Podcast 045: How To Start A Free Herbal Clinic

Episode Transcript

Katja: 00:13 Hi everybody! This is a podcast episode that initially aired on July 11, 2017 over at HerbRally.

Ryn: 00:21 It was their inaugural podcast, episode number one, and this was way back when Katja’s braces were brand new. She’s about to get them off next week.

Katja: 00:31 I’m so excited!

Ryn: 00:34 But this topic is on our minds again right now as we’re gearing up for another free clinic adventure out to West Virginia.

Katja: 00:41 We’ve been going down there for the past few years and working with a team of amazing herbalists and community organizers to provide herbal care for communities who are affected by mountain top removal.

Ryn: 00:54 So we’re really looking forward to it. We’re excited to see our friends and to be in this beautiful place again in October. In the meantime, we hope that you enjoy our thoughts on how to organize and implement a free clinic wherever you are.

Katja: 01:10 Enjoy!

Katja: 01:10 Hi, I’m Katja.

Ryn: 01:12 And I’m Ryn.

Katja: 01:13 We’re at the Commonwealth Center for Holistic Herbalism in Boston, Massachusetts. This is a funny time to be recording a podcast because I recently got braces and I’m very aware of this funny lisp. So, just feel free to have a giggle and hopefully you can understand everything.

Ryn: 01:31 It’s getting better.

Katja: 01:32 Good. Excellent. We want to talk about a problem that a lot of herbalists who are going into practice are up against and that is the desire to do work for the low income and under-resourced community, and balancing that desire against the need to pay our bills. One of the things that I love so much about the herbal community is the strong call to service for people who don’t have a lot of money, and that strong feeling that herbalists have, that this is the people’s medicine and that it should be available to everyone who needs it and that everyone should have access to it. The problem is that, of course, if we dedicate our lives to herbalism, we do require some way to pay the bills and that really becomes a kind of painful tension for, I think, most people.

Ryn: 02:46 You often have this feeling that “I should do everything for free, I should be giving away all of my knowledge and all of my plants, and making all of this available to everybody immediately and leave nothing for myself”. But as a number of herbalists have commented in various ways over the years: you can give away your flower, you can give away your leaf, you can give away your branches, but if you give away your root, then nothing’s going to be there next time and you’ll be in your own trouble and you won’t be able to help people anymore.

Katja: 03:21 Plus, the word ‘burnout’ is real. I think that doing uncompensated work for a long period of time–I mean, burnout happens anytime that we’re doing the work of caring for other people because there’s so much of that work to do and it’s so easy to forget to care for ourselves–I think that happens faster when there isn’t a clear compensation model. None of that means that we shouldn’t be doing that work that we’re called to do. That work is really critically important and especially in today’s political climate, there’s so much need and we can help. So we’ve come up with a model. We’ve tried a few different things in our school and in our clinic and we’ve come up with a model that is really working for us over these last years, and that is to do a regular scheduled free clinic. Instead of doing all of our work for free, we do a lot of work for pay (and the people who can afford it pay) and that subsidizes the scheduled work that we do for free, and that’s been working out really well.

Ryn: 04:40 When we talk about this to the people who are paying for classes or for consultations, then they feel good too. They feel like, “oh great. I’m supporting some pro bono work or some work for people who couldn’t access this otherwise”. We feel good, they feel good. We’ll get to help out some other folks. It’s really a nice setup all around.

Katja: 05:02 It really brings a sense of community to the whole work. What we want to do is talk about ways that you can implement this model, the way that we set up our free clinic, ways that you can set this up in your area, and then we want to give you some examples of some of the things that we’ve done and how that’s worked out for us. First, I would say that a really important factor in making this work is the scheduled nature. Right now, we run our free clinics in the city once a month and that is scheduled a whole year in advance, and that gives some continuity. It lets people know that they can come back on a regular basis. I think that those follow-ups are so important in herbal healthcare, and in any kind of natural or holistic healthcare, and that making space for planned followups is really important. Having that schedule is great and that schedule can be at whatever pace you can afford. If you say, “well, I see clients four days a week who pay for it and on the fifth day it’s free”, or again, we do it one day a month, and a lot of that is really just based on our schedule and on our teaching schedule. Whatever the schedule is that works for you, you can just set that up. I like to emphasize the scheduling nature of it so that people know they can come back and get follow ups, so that you can see the follow ups because that way you get feedback on what worked, what didn’t work, and how you can improve that in the future. We based our free clinic model, our current one, off of the way that you’ve worked in the past with Sam at his free clinics.

