In 2009, a study by the European Commission’s Joint Research Centre and the World Bank revealed that less than 10% of the earth’s landmass is more than a two-day trip from a city with a population of 50,000 or more. With the dramatic growth not only of the earth’s population, but also of infrastructure and technology in the last century and a half, even the wildest places left on earth are often in someone’s backyard.
Of the most remote places remaining on the planet, none surpasses the Tibetan Plateau, the northern reaches of which, according to the study, could take as long as a month to traverse. Part of this area lies in Nakchu Prefecture, in the northwest of the Tibet Autonomous Region, and Sok County, in the far east of the prefecture, while far more accessible than the northernmost counties, remains one of the most isolated places on earth.
Rongpo Town, in the northeast of the county is no exception. Lying at an elevation of more than 3,700 meters (or about 2.3 miles, roughly ten times the height of the Empire State Building), the town lies just off the main route from Lhasa to Chamdo, but from there the road quickly gets harder. The nearest of the town’s scattered villages is a two-day horse ride away.
Even more remote is Trido Township, in the southeast of the county. No roads lead to Trido, which lies in a wide bend of the Salween River, known to Tibetan’s as Gyelmo Ngulchu, or The Queen’s Sweat, and, aside from a few months in spring the township is completely inaccessible. Due to the great distance from the county school, only a few residents have achieved more than a sixth-grade education. In both Rongpo and Trido the relative isolation has contributed to economic stagnation, and most resident’s income falls short of the World Bank’s $1.25 a day poverty line.
It is here, however, in this most remote corner of the world that the seeds are being sown for the revival of one of the world’s great traditions, Tibetan medicine.
The history of medicine on the Tibetan plateau stretches back millennia, but the origins of what is today practiced as Tibetan medicine were first synthesized during the Imperial period (7th – 9th centuries, c.e.). Early in the seventh century, Songtsen Gampo led the Yarlung kingdom in southern Tibet to victory over its neighbors, consolidating power over much of the Tibetan Plateau. He then turned to the conquest of neighboring peoples, a pursuit that would occupy his successors until the collapse of the Yarlung dynasty in the ninth century. As the empire expanded, Tibetan expeditionary forces encountered sophisticated and previously unknown cultural influences in neighboring territories, including areas of what are now India, China and Pakistan. As reports of these encounters reached Lhasa, Songtsen Gampo took an interest in ideas and technologies that could help him in the administration of his empire.
During this period medical scholars from India, China, and Persia were first invited to the court of Songtsen Gampo. Over the course of the following decades Tibetan students trained under foreign medical scholars, and medical treatises were translated into Tibetan. During the reign of Trisong Detsen, his grandson’s great-grandson, the first medical conference in Tibetan history was held at Samye, the first Buddhist monastery built in Tibet.
The philosophical foundations of Tibetan medicine, as well as instructions on diagnosis and treatment, are contained within a four part treatise known as the Four Tantras, or Gyüzhi in Tibetan. Viewed by some within the Buddhist tradition as a direct revelation by the Medicine Buddha, authorship of the Four Tantras is debated amongst scholars, though most agree that the current version was composed in the twelfth century by Yuthok Yönten Gönpo the Younger.
The Four Tantras lay out the philosophical foundations of Tibetan medicine. Stemming from Buddhist ideology, which views the body along with the rest of the physical as a manifestation of the sentient mind, Tibetan medicine relates illness to the actions of the mind, and in particular to the three poisons of greed, hatred and delusion. Practitioners of Tibetan medicine diagnose patients on the basis of an interview, urinalysis and an analysis of the twelve pulses. Focusing on the interrelation between mind and body, treatments vary widely from proscriptions on behavior, to moxibustion and herbal medicines. Tibetan herbal medicines can be composed of as few as four to as many as one-hundred-fifty herbs, minerals and animal parts, and are usually given in the form of a small, round, clay-covered pill.
For centuries knowledge of Tibetan medicine was passed primarily from student to teacher through lineages in a system parallel to the transmission of Buddhism in Tibet. In the 16th century, however, the regent of the fifth Dalai Lama, Desi Sangye Gyatso, established a Tibetan medicine college at Chakpori which, for the next four-hundred years educated the doctors not only of the elite of Tibet, but also of the royal courts of other Himalayan kingdoms, including Bhutan.
