Asheville is the health care hub for Western North Carolina, and Mission Health is a major presence, dominating a swath of town that’s thick with doctor's offices.
Since 2009, however, this bastion of mainstream medicine has boasted an Integrative Healthcare Department whose staff includes nurses trained in aromatherapy, massage, guided imagery and biofeedback. The staff physician works alongside an acupuncturist and a musical therapist; massage, yoga and tai chi are offered as outpatient services. In the last three years, the department has seen some 19,000 patients; it now averages 40 to 50 consultations a day.
“It's really about what we can do to enhance the patient's experience,” Lourdes Lorenz, the department’s director, explains. “We look at the patient as a whole. We look at their mind and body to maximize the healing process.”
Thoroughly trained in conventional medicine, Lorenz has spent three decades in the field, including a stint as a critical care nurse. To her, integrative health care is just another way to make sure the patient heals; accordingly, she dislikes the term “alternative.”
“Alternative means ‘instead of’; this is a combination,” Lorenz points out. “What we introduce into the hospital has been proven to work. It's all evidence-based.”
Changing timesIt wasn’t always like this. When Cissy Majebe founded the Chinese Acupuncture Clinic in 1985, she faced skepticism and outright hostility from the established medical community and the public alike.
“When I first moved to Asheville, if I told people that I was an acupuncturist, they were surprised,” Majebe remembers. “They'd never met one; they hadn't even heard of it. It was out of the mainstream knowledge base.”
And while there were some supportive physicians back then, many warned their patients against acupuncture, Majebe recalls. She received critical letters from physicians and was even raided by the State Bureau of Investigation. Majebe and others fought back, however, and in the early ’90s, North Carolina established its Acupuncture Licensing Board.
Today Majebe’s clinic has seven full-time acupuncturists and offices in Asheville, Hendersonville and Waynesville. “Acupuncture is probably the alternative practice most widely accepted by the Western medical community,” she notes. “It's changed dramatically for most of the physicians here.”
Lorenz, too, has seen a sea change in the medical establishment’s approach to its onetime rivals. “More and more hospitals,” she says, “are incorporating [such practices] into their programs. I think primarily it was driven by the public,” which has increasingly gone outside the mainstream for treatment.
The tipping point“When you look at the cost, the burden of chronic illness in this country is getting worse,” Lorenz points out. “Stress is a huge factor in disease, and that's where this mind/body modality really helps.”
Nonetheless, obstacles remain. Many insurance providers don't cover integrative health care: Mission's own insurance program, for example, covers acupuncture, but in North Carolina, Medicaid and Medicare don't. Meanwhile, VA hospitals now incorporate the practice in treating pain, Lorenz notes.
“I think we've reached a tipping point: It's finally getting looked at.”
Majebe agrees. “I would say in 10 years, 50 percent of the people coming out of acupuncture colleges will go to work in mainstream health care settings,” she predicts. “When I came out of school 30 years ago, no one was getting a job in mainstream medicine.”
and what skepticism remains merely reflects the need for “more research to show that these practices do help people,” Lorenz asserts. “I don't see it as an obstacle: I see it as a dance.”
But patients, she adds, often “want that quick fix: They want a pill.”
Besides treating patients, Mission's Integrative Healthcare Department also gathers massive amounts of data to better analyze a given modality’s effectiveness. “There are things that really don't work, and if they don't work, let's not do them,” says Lorenz.
Even at the local level, there’s an information deficit. Buncombe County's 2012 Community Health Assessment, for example, measures residents’ access to various parts of the health system, such as cardiac care and psychology, but it doesn't include alternative practitioners.
Lessons learnedMeanwhile, even though Majebe is pleased by the medical community’s increased receptiveness to her work, she wonders whether the two approaches are being treated as equal partners.
“Anytime you have an integration you have positives and negatives,” she notes. “There may be some watering down or loss of some parts of Chinese medicine. We're being asked to come into their system and integrate, rather than two systems being asked to see the strengths of each one.”
Lorenz, however, believes it’s a two-way street. Influenced by the “patient-centered” focus of many of the practices her department uses, mainstream medical professionals are paying more attention to “trying to be a healing presence,” she points out. As a result, patients “are going to be more comfortable, and whether it's the placebo effect or the fact that they're relaxed enhances the medicine they're receiving, why not?”
And as the integrative approach continues to gain ground in Asheville, notes Lorenz, the city’s abundance of both traditional and alternative practitioners could help it become “a model for the country.”
At the end of the day, though, it's the healing she sees that most impresses her.
“The other day, our musical therapist was playing the harp, and a person in the waiting room starts humming, and then another person, and then a third person. There was a three-part harmony in an emergency room.
“That is amazing to me. If we can bring that sense of comfort to people when they're in a crisis, that's what we're here for: to help people.”
David Forbes can be reached at 251-1333, ext. 137, or at firstname.lastname@example.org.