by Reinhard Gasser
medicine is one of many traditional therapies embedded in local
culture and knowledge. Over the years the Swiss Red Cross has
developed a policy of supporting traditional medicine as a component
of health projects in Africa, Latin America and Asia. The Tibetan
programme deserves particular attention.
“When I fell ill, my daughter took me to see a government
health worker. But he was lazy, he had no remedies left and
had not received his salary for three months. So instead I
went to see the ‘amchi’ (traditional doctor) in
our village,” says Tsering, an old woman in Rungma Shang.
“He was very helpful, and with the ancient knowledge
of the lamas (spiritual leaders of the Tibetan people) he
was able to relieve my constant rheumatic pain.”
Rural Tibet is a tough place to live. Most human settlements
are located at an altitude of over 3,800 metres. Winter is
long and bitterly cold; water for agriculture, drinking and
hygiene is scarce, and so are firewood and yak dung, the traditional
fuel used for cooking and heating.
In such an environment, life for Tsering and many others
is hard and constantly threatened by death. It starts at an
early age: 120 in 1,000 children don’t survive the first
six years, compared to 6 in 1,000 in Switzerland. Women’s
lives are particularly at risk; of 100,000 children born alive,
729 of their mothers die while giving birth.
Things have come a long way for Tsering to be able to attend
an amchi in her own village. Initially, the government had
tried to improve people’s health conditions by providing
basic health services. This was quite a challenge in a country
where villages are scattered over a huge area, and roads,
where there are any, are of poor quality.
Since resources were scarce, it was impossible to build up
an expensive health infrastructure within everybody’s
reach, with sophisticated hospitals and many doctors using
costly machines and intervention techniques. So the idea was
to treat the most common health problems through simple diagnostic
and therapeutic measures together with basic medicines. These
health services were intended for everyone, even those living
in remote areas. This would be achieved by training people
from the villages as “rural health workers” and
providing them with the basic equipment.
On the whole the system has proved to be effective and since
the end of the 1980s, with the help of the Swiss Red Cross,
almost 1,000 “rural health workers” (an average
of 1 per 615 inhabitants) have been trained in the prefecture
of Shigatse, the most densely populated area in Tibet.
An old tradition is rediscovered
In the meantime, the costs for the whole health system increased,
as in most other countries. The government needed to save
money, but was looking for opportunities to maintain a good
standard of health services. That was when they discovered
that Tibet had a tradition of medical practice, a medicine
of its own.
Tibetan medicine has its own methods of identifying and treating
disease. It distinguishes three humours: wind, bile and phlegm.
All disease is considered to be a result of an imbalance between
the humours, and it is up to the amchi to discover the root
of the imbalance. The cause can be found not only by examining
the patient’s age, nutritional habits and lifestyle,
but also, for example, by studying astrological constellations.
Great importance is also attributed to the three “poisons”:
ignorance, hatred and narrow-mindedness which, according to
Buddhist belief, are to blame for human suffering and for
the difficulty of escaping from the cycle of death and rebirth
and the attainment of enlightenment.
This science has evolved over hundreds of years and has been
handed down from one generation to the other by scholars and
monks, but it has been neglected in the recent past. The authorities
discovered that it was not only an old and rich cultural tradition,
but that it had proved effective in treating many common diseases
such as gastro-intestinal or rheumatic disorders. Besides,
because of the relatively simple diagnostic and therapeutic
methods, it was much cheaper than the highly sophisticated
techniques and remedies of modern Western medicine. Tibetan
medicine was thus integrated into the health system in Tibet
and, today, a department devoted to it can be found at any
Nonetheless, the state of the health services in remote areas
remained unsatisfactory. Money was still short, and in many
cases the government could not even afford to pay the rural
health workers. Students who chose to train in Tibetan medicine
were not the most motivated, as most wanted to study modern
Western medicine. The prestige and income of a doctor were
much higher compared to those of a practitioner of traditional
medicine. This led to the idea of setting up a private school
for Tibetan medicine.
Consortium Red Cross Programme in Tibet
In 1988, at the invitation of the late Panchen Lama, the
Swiss Red Cross became the first NGO to initiate a health
care programme in the Tibet Autonomous Region. It started
with a training programme for “rural health workers”.
A year later, the first private school in Tibetan medicine
was built in Pelshong. Then another, less strict Tibetan Medicine
school followed. In 1995 an eye care project — closely
linked to the successful Nepal programme — was developed
to combat the high prevalence of preventable blindness in
the country. In the meantime, training “rural health
workers” continues with a pilot scheme in one county
which focuses on improved quality of training and increased
participation of the people.
The programme’s main operational partners are the Tibetan
branch of the Red Cross Society of China and the public health
Three years ago, Swiss Red Cross began working with Norwegian
Red Cross, and more recently with Netherlands Red Cross, to
form the “Consortium Red Cross programme in Tibet”.
not just technicians
In 1989 the Swiss Red Cross initiated its support to the
Pelshong school near Shigatse. In the premises of a former
army camp, the “amchi” who was later to become
the headmaster began to build up the school. The man is called
Jampa Trinley, a monk from the powerful and respected circle
of the Panchen Lama, a high traditional authority of Tibet.
The Swiss Red Cross came up with a plan of how to make the
best of Pelshong and the functioning rules were set down.
In the course of the six-year curriculum the students, selected
by the headmaster from villages, are taught the foundations
of the scriptures, the so-called “four tantras”,
and learn about the composition and manufacturing of the medicines.
After graduation, they are bound by contract to go back and
practise in their villages, thus providing health services
to the people of remote areas. Unlike the rural health workers,
they do not receive a salary from the State, so patients must
pay for treatment.
Teaching is strictly traditional, not only with regard to
preparing remedies and treating diseases, but also including
other aspects of Tibetan medicine such as astrology. Nor is
it confined purely to technical issues. Discipline and ethics
are strongly emphasized. The aim is to turn out exemplary
personalities with high moral virtues, not just good technicians.
the “amchis” survive?
With the completion of the training of the first batch of
36 students in 1996, the story about how the first “amchi”
arrived in Rungma Shang and treated Tsering’s rheumatic
pains comes to an end. But the other story, the one about
private practitioners of Tibetan medicine is not yet concluded.
Several questions still have to be answered. First, what
will happen to the school when Jampa Trinley retires? As yet
no successor has been appointed. Secondly, how can the “amchis”
compete as long as public health staff are subsidized and
they are not. Finally, what will happen if nothing is done
to protect the natural ingredients for Tibetan drugs? Certain
species will die out if the trend continues for the mass use
of Tibetan drugs.
The future of Pelshong and of rural practitioners in general
is not only in the hands of the Consortium Red Cross. But
certain measures will become necessary: highly qualified students
need to be selected and prepared to assist and support the
work of Jampa Trinley, one of whom will eventually be his
successor; graduates will need temporary financial support,
although of course the Consortium Red Cross cannot pay them
a full salary; a workshop with high-ranking officials involved
in Tibetan medicine and drug manufacturing should be organized
to discuss a policy to protect the natural ingredients.
In this way the practitioners of Tibetan medicine will have
a chance of keeping this valuable tradition alive.
Reinhard Gasser is Programme Coordinator at the Swiss Red
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