Vuk Stambolović1*

1 Medical Faculty in Belgrade, Serbia.

*Corresponding Author: Vuk Stambolović, Medical Faculty in Belgrade, Serbia, TEL: 381 11 2432398; FAX: 381 11 2432398; E-mail:vukstambol@gmail.com

Citation: Vuk Stambolović (2019) The social acupuncture. Medcina Intern 2019 3: 138

Copyright: :© 2019 Vuk Stambolović, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Received date: December 19, 2019; Accepted date: December 26, 2019; Published date: December 29, 2019.

Human beings are beings of development which is an inherent human feature oscillating between the phase of transition and the phase of cristallization. Human beings are beings of relation as well. That means that their development is influenced by social context. Adverse social context could lead development of both indiovidual and community to halt and to the ensuing entropy. That entropy could be confronted by social acupuncture which can stimulate the continuation of the individual and community development. The intervention by social acupuncture has to be free of rescuing, it has to be based on relation and not on power, and it has to have open plan and not a closed agenda. A case study in four acts and epilogue in which the social acupuncture is applied to inhabitants for two Roma (Gipsy) settlements is presented.

The increase of complexity (the first step of a transition) within any community could be blocked by various reasons. The direct consequence of this block is lack of development because - without increase of complexity there is no differentiation, no identification, no integration. However, the block of the increase of complexity could be overcome by social acupuncture. Namely, by applying of social acupuncture it is possible to create psycho-social spaces which are different from the dominant one. These psychosocial spaces are then creating various psycho-social streams which are capable to move the dominant system out of balance. And these psycho-spcial sterams are being created by people who have started to behave diferently, people who have started to leave typical models of behaviour, who started to create different behavioural models...

As in classical acupuncture, within the social one these life bearing streams should be supported by several conditions:

- First, the respect of the principle of wholeness which means that the action is performed with the subject and not on the object. Namely, the one who is perfoming social acupuncture knows that he/she can only do a part of intervention and that the major part of intervention is performed by those who were moved by it.

- Second, the one who is performing social acupuncture should give up various expressions of manipulative power. It is particularlyimportant to give up the resquing because the rescuer is usually using the way that suits him/her which means that he/she is gradualy turning into persecutor [1].

- Third, instead of manipulation, social acupuncture should be based on communication out of respect for the principles of wholeness. Namely, manipulation is always partial because it is focused while the comunication is open.

- Fourth, the intervention has to have an open, and not the closed agenda because both individual and community are very complex so during acupuncture (both classic and social) changes that should be appreciated are evolving.

In the case study which is following the application of these conditions is described.

The issue
Four Roma people came into our office saying that they were representatives of three Roma settlements on the outskirts of Belgrade (Grocanski Kraj, Marinkova Bara and Deponija). One of them had bunch of prescriptions for drugs. He asked us to help them either by giving them medicines, or by giving them money so that they could buy some for their sick neighbors and relatives.

Analysis
The demand was justified. There is a lack of drugs in Serbia and people who need them have to buy them even if they are covered by health insurance. In addition, drugs are rather expensive and most of Roma people are very poor.

Practicing of power
The typical power reaction in this case would be rescuing, by providing necessary drugs. For relatively small amount of money rescuers would appear great in the eyes of those who got help, but also in the eyes of those who would hear the story about “poor and sick Gypsies” and their rescuers.

However, nothing would be changed. The same Roma people would appear again next month, with the same demand. Rescuers might consider then the field study about demands of sick Roma people. Or they could organize the regular supply of medicaments. But all the time they would be wandering within the same closed circle.

Giving up power
We told our visitors that our program does not include humanitarian aid, but that we want to work with them. Our proposal was that at first we look together for the primary health problems in their settlements. We agreed that by working on common problems we could help also people who are now in need for drugs. So, we made a decision to meet again after our visitors inquired among their relatives and neighbors about common health problems in their settlements.

Issue
The group of Roma people appeared this time with a “bunch” of problems.

In Grocanski Kraj, the settlement of seasonal workers, the main problems were:

- dirt, because they were working 12 hours daily in the fields and they did not have the opportunity to wash themselves

- alcohol consumption, with resultant conflicts, fights and injuries

- consequent lack of money, meaning cold shelters and disease in winter…

In Deponija , the main problems were:

- rats who were biting children and eating food

- lack of drinking water…

And in Marinkova Bara:

- spilling of waste water into the passages between houses

- garbage littered all over

- constant police raids and return of the residents beaten and humiliated…

Analysis
Medicaments were only the “easy demand”. Now we have came close to the real problems.

