• Research Focused

    Conducting research studies and documenting patient cases helps us analyze the efficacy of our clinic and contribute to the body of evidence that supports our project model.
  • Providing Access

    According to the World Health Organization, Nepal's healthcare system ranks 150th in the world with less than one doctor per 6000 people.
  • training & mentorship

    Acupuncture Relief Project offers meaningful training opportunities and employment to interpreters and local healthcare workers.
  • Primary Care

    Since 2008, Acupuncture Relief Project volunteers have delivered over 300,000 primary care visits in rural Nepal.
  • more than acupuncture

    Our volunteers include massage therapists, chiropractors, physical therapists, naturopaths, as well as nurses, nurse practitioners and allopathic physicians.
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Our Mission

Our unique model provides effective, efficient, primary care in rural Nepal. Read More
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Our Clinics

Since 2008, our clinics have provided over 350,000 primary care visits. Read More
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Our Partners

Influencing government policy and achieving educational goals. Read More
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Volunteer With Us

We need your help. Serve others while learning new skills. Read More
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Our Evidence

Case studies and field research helps us analyze our efficacy. Read More
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VOLUNTEER COMMUNITY CARE CLINICS IN NEPAL

Nepal remains one of the poorest countries in the world and has been plagued with political unrest and military conflict for the past decade. In 2015, a pair of major earthquakes devastated this small and fragile country. 

Since 2008, the Acupuncture Relief Project has provided over 300,000 treatments to patients living in rural villages outside of Kathmandu Nepal. Our efforts include the treatment of patients living without access to modern medical care as well as people suffering from extreme poverty, substance abuse and social disfranchisement.

Common conditions include musculoskeletal pain, digestive pain, hypertension, diabetes, stroke rehabilitation, uterine prolapse, asthma, and recovery from tuberculosis treatment, typhoid fever, and surgery.

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Featured Case Studies

  • Juvenile Rheumatoid Arthritis +

    10-year-old female presents with active phase of Juvenile Rheumatoid Arthritis (JRA) as demonstrated by multiple articular bony joint Read More
  • Hemiplegic Stroke Sequelae with Aphasia +

    Patient presents with right-sided paralysis of his upper and lower limbs due to an ischemic stroke 9 months Read More
  • Ankylosing Spondylitis +

    25-year-old male presents with low back and sacroiliac pain, beginning approximately 15 months prior to consultation at this Read More
  • Hemiplegia (Stroke Sequelae) with Acute Lung Consolidation +

    81-year-old female presents with complete left-sided hemiplegia following ischemic stroke 2 months ago. Over the course of 7 Read More
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Compassion Connect : Documentary Series

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    In the aftermath of the 2015 Gorkha Earthquake, this episode explores the challenges of providing basic medical access for people living in rural areas.

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    Episode 1: Rural Primary Care

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    Acupuncture Relief Project tackles complicated medical cases through accurate assessment and the cooperation of both governmental and non-governmental agencies.

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    EPISODE 2: INTEGRATED MEDICINE

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    Cooperation with the local government yields a unique opportunities to establish a new integrated medicine outpost in Bajra Barahi, Makawanpur, Nepal.

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    EPISODE 3: WORKING WITH THE GOVERNMENT

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    Complicated medical cases require extraordinary effort. This episode follows 4-year-old Sushmita in her battle with tuberculosis.

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    EPISODE 4: CASE MANAGEMENT

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    Drug and alcohol abuse is a constant issue in both rural and urban areas of Nepal. Local customs and few treatment facilities prove difficult obstacles.

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    EPISODE 5: SOBER RECOVERY

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    Interpreters help make a critical connection between patients and practitioners. This episode explores the people that make our medicine possible and what it takes to do the job.

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    EPISODE 6: THE INTERPRETERS

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    This episode looks at the people and the process of creating a new generation of Nepali rural health providers.

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    EPISODE 7: FUTURE DOCTORS OF NEPAL

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    In this 2011, documentary, Film-maker Tristan Stoch successfully illustrates many of the complexities of providing primary medical care in a third world environment.

