The vast history of Oriental medicine has been crafted from the forces of nature by necessity. For most of human history, we have been largely at the mercy of our immediate environment, and our good health has depended upon keeping our bodies, minds and spirits in balance relative to what we experience around us.
These forces include the great array of natural phenomenon, from wind and heat to dampness and extremes of cold. It follows, naturally, that a system of medicine based upon thousands of years of accumulated experiential knowledge would find environmental analogies for its diagnostic and treatment systems.
Jason Luban and Isaac Goren hold clinic on the patio of a home in Horizontes, Guatemala.
These days, most of us practice our craft in clean office settings, applying ancient theories of environmental interaction to patients who, unlike their predecessors just two or three generations before, have great control over the environments in which they eat, sleep and work. Not until this past century have we had the ability to so totally control the space we live in, down to the temperature, amount of light, and even the amount and types of sounds we hear. For my part, I have always been curious as to how our modern patients, who are relatively out of touch with what it means to live and die by the forces of nature, compare in their response to treatment to those who live closer to the land. This curiosity, along with a greater interest in challenging myself and spreading the gospel according to the Nei Jing, led me to volunteer for the Guatemalan Acupuncture and Medical Aid Project (GUAMAP).
According to their literature, the Arizona-based GUAMAP "sends Spanish-speaking medical volunteers, including acupuncturists equipped with a full range of medicines, needles, teaching tools and treatment supplies, to selected villages in northern Guatemala." The mission of these volunteers is to train existing, indigenous health care promoters in the basics of Chinese medicine. Most of these lay health workers are the primary care givers in their communities, though they rarely have more than a sixth-grade education and a small amount of specialized training in basic Western medicine. The villages that GUAMAP serves are located in the jungles of Guatemala's northern Peten region, and are filled with resettled refugees from Guatemala's most recent civil war. GUAMAP sends two to four volunteer acupuncturists at a time to these communities, where each community's health promoters take in two-week courses on basic diagnosis and acupuncture treatment modalities. The courses are divided between didactic teaching and clinical hands-on experience. In my case, I was paired with Isaac Goren, an Israeli gentleman trained in five-element acupuncture in Florida. The two of us met in Guatemala, and trained health promoters in two remote villages over the months of September and October of 2001 along with Miguel Solval Gordillo, a Guatemalan health promoter and acupuncturist trained by GUAMAP. What follows are some of the observations of an American city acupuncturist getting a taste of living and teaching without the aid of electricity, running water, or a clean field.
Adjusting to Jungle Life - September & October, 2001
Jason provides basic instruction on acupuncture diagnosis and treatment to local health care promoters.
After four hours of unpaved roads in a chicken bus (so named as much for many of its occupants as the way it competed for its share of road with the other vehicles), we arrived literally at the end of the road in Santa Amelia. The village is basically just a rain forest, and the people who got there first burned out a spot for themselves. Now they live in wood and straw huts with mud floors and hammocks near a river. There is no electricity or running water (save the river), so people live according to the laws of nature. When the sun goes down, it's time to go to bed. Then the sun comes up around 5:30, and the whole town is awake (about 100 families).
The first night we were there, the animal sounds were so loud that we couldn't sleep -- pigs, lambs, cows, horses, roosters, crickets, lizards, ducks, turkeys, frogs, cats, dogs, and howler monkeys (which sound like an asthmatic taking a breathalyzer test), all at the same time. We soon became attuned to what was going on by the animal sounds. Before a big storm, the turkeys would go crazy, and then the pigs would come running through the town out of nowhere, snorting while they waited to be bathed by the clouds. Crickets started at the end of a rain, and also at night, when the heat wasn't so oppressive. Roosters, on the other hand, have no rules. They crow all the time, day and night, not just in the morning the way one would think. Perhaps these were roosters with posttraumatic stress.
