health freedom

Myra Lewin: Achieving Success in Business and in Life

member spotlight nama ayurveda

An interview with Myra Lewin, CAP AYT, Bali, Indonesia

by Maria Radloff

Is it possible to have a successful, thriving Ayurveda and Yoga business for over twenty-three years? Myra Lewin, NAMACB board certified Ayurvedic Practitioner and Ayurveda Yoga Therapist of Hale Pule Ayurveda and Yoga, has established that it not only is possible, but also can be done in a way that fosters self-preservation and balance.

member spotlight myra lewin ayurveda

I spoke with my Myra, who currently resides in a village outside of Ubud on the island of Bali. I could hear the tropical birds singing as we spoke on Zoom about how she was denied re-entry to her new residence in New Zealand due to the Covid-19 lockdown. When asked how this situation affected her business, she stated that many of the in-person trainings such as chef trainings and treatment trainings had already been cancelled due to Covid-19, but because her entire clientele was now online, moving locations was something that could be done with ease. Before coming to New Zealand, Myra had developed a beautiful Yoga and Ayurveda practice in Hawaii over the span of twenty years, in which 80 percent of the business was offered in person.

Being online has simplified her business and allows her to reach a global population, including people in pockets of the world that would never otherwise have access to her services. Although her business is more profitable, the struggle now is monitoring time spent at the computer since she has seen the effects on her body from sitting at a desk all day. Seven hours is tolerable, but on some days, the hours at her computer can get up to ten! She looks forward to returning to in-person clients and trainings by the end of the year.

Growing up in rural Tennessee, Myra enjoyed working on and racing cars, crafting with wood, and teaching. She got her first car at fourteen! She explored a career in manufacturing and distribution, but after ten years, the details of her true path began to unfold. She had been teaching Yoga and Ayurveda daily, doing workshops, and seeing clients since 1996, but based on an astrologer’s suggestions, she moved to the Hawaiian Islands, and felt the push to begin her full-time Yoga and Ayurveda business, even though it’s not what she ever expected she would do.

member spotlight NAMA ayurveda
member spotlight nama ayurveda

A beloved grandfather had shared words of wisdom about work and life with her, stating that those two things should co-exist. And from that inspiration, Hale Pule (“House of Prayer”) was launched in her Hawaiian home, allowing Myra to create a sanctuary for both herself and the clients she was serving.

So what are the secrets to Myra’s success?

Running a small business isn’t easy. It requires a major investment of time and energy, and there are sacrifices to be made. Attempting to become an entrepreneur can turn a person’s life upside down—leading to eating fast food on the run, not exercising, letting relationships fall apart, and definitely not making time for yoga practices. It’s almost a death sentence for some. But here is Myra, twenty-three years later, looking healthy and radiant, just going with where the universe takes her business and her.

1. Create a foundation assembled of practices that support you.

What does a normal “day at the office” look like for Myra? Since she has fully integrated her work and personal life, she starts her day early with her own practices. Unless she is catching an early flight or feeling sick, which only happens once every five to seven years, she never misses the meditation or pranayama segments of her daily yoga routine. She insists that having this foundation is critical to well-being and success. The rest of her day is filled with consults, administrative work, and team meetings. And she always finds time to cook simple meals and take a walk.

Before moving to Hawaii, Myra dabbled in Iyengar yoga, but soon switched to Ashtanga Vinyasa yoga when a friend suggested she needed a breathier practice. Working her way through Patthabi Jois’s first three series, she to this day draws from the Ashtanga practice.

ayurveda member spotlight NAMA

Investing deeply in her foundation, she studied with Richard Freeman in Colorado, as well as trekking around the world to Mysore, India, to study with the creator himself, Sri Patthabi Jois. She was willing to share some funny stories of practicing with some of these master teachers, which all seem to take place in small spaces!

She met a lovely German fellow at the original Mysore Ashtanga yoga shala, which held only twelve people. Imagine a hot, sticky room, filled to capacity with moving bodies, sweating onto mats. The German gloated about his healthy, all-cabbage diet—from both his mouth and, well, the other end.

The other story takes place at Tim Miller’s shala in Carlsbad, California. A traditional Ashtanga Mysore practice lines up practitioners in two rows, facing each other. While getting into garbha pindasana, Myra found herself doing a complete summersault out of the posture, rolling into the row across from her. Ashtanga yoga practice is good for not only building strength and flexibility, but also serving up a nice dose of humility.

A beautiful lesson that Myra enjoyed sharing with me was that you can’t rush or force things in life, regardless of how enticing they may be. Only a couple of months into her deep dive into the Ashtanga yoga system, she had hopped into an advanced class that her mind loved, but her nervous system simply wasn’t ready for. After the practice, a friend found her sitting outside on the sidewalk, noticing something was wrong, making it clear there is no fast-tracking one’s yoga practice. To this day, Myra continues to practice a true vinyasa (slow connection of the poses with the thread of the breath) from Ashtanga yoga, modified to meet her body’s balancing needs.

From her own experience in going too far, too fast, she instructs her yoga clients to practice from the inside out. She asks them to focus inward, with full attention on the body, energy, and mental state rather than what is going on around them. She encourages a challenging practice yet not going beyond your limit. One of the most prominent trends she has seen in yoga is pushing too hard and over-practicing, causing depletion and injuries.

 
 

2. Manage your energy from the inside out. 

This takes us to another important secret of success—managing one’s energy. I inquired about how she manages to fit in her own practices, cook her meals, and keep up with work, even on the craziest of days. She laughed and said she doesn’t allow herself to have crazy days. She can’t afford the vata vitiation that gets stirred up from over-scheduling or trying to do too much. She values a steady day that chugs along at a comfortable, peaceful pace. She even takes this ideology with her on trips to Japan, where—although she believes that Tokyo is the fastest place on the planet—she maintains steadiness and good measure. Anything is possible when you take the time to prioritize, stay with the plan, and be a bit flexible.