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    COMPASSION CONNECTS: 2012 PILOT EPISODE

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From Our Blog

 


Emma Goulart LAc 
February 2013
OVERVIEW

Acupuncture Case Study60-year-old male presents with sudden onset of motor deficit of right hand, tingling and weakness of right foot, as well as marked changes in function of glossopharyngeal and hypoglossal nerve. Within the course of 15 acupuncture treatments, including electric stimulation and moxibustion, there are marked improvements in motor function testing of right hand, a decrease in sensation of tingling and pain in right foot, reduced pain in the ball of right foot and a cessation of headaches.

Subjective

Patient is a 60-year-old male who presents with compromised motor function in right upper limb. The onset of symptoms started 7 months ago, reaching maximal deficit over a half hour period, affecting the right upper and lower limbs. There is suspected glossopharyngeal and hypoglossal nerve involvement due to changes in throat and tongue function.

At his hospital visit, he was diagnosed with left-sided ischemic stroke, prescribed 6 different medications, as well as shown several physiotherapy exercises to do at home.

Prior to his stroke, he had no symptoms of dizziness, pain in the chest, nausea or vomiting, nor any other abnormal signs. Patient was actively being treated for hypertension prior to stroke. The patient is mostly concerned about his right hand, since it is preventing him from being able to work. Most of his frustration is due to the loss of control of movement in his right hand. He also mentions right leg weakness and slight tingling and pain on the dorsal aspect of the foot. Further questioning reveals the feeling of weakness is caused by painful knotting on the ball of his foot.

Since the incident he has had more difficulty speaking, which he describes as a tickle in the back of his throat. This sensation in his throat came on during the stroke along with the loss of motor function in his right hand. He notes short-term memory impairments since the incident, described as an inability to remember details.

Patient is currently taking 4 medications: Amlodipine, Clonazepam, Aspirin and Atorvastatin.

Bowel movements are formed, but feel incomplete and are difficult to pass. Normally he passes stool daily, though he can go up to 3 days without a bowel movement. Patient reports scanty urination. He sleeps through the night, usually getting between 7 and 9 hours per night. He reports feeling cold inside, especially on fingers and toes. He does not perspire, no matter the level of exertion. He experiences occipital headaches regularly, and relates them to his high blood pressure. His eyes burn and feel irritated.

OBJECTIVE

Acupuncture Case StudyPatients overall health is above average for age and environmental factors. He appears strong constitutionally, with a demeanor that is generally quiet. He seems hopeful of the acupuncture treatments and open to any way in which he can participate in the process, including a dedication to coming for treatment daily.

Hospital records from June 2012 (7 months prior to treatments), are from 3 weeks after the incident. A CT scan was administered, showing evidence suggesting ischemic stroke. The carotid doppler report was normal, as was lipid testing. The color doppler echocardiography report showed aortic valve and mitral valve thickening. The mitral regurgitation grade was II-III. The tricuspid regurgitation grade was II. Fair left ventricular systolic and diastolic function. Right upper limb testing showed flaccid tone, power of 0/5 and hyper reflexion. However, all other limbs received normal scores.

Upon arrival to our clinic, several tests are undergone to assess patient.

Facial testing: Sharp/dull test: No clear findings along trigeminal nerve pathway; He is able to feel light touch bilaterally on face, though sharp/dull testing is inconsistent along his right side. Facial nerve testing is inconclusive. Expressions are all normal. He is able to raise his eyebrows, close his eyes and grimace. However, his smile appears slightly slanted down on right side.

Glossopharyngeal nerve testing is inconclusive. Speech is normal when saying O, La and Cha, though he has trouble saying E. Patient is constantly clearing his throat while talking, and has asked for water on multiple occasions due to dryness.

Hypoglossal nerve deficit is positive with a deviated tongue.

Right Upper Limb:

Sharp/dull test: Shows sensory deficit distal to wrist joint. Patient is unable to distinguish between sharp and dull in this area.

Full AROM in both shoulder and elbow joints bilaterally. On the affected side, his wrist function is compromised with extension at 30 degrees and flexion at 70 degrees. Additionally, 1st to 4th fingers slant 30 degrees laterally.

Isolated finger extension: 0/5 in 3rd to 5th digits, with no movement at all; 2/5 in 1st and 2nd digits, with minimal movement, but not against gravity;Isolated finger flexion - 3/5 in all fingers with movement against gravity, but not against resistance Grip strength is roughly 30% weaker on the right side; Wiggling fingers - 3/5

Vitals: Blood pressure is 160/90.

