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October 2002, Vol 92, No. 10 | American Journal of Public Health 1597-1598
© 2002 American Public Health Association

RESEARCH AND PRACTICE

Providers of Complementary and Alternative Health Services in Boston Respond to September 11

Elizabeth Sommers, MPH, LAc, Kristen Porter, MAc, LAc and Stephen DeGurski, MPH

Elizabeth Sommers is with the AIDS Care Project in Boston, Mass. Elizabeth Sommers, Kristen Porter, and Stephen DeGurski are with Pathways to Complementary Medicine, Boston.

Correspondence: Requests for reprints should be sent to Elizabeth Sommers, MPH, LAc, AIDS Care Project, 140 Clarendon St, 7th floor, Boston, MA 02116 (e-mail: bsommers{at}pathwaystcm.org).


   INTRODUCTION
TOP
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
Traumatic events such as the September 11, 2001, attacks on the World Trade Center can have profoundly stressful effects on individuals, even if they are far from Ground Zero.1 Responses to this type of stress can manifest both psychologically and physically with a variety of complaints, such as insomnia, anxiety, body aches, digestive upsets, and poor concentration.

A number of researchers have described the use of complementary and alternative medical (CAM) treatments, such as acupuncture and massage, for stress-related complaints.2–4 Following the attacks in New York City, groups such as the Professional Acupuncturists’ Response Team (PART) and Community Relief and Rebuilding through Education and Wellness (CREW) offered support services to firefighters, police, emergency medical technicians, and other rescue personnel.5,6

In Boston, stress reduction clinics were offered by Pathways to Complementary Medicine, a nonprofit urban public health CAM clinic. Pathways’ services were developed to complement those of the AIDS Care Project, which has been in operation since 1989. Volunteer acupuncturists and massage therapists provided free stress reduction treatments to individuals who reported that they were seeking CAM services to deal with some type of stress-related complaint related to the attacks.


   METHODS
TOP
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
Following September 11, Pathways organized a series of stress reduction clinics that were offered on Sundays in September and October, at times when the clinic is generally closed. These sessions were structured on a drop-in basis. Individuals affected by the attacks and their aftermath could come to the clinic for free 30-minute treatments. If openings were available, individuals could receive more than 1 type of modality.

The Integrative Medical Alliance (IMA), a Boston-based group that offers a variety of educational and networking activities for CAM professionals, provided its mailing list and Web site for organizing efforts. More than 40 volunteers responded; these professionals included acupuncturists, massage therapists, and other body workers. Volunteers were required to have either a valid Massachusetts acupuncture license or a valid certification for their specific type of therapy.

Public outreach efforts included flyers, newspaper announcements, e-mail messages, and Web site–based information. The message contained in all of the outreach material explained that free sessions of acupuncture and massage would be available for stressrelated conditions experienced in relation to the events of September 11.

Intake procedures were designed to be user friendly for people seeking treatment as well as for volunteers. An intake form collected demographic information, the reason(s) for requesting treatment, and the type of treatment requested. All clients signed an informed-consent statement indicating that they were to receive a sample stress reduction treatment. Written parental consent was collected for each client aged less than 18 years.

Fifteen acupuncturists, 4 reiki practitioners, 4 massage therapists, 1 shiatsu provider, and 1 Polarity therapist provided treatments. Providers recorded each treatment administered as well as specific information on the treatment such as acupuncture points used, type of body work or massage provided, and comments. Acupuncture treatments included points on the ear and easily accessible points on the arm and lower leg.


   RESULTS
TOP
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Forty-seven individuals attended the clinics and received services; 43 (91%) had never used Pathways’ services before. Each 4-hour clinic provided treatment to 14–23 individuals. Of the total, 36 (77%) were female and 11 (23%) were male. Individuals ranged in age from 6 to 60 years with a median age of 30 years (mean = 35.4 years); 2 were aged less than 18 years (6 and 12 years). Thirty-five (77%) of all clients were White, 7 (15%) were African American, 3 (6%) were Latino, and 2 (4%) were Asian American.