I think I now have posttraumatic tortilla syndrome. For breakfast, we went to the hut of one of the village health promoters for rice, beans and tortillas. For lunch it was beans, rice and tortillas, followed by tortillas, rice and beans for dinner. Chickens, dogs and pigs came through to watch us. One night we paid some money to have some chicken for tomorrow's lunch. The next day at breakfast, the two chickens we bought -- still alive -- stared at us while we ate, waiting for their turn to join us at the table. Fortunately, I also snuck in some Nutella and a few Cliff bars to keep us from going into tortilla-induced convulsions.
Left to right: Miguel, Isaac and Jason sit down for some more beans and rice.
Isaac and I have a lot of inside jokes now. It was nice to be able to say anything in English, about anyone, in a room full of people, and only we understood. We would spend our spare time singing songs about tortillas and turkeys, or making the "chchch" sound that all the children used to try to get our attention when we walked around the village. Now, in a busy bus station or whenever we may call each other in the future, Isaac and I will likely use the "ch-ch-ch," or sing "I Eat Two Tortillas" to the tune of the old reggae song "I Smoke Two Joints" ("I eat two tortillas in the morning, I eat two tortillas at night. I eat two tortillas in the afternoon, and then I eat two more.") The song "Who Let the Dogs Out (woof-woof)" is now "Who Let the Turkeys Out (gobble gobble)".
The villagers were so amused by our constant turkey imitations that the adults would make the turkey sound when we walked by or were bathing in the river. We also came up with many new advertising jingles: "Tortillas. They're not just for dinner anymore."
While we were warned by previous GUAMAP participants not to bathe in the river for fear of caimans, biting fish, and lots of parasites, the heat and humidity made our time at the river the highlight of every day. Around 5 o'clock, when clinic was mostly over and we had an hour of light left, we'd walk with our shorts on down to the water. Within a few minutes, the children's "ch-ch-ch" and the adults imitating our turkey gobbling could be heard, and we would be joined by a small group of people who would come play with us. We swung on branches or jumped in from trees. We were definitely the most interesting thing happening for miles around. Parents brought their children to see their first "gringo," and teenagers walked us back to our room, keeping us up at night asking us to teach them English words and tell them all about America.
There are so many bugs in the jungle that they eventually don't bug you anymore. At times I wished I had a tail like other animals to constantly swat at the flies. As it was, I found myself drinking water or moosh (it's actually called that, an onomatopoeic version of maize), and just pushing the floating bugs aside to get a good gulp. We would brush the cockroaches out of our dishes before we ate with barely a thought. Night brought the mandatory spider checks for safety. The few we did see were massive poisonous tarantulas, roughly the size of a kid's head, and very fast. When it wasn't raining, the night sky was filled with a million stars, with lightning bugs flying through the gaps between heaven and earth. Some of the lightning bugs would get into our room, and one could watch them fly around in the dark until our housemate, a bat, knocked their lights out. And while I was convinced for some time that the national bird of Guatemala could be the chicken, I now feel that it should be the mosquito. I counted 85 bites on my arms and legs alone at the end of the first week.
One of the bigger realizations here included some perspective on how much time we Americans spend on our psychological hang-ups. Mazlow's Pyramid of Needs speaks of us first needing to take care of our basic needs, like food and water and shelter, before having the luxury of considering our higher psychological or spiritual journeys. Nowhere was this more apparent to me than here in the Guatemalan outback. People seemed hardly as concerned with what others thought of them; how their parents raised them; or whether or not, by marrying who they did, they might really be projecting their mother or someone else in their past. The villagers thought that all Americans just play and travel and enjoy their riches. When I tried to explain a study that said Americans work harder than any other culture in terms of hours per week, only taking two weeks of vacation per year, they were confused. It was impossible to explain the concept of work as separate from the rest of the day, and the word "vacation" did not translate into their language. If they take a few days off, or the weather gets bad, they simply do not eat. I don't mention all of this to make myself or anyone else feel guilty, only to give some perspective, a reminder to keep an open heart and a healthy perspective. These people, their material poverty notwithstanding, were some of the most kind, open-hearted and, dare I say, happy individuals I have ever been around. And perhaps, just as the terrorist kamikaze bombings in New York and Washington, D.C. have made people back home more aware of what's really important, this experience has done a great deal of that for me. We're so lucky to be alive, to have the opportunities we do. It's so easy to say it, and yet so hard to truly realize it.
