Louise Demorest takes a long, thin acupuncture needle out of its white envelope and, with a practised hand, inserts it in the shoulder of the woman lying on the treatment bed.
The patient is a public health nurse who has been coming to Demorest for years for treatment. She brings her whole family.
At last count four million Canadians have tried some sort of alternative medicine — 12 per cent have tried acupuncture. The numbers are growing.
“When I started [my] practice people came in and they expected to see a bone through my nose and doing voodoo,” says Demorest, who has been pushing needles into shoulders for 20 years. “Now there is a lot more respect, a lot more interest.”
Only five provinces regulate acupuncture – B.C., Alberta, Ontario, Quebec and Newfoundland. Just two — Ontario and B.C. — regulate Chinese herbal medicine. Tattoo parlours have more rules than Chinese medicine clinics in the rest of Canada.
But one of the major issues surrounding Chinese medicine right now isn't regulation of credentials — it's the language of the practitioners.
In B.C., exams can be written and courses can be taken in Chinese — a provision that is unique in the country. No practitioner of Chinese medicine has to speak English.
Everywhere else in Canada, Chinese medicine practitioners must be fluent in English.
A group of Chinese practitioners took Ontario’s brand new regulatory body, the College of Traditional Chinese Medicine Acupuncturists and Practitioners of Ontario, to court last year. They maintain that English waters down the discipline and that Ontario’s English language requirements are discriminatory. It was the latest effort in what has been a long and ugly battle over language.
And as interest in acupuncture moves beyond the Chinese community, it's an issue that is making some people increasingly nervous.
“I commonly get patients that went to practitioners who didn’t speak English, and so there’s a big clash there," says Demorest. "You’re dealing with people’s lives, you’re dealing with people’s health. You have to do it right.”
Twenty years ago the Acupuncture Association of B.C. numbered only 54 members. Today, according to the College of Traditional Chinese Medicine Practitioners and Acupuncturists, there are nearly 2,000 practitioners. The College records show that 27 per cent list English as their mother tongue, and 62 per cent list Chinese.
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“Of course, some acupuncturists work only for the Chinese community … so you use Cantonese or Mandarin, that’s fine,” says Hong Zhan Zhu, who has been practising in Victoria since he arrived from China in 1988.
He was one of only 2,700 immigrants from the People’s Republic that year. Now there are over 30,000 a year, including a growing number of Chinese medicine practitioners schooled in China.
“That brings new blood to our community, which is good," he says.
But like Demorest, he says practitioners also need to be able to speak English to explain treatments to non-Chinese-speaking patients. "We work in Canada, we do not work in China.”
Not everyone agrees.
“We need to use the Chinese. Originally Chinese medicine came from the Chinese language,” says Dr. John Lee, who has a PhD in traditional Chinese medicine from Guangzhou University.
He is one of several B.C. practitioners who supported the court action against the Ontario College. The Chinese practitioners turned the language argument on its head, saying the important thing is not speaking English — it is knowing Chinese in order to understand some of the ancient texts.”
Lee went the furthest among those presenting the Chinese language side in the case. “Not being able to read and write Chinese,” he said in his affidavit, “may endanger a patient’s health.”
Push comes to shove
The issue continues to divide the Chinese medicine community.
“How do we retain that rich tradition and keep practice safe?” says Louise Demorest. “There has been a lot of infighting. It can get nasty.”
That was evident last fall when John Blazevic, then chair of the board of the B.C. regulatory College of Chinese medicine, unbeknownst to his organization, supported the group of Ontario Chinese practitioners in their court action against the Ontario College and the English fluency requirement.
“We have never encountered any difficulties whatsoever,” Blazevic swore in his affidavit, “… based on the fact of using the Chinese language to get licensed, take courses and treat our patients.”
The B.C. College acted quickly. A letter of reprimand, now part of the Ontario court record, was sent to Blazevic. “You were aware as a Board member,” wrote the registrar, that the college “has encountered difficulties in regulating registrants who do not speak English. The Board is concerned … that the statement is not only misleading and inaccurate, but contrary to the public interest mandate of the College."
The record of the College’s investigative committee from 2012 reports a dramatic case that hinged on language. A patient explained to her acupuncturist that scar tissue from abdominal surgery meant she could not feel pain. The acupuncturist did not understand her and used moxibustion - acupuncture that employs fire. The patient wound up in hospital with second-degree burns.
Despite the letter of reprimand, the College board did not remove Blazevic as its chair.
Meanwhile, Todd Howard, founder of the Pacific Rim College of Complementary & Integrative Medicine in Victoria and a former board member of the B.C. College, resigned over the Blazevic controversy.
“I had some differences of opinion from other members, those differences were getting too strong.” he said.
Howard agrees that a better understanding of Chinese leads to a better understanding of Chinese medicine. He teaches the Chinese terms and respects the traditions. But there is a problem, Howard maintains, in the language of practice and record keeping.
“There’s a rift between practitioners who only keep patient records in Mandarin or in Cantonese.”
This, Howard says, is where the safety of the patient is at stake. “Those records may be useless in case of an emergency - to the team who is trying to read through them.”
Lack of adequate record keeping is one of the most frequent disciplinary offences at the B.C. College of Traditional Chinese Medicine Practitioners and Acupuncturists.
“The majority of practitioners are Chinese,” Howard says. “They have brought their medicine, but we have to integrate it into western society for it to be fully and safely used.”
The Ontario court came down with its decision in February, saying fluency in English is in the public interest, and “these are not discriminatory requirements.”
'If you’re not willing to delve into the deepness of Chinese, what are you doing here in the first place?'- Beverly Osachoff, Chinese-medicine practitioner
Meanwhile, B.C. practitioners remain isolated in not requiring English language fluency. The B.C. College of Traditional Chinese medicine shows no sign of bringing in an English language fluency provision.
Practitioners are also divided.
“You can’t take the Chinese out of Chinese medicine,” says Beverly Osachoff, a Chinese medicine practitioner from Grand Forks, B.C. “If you’re not willing to delve into the deepness of Chinese, what are you doing here in the first place?”
“We don’t want the government to step in," adds Louise Demorest, but she says she's concerned about B.C.'s stance. “There’s no other profession [like this] in Canada - you can’t be a teacher and not speak English, you can’t be a nurse and not speak English," she says.
"It’s messy and it’s difficult, but we’re in Canada and it’s an English speaking or French speaking country.”