We all must plan and prioritize our activities in this busy world, which offers so many interesting opportunities and enticing choices! Because it is easy to derail with distractions, one must be focused and not tempted to chase down and invest precious time into things that aren’t on the priority list. To illustrate, she shared a story of a client who offered to teach her 250 mantras. While she was amazed and enchanted that somebody could maintain such a lovely collection of chants, Myra instantly knew that her three to four chants were sufficient for her practice and was then able to strategically decline the tempting offer. It’s important to value experiences and practical application of knowledge rather than constantly collecting data and information.

This is another trend that she sees seducing humanity—trying to do too much. Without having a conscious understanding of one’s priorities, how can the right choices be made? She sees that overscheduled children will face imbalances as they grow up from not having the discernment to turn away exciting opportunities that sidetrack them from their true goals. This will exhaust them at an early age, depleting their ojas and vitality.

Throughout the day, Myra doesn’t let the outside world dictate the inside pace of her life. There is no need to succumb to panic from others if one can remain focused on the schedule and priorities set for the day. Energy management starts with having a clear vision of what the priorities are and making choices to support them, rather than becoming distracted. It’s okay to let everything else go.

A peek inside Myra’s successful business

Myra loves watching trends. Living in Hawaii, she watched the tourists as they ate in the local restaurants. Over the years, she saw their health declining as modern eating habits increasingly diverged from sustainable lifestyles. She constantly sees eating fads in the news and uses all this information to educate her clients on how to eat without falling victim to these modern trends.

When I asked Myra if she had any advice for new NAMA Professional Members, she offered that you need to remain attuned to the reasons why you chose this path in the first place. What is in your heart? Make your choices from the inside out. Stay focused. Clear the limiting beliefs that hold you back. 

1. Health starts in the kitchen.

This is illustrated in Myra’s desire to heal those who have fallen victim to poor eating habits. She follows her heart, not getting distracted by all the other problems in the world. A yoga teacher once instructed her to make cooking a part of her yoga practice. At the time she was not one who enjoyed cooking, let alone cleaning up afterwards!

 Myra grew up learning to cook a bit from her mother since they lived in a rural area and eating out wasn’t convenient. She learned just enough that she was able to serve up an entire Thanksgiving meal when she was eight because her mom had fallen sick that day. But it wasn’t until Myra dove into Ayurveda that her cooking skills solidified enough to author two cookbooks.

Before Ayurveda really hit the U.S., there were only two Ayurvedic cookbooks available: Amadea Morningstar’s The Ayurvedic Cookbook and Dr. Vasant Lad’s Ayurvedic Cooking for Self-Healing, which focused mainly on Indian cuisine. While these books were helpful introductions, it wasn’t until she got to peek into some kitchens in India that she had some aha moments. 

member spotlight NAMA ayurveda yoga

Myra produced two books on Ayurvedic eating and cooking. The first, Freedom in Your Relationship with Food: An Everyday Guide (2008), was written as a transitional book since Ayurveda hadn’t quite found its way into the mainstream yet. The book covers how to eat in a style that is still familiar to people in Western cultures, but gently introduces Ayurvedic practices. It also offers recipes that are accessible to those living in the West. 

Her second book, Simple Ayurvedic Recipes: A Companion Cookbook to Freedom in Your Relationship with Food (Simple Ayurvedic Cooking) (2011) focuses more on recipes based on her own simple everyday cooking—nothing fancy, just meals that are tasty and fulfilling. Rather than including photos of the food, Myra left the task of visualization to her readers’ imagination so they could create their own dishes, not recreate hers. Everyone has a different kitchen, a different environment, and a different body to feed, so food should be personalized, just like everything else in Ayurveda.

I was curious about her favorite flavors and spices, and when I asked her about them, she noted that we should be wary of our favorites because those preferences can indicate an imbalance. But to play along with my question, she did offer that she loves a nice blend of cardamom, cinnamon, and vanilla, as well as the pairing up of rosemary and ginger. She loves having access to fresh cilantro and coriander in Bali, too. Her advice when it comes to spicing is to begin with three spices plus salt, until you get familiar with some tasty blends and can begin creatively expanding your own master mixes.

Regardless of cooking skills, love is always the most important ingredient. Sharing meals with friends and family is a wonderful expression of this love, and it supports a connection with one’s self, the other dinner guests, and nature. Having grown up in a large family, Myra cautions against bringing the day’s drama to the dinner table, suggesting that we just keep the conversation light and enjoyable. Having some meals in complete silence connects us with the food and eating process.

2. Yoga and Ayurveda must be used together.

While practicing yoga helps us better understand ourselves as eternal, Ayurveda heals us from the disease stemming from our disconnection from this truth. An understanding of the holistic nature of using yoga and Ayurveda together for healing explodes the old way of viewing things, and as one’s thinking evolves, incredible changes take place. This allows life to get fabulous! Peak results are derived.

I asked her which topic in Ayurveda was her favorite to discuss with her students. She expressed how much she enjoys discussing the six stages of disease with them because they begin to observe their own symptoms and how imbalances evolve, so they can then take steps to reverse the disease process.

As one of the the early disciples of the integration of yoga and Ayurveda in the U.S, Myra grew up with access to master teachers who greatly inspired her, such as David Frawley, Robert Svoboda, Patricia Hansen, and Sarasvati Burman. Now that she is a master teacher herself, I wondered what advice she would offer a student seeking to embark on a new Ayurveda program. She suggested first getting clear on the why, visualizing how he or she wants to work with clients, and how that might show up in his or her life. For example, at what level would the student like to practice? It’s important not to get hung up on titles. Some individuals may excel as a health coach or counselor and would thrive in community education and assisting individuals with healthy daily routines. Others might be talented in treating diseases and imbalances or in developing custom yoga practices and behavioral and mental therapies.

When researching educational programs, it’s prudent to consider both the academics and practical experience of working directly with clients. Teaching students the principles of these disciplines in classes without demonstrating their application cheats them of a vital part of their training. Myra includes this integration of knowledge with the experience in all her training programs.


