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Meeting the minds | Richard Mandell, Acupuncturist

He trains Ugandans to use acupuncture

Brookline specialist takes needles, hope to the heart of the African AIDS epidemic

IBANDA, Uganda -- At a health center in this tiny rural community in southwestern Uganda, an HIV-positive pregnant woman rests on a thin foam mattress supported by a rusting steel bed frame. Needles 15 inches long protrude from her legs, ears, and chest. Leaning over her, a young Ugandan man in an ironed white shirt and brown dress pants waves a smoldering stick of moxa, a sweet-smelling medicinal herb.

The practitioner is not a traditional African healer, and the woman is not undergoing some folk medicine treatment -- at least not a Ugandan one.

She is receiving traditional Chinese acupuncture, and the Ugandan nurse administering it is a trainee of the Pan-African Acupuncture Project, an organization based in Brookline. Since 2003, acupuncturists volunteering for the project have traveled to this impoverished nation to teach acupuncture to health professionals who treat patients for many of the complications associated with HIV/AIDS.

Richard Mandell, 54, a teacher at the New England School of Acupuncture, created the non profit four years ago in response to the overwhelming number of people infected with HIV in Africa. He had watched his Boston patients with HIV/AIDS respond positively to acupuncture, and he began to daydream about going to Africa to treat people in need.

"I felt like I had to go. And then I thought, this is silly, one person can't change Africa," he said with a smile.

His program was born a year later.

Instead of flying to Africa to help the afflicted by himself, he decided to train African healthcare workers to practice acupuncture themselves. "I wanted to empower them so that they have the knowledge," he said.

Mandell wrote a manual that simplified instruction, directing students on how to find acupuncture points on the body and how to use needles. The manual enables students to practice acupuncture even if they don't understand why a specific point correlates with the particular ailment. The program has trained 120 Ugandans in three districts.

On the small dirt street outside the health center, children duck and play, yelling "muzunga," meaning "white people," when they spot the seven licensed acupuncturists who come from Boston for two weeks. The visitors will train 15 nurses, midwives and other healthcare workers to use acupuncture for the symptoms of HIV/AIDS and for the side effects of antiretroviral therapy.

Inside, the trainees move about the room, holding their manuals and consulting maps of the body. Some work in pairs while others are confident enough to talk with a patient, choose correct points, and treat individuals on their own.

The pregnant woman on the bed smiles as the Ugandan nurse removes the acupuncture needles. He converses with her quietly and quickly in her native tongue, encouraging her to visit the hospital 2 miles north for prenatal antiretroviral drugs that would greatly reduce the risk of passing her infection to her unborn child. She agrees and leaves the center with a shy thank you.

Uganda, by most estimates, has more than 1 million people with HIV/AIDS, out of a total population of about 28 million. Mandell said he chose Uganda, where the average annual salary is $280, for the acupuncture project because health officials were the most responsive of all the Sub- Saharan African countries he attempted to contact.

Introducing acupuncture into a poor country with tremendous sickness has many benefits, he said, including economic. Acupuncture is cheap. After training, the only supplies needed are the inexpensive needles, some cotton balls, and the moxa (artemis vulgaris), an herb that can be grown locally and used to heat up the needled areas and encourage energy. It costs $6 to treat one patient once a week for a month, he said.

Western medical studies support the idea that acupuncture can help those with HIV/AIDS. According to the National Institutes of Health, acupuncture significantly helps chronic diarrhea and insomnia, two recurring symptoms often experienced by HIV patients.

Believed to have originated in China more than 2,000 years ago, acupuncture is one of the oldest, most commonly used medical procedures in the world. At its most basic, acupuncture is the act of placing thin needles into specific points on the body.

According to Chinese medical theory, the body is full of invisible channels that circulate energy, called qi, throughout the body. The acupuncture points are believed to be the locations where the qi rises close to the surface, and the treatments work, according to Chinese medical theory, by normalizing the free flow of qi throughout the body.

When villagers hear that Westerners are in town offering a free treatment, the word spreads like a brush fire. Each day, almost a hundred people show up -- some with HIV/AIDS, some with other ailments -- and wait patiently to be seen and "pricked."

On the clinic's designated HIV/AIDS day, a lanky 6-foot shoeless man stood up and greeted stands up and greets Mandell. He says he received an acupuncture treatment in December, and afterward , he felt more alive. He delivers his testimony to the crowd, and people listen.

David Koojo, a health counselor from the Virika Hospital four hours away, did his third and final training with the Boston group this spring. Although he has been using Western medicine for the past 15 years, he said he has no reservations about incorporating acupuncture.

"We have tried Western medicine; let's try Chinese medicine. From what I've seen, very many people have been to hospitals [and their] pain has not been relieved. Here, I've seen results in a single day," he said, while treating a patient with an enlarged spleen. He thinks acupuncture, which doesn't have the side effects of Western medicine, should be accepted as another way of relieving pain.

"Perhaps Western medicine is partly working and partly failing," he said.

Mandell hopes to expand his program ( to Malawi and other African nations.

"We aren't claiming this to be a cure -- we are doing it to improve quality of life," he said. "It's not a miracle. I wish it were."

(Correction: Because of an editing error, a story in Monday's Health & Science section about teaching acupuncture in Uganda incorrectly described the needles used in a procedure to treat a patient's knee. Fifteen one-inch needles, not 15-inch needles, were inserted in the patient.)