Ryn: 07:14 Right. I first saw this in action when I went down to Sam–that’s Sam Coffman, he’s at the Human Path Herbal Medics University down in San Antonio, Texas. I went down to visit him a few years back to take one of his wilderness herbal first responder courses and a couple of extra things on there for a combat medic certification that he offered. During the course of that, one of the things that the students do is organize, arrange, setup, and then staff a free clinic. There are experienced herbalists around, but there are also students who have had a little bit less training in herbalism and a little bit less experienced with the plants, but who are capable of taking intake, getting the story, and asking some basic questions. Then the more experienced herbalists would come along, kind of refine that, and come up with a formula or blend of herbs for the individual. So, my first time seeing a free clinic on this particular model was there during that course, and I thought it was great and I thought it was a good model that we could emulate. When I came back from there, I was really motivated to try to offer that somewhere here in Boston, and our first attempts were to try to find someplace other than our own facility to offer it in. At our particular school, we’re in a part of Boston called Brookline. It’s technically another town, probably the Brookliners are a little annoyed at being considered Boston. Our school is kind of right on the border between Boston and Brookline; it’s pretty close to Fenway Park, if you’re into the baseball thing. It’s a fairly affluent area. We’re right next to a major college and university.

Katja: 09:15 Actually, in a whole ring of colleges on the other side. It’s a really academic area, and that works out nicely for us, but we felt that it would be a little bit of an intimidating area for people in the demographics that we wanted to reach.

Ryn: 09:33 Yeah, and we thought maybe we can get out to one of the suburbs or to one of the areas that are, again, less well served by conventional medicine, where we recognize that there’s more need for this kind of support. We tried reaching out to community centers, churches, and a variety of different places and we found a fair amount of reluctance. I know that other herbalists in different cities have had an easier time with this and have been able to get set up and started really, really rapidly. Here in Boston, it seems like there was a little bit of hesitation around the idea of it being a clinic of whatever kind. That may have triggered ideas of there being medicine, liability, or that kind of thing. Of course as herbalists, our practice is a bit different. We’re not licensed, we’re not doing anything that’s dangerous enough to require a license.

Katja: 10:33 We’re also not practicing medicine.

Ryn: 10:38 So it’s a different situation, but we had a little bit of difficulty getting that across through emails, phone calls, and that. After awhile we said, “well forget it, we’ll just do it at our place and we’ll just try and get the word out there to people who need it”. I feel like our first few rounds of running free clinic there at the facility, we mainly brought in people who probably could’ve afforded appointments or classes and were just drawn by it being free.

Katja: 11:09 Or people who couldn’t at the time. They were otherwise, you know, fairly privileged–grad students or whatever–but in this moment didn’t have money.

Ryn: 11:21 Right. But as time has gone on, the word has gotten out there a bit. You know, one student tells a friend, then they tell somebody else, and they show up. We do seem to be bringing in a broader demographic, racially, in terms of age, in terms of what kind of jobs people have, and what their educational background is. So, that is slowly evolving.

Katja: 11:46 I wanted to say there that actually in the beginning, I felt some frustration about why these people who could afford it are coming to free clinic. That was a little bit of a struggle for us to just sit with that and say if it’s free clinic, it’s free clinic. It doesn’t matter who shows up, it’s free for everyone and to just let that be okay, even if it was people who could have paid for it. In the end actually I think that worked out to be a very good choice because sometimes people come to free clinic, not because they need the free part, but because they are so new to this concept that they are trying something out in a way that feels no risk to them. Many of those people have gone on to either donate at free clinic to help cover the cost, to become regular clients, or even students. I share that because if that happens for you and you start to feel frustration about people who could otherwise afford it, it’s really important to realize that it isn’t just about money, it’s also just the risk of trying something totally new that’s very unfamiliar, and so that’s another way that we can just be out there and available.

Ryn: 13:09 Yeah. Let’s talk for a minute about the nuts and bolts of this. The model that we use is that people can come in and when they first come in, we’ll have somebody just to greet them and say hello, take what name they prefer. They don’t have to give us their real name, they just have to be consistent about it. So, if today they show up and they want to be called Julie, Neville Longbottom, or whatever [laughter], that’s fine; they just have to remember it for next time and then we’ll use that. We want to give people space on that one. Anyway. We get their name, we take the time when they came in, then ideally we’ve got somebody ready right away to take them, but if it’s a very busy night then they might need to wait around. We usually don’t have a wait time longer than about a half hour, but more often we’re ready to see them within a few minutes. We have space in our location right now to have two consults going on simultaneously. We initially had them sit with one of our students who’s in their second or third year of training with us. These are students who already have had some instruction in the interview process, asking the right questions, your good old acronyms like ‘SAMPLE’ and OPQRST, that kind of thing just to get the person’s story, and asking some targeted questions about their lifestyle, their habits, their diet, what might be influencing their problem. Or if it was something more acute like, “when did this start?”, “How bad is the pain and where is it affecting you”, and those kinds of things. Our more advanced students are able to start to come up with ideas around what herbs might be appropriate for this person or what other kinds of recommendations may help them out. In any case, Katja or myself will go in after about 10 or 15 minutes and look at what information our student has collected so far, ask a few more questions, and either refine or approve the formula or the idea in terms of herbal remedy that our student clinician has come up with.

