The Bronx Ink

In a dimly lit room at Lincoln Recovery Center in the South Bronx one September morning, six middle-aged men were sound asleep, five needles poking out each of their ears. Meditation music played from a 1990s cassette recorder.

This was acupuncture therapy, the first on the center’s agenda every weekday at the East 142nd drug treatment location. Next comes group therapy and reiki sessions.

Nearly a decade ago this center was a thriving community service hub and a crucial therapeutic refuge for those afflicted by rampaging heroin addiction in the South Bronx.

But two weeks ago, a dozen chairs in the acupuncture room remained empty. Apart from the occasional banter between patients, the waiting room was eerily quiet throughout the day.

“The center used to be more community-based,” said Angela Torres, the clinic’s supervisor and senior addiction counselor. She has been working for the program for 24 years. “We tried to keep it in the community, but there have been more regulations from the hospital.”

Lincoln Recovery Center began as a grassroots organization, developing into a core neighborhood service treating drug addiction with experimental holistic methods. But, the treatment center has since disappeared from the heart of the community, and its patient census continues to decline.

In December 2011, Lincoln Hospital administrators relocated the center from a four-story building on East 140th Street, to the basement of the Segundo Ruiz Treatment Center half a mile away. Since then, the center has seen fewer patients every year. This current August, clinicians had 21 patients, less than a quarter of its monthly average of approximately 120 before the move.

Yet, opioid overdose rates have been increasing over the last decade, particularly in the South Bronx, which has become the epicenter of a growing supply of prescription opioid drugs.

In 2018, the borough had the highest rate of overdose rates in New York City. Nearly 400 residents died, up 9% from the previous year, according to a recent report by the NYC Department of Health and Mental Hygiene. Mott Haven-Hunts Point had the second highest rates in the borough.

Lincoln Recovery Center was established as part of a community activism in the 1970s to combat an epidemic of drug addiction in the area. At the time, the New York Times reported 20,000 drug addicts were roaming the streets of the South Bronx. The activist and militant groups of the Young Lords and the Black Panthers made headlines by marching into Lincoln hospital and taking over the sixth floor to implement a drug program that became known as “Lincoln Detox.”

“The detoxification program came out of desperation because the healthcare was substandard and there were no drug programs to help addicts in the Bronx,” said Carlos Alvarez, who started working for the program when it began.

Activists began treating patients with holistic practices and methadone, a synthetic opioid receptor that is prominently used today in medication-assisted treatment (MAT) to reduce opioid withdrawal symptoms. Concerned about the addictive nature of methadone, counselors began to experiment with acupuncture after hearing about the work of Dr. H.L Wen in Hong Kong, who found that acupuncture combined with electrical stimulation could relieve opioid withdrawal signs in addicts.

Conflicts between the program and hospital administration resulted in the unit being shut down in 1978 by city hospital officials from NYC Health and Hospitals, led by then-Mayor Ed Koch. It was then relocated to an abandoned 21,000 square-foot building on East 140th Street, which the corporation bought for one dollar.

Acupuncture became the center’s main treatment method, pioneered by Dr. Michael Smith, founder of the National Acupuncture Detoxification Association (NADA). The association set the protocol known as “acudetox,” a non-verbal therapy approach, often set in a group setting that involves the gentle placement of five small, sterilized, disposable needles into specific sites in the ear.

The acupuncture association estimates that approximately 25,000 people have since been trained in this method worldwide, which continues to expand as a modality within addiction and behavioral health treatment, including prisons, military medicine and disaster relief.

Nancy Smalls began working from the program in 1973.“It was like a big family affair, it was wonderful,” she said. The center had a game room, a big backyard and would run weekly activities and trips.  “We had clients coming out of the woodwork. The acupuncture had to be doing something.” 

Smalls also launched the Maternal Substance Abuse program as part of the centre’s services in 1987. “No one was handling the drug treatment of women,” she said. “We found out that acupuncture worked even better for pregnant women who were withdrawing. It removed the want to get high.”

Studies on the science behind acupuncture remain varied and often inconclusive.

“Acupuncture can be helpful to any type of withdrawal, simply because it calms the sympathetic nervous system related to the fight or flight response,” said Pooja Shah, doctor of integrative and family medicine and a licensed acupuncturist. “It’s hard to research the effects, because there is a lot of variability that can change the outcome, such as the group dynamics and the relationship between the patient and the practitioner.”