TCM: Tongue is deviated, overall sticky white coat, yellow at root; Scalloped edges with red body on sides

Pulse on right is thin and wiry. Left is full and surging, but weak in chi position.

ASSESSMENT

DX: CT scan taken 3 weeks after incident shows evidence of left ischemic CVA. These medical results, combined with a decrease in motor function of upper right limb, and a notable change in throat and memory impairments, meet criteria to confirm diagnosis given by hospital of left ischemic CVA with right hemiparesis.

TCM DX: Blood stasis pattern causing blockage of channels and collaterals resulting in internal wind; Underlying Liver yin deficiency causing Liver yang to rise

PROGNOSIS: At initial consultation, patient had already regained motor and sensory deficits since his hospital visit 7 months prior. Due to these changes, combined with patient’s strong constitution and dedication to physiotherapy exercises, further recovery seems promising. It is hopeful that acupuncture and physiotherapy exercises will continue to aid successful management of motor and sensory deficits, though full neurological recovery may not be possible.

PLAN

Treatment principles: Move blood stasis, open channels and collaterals, and nourish the Liver yin.

Treat with acupuncture 6 days per week for 10 treatments before full reassessment. Long-term treatment, however, is likely needed 3 days per week. Treatment approach is to open right-sided Yangming and Shaoyang channels, unblock qi and blood in collaterals. Scalp points along primary motor cortex on left side to stimulate right-sided motor function, occasionally with electric stimulation. Local points on right side around affected area of mouth and throat to stimulate affected nerve pathways.

Typical treatment: Bilateral treatment: LI4, LV3, DU26, REN23, REN24, DU15, DU16; Right-sided: GB34, Ba Xie and Ba Feng, electric stimulation between LI12 and LI4, LI11 and SJ3, UB60 and LV3, GB40 and GB43. Needling along the motor cortex line on left side of head, roughly between DU20 and GB6. Most treatments consist of stick moxa along his right metacarpalphalangeal joints to open blockage in channels and collaterals.

Additional physiotherapy and coordination exercises are provided for at-home treatments: Making a fist and opening it for motor function, touching thumb to each finger to improve coordinated motor function and touching hands behind back and above head for proprioception. Patient is sent with a moxibustion stick to use for warming the Yangming and Shaoyang channels on his right hand.

OUTCOME

The patient came almost every day that the clinic was open for 4 weeks, even though his home is an hour and a half away. There was significant visible progress, over the 4 weeks of acupuncture treatment and physiotherapy exercises, of the motor function in his right hand.

After the 2nd treatment, he reported an increased ability in moving his right fingers, noticeable while getting dressed and tying his shoes.

After the 8th treatment, during our 2nd week, there was marked improvement in isolated finger extension. He presented at 4/5 rating on all digits except the 4th, having the ability to maintain position against gravity and against minimal applied resistance. His 4th digit, at 2/5, was unable to move against gravity. This was a great improvement from 0/5 on his first visit to the clinic 2 weeks earlier. Additional new testing was done on his 8th visit. Touching each finger to thumb - movement was slow, though possible on all fingers except his thumb to 5th digit.

At treatment 10, a reassessment of sharp/dull testing on the affected hand was normal, aside from his 1st finger, which had unclear results, showing some areas with lack of sensory function. This was an improvement from his 1st visit, which showed sensory deficit distal to wrist joint. Overall, he felt that there had been improvements in movement of fingers. His main concerns at our re-evaluation were his persistent headache and the stiffness he feels in fingers of affected hand.

At treatment 15, patient felt positive about his hand, though he noted swelling in his 3rd and 4th digit at 2nd interphalangeal joints. The area of tingling on his right foot had decreased by 50%, and the pain on the ball of his foot was intermittent. Testing touching thumb to fingers was the same as our testing at treatment 8, with an inability to touch thumb to 5th digit.

CONCLUSION

Patient sought acupuncture 7 months after his stroke and within 15 treatments saw marked improvement in motor function of his right hand, as well as further sensory function in right foot. His headaches subsided within the last 3 treatments. The patient was advised to come 3 times per week for another month, with the hope of continuing to improve motor function. This will hopefully maintain a slow and steady improvement, aiding in his recovery. It is unclear whether the acupuncture will allow full recovery of motor function of his right hand. However, it can certainly be a means for managing the deficits caused by the stroke.

 

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