The hard parts of business 

It would be unfair to say that running a business is as easy as Myra makes it look. I had to know where she got hung up! The first thing she mentioned was marketing. This wasn’t a skill she developed in her previous business career since advertising was actually frowned upon in her industry. She had to begin from scratch, which was okay, because everyone was starting from scratch as the internet was just emerging in the mid to late nineties, perfect timing for her business, which opened in 1999. Honoring the flow, she accepted the resources that showed up when she needed them, nudging her toward developing a website and helping her to bring it to fruition. As online publishing gained momentum, she had to face her introverted personality and begin the process of posting photos and videos. She set out to prove that the integrated practice of yoga and Ayurveda is not just a fad, but a potent approach to healing and living.

If there is one thing to conclude from all of Myra’s advice, it’s to be naturally driven from within, which empowers creative choice. Design a marketing strategy from a place in your heart rather than being led around by external surroundings and circumstances. You should allow your marketing to express who you are. This authenticity will get people’s attention and allow them to receive and understand your message and will ultimately generate the results you are seeking.

Besides marketing, Myra finds administrative tasks somewhat burdensome and difficult. As technology develops, the simplest things become complex. These administrative tasks also require more hours at the computer, which continue to pile up these days.

Other than that, business for Myra has been enjoyable and a bit of an adventure. By maintaining her foundation built from supportive practices and by managing her daily energy from within, built around a list of priorities, she has found success both in her business activities, but more important, in her pursuit of overall happiness and well-being.

 

The future of Ayurveda in the West

As a Professional Member of NAMA, Myra values the many benefits of membership, like connecting with other members, making lifetime friends, and feeling supported in her work, as well as enjoying continuing education with monthly seminars. She’s no stranger to the annual conferences and loves to buy the recordings when she can’t attend in person.

Speaking about her vision of what is possible practicing Ayurveda in the U.S., she notes the importance of healthcare freedom laws. She hates to see limitations on the way Ayurveda is practiced and wishes that the rest of the states would follow the lead of the eleven states that have already embraced freedom in healthcare choices. She is concerned the practice of Ayurveda could get diluted when used within our current medical system, especially if it becomes commercialized. She yearns to see Ayurveda practiced to its full extent as a comprehensive system of knowledge and healing and feels that great education is the key.

To learn more about Myra and her Yoga and Ayurveda services, please visit Hale Pule.

 

About the Author

Maria Radloff is currently a student at Kerala Ayurveda Academy and practices and teaches Ashtanga Yoga and Sanskrit. Besides her passion for yoga, she loves design and writing and works as a graphic designer, specializing in non-profits and yoga businesses.

Dr. Anu is Helping to Grow and Expand Global Awareness of Ayurveda

87848719_10212592744852083_1821061310255726592_o.jpg

One of the foremost leaders in the field of Ayurveda, Dr. Anu is helping to grow and expand global awareness of Ayurveda. I sat down with her in February to discuss her inspiring travels around the world.

In October 2019 Dr. Anu traveled to China for the World Traditional Medicine Forum. Here is a brief description of her time there.

I was honored to receive an invitation to participate in the Shanghai Forum for World Traditional Medicine as a representative from the field of Ayurveda. Experts from Germany, Japan, Thailand, the USA, China, Australia, Malaysia, and Sri Lanka, along with three international organizations, were there to discuss the latest developments in traditional medicine and international standardization of traditional complementary medicine in their home countries and their region of the world. During the last part of the trip, I had the opportunity to visit a few temples in Shanghai. These experiences made my time in China very special.

 What did you find most interesting about the forum?

[I was very amazed ] by the progress of  traditional medicine in other countries. It was interesting to learn how these traditional healing arts are practiced in some of these countries and how they have been integrated into the main healthcare system. I was proud to represent Ayurveda at this conference. We are also at the forefront of this resurgence of traditional medicine. Ayurveda is one of the oldest  medical systems in the world and a fully developed approach to healthcare in India, and it has been growing globally over the past few decades. 

What were your takeaways from the forum?

Understanding how other systems of medicine, like Chinese Medicine, have gained acceptance worldwide helps me envision how Ayurveda can achieve the same. The biggest difference with Chinese Medicine is that Chinese scientists have been successful in promoting its practice with evidence-based research, while Ayurveda is still in the process of doing so. We need to conduct more pharmacoepidemiological studies documenting the safety and effectiveness of Ayurvedic  medicine. Different systems of medicine can learn how to progress and grow from each other. 

You have also traveled to Japan; can you tell me about that?

Since few years, I have been travelling to Japan to give a talk at Japan school of Ayurveda and this time I also got the invitation to give a lecture organized by Tokyo University, and Nihon Pharmaceuticals university. While I was there, I also taught an introduction to Ayurveda at a yoga center. Ayurveda is gaining popularity in Japan. Its educational aspect is the primary focus of interest in that country. Over the last 10–20 years, a few clinics in other healthcare modalities have introduced Ayurvedic approaches to wellness. It is very interesting to see that few Ayurvedic research studies were also conducted there. Since aging populations are a major concern in Japan, medical providers there are more interested in the practical application of Ayurvedic strategies for preventing disease and optimizing health.

Can you tell me about your participation in the World Health Organization’s benchmark development meeting?

 It was a great honor to be part of the World Health Organization meeting on benchmarking documents for the practice of Ayurveda, Panchakarma, and Unani. There were 53 members from different countries who participated in this meeting. I truly enjoyed working with this team, and I am so proud to see the growth of Ayurveda globally! 

The WHO is currently taking an active role in developing global training, practice, and educational standards for Ayurveda, and I was glad to be able to represent the U.S. in discussions toward that end.

To what do you attribute the current surge in interest in establishing global standards for Ayurveda? 

The Indian Government is putting a lot of effort into the development and growth of Ayurveda worldwide. In India, AYSUH is collaborating with the WHO to establish consistently rigorous standards for Ayurveda practice and education globally. I believe that we are on the right path, though it may take some time to develop and implement these standards. Once our profession is firmly grounded in standards that ensure the safety, quality, and effectiveness of our services, Ayurveda will gain increased acceptance and respect around the world . 