Katja: 15:38 We found this to be not just a great method in terms of helping the clinic run smoothly, but also a great method in terms of education for advanced students. These are students who are intentionally studying to become clinical herbalists, so they already have this mindset. A lot of times, they really get to the meat of it all and we come in like, “hey, great job–I wouldn’t change anything”. But the really great benefit for the students is that they have a chance to practice in a situation that is completely safe. If they are sitting there and somebody has a health situation that’s very intimidating to them and they start to think, “oh gee, I don’t even have any ideas”, they’re not just left hanging there. We’re right there, they can call us over if they need us. That’s been really excellent to give our students a lot of confidence and make them feel like they are much more ready to apply what they’ve learned, just because it’s such a safe, supported environment.

Ryn: 16:53 Yeah. So, now we’ve got a plan, or a formulation, for this person at our free clinic. We send people away with one free herbal preparation. That might be a bottle of tincture, a bag of tea to brew, or it could be some salve to apply. They’ll get one thing for free. What will happen is we’ll bring that sheet (or that intake form) that the clinician has filled out with their plan and with the formula that they want put together and bring that over to another student working in the apothecary. That’s going to [say], “I want to have this gut heal tea blend and it’s going to have calendula, plantain, peppermint, ginger, a little bit of fennel, and maybe a little touch of licorice”. The students working in the apothecary will start to put that together. That also turns out to be a learning experience for them because sometimes we run out of things and they say, “hmm, okay, well what can I put in here instead of licorice? We’ve got some Goji and that’s got some similarities. Okay, let’s try that”. Right? There’s that aspect of learning, thinking on your feet, being adaptable, and all of that as people are filling the order as well.

Katja: 18:20 Of course, we’re always right there to help if there’s some kind of question.

Ryn: 18:24 Right. Then they just wrap that up, make some labels, make sure the instructions are clear, then bring that over to the person and say, “here’s your preparation, your bag of tea. For this one, you’re going to make it in this manner”. If you’re going to make a short infusion, a long decoction, or here’s how many dropperfuls of tincture you need to take and how frequently in the day; they’ll explain all of the ways to take the herbs to the client, see if they’ve got any last questions, and then they get sent on their way. So, that’s the process, except I left out probably the most important part, which is that when they come in, before they sit down with the clinician, they’re going to read through and sign an informed disclosure form. There’s lots of different ways that people write these. You can definitely find a number of examples if you go to any herbalists website, they should probably have an example of their informed disclosure form there, or if you email them, they’ll often send it right to you. You can definitely email us anytime and we’ll send you the ones that we use, both for private consults and for free clinic. For ours, we keep them in pretty plain language. We didn’t want this to get up into legalese. We wanted it to be very clear and straightforward, but also of course to protect us or to cover what’s necessary from a legal standpoint. This is something that Katja and I have both a dug into pretty extensively. I have one article up on our blog right now about the practice of medicine in Massachusetts, because this is defined state to state, it’s not a national thing. So, I would advise you to look up the statute or the law in your state that defines the practice of medicine and just investigate what’s written in there so that you know some specifics about what kind of terms you need to avoid. Generally, that’s going to be a list like ‘diagnose’, ‘treat’, ‘cure’, or ‘prevent’ any specific name to disease condition. Those are things that you want to avoid. Also to not let anybody call you ‘doctor’, never to refer to yourself as ‘doctor’, or to claim that you are practicing medicine. There’s obviously a lot more to say about that, but again you can check out the blog entry I wrote for Massachusetts, or if you want to email me, I can point you at some other good resources about that.

Ryn: 21:04 On our informed disclosure form, it starts out really simple. It says: we’re not doctors, we are herbalists and educators; our primary goals are to help you nourish and support your body so it can heal itself. We’ve also got some paragraphs in here and I won’t belabor the point and read the whole thing to you, but we note in here that we’re happy to provide you with research or further information in writing for your own reference, and that you can provide to any other healthcare practitioners you’re working with, that you should tell us (and that it’s very important for you to be clear to us) about any pharmaceuticals that you’re taking, whether that’s prescription or over the counter, and also that it’s your responsibility to talk to your doctor or your pharmacist about herbs that you’re going to start to work with. We like to stress that what we’re doing is educational in nature, that a decision to follow any recommendation is always yours, and you’ve got to keep your critical thinking hat on while you’re sitting with your herbalist.

