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The Use of the NADA Protocol for PTSD in KenyaDie Anwendung des NADA-Protokolls bei post-traumatischem Stresssyndrom (PTSD) in Kenia

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Abstract

Background

The five needle auricular acupuncture technique known as the NADA protocol was originally developed to address issues of addiction. It has since found wider applications in behavioral health, including use in the treatment of Post Traumatic Stress Disorder.

Objective

To optimize applications of the NADA protocol as it is used in communities affected by physical or mental trauma, particularly those residing in developing countries.

Methods

NADA trainings were conducted in Kenya among refugees after the 2007 post-election violence which left hundreds of thousands of persons displaced and traumatized.

Conclusion

Our experience shows that the NADA protocol can have a profound effect on communities experiencing hardship and transition. Elements we found to be important to the success of such trainings include sponsorship by an international agency, contacts among local service-providing organizations, inclusion of community members in decision-making, follow-up communication with all collaborators and participants, and complete flexibility around clearly defined goals.

Zusammenfassung

Hintergrund

Das NADA-Protokoll mit der Nadelung von fünf Ohrpunkten war zunächst für die Therapie von Menschen mit Abhängigkeitserkrankungen entwickelt worden. Seitdem hat sich das therapeutische Spektrum erweitert, so auf dem Gebiet psychischer Störungen allgemein wie auch bei PTSD im Speziellen.

Ziel

Die Erprobung des NADA-Protokolls an Menschen, speziell in Entwicklungsländern, die durch umweltbedingte oder politisch-soziale Katastrophen physische oder psychische Traumata erlitten haben.

Methoden

Nachdem im Jahre 2007 in Kenia die Wahlen zu blutigen Aufständen mit Hunderttausenden von Flüchtlingen geführt hatten, führten wir in Flüchtlingslagern Ausbildungskurse für das NADA-Protokoll durch.

Ergebnis

Unsere Erfahrung zeigt, dass das NADA-Protokoll einen profunden Effekt auf traumatisierte Menschen haben kann, die eine Phase von Not und Flucht hinter sich gebracht haben. Wichtige Voraussetzungen für den Erfolg solcher Ausbildungen sind: Die Unterstützung durch eine internationale Hilfsorganisation, Kontakte zu lokalen Hilfsorganisationen, die Einbeziehung der betroffenen Gemeinschaft in die Entscheidungsschritte, ein Follow-up mit den Mitarbeitern und Beteiligten, sowie ausreichende Flexibilität in der Handhabung klar definierter Ziele.

Section snippets

Contextual background – a need for treatment

Our initial project addressing PTSD trained local persons to provide NADA treatments to Kenyan refuges in Uganda. Beth and I had met on an international acupuncture project in East Africa, and in December of 2007 I had returned to the continent to train Kenyan healthcare workers in basic acupuncture protocols. The atmosphere in Kenya at that time was charged with anticipation of the upcoming presidential elections, which were held one week after my departure. The results of the elections were

Project Development

Because of on-going security dangers in Kenya itself, we decided to focus our efforts on the thousands of refugees pouring over the border into Uganda. We immediately contacted friends and colleagues in that country for news and suggestions of how to proceed. We were put in touch with a Franciscan nun who ran a school in the border town of Tororo, who in turn connected us with a local man who was volunteering with an organization providing support to a refugee camp set up by the United Nations

First encounters

In our attempt to identify suitable trainees from among the thousands of camp residents, we appealed to community leaders. The camp was divided into 6 blocks, so we called a meeting of the male and female heads of each of these. We offered a basic description of acupuncture, a more specific description of the NADA protocol we were proposing to teach, how we would like to select trainees, and asked for questions. After a lengthy polite and smiling silence, our facilitator suggested we give the

Selecting trainees and training site

We had originally decided to train 10 people in the technique but increased our training group to 20 people when several times this number presented themselves for training. We used as our selection criteria:

  • Previous experience in patient care (healthcare workers, social workers, counselors)

  • Availability to attend the full training session

  • Willingness to provide free treatments to the community after the training

  • Ability to speak and read English

As most of the buildings within the camp were in

Five or three needles?

Although the standard NADA protocol uses 5 needles, there is a trend in relief work of using only 3 needles per ear, or a total of 6 needles per treatment. This is based on NADA founder Dr. Michael O. Smith's experience of treatment delivery overseas, and subsequent advice to others treating in similar settings [2]. There is a clear advantage in using fewer needles, as the needle supply will treat around 40 % more patients, but is this method as efficacious for the patient?

In previous projects

Amending the NADA protocol for children

The refugee community included hundreds of children and they, also, came in for treatment. Children could choose whether to receive needles, or the acupressure-style application of ear beads on the points. Many parents described an increase in fear and anxiety in their children since their lives had been disrupted by violence, with experience of nightmares and a significant rise in bed-wetting. For these families living in tents with no electricity or running water, this last symptom was

Follow-up site visit

When we returned to the community in December 2008 six months after the initial training, these NADA practitioners had delivered over 18,000 treatments. In an hours-long welcoming ceremony we were regaled with songs, dances, and several plays put on by different community groups, usually depicting lives changed, stresses relieved and general improvements to people's well-being with the application of the NADA protocol. Our trainees were the last group to perform, and their play was about a man

Conclusion

From these experiences, Beth and I recognize that the NADA protocol can have a profound effect on communities experiencing hardship and transition. Elements we found to be important to the success of such trainings include sponsorship by an international agency, contacts among local service-providing organizations, inclusion of community members in decision-making, follow-up communication with all collaborators and participants, and complete flexibility around clearly defined goals.

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