What are your goals for the future of Ayurveda?

My dream is to see Ayurveda as a mainstream practice in U.S. Though this may take time, we need to start doing groundwork for this. I believe that this ancient medicine has so much value. It is a time-tested medicine practiced for thousands of years. Recent studies in modern medicine indicate the importance  of diet, sleep, and exercise for health promotion and disease management, a concept that emerged thousands of years ago in Ayurveda. Ayurveda is a complete science, but it is not yet very well known to the world, so we have to educate others about this profound healing science of life—Ayurveda. 

Do you have any advice for new practitioners?

It can be overwhelming when you are starting out, because of the need to master the specific language, terminology, and extensive knowledge base of Ayurveda. In the U.S. the number of educational hours required for graduation from Ayurvedic programs is increasing, and this is very important and good for the students. Do not give up; have commitment to and a passion for learning Ayurveda. Practice in a genuine way, without relying on shortcuts. Our profession is growing with more and more  clients seeking care from Ayurvedic professionals. Protect the profession while practicing and teaching. Strict ethical standards need to be followed. Understand your limitations and the scope of your practice, pursue continuing education, and read the classical texts. I also feel that we need to learn to speak in a shared language that makes Ayurveda understandable to everyone. Ayurveda is a patient-centered, customized approach to healthcare for individuals and families, as well as an all-encompassing way of life. The unique value of Ayurveda lies in consciousness-based practices that nurture health in body, mind, and spirit and that promote balance in every aspect of our life. A balanced and peaceful state of mind is a key aspect of well-being. Ayurveda has taught me to value community, family, relationships, love, compassion, and peace. Its lessons inform my belief that we must all join hands with each other because our future depends on a community that stays together. A strong, united community will guide the mission, vision, and growth of Ayurveda. 

Your work is currently receiving international recognition. Which awards have meant the most to you?

I am extremely honored and humbled to have received the Sheikh Zayed International Award for Ayurveda in Abu Dhabi. This award bears the name of late Sheikh Zayed bin Sultan Al Nahyan, the founder of the United Arab Emirates (UAE) and a visionary statesman who dedicated his life to laying a solid foundation for a progressive society that benefits everyone. The award aims to create, recognize, and reward excellence in traditional, complementary, and alternative medicine. 

The APHA ICTHP service award for outstanding leadership, service, and dedication to integrative complementary and traditional health practices also means a great deal to me.

 Another award that I cherish came from the SoCaL Kerala Ladies: the 2020 Surya Prabha Women Achievers Award for outstanding contribution in the field of Ayurvedic medicine.

I dedicate all these awards to my family, teachers, friends, students, and the Almighty. These honors make me more determined than ever to dedicate my life to Ayurveda. Ayurveda has been practiced for thousands of years. As the adoption of this powerful healing system continues to spread around the globe, the ancient science of Ayurveda now promises to become one of the most valuable contributions to the future of modern healthcare. 

Anupama (Anu) Kizhakkeveettil, BAMS (Ayurveda), MAOM, L.Ac., CMT, C-IAYT, Ph.D.

Dr. Anupama (Anu) Kizhakkeveettil is an Ayurvedic Practitioner, licensed acupuncturist, and certified yoga teacher. She is a professor and Program Director of Ayurvedic Medicine at Southern California University of Health Sciences. She serves as Board Director for National Ayurvedic Medical Association and California Association of Ayurvedic Medicine. She also serves as president of Athreya Herbs.


anjali+deva+2.jpg

About Author

Anjali Deva, AP

Anjali Deva is an Ayurvedic practitioner, writer & teacher in Los Angeles. Her private practice Rooted Rasa specializes in understanding anxiety, depression, PTSD, digestive disorders and women’s health. Anjali has been greatly fortunate to have been introduced to Ayurveda at a young age by her father and mentor Arun Deva. 

The Value of the NAMACB Certification Board Exam 

By Paula A. Witt-Enderby, Ph.D., CAHC
 
When new graduates think about preparing for the National Ayurvedic Medical Association Certification Board (NAMACB) exam, they probably become nervous as I was when I was getting ready for mine. We dread studying. We have doubts about our mastery of the subject matter. We wonder why we’re doing this.   
 
It’s perfectly normal to feel this way. When nearing the end of my health counselor training in May 2017 at the Kripalu School of Ayurveda, I wondered if I was prepared enough to pass the boards. I wasn’t sure when I should take the boards—I didn’t want to take them before I had studied sufficiently, but I also didn’t want to wait too long for fear that I would have trouble recalling all that I learned during my training.  
 
Nevertheless, I took the boards soon after graduating because I recognized their importance. The NAMACB boards play a critical role in standardizing training from the different schools of Ayurveda, lending credibility to our field, and ensuring that each of us emerges from our respective training programs as a truly competent Ayurvedic professional. 
 
From everything I now know after a year and a half in practice, I can say without a doubt that preparing for and taking the boards has given me confidence in my counseling skills and lent credibility to my services as a certified Ayurvedic health counselor. I proudly display my NAMACB-recognized Ayurvedic health counselor insignia on my business cards, on my website, and in any informational brochures or presentations that accompany my workshops.  
 
Getting ready for the boards by reviewing the study guides prepared by NAMACB and posted on its website helped me untangle many of the complexities of our field: I gained a clearer understanding of how to place the philosophy and history of Ayurveda in the proper context, what the 25 principles of samkhyaare and how they form the entire basis of Ayurveda, and how to differentiate between interrelated yet distinct Ayurvedic concepts such as the following:

  1. The goals of Ayurveda (maintain the health of the healthy and cure the sick) 

  2. The three pillars of Ayurveda (diet [ahara], lifestyle [vihara], and herbs [auśadha]) 

  3. The three pillars of health (diet [ahara], sleep [nidra], and energy conservation [bramacharya]) 

  4. Ayus(body, mind, senses, soul) 

  5. The three causes of disease (misuse of the senses [asatmyendriyartha samyoga], crime of the intellect [prajnaparadha], and temporal factors [parinama])  

 
The study guides helped not only clarify the six schools of philosophy and their main principles—areas that I had trouble synthesizing during my training—but also deepened my understanding of the characteristics and symptoms associated with amaand low ojasby dosha(vata, pitta, kapha) and by system (digestive, musculoskeletal, nervous, general) as they relate to imbalances in the mind and body.  
 