Of course, most of the problems mentioned by representatives of Roma settlements were structural ones. So, they had to be dealt by institutions on the city level, or even on the state level. There, however, Roma settlements were (for years) very low on the priority scales. So, it was important to move somebody else.

Practicing of power
The typical way in which manipulative power reacts to structural problems is positivist education. Positivist education is politically safe and is well paid for, as well. In this way the control is widened to social strata where lecturers could be recruited.

In this phase, therefore, from the position of power, various lectures and courses would be organized in Roma settlements: beginning with courses for young leaders and ending with lectures about alcoholism. Or vice versa.

However, this kind of education is either repellent and boring, or has a missionary essence and tends to create converts. In the first case, the typical product are drop-outs (visible or invisible). And in the second one, the typical product are followers who strive to find their place in the missionary structure and not in their (former) settlement.

Giving up power
We suggested to our Roma visitors that they prepare the project which we called together “The Eco-poster”.

The initial goal of this project was to include more people in the activity dedicated to the problems of settlements.

In the first part of the project a competition among young residents had to be organized. The topic was: main problems of settlements, and participants in competition had to present problems in two versions: “How it looks now?” and “How would I like it to look?”.

In the second part of the project, drawings chosen by settlement jury would be printed like posters and exposed all over the settlement.

We made an agreement that our visitors establish “health committees” which would be responsible for competition in both settlements. (It was winter, so Grocanski Kraj was deserted). In Roma language the health committee was called “Amalipe te avel amendje maj lache”, or “getting together so that we get better”.

Issue
Our Roma coworkers came excited by all events that came out of the “Eco-poster”.

They talked how people in settlements became agitated by posters and by stories around them. They spoke about meetings they organized. They boasted how they succeeded to bring the Vice-president of a borough to one meeting, and how they persuaded a chief of a department in a public health facility to start a campaign for rat extermination in their settlement (both visits were the first in the settlement history). They spoke that something must be done now.

Analysis
In two Roma settlements part of their residents got “awakened”. In addition, something very practical was achieved. It was achieved, though, due to the good will of individuals from institutions that responded positively to the appeals of residents. For the confrontation of basic problems this kind of good will would not be enough. A serious engagement of institutions would be necessary. Institutions, of course, do not understand appeals. They speak the language of facts. So, at least some facts had to be collected to start the discussion with institutions.

Practicing of power
The typical answer from the position of power would be the engagement of experts. Experts would make a screening of basic problems of Roma settlements; they would add then a list of consequences and a list of solutions as well.

However, it is likely that these findings would stay in somebody’s drawer. Namely, neither institutions, nor residents would feel that these findings belong to them. So, there would be no driving force within them. And without driving force it would not be possible to attain much. Especially when dealing with investments in slums, where on the eve of elections it would be enough to come with the truck full of flour to get all attention and support.

Giving up power
In an open discussion with representatives of two Roma settlements we came to the conclusion that the pressure should be put on city and state institutions. We have also agreed that the most effective pressure would come from the residents because they are those who are interested for changes. Of course, this pressure had to be based on the actual situation and that means on the exact data.

To get the exact data we needed an inquiry. So, a question was raised: ”which data should we look for?”, or “which data would represent in a best way the difficult living conditions of the Roma settlement residents?”.

The mutual opinion was that the best solution would be to get data about social and health status of residents. In addition, the emphasis was put on literacy because of its importance for communication with institutions. So, both health committees, or both Amalipe te avel amendje maj lache, made questioners, engaged pollsters among residents and their members, and polled 2500 residents of Marinkova Bara and Deponija, with the expert supervision. 

Issue
According to the findings, 80% of hose polled did not have any regular income. 27% supported their families by periodical physical work and 21% by smuggling. Also, 80% lived in damp houses in which 45% had water supply and 17% water closet. Regarding health, 37% of residents had chronic illness, 23% had to take medicaments but could not get them regularly and 14,5% said that they could not get medicaments at all. Among children, 24% were sick during visit of pollsters, 10% did not get any vaccine, and 21% were vaccinated irregularly. In accordance with that, 20% of people of the school age were illiterate, and 13% new to sign their name only, 20% did not go to school at all, and 15% went to schools or classes for retarded children. Also, 24% did not finish the compulsory primary school. Among adults, there were 24% of illiterates and 17% could sign their name only.

Analysis
The inquiry has shown that residents of two Roma settlements are in need of serious support even in matters which are generally available, like primary education and vaccination.

