Acupuncture in the Global Village: Experience of the PanAfrican Acupuncture Project in Uganda

The goal of the PanAfrican Acupuncture Project (PAAP) is to improve the health and quality of life for individuals living with HIV/AIDS in Africa. Through training local health care workers to use simple and effective acupuncture treatments, communities can add these resources to their strategy for improving public health. At the invitation of public health colleagues at Makerere University in Kampala, Uganda, PAAP designed a training program that emphasized and integrated considerations of mind, body and spirit. The first session was held approximately one year ago, and included an intensive two-week curriculum designed by acupuncturists trained by the National Acupuncture Detoxification Association, who are also involved with the AIDS Care Project in Boston; a second level of training to enhance this curriculum was held several months later. Both trainings emphasized treatment for common and highly prevalent conditions associated with HIV/AIDS such as body pain and neuropathy, night sweats and fever, insomnia, menstrual problems, weight loss, depression, and fatigue. Protocols for treating people diagnosed with tuberculosis and malaria were included.

The training incorporated didactic elements, such as discussion of the origins of acupuncture and Asian medicine, as well as point location and indications for using various point combinations. Issues of the body and spirit were addressed through practice by having students treat each other, as well as learning exercises on tai qi and qi gung. The trainees were enthusiastic about the learning opportunities; they enjoyed and benefited from the daily group practice and reported that they were experiencing improvements in their individual health and stamina.

Thirteen health care workers participated in PAAP's first training program. The group included physicians, physiotherapists, nurse-midwives, and a traditional healer. Patients came from both urban and rural areas. The principle organizations providing leadership and support included The AIDS Support Organization (TASO), Women Against AIDS in Africa (SWAA), and THETA, an association of traditional healers and medical doctors.

The response to participate in the training was enthusiastic and demonstrated the health care workers' high level of motivation to develop their skills. Taking time away from their jobs, traveling to the classes, and devoting themselves to training represented significant dedication and sacrifice that inspired the trainers and their colleagues.

Even without formal solicitation or advertising for patients, numerous individuals came for treatment each day. The level of acceptance for this type of treatment was high, despite the fact that acupuncture is not a common form of treatment in Uganda. The entire country has only a few acupuncture providers, all of whom work in private practice, which makes it inaccessible to most Ugandans living with HIV/AIDS.

Although the success story of Uganda in addressing the AIDS epidemic is inspiring (it was the first country anywhere in the world to actually reverse its prevalence rates through an intensive educational campaign conducted at every level of the government and private sectors), approximately 95 percent of those diagnosed with HIV/AIDS are without medication. This fact helps to create an opportunity to introduce acupuncture not as a cure for AIDS, but as a means to prolong the lives and enhance the health of people until medication becomes available.

Preliminary data on utilization and efficacy include information on 218 individuals who received treatment. One hundred fifty-seven (72 percent) were female, and 61 (28 percent) were male. Ages ranged from eight months to 78 years of age, with an average age of 34 years. The most prevalent conditions were gynecological symptoms, and conditions related to TB and malaria. Over half of the individuals treated reported moderate to significant improvement.

Trainers included Richard Mandell, founder of PAAP (Boston), Alison Quiring (Chicago), and Debi Shargel (San Francisco). All commented on the dedication and passion of the trainees to learn and share the simple, yet powerful therapeutic value of acupuncture. "One of the most important lessons for me was seeing how helpful a simple acupuncture treatment could be for sensitizing the practitioner to a focus of care that is wellness-based and expands treatment options. I was inspired by patients' responses. Treatments brought them to the health centers more frequently and seemed to give both patients and providers a more active, empowered stance on wellness and health," Quiring commented.

PAAP will continue to nurture its roots, and plans to provide training this summer for a new group of health-care providers in rural Uganda. PAAP will also provide ongoing educational support to the first cohort of trainees in Kampala.

Mandell has been moved by the "simplicity of what we are doing, trying to reduce pain and suffering. It extends back to 3,000 years ago in China." For him, "PAAP represents nurturing by NADA and work in substance abuse treatment. The treatments bring tranquility and calmness to the noise of HIV/AIDS, reminding us that healing and change are always possible and available."