Equally important, studying these guides helped realize what I didn’t know, sending me back to my class notes, training handbooks, or Dr. Lad’s textbooks to fill the gaps in my knowledge. The preparation process also forced me to memorize all the relevant details about herbs—their Sanskrit name, classification by genus and species, indications, contraindications, qualities, etc.  
 
As a professor for 23 years in a pharmacy school and coming from a discipline where testing, certification, and licensure are routine steps to a successful career as a healthcare professional, I want to reassure every examinee that the high quality of our Ayurvedic training ensures that we gain the competence required  to complete  a similar path to professional credibility.  
 
No doubt your training was as rigorous as mine and your teachers, like mine, did a brilliant job of infusing your training with the essence of Ayurveda as it was conceived in classic texts and passed down  in words, mantras, songs, and writing exercises and presented you with enough case scenarios from their diverse backgrounds and broad and deep experience to enable you to not only pass the boards but also achieve excellence as Ayurvedic professionals. 
 
We were led to Ayurveda for a reason. We are lucky to have been given this ancient wisdom. May we all trust in ourselves as our teachers and the Ayurvedic community trust in us!


Paula%252BWitt-Enderby.jpg

About the Author

Dr. Paula Witt-Enderby, Ph.D., CAHC is a Professor of Pharmacology and Toxicology, NIH-funded melatonin research scientist and Board Certified Ayurvedic Health Counselor. She blends Western and Eastern medicine into her research on bone and breast cancer.

State Licensure For Ayurveda Legitimacy and Recognition

By David T. McConaghay, AD

State licensure will grant Ayurveda the legitimacy and official recognition it needs to realize its full potential to positively impact the lives of millions of people.
 
Licensure is a state-level function. As the pre-eminent national Ayurvedic organization, NAMA is busy doing everything in its power to facilitate the pursuit of licensure. These foundational efforts include the establishment of scopes of practice, national board exams www.namacb.org for three levels of Ayurvedic professionals, as well as a council to accredit Ayurveda schools (NAMA Accreditation Council, NAMAAC).
 
NAMA, however, can only do so much. Therefore, if we are to perform our role as modern-day stewards of the vidya that is Ayurveda, those of us invested in properly protecting and promoting its study and practice must organize ourselves at the local level.
 
There is already a great deal of ongoing activity in this arena. Formal state associations currently exist in California, Colorado, Florida, and Minnesota, and there are groups currently forming in many other states, including but not limited to Connecticut, Massachusetts, New Jersey, New York, Pennsylvania, and Texas. Leaders from these groups meet monthly to share best practices and inspire each other.
 
State organizations serve as a focal point for local Ayurveda communities. They offer membership benefits, send informational newsletters, host educational events, and hold regular leadership meetings to serve the needs of Ayurvedic professionals in their state.
 
In addition to cultivating community solidarity, these state groups will serve as the avenues through which the Ayurvedic profession will achieve the official recognition it needs to reach a mass audience in America.
 
While each state organization is inherently independent, we see immense benefit to maintaining general alignment and open channels of communication between states and with NAMA. Look for updates in 2019 detailing more about the precise structure of the relationship between NAMA and the state organizations.
 
If you are curious about what’s happening in your state or want to make something happen in your state, please contact us jolynne@ayurvedanama.org, and we’ll get you connected!


David

ABOUT THE AUTHOR

David T. McConaghay, AD is the Communications Chair of the Colorado Ayurvedic Medical Association (COLORAMA) and is the Chair of the NAMA's State sub-committee, whose mission is to be an organizing force offering support to state-level Ayurveda organizations.

The Legal, Unlicensed Practice of Ayurveda

Ayurveda is at an exciting stage in its development as a healthcare system in the U.S. We have a growing number of schools producing an exponential number of new graduates. Awareness of our profession is growing among the general public. With this growing awareness, we must all be cognizant of the importance of appropriate professional behavior. This can be a bit tricky as there is currently no licensure for the practice of Ayurveda. Our profession is at that awkward teenage-stage of development when it’s sometimes unclear about what to say and how to behave.

All states have medical practice laws that prohibit the practice of medicine without a medical license. Fortunately, complementary alternative medicine (CAM) practitioners have worked diligently with their state legislators to pass health freedom acts in 11 states. These Acts exempt non-licensed practitioners from the violation of any licensing law related to health care services provided the practitioners comply with a list of things they can and cannot do. These requirements are relatively straightforward and compliance is not onerous. The specifics vary somewhat state-to-state, but they are all similar.

For example, an unlicensed practitioner cannot perform surgery, administer x-rays, prescribe pharmaceuticals or represent himself or herself as a doctor or physician. Regarding the must-dos, the unlicensed practitioner must advise their clients prior to providing services that they are not a licensed doctor, that their services are alternative or complementary to healing arts services, that their services are not licensed by the state, they also need to explain the theory upon which their services are based, and describe their education and training. Compliance is really quite simple.

Ayurvedic practitioners have a reasonable amount of latitude practicing in these states provided they structure their language in Ayurvedic terms. They can diagnose and treat Ayurvedically. There are some cautionary aspects, so practitioners must be familiar with the specifics of their state’s health freedom act. Organizations formed to help pass these health freedom acts have helpful information interpreting the acts along with practitioner’s compliance information and client document templates. Get involved with the National Health Freedom Coalition.

We must all be knowledgeable of the medical practice law in our respective states to practice Ayurveda legally. Simply do an online search for “[your state] medical practice act”. Most of these laws are written in simple, common sense language.

