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Pacific in the Community Students gain valuable experience in off-site clinics
Under the supervision of Pacific College board member Ana de Vedia, L.Ac., senior students of Pacific College in San Diego have had the opportunity to gain valuable experience in integrated health care settings, while providing much-needed care for people in the community. Through the off-site internship program, students can volunteer at the San Diego Hospice, the UCSD Free Clinic Project at Pacific Beach Methodist Church or at UCSD-RIMAC. Below are the comments written by some of the students who have participated in these externships. San Diego Hospice
As I put my experience into words, it is difficult. There are no words eloquent or descriptive enough to fully explain the dimensions of my work at Hospice. It has changed me on both a professional and personal level. Professionally, I was given the opportunity to really see what acupuncture alone is capable of. I had always been of the mind set that no treatment was complete without prescribing herbs. That idea has been banished. I have seen the simple profoundness of a three or four needle treatment and the power of auricular points used alone. I have been challenged to think differently about Chinese Medicine. At hospice, we are not always able to treat as we do in the clinic. Our treatment tables are the patients’ beds, and the patient’s position is never changed. Their clothes may not even be acu-friendly. So, the challenge becomes to fit the medicine to the patient and not the patient to the medicine. We are fortunate to have a system of medicine that is so multi-faceted and rich that it moves in a circular fashion to allow us to meet these needs. When I first began, I knew in my heart that these people had come to die, but my mind and ego wanted to cure. It took time to be comfortable that my purpose was of a palliative nature and not a curative one. At times it was difficult to walk into rooms where there was such profound suffering. The challenge was not to change the suffering, but to be present with both patients and families as they talked, relived memories past and even cried There was one case in particular that touched me on levels unexplainable. A 16 year old body had come to die. His life paralleled closely that of my own son’s. I ached as his mother sat day after day caring for her young man now child again. I thought of my son. I could only imagine the depths and dimensions of this mother’s suffering and the dreams once dreamed that she now had lost forever. I grieved with her. I cried that day and tears still come as I remember him. My heart’s capacity for compassion and care had grown. All of this is a part of life and a part of the experience of Hospice. Healing here does not mean that patients are cured or even that they can go home. Healing comes in a flickering second when the heart’s clarity enables the patient to say one last “I Love You,” or even “Goodbye.” If this is the pearl that comes perhaps only once from working at Hospice, then it is work worth doing. UCSD Free Clinic Project - Pacific Beach Methodist ChurchI registered for the Wednesday night clinic shift without realizing I would be working at the Pacific Beach Free “Homeless” Clinic. When I learned of the assignment, I was concerned about what it would be like to work with homeless people. I was apprehensive about safety and sanitation issues, but primarily about the attitudes and state of mind of the people I would be treating. Would they be mentally unstable, extremely dirty? Would I be exposed to disease? Needless to say, I approached the first night with much apprehension. As I drove home after the first night I was absolutely inspired and delighted at my good fortune to work in this clinic. I found the patients to be delightful people and their appreciation of our work was inspiring. Wednesday evening at Pacific Beach Methodist Church for the clients begins with a free, nutritious meal in the church cafeteria. In addition to PCOM’s acupuncture clinic, there is a UCSD Medical clinic where medical interns are learning and working with patients as we are. In addition, there is a legal clinic upstairs where USC law students work with the clients. Lots of activities are going on at once, and the atmosphere is one of support and cooperation. Mary Mahy who developed and runs “Harvest for the Hungry” welcomed us the first night and explained the functions of her organization. Her story of how the clinic began brought tears to our eyes and we were all proud to be a part of her program. The clinic is set up each night in the basement of the church in children’s classroom. The walls are lined with delightful pictures and art work created by the church children. The windows with their pleasant pink curtains let in a constant breeze to give the clinic a fresh open feeling. The sex treatment beds are set up across the room and supervisor, interns and assistants all work as a team to serve as many patients as we can fit into one, three-hour block of time. this open setting allows us all to interact, observe and learn from the treatments being administered throughout the night. We all work as a team and the energy is very upbeat and positive. The patients who come to the clinic are the real joy of the experience. They obviously look forward to this night and most clean up and are pleasant and courteous. The evening is well supervised and they are to be sober and drug free when they come to the clinic. The patients heartfully appreciate the nurturing, healing environment of the clinic and the attention they receive from the PCOM group. Many of the patients’ complaints are associated with life on the streets or in a stressed environment. Without a comfortable or safe place to sleep, there are numerous musculoskeletal problems. We also do much work with addiction withdrawal and stress relief. (I have gotten very proficient with the NADA protocol.) We only use acupuncture and massage in the clinic. This challenges us to seek out the best acupuncture treatments and to rely on the core of our medicine to product beneficial results. There are usually more patients seeking acupuncture treatment than we have time to handle. As a result, everyone is always very busy and, as an assistant, I have numerous opportunities to participate in patient intakes, evaluation and treatment strategies. We are all called on to utilize as many of our skills as we have acquired in the classroom. In this clinic, no one just stands around watching, we are all working to our capacity. Many