A 2012 systematic review concluded that after 35 years of research by both Asian and Western scientists, the efficacy of acupuncture in the treatment of opiate addiction had not been established. A 2017 study on NADA protocol states that is not a standalone intervention as a treatment for substance abuse.

Research into acupuncture’s mechanisms is currently being conducted in Brigham Young University. “Right now it can only be used as an adjunct therapy, but it has potential,” said Scott Steffensen, professor of cognitive and behavioral neuroscience. “If you activate certain receptors in the body without using drugs, you can modify the whole nervous system in a way that it could be used to reverse the craving associated with opioid withdrawal.”

The relocation of the Lincoln Recovery Center in 2011 came as a shock to the local community and former employees. The building has been abandoned since then but is still under the ownership of NYC Health and Hospitals. 

“They said the rent was too high,” said Angela Torres. “We could all have chipped in to pay a dollar.” 

After the women’s program was closed down in 2013, Nancy Smalls retired. “Everybody we serviced, we made a difference in their lives,” she said. “I just don’t understand why they are not using that building. The city did a huge disservice to the population when they got rid of Dr. Smith.”

Numerous attempts to reach the communications department at Lincoln Hospital in person and by phone were unsuccessful.

Currently, 22 recovery services across New York offer acupuncture, according to the 2019 National Directory of Drug and Alcohol Abuse Treatment Facilities.  Lincoln Recovery Center is the only facility listed in the Bronx.

Activist group South Bronx Unite has since been campaigning for the hospital agency to hand the building over to the local community. On September 7, plans were showcased to transform it into a H.E.A.R.T (Health, Education and the Arts) Center to house local non-profit organizations and a mural was unveiled on the side of the building.

The Lincoln Recovery Center has changed from a community hub to a more structured medical service.

“It used to give people somewhere to be, it had a homey kind of atmosphere,” said Dorine Seabrook. “Now it’s much more appointment driven, we are required to people in and out of treatment faster.” 

Patients at the Lincoln Recovery Center are now referred by the Consult for Addiction and Care Team in Hospitals team (CATCH) at Lincoln hospital, the courts, or by the city’s Human Resources Administration.

Dr. Mark Sinclair is Medical Director of the CATCH program and the Lincoln Recovery Center. “We try to encourage patients who need treatment to go there,” he said. “The services at the Lincoln Recovery are great but they need to be more integrated here in Lincoln Hospital with the other patient’s healthcare needs.”

Patients are referred depending on their needs, either using the center as their sole service or on top of their methadone program.

But employees cite the location as the main reason for the lack of patients and their frustration with the administration.

“Our biggest problem is that the program is a mile away from Lincoln hospital,” said Program Director Christina Laboy. “I have pushed to set up a transportation service. People don’t end up coming here.”

“We need exposure,” said Serge Ernandez, the licensed acupuncturist at the center. “No one knows we exist here anymore.”

New York City students were allowed to skip school last Friday, but they were not the only generation taking part in the climate strike in which 250,000 people took to the streets of Manhattan. They were inspired by 16 year old Swedish activist Greta Thunberg who started the movement ‘Fridays for Future.’

Over five million people went on strike across 150 countries to demand urgent action on climate change. In New York, the city’s 1.1 million public school students were granted permission by Mayor Bill de Blasio to take the day off. Thousands marched from Foley Square to Battery Park, ahead of the U.N. Climate Action Summit on Monday. 

However, the strike was not just attended by the younger generation.

Eileen Jones, 67, from Manhattan held a sign with the caption, “Vote because the kids can’t.”

“I am here for the future, for my kids, for me, for all of us,” Jones said. “My job is helping to save the world.”

The march led to the main event in Battery Park which included speeches and performances by climate activists from around the world, including Greta Thunberg.

Thunberg started Fridays for Future over a year ago to encourage students to skip school to protest for action on climate change from their governments. Since then, she has become the face of a global movement. 

Thunberg arrived in New York at the end of August after a 2-week trip sailing across the Atlantic on an emissions-free yacht. 

Alexandria Villaseñor, 14, introduced Thunberg to cheers from the crowd. Villaseñor is the co-founder of US Youth Climate Strike and skips school every Friday in front of the UN headquarters. 

“We have not taken to the streets, sacrificing our education for the adults and politicians to tell us that they admire our work,” Thunberg said. “It should not be that way, we should not be the ones fighting for the future, but here we are.” 

An estimated 250,000 people gathered in New York to hear Greta Thunberg speak.

