NADA Acupuncture at the Al Manaar Mosque post Grenfell

To coincide with publication of the first phase of the report into the Grenfell Tower fire, Rachel Peckham, director of the World Medicine project there, reflects on the the work carried out with survivors.

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NADA Acupuncture at Al Manaar Mosque post Grenfell

The unimaginable event that was the Grenfell Tower block fire happened last year on June 14th. Nearly 80 people are known to have lost their lives. It was and remains horrific. Nearly a year later, the block stands as a crime scene only partially covered by scaffolding and white sheeting. Mental health experts say the haunting image of Grenfell against the skyline is affecting both survivors and the community. Latest reports say that 11,000 people in the surrounding areas as well as survivors will experience mental health problems as a result of this terrible tragedy.

The huge volume of help that arrived literally from the next day onwards was extraordinary and wonderful. I live and work five miles from the area and have patients and NADA contacts who were involved with that very early support. They would report how the distress was unbearable and that the chaos was very difficult to deal with. Understandably there was and is a lot of anger.

Dr Michael Smith MD DAc (1942 – 2017) was the director of the Lincoln Recovery Centre in the South Bronx, New York, and he is the founder of the National Acupuncture Detoxification Association – most commonly know as NADA. Dr Smith used the acronym NADA because it means nothing in Spanish. The NADA protocol is a simple Taoist-based concept of acting without acting. Taoist philosophy suggests that the name NADA is important, because, as Dr Smith has told us, in treating people we do a lot, maybe even too much, and we can forget that the rest of life is out there. Until you get out of things, you can get trapped by your own mind. NADA has to be simple because everything else is so complicated.

And the fire at Grenfell Tower falls most unfortunately into these latter categories. I was in admiration of the acupuncturists who were there at this time, treating and helping all who were affected – and managing to do this on the streets amidst all the chaos. At this point I was thinking of the work that had been done by NADA US following the Twin Towers attack 9/11. A NADA clinic was started two weeks subsequently at St Vincent’s Hospital in Manhattan, close to Ground Zero. I’ve been showing a short film to NADA trainees every time I run a NADA training about the St Vincent’s clinic, plus other trauma settings where NADA has been offered. The film, Unimagined Bridges, demonstrates the power of NADA acupuncture in helping to cope with trauma following a catastrophic event. This clinic ran regularly until 2010 and was open to anyone affected by the event. It showed that people chose to have acupuncture rather than counseling as they didn’t want to talk about the trauma. Reports showed that the acupuncture helped with sleep, anxiety, grief and generally enabling people to feel a sense of calm. Plus it brought communities together as people sat quietly in a group all having acupuncture treatment for a common cause.

I began to have telephone conversations with Alison Gould chairperson of World Medicine Charitable Trust, and we spoke about the possibility of a collaboration between NADA GB and World Medicine (WM) to set up a volunteer service delivering NADA treatments. I also spoke to Gisela Norman and later on Sheira Kahn who were among the first responders of acupuncture and did such a remarkable job in terrible conditions. They went on to head up Emergency Acupuncture, a large body of volunteers which preceded the NADA clinics we began delivering four months after the fire.

Emergency Acupuncture had established a venue at the Al Manaar Mosque in North Kensington and had been given a room for delivering acupuncture treatments. The mosque wanted to continue the service as they had seen the benefits acupuncture treatment was bringing to the survivors and to the Grenfell community. This was clearly something NADA could offer, so early in August last year Gisela set up a meeting with myself and Mr Sayed, CEO at the Mosque. We agreed to start a weekly NADA clinic there and committed to run clinics for a year provided the service was taken up. The clinics started on 3rd October and have been running weekly on Tuesday mornings ever since.

Later in August, World Medicine held a NADA training day for BAcC members who wished to volunteer at the then future NADA clinic at Al Manaar Mosque. I ran the training which was free of charge. All the World Medicine trustees at that time were there plus eight attendees, a few of whom had already volunteered at Grenfell under the auspices of Emergency Acupuncture.

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So what is it about NADA acupuncture which makes it so suitable for helping in this situation? The obvious reason is a practical one. One or two practitioners can give between twenty and thirty treatments in a two-hour session, provided the space will fit that amount of people seated. It is low cost and easy to administer with minimal consultation required. People don’t have to remove any clothing to receive NADA acupuncture. This aspect is entirely relevant in this situation as a proportion of people receiving treatment at the mosque are Muslim women who can simply tuck their headscarf behind their ears ready for treatment.