Katja: 22:09 That’s such a really important part for us because the current conventional medical system is built on disempowerment. It’s really set up intentionally to incur reliance of the patient on the practitioner. We’re not just saying that as a critique–those words are actually in the practice of medicine laws in Massachusetts, right out there. “Intentionally…

Ryn: 22:41 …to encourage the reliance upon an individual’s knowledge or skill in the maintenance of human health.”

Katja: 22:46 Right. I don’t want somebody to be reliant on me for their health. What I want is to teach someone how to be self reliant with their health and self sufficient about their health, and I think that really in all cases, that’s what healthcare should be. You know, doctors can be educators, but in the end we’re the ones that have to make the choices about how we take care of our bodies. So, the benefit of being unlicensed as herbalists is that we can’t ever get into that trap. We can’t ever be in that position of taking the power, the rights, and the responsibilities away from our clients because that would be the practice of medicine and that would be illegal. It really keeps us in that place of not just empowering people to take control of their own health because I believe that’s what’s right, but also because that’s the law, so that’s really excellent.

Ryn: 23:46 We like to make that explicit. We also have a line in the disclosure form that says any information you share with us is going to be confidential and that what we’re doing here today is free; donations are appreciated if you have that, but it’s not expected in any way. That’s the way that we like to run things, and that does mean that we’re relying to some extent on whatever people are able to donate or basically that, like we said before, the work that we do for pay is going to subsidize the free clinic. In general, we’ll do free clinics that are either two or four hours long. We generally have between eight and, in some cases, as many as 20 people come through. So, on a given Sunday, we might be giving away a couple hundred dollars worth.

Katja: 24:45 It might be $300 of materials plus the labor (which of course we’re not counting), but we do go afterwards and do a little accounting, just so that we have a record of what exactly did we give. We have that in each individual sheet, but for each month’s free clinic file, I go back and I put up a front summary page that says how many people we saw, their complaints, what we gave them, and the total cost of the materials that we used for that free clinic. We do that just because keeping that kind of accounting is a really, really good idea, just in terms of business sense.

Ryn: 25:33 Yeah, and it helps us to be able to find people. If they came once two months ago and now they’re coming back again, we can just look at that front sheet, see the given names people turned it in, and we can find them again and say, “Okay, this was the formula we gave you last time; I can refill or modify that as required”.

Katja: 25:54 Keeping that kind of a record also can be super helpful if your free clinic grows considerably. Having those kinds of records can be great if you’re going to go and try to get donations from the community to support your free clinic. Now you have that data and you can say, “Listen, we’ve been doing this every month, we’ve been seeing this many people, we’ve been giving away this amount of material”. Having those kinds of records is verifying, it’s validating, so that people who might be inclined to donate can say, “Wow, that’s really great, I’d be happy to donate to that”. Another really cool thing about this method is that it’s totally portable. Here in Boston, we have certain needs, but we also know that there’re needs around the country that we want to address and we want to be a part of the solution for a lot of those issues. So, getting very comfortable running a free clinic in our own space–where we know where everything is, exactly what we have, and whatever–has made it very easy for us to say we can take this on the road and we can go and help people in other places. Coming up, we’re going to do that in West Virginia.

Ryn: 27:24 This is a community in the Coal River valley. It started out as something that [Herbal Medics] Sam Coffman and his wife, Suchil, were doing as an extension of their work as teachers down in San Antonio. We started to collaborate with them a couple of years ago, teach together, and go on some of these adventures together to different communities. It’s also been a matter of training local people. The ideal is that we would go into an area, establish a free clinic for a few days or a week, make some contacts with people there who already had some herbalism or were ready to dive in and learn a lot. Do that as a seed to get the idea planted and then to offer training–generally like online training–to those local folks who were going to spearhead the effort, and then come back on some kind of a recurring basis to continue that and to keep that moving forward.

Katja: 28:44 That kind of a setup is really important because it’s so much more helpful if we can empower an entire community to move themselves towards self sufficiency than if we just show up for one week and then we never come back again. So, having those relationships and then being able to share that knowledge with the people in that community in a way that’s very organized and sustainable is really, really important.

