The acupuncture clinic has been full of patients this week, sometimes with a line out the door. Some walk as much as three hours each way along dusty dirt roads weaving through rice paddies to get here. They come for acupuncture, Chinese herbs, Ayervedic massage, and Tibetan medicine provided by volunteers, in exchange for the price of a cup of tea. Some patients also bring fresh eggs or homebrewed moonshine to give directly to their practitioners as a gesture of gratitude. They come for all sorts of issues- back pain, knee pain, shoulder pain, stroke recovery, digestive upset, loss of appetite. Some of them lost their homes in the earthquake, some of them were injured by their homes in the earthquake. The most surprising thing is that almost none of the patients complain of the stress, anxiety, depression or trouble sleeping, that I am so accustomed to treating in New York.

Beyond offering acupuncture and other forms of medicine, I have noticed that the clinic also provides a community gathering space surrounding health and healing. Most patients come weekly on the same day. They get to know each other, listen to each others’ intakes, and keep track of each others’ problems and progress. They are enthusiastic when someone’s symptoms improve, and supportive when new problems arise. They give each other advice, and even as they receive their treatments with resolve, without complaining about needles or the discomfort of having their bare feet touching the freezing cold floor, they continue to talk and share and participate.

It makes me wonder, at the community clinic where I work in Brooklyn, where the same patients share the same waiting room and treatment rooms on a weekly basis as well- do they ever acknowledge that they have something in common? Or, according to the rigid rules of New York City socializing, do they avoid eye contact, feign lack of recognition, and work hard to maintain the feeling of separation that they have carefully carved out for themselves in such a crowded and overwhelming city? I know I would. It is interesting to think about what it would mean for “community clinic” to signify not just a shared treatment space, but a shared treatment experience. Studies have been done that demonstrate that when a group of people receive acupuncture, people in the same room that do not receive the treatment also show signs of physiological benefit. Perhaps the energetics of healing are contagious, and even synergystic, and the role of community and human connection play a vital role in the journey through sickness and health and personal transformation.

It makes you question, what is HIPPA beyond a lot of paperwork about privacy practices? It is interesting to evaluate how it has shaped our delivery of health care and changed the social fabric of medicine, community, and culture. In the last few decades, individualism and the right to privacy, or in other words, isolation, have become prized above all other communal aspects of life, and even considered a human right whose violation is grounds for a substantial lawsuit. As each individual embarks on their own personally complicated and challenging journey through healing, living, and dying, the coveted privacy that HIPAA aims to protect is preserved at all costs- even at the cost of the type of healing that can be accessed only through human connection itself.

In the amazing novel God's Hotel, Victoria Sweet vividly describes the atmosphere of the old Laguna Honda hospital in San Francisco before it was demoslished. As the last almshouse in the country, it provided open air wards and sunlit community gathering spaces for patients in need of long-term care. The building itself was modeled after Eurpean almshouses for the poor, where nuns offered free nursing care to the old, the sick, and the disabled. Sweet describes the different wards as mini-communities within the larger society of the hospital. There was the little old lady ward, and the little old man ward. Mostly, there were mixed wards whose community was not assembled based on the modern method of clustering by diagnosis, but based on selecting individuals based on mental acuity and nursing needs, which “had been good for the patients because the disabilities in any particular ward were complementary- the physically disabled watching out for the demented; the lame leading the blind, in fact.”

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Eventually, in the 1990s, as litigation became the primary factor in establishing medical policies and styles of practice, Laguna Honda was sued, repeatedly, for providing long term care to the disabled instead of releasing them back “to the community” (aka, to the streets, or to debilitated and dangerous SROs on skid row) and for violating patients' rights to privacy by housing them on open wards. Interestly, when most patients were given the chance to be discharged, or to move to private or semi-private rooms, they declined. There was an awareness that isolation is a step on the path to death, that loss of community is synonymous with loss of will to live.

 

Just like in Laguna Honda, the will to heal, live, and be well in Nepal flourishes through community, mutual support, and compassion. The traditional value of community, not privacy, is ingrained in Nepali culture and serves as a base for strength and resiliency. It is an instinctual social behavior developed for survival in the face of shared suffering, rather than a intellectually developed human right, based on the innate wisdom that as social creatures, human beings cannot thrive in isolation. All around, our distant relatives remind us of this unchanging fact of nature.

 

Which brings up the question, why, in New York, have we come to believe that we can and should thrive in isolation? Self-reliance, it is called in celebration- the opposite of the dreaded co-dependence, or, the admission that as social creatures human beings cannot escape from relying on one another to survive, thrive, and grow. Perhaps this denial of our true nature is the basis of so much of the self-loathing, anxiety, depression, stress, and insomnia that permeates our culture. Perhaps healing is the recognition that we are all connected, and by embracing that connection without fear we become the human beings we are truly meant to be.