The most common feedback from people receiving NADA acupuncture is that they find their sleep improves if they have a disrupted pattern; they feel less anxious; they experience improvement in mood (feel happier); and their tension decreases which often manifests in aches and pains in the body. The NADA treatment generally induces a state of relaxation and better energy—it has a balancing and homeostatic effect on the patient enhanced by the unique group setting.

A very important advantage of this group treatment is that it is non verbal.

Minimal consultation is needed prior to giving the treatment. The patient is asked a few questions about their medical history and current health before receiving their first treatment, and then they are subsequently considered (consequently) fine to receive treatment (thereafter). The practitioner doesn’t need to know about symptoms or their story. This might be something the patient will disclose after the treatment should they wish to do so. There is a counseling service available at the mosque which we could refer patients to if needed.

As mentioned previously, it has been observed that following a trauma, when given the choice of support, people choose to go for acupuncture rather than a verbal therapy. Counseling would perhaps be more valuable when the shock has subsided after a period of time. The non-verbal aspect of NADA acupuncture is also beneficial for the practitioner as the clinics are quiet and peaceful and talking is discouraged. This is unlike a one–to-one session where patients are invited to talk.

Many practitioners including myself are not trained in trauma counseling – the risk in this context is getting out of one’s depth and being overwhelmed by the horrific events suffered by the patient(s) and the acutely distressed nature of their presentation. As Dr Smith has told us, “There are times when verbal interaction is like trampling on the flowers”.

Dr Smith said these words in a keynote speech at the NADA annual conference held in Michigan, 06/06/2009:

“I have just two concepts I want to introduce about our work.

The first is that NADA acupuncture, and you could say acupuncture in general, is what you call a foundational message. It's a message to the most basic part of the person. Therefore it’s not a message about disease. It's not a message about addiction. It's a message that says: You’re still alive. You’ve been alive. And now we’re going to talk about the most real part of your life, which is: What picks you up? What keeps you going? What is always safe and healthy and what always renews?

You have business that doesn’t renew, friends that don’t renew, ideas that don’t renew, and all sorts of other things that change. And yet our own inner spirit can be reached by acupuncture, even by a practitioner who has no idea what they are doing with acupuncture. Our own inner spirit can renew in a safe and productive way, all the time, every day. And why should anyone with a hard life believe that could be possible?

Now, the second part of what I want to talk about is not just that the treatment works, it is that ear acupuncture is a socially dominant treatment. That’s very important. We’re not talking just about 10 people in Kenya. We’re talking about 18,000 treatments in six months. Yes, there are a lot of fads, there are a lot of things that are curious. But they are not 18,000 treatments in six months when nobody was counting. It was done because it made sense to do it. We hear that acupuncture is used in a prison in England and say ‘Wow!’ But No, it’s used in 130 prisons in England! The social dominance of ear acupuncture has meaning for the world.”

The mosque has provided one of their conference rooms for the NADA clinics. All volunteers need to meet the following criteria in order to be eligible to deliver treatment. They must:

  • complete the World Medicine volunteer application form;
  • be an appropriately qualified acupuncturist with NADA training;
  • be appropriately insured via a member organisation;
  • hold a current DBS certificate, or apply for one with World Medicine;
  • have a phone- or in-person interview with the project leader (Rachel Peckham); and
  • attend a trial session at the mosque.

The NADA protocol is a very specific protocol with a code of safe practice ensuring excellent standards of safety which must be adhered to at all times. This has been developed through many years of established NADA clinics, within drug/alcohol rehabilitation in particular. The client group in this context is chaotic proving a large consideration regarding safety, therefore experience has informed the NADA Code of Safe Practice.

For acupuncturists, learning and needling the five NADA points is relatively straightforward, but it is the handling, removal and retrieval of the needles which is very different from one-to-one practice. Plus the environment has to be conducive to large groups of people seated and having acupuncture, i.e., suitable chairs, appropriate flooring, a well-ventilated room, etc., and a clean field for treatment. The focus during the NADA training is on the procedural aspect of this treatment to ensure the safe handling and retrieval of the acupuncture needles. Large volumes of acupuncture needles are used per session. For example, if there are 25 patients over the period of a two-hour session this would incur the use of 250 or more needles. It is essential that we have procedures in place which ensure that all needles are accounted for and that the client and practitioner are safe at all times.

Confidential records are kept for each patient noting the auricular points used at each session with a written documentation of acupuncture needles used and acupuncture needles retrieved at each session. This, along with other measures put in place for needle count, ensures that no needles will go missing.

World Medicine are providing all the equipment for the clinics, and the acupuncture needles purchased by World Medicine are being matched free of charge by Phoenix Medical. Two practitioners run the Tuesday morning session between 10 am and midday. Currently the numbers vary from 10 to twenty-five people each session. Mosque doors are open to everyone, but it is generally mosque users who come for treatment as their community have been badly affected by the fire.