So, the first question was: “Where to start?” We thought that the beginning which could offer chances for the most effective personal engagement for improving social status was - eradication of illiteracy.

Not the usual eradication of literacy though. Namely, the needs of residents of Roma settlements were, at least partially, caused by segregation. That was why it was necessary to avoid elements of segregation in teaching illiterates. And that meant that the learning itself had to be performed on Roma language, by paying attention to cultural and generational contents.

Practicing of power
Within the context of practicing of power, data from inquiry would move to rescuing behavior. This kind of behavior would most often manifest in establishing of parallel services of medical or educational nature which would compensate for neglect and insufficient engagement of official institutions.

However, the typical problem of these parallel institutions is their technical orientation. That means that almost no attention is paid to inherent components of manipulation and segregation. That is why, from the very beginning, or somewhat later, parallel services are repeating the pattern of official institutions.

Rescuers do not pay attention to that. For them it is more important to establish an additional structure which is under their control.

Giving up power
Two Roma teachers joined the group. We found two primers of Roma language. Roma youngsters interested to engage as teachers started to collect concepts which could have special meaning for their future pupils, the decision was made to organize groups according to age…

And then, it became clear that our Roma coworkers, organized in health committees, started to hesitate. It appeared finally that they did not abhor their educational engagement but something else: their compatriots who imposed themselves as authorities of Roma public opinion, by editing a journal on Roma language, either by writing or by engaging in an international Roma organization.

So, we proposed to our Roma coworkers to start another project. That project could also serve as the support for personal engagement and it was dealing with segregation as well.

The project was named: “Maps of Roma settlements”. In the first phase of the project, all Roma settlements in Belgrade were to be visited. The basic data were to be collected regarding location, history, number of residents, infrastructure…

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After that, each of these settlements would be presented on the map. In the second phase of the project, the same people would visit the settlements bringing with the maps. This time they would have meetings with residents. During these meetings they would at first correct their former findings. In addition, they would ask for special data.

These special data would be found by asking additional questions like: “What would you like to s\change in your settlement, or “What is it in your settlement that you are proud of?”

New maps would be constructed then with names of all contributors, and given to people from settlements. What did we expect form these maps?

At first, the growth of the network of people engaged in psychosocial spaces. Then the spread of knowledge about mere number of Roma people, i.e. about their quantitative power in the city.

We also hoped that the spread of knowledge about values of which they are proud would affect their image in a positive way, that it would make known values which they could offer to other people, for all kinds of exchange…

The program within we have been developing projects with our Roma coworkers was abolished. So we lost the contact with them.

However, several months later, a friend from Doctors of the World came to a private visit and started to speak about his impressions: “I have met a strange group of Roma people - he said - the first thing they told me was that they do not want medicaments.” We knew, in an instant, whom he had met. And he soon confirmed that we were right…

If we would analyse the social acupuncture in terms of social theory, we could say that by applying the social acupuncture we have supported the self-organization of a group of Roma people throught joint engagement. Within that engagement, at first, we have identified conditions which have jeopardized the health of inhabitants of two Roma settlements, and after we have been working to change them.

With Roma people we have been supporting we had established a relation of partnership, i.e. relation of mutual respect and trust. Our role was role of facilitator, and our aproach was complex with an orientation to the roots of the problems and emphasizing the strengths and potentials of the Roma community.

Work on the project was interupted due to the “force majeure”, so we could not follow the futher development. However, within the stages that have been completed activities and events that are not often seen in the work on health promotion were clearly expressed. Key among them were:

1. Constructivist paradigm , demonstrated through the use of practice based work, drawn from actual community based health promotion efforts [2].
2. Social capital developing, demonstrated as an accumulation of outcomes which are linked by the common good [3].
3. Capacity building, demonstrated as creating an infrastructure and fostering problem solving capabilities [4].
4. Empowerment, demonstrated as a constant process of enabling individuals and groups to take part in collective action [5].

1. Steiner CM (1981) The Other Side of Power, Grove Press, Inc. New York.
2. Labont R, Robertson A (1996) Delivering the goods, showing our stuff: The case for constructivist paradigm for health promotion research and practice. Health Education Quarterly 23: 431-447.
3. Hyde J (1999) Health System Reform and Social Capital. Development
   42: 49-53.
4. Putnam RD (1994) Making democracy work. Civic traditions in modern Italy. Princeton, Princeton University Pres.
5. Erben R, Franzkowiak P, Wenzel E (2000) People Empowerment vs. social capital. From Health promotion to social marketing. Health Promotion Journal of Australia 9: 179-182.