, leaving him depressed, traumatized, and feeling that he had no hope for the future. He had been continually losing weight for 1 year, was very weak, and was unable to sit up when Sandra first met him. Thanks to her treatment, he had improved and felt stronger. Although able to eat a bit better, he was very thin and still needed a lot of help.
The focus of our treatment was his trauma, lack of sleep, and his digestive system. I used NADA on most days, as well as points such as Du-20, HT-7, Yintang, Ren-6, Ren-12, SP-6, SP-15, and ST-36, plus a lot of moxibustion. I'm pleased to say, his sleep went from only 2 hours a night up to 6 hours per night, and he was able to eat more without experiencing so much discomfort. It was so lovely to see the Shen returning to his eyes at least a bit. He also started to smile and communicate more. My son is only 1 year older than this man, and I cannot imagine seeing my son in this state and going through such unbearable suffering in his young life.
Case 3
Ms. D, 68, from Afghanistan. She was sold by her family when she was age 9, to be married to a 45-year-old man as his second wife. Although sexual relations apparently did not start until she reached puberty at 15, she had been beaten and been subjected to enormous cruelty, by him and his other wife. After he died from a stroke, she managed to escape, and, although she had been given asylum, did not want to leave the camp without her son. Deeply traumatized, her symptoms occurred mostly at night, when she could not sleep and felt very afraid. Her head felt full, she had palpitations, and she “shook.”
Of course, getting exact details can be difficult when using young translators who do not know medical terminology, but Tongue and Pulse assessments and palpation helped enormously. I used NADA, then points such as Yintang etc., but also HT-7, HT-8, HT-9, and KI-6 to address her nightmares. We treated her on most days, and like the other patients, her treatment varied according to how she was feeling on each treatment day. Her symptoms were reduced, especially those involving her sleep, which had been almost nonexistent, to 1 night, when she slept nearly all night. We shared a big hug that day, and she joked about her people being from the Hazara ethnic group who have flat noses! I confess there were tears in my eyes on the day we had to say goodbye to each other.
Summary
In our 10 working days, we saw 25 patients, (15 females and 10 males) and carried out 127 treatments. Some patients came on most days and other patients we saw only once or twice.
Despite the awful circumstances that made these people take their hazardous journeys to this clinic, leaving everything behind, they showed us nothing but extreme gratitude and warmth. We formed bonds I could not have imagined in that short time. The team effort of all those at Earth Medicine is so heartwarming, and it felt more like a family community than anything I have experienced before in my working life.
LESVOS SECOND TIME
In September of 2022, I returned to Lesvos again. This time, I was based in the new shipping container which Earth Medicine had converted into a clinic inside the camp. Access to the treatments we provided was, therefore, easier, but some of the refugees still needed to go to the clinic in town. My friend and colleague, Houri Alavi, BA (hons), Lic. Ac., Dip TuiNa accompanied me this time, and she had the enormous advantage of speaking Farsi, which enabled us to achieve a better understanding of the patients' medical issues.
The attendance varied, and although not ideal, even 1 or 2 treatments seemed to have a remarkably positive effect in this acute setting. Patients who were having cumulative ongoing treatment certainly had greater benefits, particularly in terms of pain reduction. Both acute and ongoing treatments were useful in different ways. Having somebody showing compassion, offering time and a therapeutic encounter, meant a lot to these patients after all they had been through.
UNITED KINGDOM
Back in the United Kingdom, a group of volunteer acupuncturists set up a project for treating asylum seekers and refugees locally. We offer this treatment every Saturday morning. Many have been placed in hotels by the U.K. government. Although their stories may be varied, they have all had to flee from their beloved homes, whether in Afghanistan, Ukraine, Iran, or Syria, as well as many other places. Their journeys have usually been hazardous and life-threatening, and the uncertainty about their futures has profound effects on their physical and emotional well-being. In terms of ongoing efficacy, most of these patients have found it very helpful and relaxing enough to attend our clinic every week for several weeks, during which their sleep and general stress and anxiety levels have improved.
A generous grant from World Medicine enabled us to rent the venue, buy equipment, and pay the volunteers some travel expenses. See Funding Information.
CONCLUSIONS
This work is both hard and very rewarding. Practical and professional decisions often have to be made rapidly. Flexibility is essential while negotiating the time, space, and resources available.
Working on Lesvos has had a profound effect on me and I plan to go back.
If you are interested, you need to be experienced, preferably with some background of having dealt with trauma professionally. Other trainings that would be useful are: Japanese direct moxibustion; tui'na; and herbal medicine.
Footnotes
ACKNOWLEDGMENTS
AUTHOR DISCLOSURE STATEMENT
No competing financial conflicts exist.
FUNDING INFORMATION
A generous grant from World Medicine enabled us to rent the venue, buy equipment, and pay the volunteers some travel expenses. Mainsducoeur and Scarboroughs Acupuncture Supplies sponsored our work (Grant No. 22/Ex/02).