Now… about those other 40 states. Ayurvedic practitioners in these remaining states have a more complicated task providing services. Some of these states’ statutes provide a little leeway, but some are completely restrictive. The following excerpt is a good example of how restrictive statues can be, “any person who practices or attempts to practice… any system or mode of treating the sick or afflicted … or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition … without having a valid certificate… is guilty of a public offense”. This statute clearly prohibits all forms of treatment by any system for any ailment. Operating outside the statute leaves the practitioner open to both civil and criminal charges up to and including felony charges. This reflects poorly on both the individual practitioner and our entire profession. Again, it is very important that you have read and understood your state’s statutes.

All is not lost! You can practice Ayurveda in a non-health freedom state, but everything you do must be in terms of providing education. Your verbal and written communication and your actions must consistently demonstrate that you are acting as an educator, and as such, you are not practicing medicine without a license.

A service agreement is a good first step in establishing the educational nature of your services. All of the health freedom acts require a similar document. The service agreement demonstrates your intent to act as an educator. This is a document that defines the terms and conditions of your relationship with your client. It lists the parties involved – you and your client. It should specifically state that you are not a doctor, that you cannot legally diagnose or treat, and that you are only providing educational services. The payment terms and duration of the services you provide should be specified. Both you and the client sign this document.

Once you have stated your intent and signed the service agreement, you have to operate within the terms of the agreement. Do not diagnose or treat, not even using Ayurvedic terminology. Remember, as the above example illustrates, some state’s statutes are globally prohibitive.

The next step is ensuring that your language does not slip into the realm of practicing medicine. To avoid this do not make any personally prescriptive recommendations or instructions to your client. Also, do not make any recommendations to treat a specific condition or issue, even if you are using Ayurvedic terminology. All communication and actions must be educational in nature and in no way be personally applicable to the client.

Clients seek healthcare services when they have a health issue. They come to the health practitioner with the expectation that they will be told what to do to resolve their issue. You cannot move into this personally prescriptive role, you must maintain the educational boundary between you and the client. It is appropriate to explain the legal issues and limitations and why you must communicate in this particular manner. Clients are obviously open to alternative healthcare, they have sought your services and they will be understanding and appreciative.

Special care should be given to any documents you provide to your clients. All documents should contain an educational disclaimer that states that the information is for educational purposes only and the information is not to be used as, used as a substitute for, or considered as a medical diagnosis, treatment or prescription. The disclaimer should also encourage your clients to consult a licensed health care professional before using any herbs or herbal products, before beginning any new exercise or health regime, and for any persistent problem or complaint.

What does this mean in day-to-day practice? How do you conduct a consultation? You can certainly assess a client. (Another nuance, do not use the word patient. You must not use any language or perform any actions that could imply the practice of medicine – so, client, not patient.) You can ask questions, prashna. You can ask your client to complete a health questionnaire that you provide and review it with the client. You can discuss the client’s specific health concerns and goals. You can perform an exam. You can review all the information you have collected and then provide a factual report of findings of their prakruti and vikruti.

Now for the important part: You cannot make any recommendations that are personally applicable to the client. You would not want to say, for example, “ Take Triphala to reduce Vata in your colon”. This is a prescriptive recommendation personally applicable to the client. Your state’s statues likely prohibit even this type of diagnosis and treatment.

What you can say in your report of findings is: “According to Ayurvedic theory, the symptoms you describe are typical of a person with elevated vata in the colon area. I also detect elevated vata in your colon pulse. The Ayurvedic formula, Triphala, has been classically used to support normal colon function”.

What’s the difference in these two statements? In the second statement, you have educated your client as to the Ayurvedic perspective of their symptoms. You have advised them that their vata is elevated. This is not diagnostic, only a descriptive fact. This is similar to reviewing a patient’s laboratory test results and confirming to them that their cholesterol is 265, but you are not interpreting and evaluating this information by saying they have hyperlipidemia. The difference is factual statement vs. diagnosis. You have provided education about Ayurvedic herbology in a very specific manner. What you did not do is make a medical claim. A medical claim is stating “take this to fix that”. Continuing with our cholesterol example above, saying “take guggulu to lower cholesterol” is a medical claim. Saying “classically Ayurveda has used guggulu to support normal liver function” is not a medical claim. Additionally, you did not make a personally prescriptive recommendation, only a correct factual statement.

You could even make the additional cautionary disclaimer, “I am not a doctor or a physician. I am not saying that you should personally take Triphala or guggulu, but should you decide they are appropriate for you, you may want to discuss this with your doctor before starting”.

You do not instruct the client to do or change anything. You provide education that is relevant to their health concerns and goals. You make it clear that you are not making personal recommendations. Communicate to the client that it is their responsibility to decide if the education you have provided is applicable to them and that it is also their responsibility to decide if they take action based on that information. The essential aspect of practicing in this way is that you always act as an educator. You must be consistent in your verbal and written communications and your actions, and they must be educational in nature. Our first amendment right provides for the freedom of speech, which includes education. That said, you are providing services for payment, you are still liable for providing correct and accurate information.

While adapting one’s language to be legally correct can be a bit tedious until it becomes a habit, it is straightforward. There are a number of phrases that you can incorporate to keep you in the educational realm. Phrases such as, “according to the classical teachings of Ayurveda” or “Ayurveda believes or recognizes” keeps the conversation educational and not personally instructive. You can also say, “what I would do for myself in similar circumstances is….”. This is your personal opinion about yourself, you are not telling the client to take specific action.

Even if you do everything correctly, this does not mean that you are 100% insulated from investigation and potential legal action. This will only occur if someone files a complaint. If a complaint is filed, the appropriate agency is required to investigate. That does not mean the action has merit. If you have taken the proper precautions, you will be able to demonstrate consistent good intent of your role as an educator. Common sense goes a long way in avoiding conflict. If you have an unhappy client, immediately give them a complete refund and ask that they return the herbs, supplements and documents you supplied them. It is rare, but other practitioners sometimes file complaints. This is often due to jealously or the fear of losing revenue. There is nothing that can be done to avoid this besides maintaining good relationships with fellow practitioners.