Ryn: 29:17 Last summer, I went out to West Virginia, one of our graduates went along with me, and we met up there with Sam, Suchil, and a number of their students. We put together a week long series of free clinics in a couple of towns next to each other in Coal River valley in West Virginia. We got to know some of the people there and began to train and offer our online programs to a couple of women who already had some interest and some experience with herbalism, but they were ready to bump it up a bit and to get well trained, educated, and be able to handle this on their own eventually. This first round, a lot of it was really reliant on herbs and materials that Sam, Suchil, their group, and also myself and Kim brought over there. We basically brought in everything–all of the people, all of the training, all of the plants, first aid supplies, and everything else. We did that, it was a great success, and the community was really into it. We feel like we were able to help people who really needed it, because these are communities that have been basically devastated by mountain top removal mining, which doesn’t just pollute all of your water table, your air, and a whole bunch of other things, but it also basically takes nine out of 10 peoples’ jobs away from them. Mountain top removal basically is a lot more automated than the older styles of mining, in addition to being enormously environmentally destructive.

Katja: 31:06 There’s no good, there’s only bad everywhere you look.

Ryn: 31:11 Unless, you know, you’re a mine owner in which case…

Katja: 31:15 I don’t care if it’s good for them.

Ryn: 31:17 Anyway. So, these people need a lot of help and we were able to provide that, and that was really nice. Now it’s a year later and we’re going to be going back. This time, Katya and I are going to go, we’re bringing another one of our graduates, actually two are going to come along with us and help us out. We’re going to bring a few things and bring some herbs that have been donated by community herbalists here in town and stuff like that. But the majority of the herbs, tinctures, salves, and whatever else are being made by our contacts out there.

Katja: 31:53 Not just made, but also grown. One of the big things that Kim was able to do (Kim, one of our graduates, is also a permaculture teacher) during that week, free clinics were going on, but she was also doing a lot of work helping them set up community gardens. Not just teaching them how to do it, but actually they went out and did it. Those gardens are now yielding pounds and pounds of herbs that are going to be used in the clinics this year, and that’s just so exciting.

Ryn: 32:29 Yeah. So, we’re really looking forward to it because it feels like we’re going in the right direction, we’re getting more and more of this work into the hands of the community members and the people who have roots there.

Katja: 32:44 Also, we’re bringing a very small team; I mean, there’s only four people. This time they’re supplying all of the student workers. That’s really exciting, too, that we’ve been training this handful of women who are kind of in the leadership positions of this organization, but they’ve been passing that in through the community so that they’re now ready to have people of their own being trained up to do this. It’s so exciting.

Ryn: 33:16 Yeah, it’s a nice collaboration between the couple of groups at play here, and many of them are the same people, but they’re just wearing different hats. There’s a group called Mountain Soul and they do a lot of outdoor education for children. You know, if you teach them young to identify plantain, poison ivy, and everywhere in between, then that’s knowledge for life, so that’s really cool.

Katja: 33:41 Not just herbal knowledge for life, but also if you teach them young to have an appreciation of nature, then they will protect nature. This is so critical for all of our children everywhere, but maybe especially for affluent children because they’re the ones who are more likely to be able to do the widespread damage. Like the children of those mine owners really need to be learning that plants are important and animals are important so they can make different choices than their parents did. Anyway. Non sequitur there.

Ryn: 34:17 If that could happen, that would be good. Then there’s another group there called Aurora Lights and they’re doing a lot of work that’s kind of culture-based to bring people together and form better community. Then our host spaces, a building that’s a mostly inhabited by a group called Coal River Mountain Watch–again, most of their work has to do with the mountain top removal. It’s nice that we’re going to be in there kind of at an intersection of some really important community efforts to educate, to teach, to inspire, and to do a little bit of political action as well. Wasn’t quite going for agitation there, but you know, sometimes. [laughter] Alright. So, that’s our plan with West Virginia and we’re really looking forward to that. That’s next week, almost?

Katja: 35:19 A week and a half. It’s kind of crazy. This has been a way that we can really use this model, not just to help people where we are and not just to go in at a one time shot to help people somewhere else. Using this model, we’ve been able to then spread a lot of education, not just individual consultations but also community education. If this sounds exciting to you, then I would say please try it because it has been so, so successful, and if more herbalists are doing this kind of work, then we could be spreading more and more awesome goodness out into the world. By awesome goodness, really I mean self sufficiency, health empowerment, and that kind of awesome stuff.

Ryn: 36:23 I think that’s about what we wanted to cover today. If you have any questions, you can always reach out to us. Our website is commonwealthherbs.com and there’s a contact form right there. You can also find out about our projects and the other stuff that we’re up to. We hope to hear from you and thanks for listening.

Katja: 36:44 Bye!