Grassroots therapy

“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.

Hard conditions

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 county hospital.

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 bureau.

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”.

Personalities, 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.

Will 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.