One last issue that often arises is the question of providing hands-on therapies such as abhyanga. Ayurveda certainly recognizes abhyanga as distinct and unique from massage. But to the non-Ayurvedic observer, abhyanga and massage appear to be the same thing. While one could attempt to argue that the client is being educated about abhyanga by the demonstration of receiving abhyanga, the counter argument is that the practitioner should be affiliated with a licensed massage school. To practice Ayuvedic bodywork safely, one should either have a license that allows for touch, or work legally under the supervision of a licensed healthcare practitioner. It is certainly acceptable for the practitioner to demonstrate self-abhyanga to their client.

Our profession is growing. This is the result of the actions of practitioners who came before us. We all have the responsibility to continue this tradition by practicing both legally and ethically. The intent of this article is to raise awareness of the importance of practicing legally. This article is much too brief to cover all legal aspects as each practice is unique with its different types of services offered and areas of specialty. Take the time to become knowledgeable about your state’s statues and how they apply to you. If you have any questions or concerns, retain a knowledgeable attorney for an hour’s consult. This will allow you to confidently operate your practice within your area of expertise compliant with all legal requirements.

 

About the Author

Jeff Turner operates Living Ayurveda, an integrated health clinic in Monterey, CA specializing in advanced chronic diseases and panchakarma. He is an author and an Ayurvedic educator teaching at various Ayurvedic schools in the U.S. and the California State University system. He has been actively involved with Ayurvedic legal and licensing issues since NAMA’s inception.

Legal Disclaimer: The information provided in this article is for informational purposes only and should not be considered to be legal advice. This article may contain links to other resources on the Internet.  These links are provided as citations and aids to help you identify and locate other Internet resources that may be of interest, and are not intended to state or imply that the National Ayurvedic Medical Association or the principal author recommends, supports, sponsors, or is in any way affiliated or associated with any person or entity associated with those links, or is legally authorized to use any trade name, registered trademark, logo, legal or official seal, or copyrighted symbol that may be reflected in the links.

Credentialing the Ayurvedic Profession

NAMA has been systematically building a credentialing program based on the belief that credentialing is one of the most important ingredients to the advancement of the Ayurvedic profession and a key component to the goal of licensing. There are many steps toward credentialing and NAMA has been hard at work over the past twelve years laying the groundwork. We are now ready to establish viable and fair National Exams for the Ayurvedic Health Counselor and the Ayurvedic Practitioner and will eventually create one for the Ayurvedic Doctor level.

Here we answer some questions you may have about the certification process, its impact on you and why NAMA’s certification program will be recognized nationally as the gold standard for competency in the field of Ayurveda.

Why Credentialing?

Credentialing facilitates standardized practice across a wide variety of treatment settings. Most importantly it assures ethical professionals are available to clients, families and their communities. Certification serves the following purposes:

  • It gives the general public a basis for evaluating a service provider

  • It helps employers judge the skills of existing or potential employees

  • It allows those who are certified to differentiate themselves from others in the profession and to advance their career

What is NAMA doing in the certification process?

First, NAMA had to identify the competencies an individual must possess to perform his/her job functions competently at various levels. NAMA identified Scopes of Practice required for these various levels of professionals. Additionally, we looked at educational guidelines required to meet the scopes of practice and took into consideration the value of experience needed to successfully complete a competency-based exam. These steps have been completed.

The next step was to find an experienced and appropriate partner to assist in creating the exams. After evaluating a number of proposals, we have teamed up with an outside consulting firm to provide expertise in psychometrics to ensure a valid and rigorous competency exam. A well-designed examination avoids the pitfalls of developing test questions that are not legally defensible or valid, thus resulting in poor data, and potential legal challenges.

Why develop a certification process?

According to the Center for Association Leadership, certification programs have become increasingly popular during the last few years. There have been many cases of organizations setting up certification programs and credentialing examinations without the proper rigor, judgment and stakeholder buy-in. For some organizations, it is seen simply as a quick revenue stream.

NAMA has chosen this rigorous path of certification in order to foster increased recognition of the profession nationally. However, creating and then maintaining a certification program requires planning and close attention to several important steps. NAMA is committed to a thorough and comprehensive process that includes the use of an experienced organization skilled in the creation and implementation of fair and legal examinations. The costs and time are significant in developing, marketing and administering a certification program and must be thoughtfully planned and implemented.

What are the biggest mistakes that some organizations make?

Underestimating the support needed in creating a defensible rigorous certification program. The support of the Ayurvedic community from the practitioners to the schools is paramount to its success.

>>NAMA has long worked with representatives of Ayurvedic schools, practitioners, and other key members of our community. In the cases where this is not done there tends to be many issues that arise around fairness and even legality of the exam itself. Thus creating a weak and indefensible component to the future licensing ingredients.

Underestimating the time needed. The variables included in the exam process include identifying the job tasks (competencies), identifying the exam objectives, the subject matter expert availability, and obtaining a good sample of beta candidates. If shortcuts are taken here, they usually come back to haunt the program in poor test items, unsatisfied test takers, and unreliable data.

>>NAMA has thoughtfully been working on the entire process over the past 10 years and is now entering the phase of the actual exam creation with a target date of December 2016 for implementation.

Failure to account for recertification. Few organizations certify for life without at least requiring some sort of skills maintenance. You should be skeptical of any organization that does not have a recertification process.

>>NAMA is making a long-term commitment by assuring a process for recertification through a continuing education program that will require those certified through the grandparenting process, or ultimately through the examination process to maintain and/or improve their skills on a regular basis. Developing side-by-side with the examinations, the Professional Ayurvedic Continuing Education (PACE) requirements provide evidence that our organization is continuing to invest in the credential that will maintain its value in the health field.

Failure to have a certification revocation process. This involves two steps: developing and distributing a “Code of Ethics” and confirming that all Professional Members have agreed to adhere to this standard, and creation of a “States of Professional Conduct” plan to establish a process by which complaints can be lodged and investigations conducted.