As it is customary for Muslim men and women to be in different rooms, we have the main space dedicated for female clients (women form the majority of patients so far), and a smaller space in the waiting area for men. This has worked well as at present all the volunteers giving treatment have been women. Some of the female patients do wear the headscarf and are not able to remove them in the presence of men. A difficulty we have experienced is being unable to keep the door to the room open if there are no seats available out of the view of the hall outside. We prefer to have an open door policy as often people like to look in and see what’s happening which invariably gives them confidence to come in and try the acupuncture. We have posters outside the clinic room as well at the entrance to the Mosque.

The mosque managers and receptionist very much value our presence and the contribution NADA is giving to the community. Consequently they are very pro-active in encouraging anyone in the mosque to have acupuncture, and they work hard at spreading the word via prayer meetings, their facebook page and all the organizations they are linked with. On a Sunday in February, Al Manaar Mosque, along with 200 other mosques in the UK, took part in a national ‘Visit My Mosque’ day. This was to invite anybody, especially newcomers into the mosque by holding an open day of activities. NADA had a stand at this event and two volunteers gave out treatments to visitors. We are constantly being invited to events at the mosque which link up with outside health organizations to promote the clinics. This is a great opportunity which is often not able to be taken up because of time constraints.

Data collected up until the end of March over a 24-week period shows that the NADA clinic has seen 126 patients and given 322 treatments. Of these, 110 are female and 16 are male. Initially we were only collecting people’s names for our records. At the end of last year, the clinic began attracting positive outside attention. I had a meeting with a Kensington and Chelsea counsellor with the view to applying for potential funding for the clinics, plus another space to offer NADA acupuncture outside of the Mosque to reach the wider community. We were advised that we needed to collect more information from our patients, i.e., age, gender and postcodes. With permission from the mosque we began to collect this information as from January this year. I will stress that this is just a snapshot of the work that has been done so far as we have only recently begun to collect the following data:

 

Number of Treatments Patient Received
10+ 8 or 9 6 or 7 5 4 3 2 1 Total
Male 1 0 1 0 1 2 3 8 16
Female 3 4 6 5 5 11 16 60 110
Total No. of  Patients 4 4 7 5 6 13 19 68 126
Total Treatments 48 34 46 25 24 39 38 68 322
 

Out of 126 patients, 68 only visited the clinic once (54%). 39 patients had 3 or more treatments.  Figures for 10 + is based on 12 treatments, 8 or 9 is based on 8.5 treatments, 6 or 7 is based on 6.5 treatments.

As with all NADA acupuncture groups it takes a while for the quiet ‘yin’ environment to evolve. Initially people chat, have their mobiles out, use the room as a throughway to the Pilates class, gym, etc. With the help of constant reminders from the practitioners, the quiet space soon became important to the patients and they got it – that this was an integral part of the treatment. Recently one of the patients knocked loudly on the wall to quieten a Pilates class that was going on next door! Plus patients will get annoyed if others are talking and ask them to be silent.

There are a group of people who come in very regularly and set the mood by sitting in a meditative state for 40 minutes which is the optimum time for this treatment. This makes a strong statement for newcomers as well as showing them what to do. It also sets an inviting, welcoming energy so that people feel they can be part of the group without having to do or say anything.

I was given a testimonial recently which I think highlights the added dimensions NADA brings. The following was written by a senior member of staff at a long established homeless shelter in London:

“Acupuncture was an amazing experience, unlike anything I’ve done before –  at the end I felt seriously relaxed. While I was sitting there with the needles in, it struck me that what Jane, the practitioner, was actually doing with clients was teaching and building trust. Sitting in the dark with your eyes closed in a roomful of other people could be a huge step for a lot of our clients, let alone having someone stick 10 needles in your ears!

It occurred to me that I had never shut my eyes in the same room as clients before, and that was also an act of trust. A big part of how Jane does this is definitely her reassuring manner and the time she takes with everyone. She supported myself and the clients exactly the same.

I was telling everyone I saw about my experience of acupuncture for the rest of the day. I felt incredibly grateful to have the opportunity to try something like that while at work, and humbled by the fact that we offer something to our clients that is usually inaccessible to a lot of people.”

The patients ages range from young to fairly elderly. From observation, the majority are 50+ with a large proportion over 60. Due to the later additions to information on our patient forms, we only have data for 25 patients most of them being over 60 years.