The room where we slept and ate became the classroom in the morning, and the clinic in the afternoon. By 8:00 am, we were teaching the basics of diagnosis and acupuncture treatment. Afternoons were then spent applying and honing those skills in an open clinic environment. Each of the surrounding villages sent their health promoters to us to learn Chinese medicine, and each promoter told their communities that American doctors were in town. Rain or shine, people would begin lining up for the clinic in the morning, and would often wait patiently for hours to be seen. Isaac and I each took on half of the class of health promoters, and would see anywhere from 10 to 20 patients per hour. At our busiest times, patients were sprawled out all over the floor, on benches, in chairs, even standing on occasion. Women would bring their entire brood of five or six children, all with different complaints, and one of our students would translate from the patients' native tongues into Spanish, while we bounced suggestions and clinical instruction back through Spanish into their language again.
Jason listens to a student translate the concern of a mother and her four children.
People came through the day and into the night with heart attacks, gastritis, machete accidents, and a baby that had somehow found some gasoline and drank it. We often treated them by candlelight, trying to explain that they needed to go to a hospital, though there wasn't one anywhere nearby. It was sad treating so many children (at least 50% of the patient load), most of whom suffered from gross malnutrition. Ten-year-olds with the physical development of five-year-olds came in alone. Women with prolapsed uteruses were also common. The women start having children when they are about 15, and often don't stop until they can simply no longer get pregnant. One woman whom we treated daily had had a prolapsed uterus for 12 years. The oldest person I met was only 60; no wonder, given the daily hardships these people endure.
At first blush, it may sound incongruous to bring the ancient medicine of a country and culture half a world away into the Mayan jungle of the 21st century. As it turns out, traditional Mayan medicine and Chinese medicine are remarkably similar. A book on the subject, Wind in the Blood by Garcia, Sierra and Balam, speaks of Mayan acupuncture, herbal medicine, and diagnostic principles, and their similarities to Chinese medicine. For centuries, Mayan healers have been passing on a medical system with environmentally-based diagnostic concepts that, in many cases, are almost identical to their Chinese counterparts. It is especially interesting to note that Mayan medicine has used many of the same acupoints as the Chinese, and classifies herbal formulas and gives herbal treatments based on similar principles.
One of the many children treated by Jason, Isaac and Miguel.
Perhaps it was these close associations that made the people we saw in the clinic so seemingly comfortable and open to treatment. Even children sat stone-faced as we needled them. The rapid results we saw in the clinic were sometimes hard to believe. Often, after just one treatment, chronic issues would disappear altogether. Isaac and I found ourselves wondering if people were trying to be polite with us, not wanting to tell us if the treatment was not working for them. But in the end, I believe that the efficacy of treatment in this "primitive" environment had a lot more to do with Chinese medicine's energetic principles, and the compatibility of those principles with a slower, more simple way of life.
In our fast-paced Western culture, we are so overrun by our technology, our electricity. We wake up to an alarm; drink coffee to get going faster; drive like maniacs (or sit in traffic) while listening to piped-in music. We eat food that we do not make; go home after dark; and stay up late with artificial light and television. With all of that stimulation, it may take an energetic sledgehammer to get us to change. It may be that the subtle energetic art of acupuncture is more attuned to those who are in harmony with their environment. In a place where people eat what they grow, and wake and rest with the sun and the seasons, Chinese medicine has never seemed more at home.
Editor's note: The Guatemalan Acupuncture and Medical Aid Project (GUAMAP) is based in Tucson, Arizona. For further information, visit www.guamap.org, call (520) 623-6620, or e-mail
. Please note that the author does not speak for or represent GUAMAP in any way. His experiences and opinions are solely his own.
Jason Luban received his Master of Science in Traditional Chinese Medicine from the Academy of Chinese Culture and Health Sciences in 1997, and has been in private practice ever since. He currently practices in Lafayette, Calif., and teaches continuing education courses on medical communication through his site PracticeRapport.com.