>>NAMA has a “Code of Ethics & Professional Conduct” in place and all professional members agree to follow the code when they submit their membership application. All professional members are also required to take a short Ethics Exam every two years as a part of their Professional Ayurvedic Continuing Education requirements. NAMA’s Ethics Committee reviews any complaints or breach of the code of ethics by professional members. The next step in the development of a certification revocation process is to take great care to ensure a disciplinary process is applied consistently and fairly. This process must also allow for a mechanism by which disciplinary actions can be appealed.

Failure to design a rigorous and fair exam that has both internal and external validity. When looking at a certification exam ask if it’s an exam that’s criterion based. That means it provides an objective reference standard. In a nutshell, this means that the candidates taking the exam are evaluated on how they perform relative to a fixed set of criterion, and not judged relative to their peer group’s performance.

>>NAMA is engaging experts in the field to work with us to assure this validity.

Failure to use experts in the exam development. Creating a fast and easy quiz or test without attention to the details of the exam process can result in invalidating any credential offered for everyone who has taken the exam.

>>NAMA has recognized few people are trained in rigorous test development. We’ve acknowledged that to provide a rigorous exam it needs guidance and expertise in exam development. We have teamed up with a psychometrical team of experts who are working closely with us to provide the necessary tools and guidance to help ensure our certification exam is:

Useful: Achieves our professional goals

Credible: Has perceived value and holds up under the scrutiny of others in the healthcare field

Reliable: Consistently measures whatever the test is measuring

Valid: The scores provide meaningful information based on the purpose of the test(s)

Legally Defensible: Has followed best practices to help ensure the test scores are fair, reliable, and valid

A lot boils down to the integrity of the exam. If the certification exam is too easy, too hard, or does not measure what it’s supposed to, then everything else will fade over time.

It is not enough to just offer a certification program for its own sake. We must raise the bar for the profession and follow through with a certification process that identifies and supports the best practitioners in our profession - those that practice to a well-defined and excellent standard of practice. NAMA is committed to offering a rigorous, valid and fair certification exam and has spent the last 12 years creating the groundwork to put it all in place.

NAMA has taken on this challenge for its members and ultimately for the viable future of Ayurveda in the United States. State organizations that adopt NAMA’s credentialing process, including the certification examinations, will have a strong and fully developed program to present to their legislatures in the efforts toward licensure. With a strong, thoughtful, and well-designed process, everyone wins.

 

References

Institute for Credentialing Excellence (2010). Defining features of quality certification and assessment-based certification programs. Retrieved from: http://www.credentialingexcellence.org/

Kryterion. Test development Analysis: retrieved from: http://www.kryteriononline.com/services/test_development/job_task_analysis/

Lenora G. Knapp, PhD, Joan E. Knapp, PhD (2014). Business of Certification: A Comprehensive Guide to Developing a Successful Program. Center for Association Leadership. Retrieved from: http://www.asaecenter.org/

Institute for Credentialing Excellence (2010). Defining features of quality certification and assessment-based certification programs. Retrieved from: http://www.credentialingexcellence.org/

Reed A. Castle, PhD. (2002) Developing a Certification or Licensure Exam. Schroeder Measurement Technologies, Inc. Retrieved from: http://home.smttest.com

BAMS In the U.S.A

Over the past 40 years, many graduates with a Bachelor of Ayurvedic Medicine and Surgery (BAMS) degree, as well as BAMS MD, have come to the U.S. We owe a great deal to these individuals and are very fortunate for the risks they have taken and challenges they have overcome in bringing Ayurveda to the west.

We can consider these generous souls to be our Ayurvedic godmothers and godfathers as many were our first teachers, offering short courses and introductions to Ayurveda. As their students increased in number and dedication, many began to teach more formally. Historically, this is how many of our current Ayurveda schools were founded. It is because of the dedication of these early leaders and teachers that Americans leapt into the sacred waters of Ayurveda and began to study in earnest.

It is not an easy task to introduce a new system of medicine into a completely different culture. It has taken these pioneers of Ayurveda several years in order to be comfortable enough to talk about and share their wisdom. They have had to acclimate themselves by examining our western culture, the environments in which we live, the foods we eat, and our ways of being in order to appropriately apply the principles of Ayurveda to our western world. Through their own personal studies of the American culture, they have succeeded in translating Ayurveda into not only the English language, but also the western culture as a whole.

Unfortunately, it is not possible to presume that all immigrants with a B.A.M.S. have had this kind of exposure to and education about the U.S. To practice or teach Ayurveda here, it is essential to understand the laws pertinent to practicing as a health care professional – licensed or otherwise. Currently, it is not legal to practice the full scope of Ayurveda here in the United States as it is in India. Considering that 40 out of 50 states do not have health freedom legislation, anyone residing in those states and practicing Ayurveda must understand their legal limitations and take the appropriate steps to protect themselves and their practice.

Much of what Ayurvedic doctors and B.A.M.S. professionals practice in India is not legal here. There are many herbs, treatments and procedures that simply cannot be offered. In many states, Ayurvedic professionals can only work as Ayurvedic educators within the realm of diet and lifestyle. This, of course, limits the scope of practice that many B.A.M.S. graduates have been taught.

Equally important for those relocating to the United States is taking the time to learn the language, the types of foods people eat, and the American lifestyle. It is difficult for Americans to understand recommendations that do not apply to their environment and lifestyle. Often these interactions end up being ineffective and clients walk away discouraged and confused.

In conventional medicine, doctors emigrating from other countries are required to meet U.S. medical school standards, which often requires returning to school and passing a series of tests before they are allowed to practice as an M.D. Although this is not expected for B.A.M.S. immigrants, it is encouraged that a period of education and acclimation be considered before entering into an American practice.

Recommendations for Recent BAMS Immigrants 

1. Join NAMA as a professional member. This will provide many levels of support and education that you may need as well as connect you with a community of Ayurvedic professionals including members with B.A.M.S. degrees that have experience practicing in the United States.

2. Take time to polish your English conversational skills.

3. Find a local NAMA member to mentor you. Shadow them for a while to get comfortable with American customs and attitudes.

4. Take Professional Ayurvedic Continuing Education (PACE) courses for topics in which you may need additional training or study.