 

Patients Treated by Age Groups
No Age Recorded Under 30 30 - 39 40 - 49 50 - 59 60 plus Total    
Male 15 0 0 1 0 0 16
Female 86 0 4 4 2 14 110
Total Patients 101 0 4 5 2 14 126 126
   

In terms of finding out where our patients are living, we only have postal information for 60 patients so far. Of these only 32 (53 percent) are from the Kensington and Chelsea Borough.

As NADA is a non-diagnostic standard treatment, we don’t ask specific questions other than the necessary medical information required before somebody has treatment for the first time. However, patients will often volunteer information if they have underlying conditions such as diabetes, hypertension, arthritis, etc. So we make a note of that. Some of the patients don’t speak English which could potentially present problems. Until now we have had either a staff member or another patient in the group able to translate if needed. We wanted to begin to record outcomes of the treatment so have recently begun to ask patients the following after each treatment: Whether there has been no change; some improvement; significant improvement; fully recovered.

Of course this is non-specific, i.e., not related to a main complaint so we ask patients how they feel in a general way. We have had some surprisingly enthusiastic responses from several regulars who have said they feel fantastic, have renewed vigour and feel happier. Some of them literally skip out of the room after treatment! Others have said that it helps them feel less stressed, less anxious and that they are sleeping better. A few who have been attending every week for some time and sit quietly saying nothing, tick the ‘fully recovered’ box at the end of the session and look happy.

 

Outcomes  
No Outcome Recorded Fully Recovered Significant Improvement Some Improvement No Change Totals
Male 12 0 0 4 0 16
Female 78 3 12 15 2 110
Total Patients 90 3 12 19 2 126 126

The issue regarding the data above is that for 71 percent of patients that have received treatment since October last year, no outcome is recorded. On a positive note, where we have the outcome information, 31 patients have said they felt some or significant improvement in their well being.

To conclude, the NADA acupuncture clinics are making a difference in the community as has been illustrated in the snapshot of data collection so far. Patients are returning for treatment, some every week. A large proportion are reporting it is helping them. The clinics seem to have become an established provision of help for mental health well-being at the mosque. We have only had to cancel a clinic once since October due to a volunteer not being well enough to deliver treatment, and the service was missed that day.

We have a pool of 17 volunteers with around seven or eight regular practitioners, the main difficulty being time constraints and availability for practitioners. All the practitioners so far report a very positive and rewarding experience delivering the NADA treatment at the mosque. It is a unique and unusual setting in which to provide acupuncture treatment, and the patients are so grateful and appreciative. For the practitioner, it offers a very different experience to the treatment room. Most practitioners report feeling energized and moved when delivering the acupuncture and being a part of a containing environment which brings people together for a common cause.

Dr Smith would understand this very well – he has told us that “acupuncture gives practitioners a unique privilege.  We are able to work with a partner (the living human body) that has much more capability than we do.  Most health care methods focus on substances or activities that act on the body.  Practitioners of these methods must rely only on their own knowledge to determine the appropriateness and limitations of the treatments being provided.  Hence an obsessive need for control dominates most health care.  Acupuncture and other Qi-related therapies transcend these limitations.”

We are currently researching more venues to set up another NADA clinic in the wider community. Even though Al Manaar Mosque welcomes anybody through their doors, we realize that the people we are treating are mostly mosque users. The mosque is unusual in that it has welcomed and hosted an acupuncture service within the premises with no cost involved. I believe this happened largely because they witnessed the benefits of the acupuncture given in the early stages immediately after the fire, as they opened their doors to host all kinds of support for the survivors of the fire and the community.

Challenges we face now are initially to find public venues in the Grenfell vicinity where we can provide another clinic and reach the wider community. This will need to be low cost or free of charge. We are working on this and have already inspired interest. We have visited a few places but, as always, our resources are limited in terms of follow-up. We will also be putting a funding proposal together using the data collected which is a time-consuming task, but people are coming forward to help with this.

To finish for now, more words from Dr Michael Smith about how NADA acupuncture meets global needs:

“NADA provides social integration with other services. Apprenticeship training is always necessary because the clients are often troubled and distracted. NADA is a non-verbal approach. There are no diagnostic procedures. The ear points provide a balancing effect: some people fall asleep, some feel relief of depression, and some seem to be meditating.  These balancing effects continue from one to several days even though the patient may be exposed to contrasting emergencies during that time. It is a coping and preventive effect. NADA acupuncture helps the body help itself. It is not a dominant process – it is supportive and integrative, and it adds a valuable component to the behavioral health fields.”

We always welcome more volunteers, as practitioners , admin support and organisers and will be putting together more data as time goes on.