Amchi Health Worker Training Programme
High in the remote Himalaya is the land known to some as "Little Tibet". Ladakh is the most remote region of India - a barren, virtually rainless area which lies north of the Himalaya - an area known geographically as the Tibetan Plateau.
This paper concerns an exciting and vitally needed programme of medical support for the people of Ladakh.
Ladakh
The Himalaya serve as a barrier to clouds carrying rain from the south; virtually none of it gets across to fall on Ladakh, which in consequence has only a few centimetres of rain per year - as little as the Sahara. The result is a barren, grey-brown landscape utterly devoid of vegetation: this is why it is sometimes known as 'The Moonland'.
The people of Ladakh are related to the Tibetans and follow similar cultural and religious practices. In fact Ladakh is perhaps in some ways more 'Tibetan' than Tibet, whilst Tibet is now politically part of China, and Ladakh politically part of India.
Ladakh is situated on a high altitude plateau, between 3000 and 4000 metres above sea level. The main settlements are strung along the Indus river valley; the others are remote villages high in the Himalaya, sometimes consisting of only one house and family and often accessible only at certain times of the year - some in winter when the frozen rivers become the 'road' and some in summer.
The economy is mainly a subsistence one, producing food, woollen clothing, household utensils made of beautiful decorative copper, jewellery and religious objects. Some Ladakhis are nomadic, herding goats which are noted for their Pashmina wool, to high altitudes in the summer.
Amchi Health Worker Training Programme - Objectives
To train one resident villager in basic Amchi (Tibetan) medicine from every village within the remote area, with no immediate access to medical care.
To assist remote village communities in Ladakh. The most immediate problem facing many such communities is the total absence of on-site medical care.
Most Ladakhi villages are remote places. Few have road access. Some are three weeks' walk from the nearest road and totally cut off by snow on the high passes for up to half the year. Such conditions are fundamental to any consideration of development goals and implementations strategies.
Hospitals are largely irrelevant to a Ladakhi villager who suddenly falls sick. Villagers require basic local medical facilities capable of dealing with the more common complaints swiftly enough so that they do not develop into something too serious. If a bad 'flu' is swiftly treated, the patient may be saved from chest infections and consequent pneumonia, a common complaint during winter when temperatures can drop to -30C and lower.
Amchi (Tibetan) medicine is a thousand year old tradition; a system of medicine developed specifically for the climatic and cultural conditions of the Tibetan plateau. Ladakh is one of the few remaining areas in the Himalaya where Tibetan medicine is still the indigenous medical system.
Although there is at least one amchi present in most areas, he must usually serve many villages several days walk apart and often cut off by landslides, snow and avalanches: access to him is therefore often difficult. The nearest government allopathic Medical Aid Centre (MAC) is often similarly inaccessible, and currently often seems to inspire little confidence in the villagers. The project proposed in this paper is targeted at villages with no immediate amchi health care.
The community solution
To train Amchi Health Workers (AHWs) in the remote villages: people
who are resident in their villages, will not be tempted to leave their
village by higher incomes on the plains of India or in the West, and
can provide, after a short training, immediate health care for most
basic village health problems.
The aim would be to catch and treat medical problems before they become
too serous: where referral to a full amchi or to an allopathic
practitioner for anti-biotics etc is necessary, the AHW could play a
vital role in such referrals - judging when they are appropriate and
having the confidence of the villagers.
The Amchi Health Worker Programme is the most cost-effective and
appropriate way in which the amchi system can be supported, and
effective health care delivered to Ladakhi villagers.
Training programme details
Training would take place during the winter, when villagers can afford to take time off from agricultural activities and to leave their villages for an extended period. Three training courses each lasting two months per annum are envisaged leading to a certificate of qualification for the Amchi Health Worker.
Trainees would be regular inhabitants of remote villages with a basic command of Bodhi script, and would be chosen after consultations between Amchi Tsewang and the village. Where possible the trainees would be drawn from amchi families ('rGyudpa').
The training centre is established and run by Amchi Tsewang Smanla
with an Amchi Assistant and Chokidar (watchman) as additional staff.
This centre would take on three new trainees per annum, up to a maximum
of nine trainees at any given time once the project was fully
operational. The training centre would be a fully-functioning Amchi
clinic, possibly with one or two in-patients, and treating regular
out-patients. This is an essential requisite for the trainees to gain
practical experience. Trainees would assist in the production of
medicines, for their own use and possibly for sale. The centre would
also host the Amchi Winter Meet, run other courses for amchis, assist
with the annual Amchi Seminar, and possibly organise exhibitions and
seminars for visiting foreigners.
Once qualified, all Amchi Health Workers would be supervised by Tsewang
Smanla.
A vital part of the AHW training project is the planned AHW booklet, which will set out the basics of amchi medicine, including information on diagnoses, common diseases, symptoms and prescriptions, medicines, diet, lifestyle etc. This booklet would initially be produced in Ladakhi, with Bodhi script, and possible later in an English language version.
Who is involved?
Tsewang Smanla, from Nurla village in Lower Ladakh
is a 'rGyudpa' amchi, his father having been village amchi before him.
He has trained under Ven Trogawn Rinpoche as well as Dr Passan Yonten,
Principal of the Tibetan Medical college in Dharamsala. Tsewang Smanla
is a well respected Amchi in Ladakh.
Since 1984 Amchi Tsewang Smanla has:
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established regular contact with all amchis allover Ladakh, toured their villages, held clinics with them, and activated a record-keeping system
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supplied rare medicines to village amchis: medicines which are no longer easily available in Ladakh
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procured rare amchi texts for study in Nurla, and published occasional amchi newsletters containing important medical information
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established a collection of Ladakhi herbal plants in Nurla, to facilitate identification and for use in training seminars
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run amchi herb-collecting tours, and stimulated medical herb exchanges between amchis in different parts of Ladakh
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organised annual amchi seminars in Leh and Nurla centre, well-attended by amchis from throughout Ladakh, with prominent guest speakers from Dharamsala and other amchi centres. Proceedings have been published both in Tibetan and English
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organised amchi winter meetings, smaller than the summer seminars, focusing on practical techniques and procedures, often with prominent invited amchis from outside Ladakh
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written a unique booklet, with Andrew Law, "A Tibetan Guide to Health, Diet And Nutrition in Ladakh According To The Amchi System of Medicine".
Conclusion
By helping to support village life and the skills of those willing
to stay in their villages, the Amchi Health Worker Programme is clearly
helping to promote sustainable rural development. It is also totally in
tune with the specific needs and the culture of the people of Ladakh.
It is cost effective and can be easily monitored by Amchi Tsewang
Smanla at Yuthog centre Nurla.