of the patients return each week. This provides an excellent opportunity to evaluate the degree of success achieved by the treatments we administer. Also, because we are so busy, we have much more opportunity to utilize treatment protocols and evaluate the success of one over another on different patients. I am hopeful that my schedule allows me to continue to participate in this clinical throughout my time at PCOM. There is no doubt in my mind that I will be far more experienced and ready to work as an intern and eventually a practitioner from the experience I am gaining in the Pacific Beach Clinic. Working at the Pacific Beach homeless shelter has been one of the most rewarding clinic shifts of my interning career. The atmosphere is open and warm and there is a lot of contact between the acupuncture team and the medical and dental students. As part of their orientation, all the students are given a tour of our acupuncture area and many of them return when they have a free moment. Most of them seem to be genuinely interested in what we do. Several medical students have stopped by and spent fifteen minutes or more watching treatments and asking lots of questions. Some of them have even returned to get treatments themselves. The medical and dental students who work at the clinic hold their own fundraising activities to pay the expenses of keeping the clinic open, buying medication, etc. Everyone there has a genuine commitment to making the homeless shelter a success. This is reflected in the general sense of teamwork and the respect that everyone shows each other. In terms of the acupuncture group, interns practice side-by-side in a room that is normally a children's area - lots of cute drawings and posters on the walls really soften the area up. The fact that everyone works in the same space makes it easy and comfortable to share ideas and communicate about patients. Everyone in the group works very well together and there is always someone there to help you out, usually before you even ask. The assistants on this shift have been incredible - willing to do a lot of work and prepared to jump right in. Since we usually keep very busy, the environment provides an invaluable experience for motivated assistants to actively participate in treatment. My first exposure to the reality of the homeless arose very early on when I asked a patient what made his pain worse - heat or cold. This was a touch question for him because most nights of the week he slept outside on concrete. The showers that are provided for the homeless are usually cold and he really had to think back to what it was like the last time he had a warm shower. So I've had to learn to ask different questions. This extends to treatment as well. Before I use Po Sum On I have to ask, "Do you have someplace warm to sleep tonight?" I've also had to become very practical in the lifestyle advice I offer since the homeless rarely have the resources to make the changes I ask of my other patients - suggestions I've made so often that it has almost become a mindless activity on my part. My experience here has made me much more aware of the importance of really understanding a patient before developing a treatment plan or suggesting any sort of lifestyle change. At the PCOM clinic I tend to see a fairly homogenous patient population and it is dangerously easy to become too comfortable with a standard set of "solutions" which may be completely inappropriate for a patient who doesn't fit the mold. The homeless patients have been some of the most gentle people I have ever treated. Most of them have a great sense of humor, too. All of them deeply appreciate the care they receive in our clinic. I feel privileged to be able to participate in their treatment. For many of them, the attention we provide is the nicest thing that happens for them all week. Unless we are very busy, we usually get to see some of the same patients each week. This makes it possible to develop rapport and follow a patient's progress in terms of their health as well as their search for work and a stable living situation. Since the treatments are free, patients tend to return, providing us with the opportunity to follow their progress over a longer period of time than many of our paying clients at the PCOM clinic. The fact that money isn't involved in these treatments coupled with how much the patients appreciate our care makes the homeless shelter a truly rewarding experience. Assisting at the PB Homeless Clinic has helped me not only to keep my perspective on life in general but serves as a weekly reminder of why I am in school. Not often have I been so deeply moved by a group of people. The group I am referring to not only consists of our patients, but the volunteers with Harvest for the Hungry who feed the homeless, the UCSD medical students and dental students, as well as the interns, other assistants and supervisors from PCOM. We all come together for a common goal every Wednesday night and in that communion we see the best there is in each of us and that renews me. Most of our patients are articulate, funny, honest, kind and very appreciative of what we do. They often present us with difficult cases and assistants have an opportunity to be very active in treating the patients. Even though we see a lot of people in one night and move from one patient to the next pretty quickly (great for improving time management) there are always seem to be plenty of time to discuss and learn from each case. The interns and supervisors keep me very involved in the treatment, let me do a lot of needling, pulse and tongue work and take the time to answer questions and hear my thoughts and ideas. We also get to work with the UCSD medical students who are right across the hall. Some are quite curious and very open to what we have to teach. We even find time to treat them on occasion. As a student I consider myself very lucky to have this unique opportunity to be an integral part of a very worthwhile organization, and to make a difference in people's lives as well as in my own. Regardless of how tired I am when I arrive for my shift, I always leave feeling energized, humbled and touched by the grace of those I have just spent the evening with. I can think of no better gift to give myself. UCSD-RIMACUCSD is the first campus in the nation to allow acupuncture to be used on their athletes. The shift is fast-paced and hectic. There are no assistants or administrative personnel on the shift so you have to pull your own charts, make up your own supply trays, set up the tables and be completely responsible for a treatment from