To wild cheers – followed by chants of “Greta! Greta!” – she told them: “We will make them hear us” https://t.co/jUfVHc1LvK pic.twitter.com/CVIllJ1XbR

— Sky News (@SkyNews) September 21, 2019

Students in Battery Park also expressed anger at their predecessors. 

“We are going to have clean up after the adults,” 8^th grade student Ollie Davis said. “I skipped school because the planet is on fire and we need to fix it.”

Canadian Environmentalist Philip McMaster, co-founder of the World Sustainability Project and the Republic of Conscience, created his character ‘SustainaClaus’ in 2012 –  “the Santa Claus of Sustainability.” He travels the world advocating for change across all generations.

“Kids seem to have this feeling of incredible urgency, but parents don’t,” McMaster said.  “They really need to understand the urgency of the climate crisis.” 

On a Thursday afternoon, Kimberlee Afzali’s kitchen table was piled with homeschooling guides. Her three-year old son Tuntiak ran around the living room surrounded by a sea of toys. Educating him recently became her full-time job.

This was not the plan. Azfail was going to go back to work and put Tuntiak in a day care program in the East Bronx before enrolling him in pre-K, But now, because of a new state law, Tuntiak would not be allowed to set foot through the door. This year all students in New York State, must receive mandatory immunizations to attend school and child-care centres. Tuntiak is not vaccinated.

“I care about what I put in my child’s body, that’s why I won’t vaccinate,” said Azfali. “I don’t want to risk killing my child.”

As of June 13^th, New York State no longer allows religious exemptions from mandated vaccinations. In August, the Department of Health and Office of Children and Family Services also issued emergency regulations to strengthen the medical exemption process.

Previously over 26,000 students were attending New York schools with a religious or philosophical exemption. Azfali believes that the removal has forced more parents to homeschool their children.

“The homeschooling community has just blown up,” she said.

Enrolment figures from the state won’t be available until October so it is not yet clear whether fewer children are attending school because of the mandatory vaccinations.    

Azfali communicates with other parents on Facebook via homeschooling groups based in New York and anti-vax pages such as  ‘Vaccination Re-education Discussion Forum’ which currently has over 172,400 members from across the United States.

The removal of the religious exemption for vaccinations was prompted by a measles outbreak in Orthodox Jewish communities in Brooklyn. The outbreak was the largest in nearly three decades, and since it began in October 2018, 1068 cases were recorded across New York. On September 3^rd Mayor de Blasio announced that the outbreak was over.

According to the state’s School Immunization Survey in 2017-18,  95.7% of Bronx students were immunized against polio, measles, mumps, rubella, diphtheria, hepatitis B and varicella. 0.07% of students had religious exemptions and 0.02% had medical exemptions.

Herd immunity against an infectious disease such as the measles requires that approximately 92-95% of the population are immune to prevent the illness from spreading.  

Under the new law, the child’s proof of immunization must be provided within two weeks after the first day of school. 

Not only does Kimberlee Azfali not want to vaccinate her son, but she also doesn’t want him to be around other children that were recently vaccinated.

“I fear my son catching something from the children that have just started school and been vaccinated because of the shedding,” said Azfali.

Some vaccines – such as the MMR (measles, mumps and rubella) – contain a live, but weakened version of the virus. Azfali and other anti-vaxxers fear that people who are recently immunized could “shed” the virus to the people around them. But studies indicate that the vaccine reproduces a significant amount less of the virus, and it’s “designed to produce immunity without causing symptoms,” according to the Children’s Hospital of Philadelphia.

“Parents should be more concerned about their child being unvaccinated,” said said Dr Melissa Stockwell, Medical Director of the New York-Presbyterian Hospital Immunization Registry. MMR is a live vaccine but there is really no risk of shedding. Stockwell added.

Journei Bimwala, has been homeschooling her three children – the youngest two are unvaccinated – for the last decade in her Wakefield home. She runs an outdoor program called ‘Nature Classroom’ for other homeschooling families in the Bronx. She said that parents like Azfali have been given no choice regarding mandatory vaccinations.

“They’ve taken away the rights from the parents,” Bimwala said. “If something goes wrong and our children are disabled, we still have to bear the end results of it. Nobody else does.”

The fear that vaccines increase the risk of autism came from a discredited 1997 study by Andrew Wakefield, a physician turned anti-vaccine crusader. There have been a number of studies since then to disprove the link between the two.

But Dr Stockwell is most concerned about the vaccine hesitant families. “That’s the group we want to focus on to provide them with accurate information,” she said.

“They want to do right by their child but they don’t know what is right anymore because there is so much misinformation.”