Figure 1Go details the reasons individuals requested treatment. Individuals could report multiple reasons for treatment, and 30 individuals (64%) listed 2 or more stress-related complaints. However, only the first reason given by each is shown and included in Figure 1Go. A total of 81 treatments were provided during the clinic sessions. Of these, 51% were acupuncture (reflective of the fact that most of the volunteers were acupuncturists), 15% were reiki sessions, 12% were shiatsu, and 9% were massage. Tui-Na, Polarity, and acupressure made up the remaining treatments.



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  		FIGURE 1 —Reasons given by individuals (n = 47) who requested and received CAM treatment for self-described stress-related complaints.

 
Twenty-four (51%) clients received 1 treatment, 16 (34%) received 2 treatments, and 7 (15%) received 3 to 6 treatments. At least 8 individuals indicated that their treatment at the clinic was their first use of CAM therapy. Although no formal evaluation of treatment efficacy was conducted, 12 clients who received more than 1 treatment reported the following responses: improved relaxation and sleep (33%), pain reduction (25%), reduced stress (17%), and increased energy (25%).


   DISCUSSION
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
Following September 11, CAM therapies have played a role in the treatment of posttraumatic stress and crisis support. CAM offers another avenue of supportive care that can be mobilized to respond to critical public health and safety emergencies. Services at Pathways’ free clinics were requested for a variety of stress-related conditions by a diverse group of individuals, many of whom had not previously used CAM. As consumer demand for CAM services continues to increase,7 areas of innovative collaboration with public health colleagues can correspondingly develop, resulting in mutually rewarding partnerships that contribute to public health and well-being.


   Acknowledgments
 
We would like to thank the CAM volunteer providers who staffed the clinics: Madelow Amburg, Marcia Chartier, Julie Cormier, Valerie Courville, John Coville, Ann Driscoll, Anne Drogin, Benjamin Hawes, Julia Herskowitz, Mary Kinneavy, Irene Martyniuk, Jeff Miller, Joyce Nemser, Jennifer Otte, Tony Phillips, Judith Poole, Stephanie Prady, Nancy Pressler, Alison Quiring, Bella Rosner, Janet Ruggeri, Marjorie St. Paul, Elaine Scaramoutzos, Edie Snow, and Huang Hu. We appreciate the help of Susan Columbaro and Maureen Jordan, students from the New England School of Acupuncture, in compiling the data and preparing the report. Thanks also to Health Resources Network and its programs, Pathways to Complementary Medicine and the AIDS Care Project, for use of their clinic and facilities.

Human Participant Protection
Record review was conducted under the auspices of Health Resource Network’s Human Protections Administrator.


   Footnotes
 
All contributors made substantial contributions to the article. E. Sommers was responsible for planning the study, compiling the data and results, and writing the first draft of the article. K. Porter implemented the project and provided valuable editing and insight. S. DeGurski contributed to writing and editing the article.

Peer Reviewed

Accepted for publication June 7, 2002.


   References
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Schuster MA, Stein BD, Jaycox L, et al. A national survey of stress reactions after the September 11, 2001 terrorist attacks. N Engl J Med. 2001;345:1507–1512.[Abstract/Free Full Text]

2. Roth B, Stanley T. Mindfulness-based stress reduction and healthcare utilization in the inner city: preliminary findings. Altern Ther Health Med. 2002;8:60–66.[Medline]

3. Fairfield KM, Eisenberg DM, Davis RB, Libman H, Phillips RS. Patterns of use, expenditures, and perceived efficacy of complementary and alternative therapies in HIV-infected patients. Arch Intern Med. 1998;158:2257–2264.[Abstract/Free Full Text]

4. Eisenberg DM, Kessler RC, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246–252.[Abstract/Free Full Text]

5. Toomin R. Treating many where treatment is needed most: current and historic use of acupuncture for post-traumatic stress and crisis support. Acupuncture Alliance Forum. Winter 2001–2002:10–17.

6. Golden K. The phoenix rises from the ashes. Acupuncture Society of New York. Available at: http://www.asny.org/javitz.asp. Accessed February 5, 2002.

7. Pelletier KR, Astin JA. Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis. Altern Ther Health Med. 2002;8:38–48.[Medline]




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