start to end (which is often about 20 minutes in total). So, it's not the shift you want if you want to do internal medicine with zang fu, tongue and pulse diagnosis Having said all that, I want to express my gratitude for this opportunity. In my opinion, this is a unique opportunity to showcase the benefits of acupuncture in sports medicine. It is groundbreaking and exciting every single week. We work individually or in pairs. Matt Callison supervises the shift and he shares his technique openly and with great enthusiasm. His commitment to this work is inspirational. Every week you learn so much and build so much confidence that I wish I could do shift at RIMAC every day. In a short time, I believe that the first PCOM team has earned the respect and trust of the trainers at RIMAC. Not all pioneers get arrows in their back. And we've also ironed out some of the logistics and administration details so the next shift should go very smoothly. It is an amazing opportunity. Even if sports medicine isn't your thing, it's work the experience. RIMAC is the place to be if you're interested in treating musculoskeletal problems in a truly integrated and complementary style. At the present time it's still a work in progress, but if it continues on the present course you can plan on being quite busy while working at a faster pace than typically experienced at the PCOM campus clinic. The time constraints of the athletes and the nature of the treatments necessitate a modified version of the intake process. This "streamlined" process facilitates the needs of greater numbers of patients without compromising the quality or diminishing the integrity of the treatments. Thus far, the student athletes and staff have shown a good deal of support for the addition of acupuncture into the treatment room. They are gaining first hand experience in the difference acupuncture can have in recovery and performance after a compromising injury. In short, a typical treatment works like this: A patient comes in for treatment. One, or several, interns are assigned to that patient to conduct an interview and assessment. The assessment is personally confirmed and/or modified by Matt. The patients treatment is then discussed with considerations given to coordination with the athletic training staff and the specific needs of the athlete. Treatment begins and.. you know the rest of the story. Interning at RIMAC is a great opportunity to learn about the management of musculoskeletal injury. It is also a great place to work on public education skills since most of the students are very curious and ask a lot of questions about the treatment. Do be advised, however, that the scope of this internship is definitely more focused. It is not the place to be if you're looking for an off-site location to practice internal zangfu with raw herbal formulas. On the other hand, if you are interested in muscles and bones then this is the place to be. Just make sure that you are well studied and comfortable with anatomy and orthoneuro tests. I can't emphasize enough that the more you are familiar with these two subjects, the more you will get from your experience. Go for it!
My experience at UCSD's RIMAC center has been one of the most dynamic and interesting clinic experiences I've had while at PCOM. Here are what I've seen as the pros and cons for me. PROSWe see LOTS of patients - we are always either treating or co-treating, and I have seen as many as 5 patients per shift so far. This is more that I am allowed in the PCOM clinic. We started out a little slow, which allowed us to learn and practice the techniques that Matt uses before we were so busy with patients that there was not enough time to think about what we are doing quite so thoroughly We are treating young, healthy athletes with athletic injuries. This lets us see how powerful acupuncture can be with patients whose bodies are still in optimal condition. It allows me to really focus my energy on treating one type of condition for an entire semester, which really allows me to learn and retain more information The treatment environment is often the training room. This allows us to have constant exposure to all of the athletes and trainers who are in the room. While is does not afford a lot of privacy for the patients, it allows us as interns to have nearly constant attention from a supervisor who is able to see what is going on with everyone at the same time. The inability to use internal medicine gives me a chance to see just how powerful acupuncture can be. We are getting great results with these patients using only needles, massage, and external herbal applications. The opportunity to work alongside the athletic training staff, including their orthopedic consultants allows me to see how other medical professionals treat a patient. It also allows them to see how we approach athletic injuries, allowing a seemingly rare opportunity to blend eastern and western techniques. Between this experience and Matt's points 6 class, I am becoming much more confident in my knowledge of anatomical structures, and in my ability to do deeper and more aggressive needling with out hurting a patient. (I have typically gravitated towards a Japanese approach to acupuncture, so this style of needling is very different from what I have used in other environments. Part of why I wanted to take this shift was so I could learn these techniques and practice them under supervision.) We are working with a population of people who would never have thought to try acupuncture without it being offered to them in this environment. Many patients who were skeptical at first have come back for 2nd and 3rd treatments, and are excited about the results. They are telling their friends, and referring other teammates for acupuncture. This is opening up our field to a whole new population of people. CONSAdditional cost to us - parking permits - is a bit of a strain on an already strained budget.
Inability to use internal medicine does not give me practice in using herbs. However, I am getting ample opportunity to practice internal medicine in the PCOM clinic, so I don't think this is hurting my education process in herbs.
The pace is fast enough that I don't have quite the degree of personal interaction with my patients at RIMAC that I have in the clinic. While this is sometimes frustrating, it is also a very good experience for me to be forced to work a bit faster and talk a bit less! As you can see, the pros far outweigh the cons! I wish I could have been in this environment for a shift every semester.
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