The medical college at Chakpori was finally succeeded in 1916 by the new Mentsikhang, founded by the personal doctor to the 13th Dalai Lama, Khyenrab Norbu. Where the graduates of the medical college at Chakpori were primarily monks who, for the most part, remained within their monasteries, offering medical treatment to other monks, the Mentsikhang had a distinctly secular focus that would later allow it to become an institutional center for Tibetan medicine. During the early years of the 1960s the leaders of the Mentsikhang focused on modernizing and secularizing the practice of Tibetan medicine, creating specializations within the art, training doctors in a classroom setting with a standard curriculum, stock-piling medicines and requiring doctors to wear the white lab coats worn by Western doctors.
Beginning in the mid-1960s however, Tibetan medicine increasingly fell out of official favor. During this time both the teaching and the practice of Tibetan medicine were forbidden across the majority of Tibetan areas, bringing to an end many of the lineages of Tibetan-medicine training. By the early 1970s Tibetan medicine was on the verge of completely disappearing.
In 1980, the social and economic reforms meant to correct the excesses of the Cultural Revolution finally reached Tibet. Almost immediately Tibetan medicine was singled out for the significant contribution it could make to the state of healthcare in Tibet while preserving an important aspect of Tibetan culture. Reforms, however, brought both benefits and new challenges to healthcare in Tibet. Collectivization had reorganized the lives of rural Tibetans around the commune. Communes provided healthcare services, funded by the central government. With the transition to an increasingly market oriented economy in the 1990s, the costs of healthcare fell increasingly to the provinces and prefectures, and the patients themselves. Western medicine, however, is largely beyond the relatively meager means of rural Tibetans and, with the Tibetan medicine system still just beginning its recovery, many Tibetans forego medical treatment, seeking medical attention only after their condition has become critical.
Despite increasing government support for Tibetan medicine, by 2000 the Tibet Autonomous Region had a mere 500 beds in Tibetan-medicine hospitals and 1,100 formally trained Tibetan-medicine doctors, serving a population well over two million. In rural Nakchu Prefecture, there were only 113 Tibetan-medicine doctors who had achieved the minimum certification (a zhongzhuan degree, equivalent to a U.S. associate’s degree) required to practice medicine. More than half of the medical personnel in the prefecture had received only short-term training, ranging from two weeks to six months.
Recognizing the dire state of healthcare in Tibetan communities, Trace Foundation began working to support the tradition of Tibetan medicine in 1999 with a variety of initiatives across the Tibetan Plateau. In the Tibet Autonomous Region, Trace sponsored a variety of initiatives, but the Foundation’s efforts focused on strengthening Tibetan medicine and providing high-quality training for health workers who can in turn provide affordable, accessible health care to rural communities. Focusing on clinic management, identification and sustainable collection of medicinal herbs, documentation of practices, and basic healthcare worker training. The project ultimately helped 72 students graduate with zhongzhuan degrees and another 52 to earn their dazhuan (equivalent to a U.S. bachelor’s degree). Nearly 80 additional students received more than two years of training in Tibetan medicine. Among the trainees, two students stood out in particular.
Hailing from Rongpo Town and Trido Township respectively, Trinlé and Künzang sought to bring medical care to areas where it no longer existed. Rongpo Town had never had a permanent doctor before and of Trido’s two Tibetan medicine doctors, one had passed away and the other, too old to continue practicing, had moved to Lhasa. With no local clinic to rely on, residents were forced to make the ninety-mile journey to the county seat, a journey of several hours over winding roads by car, or of several days on horseback. Sick patients often found the journey impossible to make, and often the most critically ill died along the way.
Trinlé and Künzang joined the first of Trace Foundation’s county-level health worker trainings in 1999. After completing the program, the two received additional support from Trace to pursue the four-year dazhuan degree at Lhasa Medical College. Although Trace was able to secure positions for fully half of the students we supported at Lhasa Medical College, in 2004, after their graduation, Trinlé and Künzang elected to return home to the countryside with only their education and a starting set of Tibetan medical supplies provided by Trace Foundation: a selection of the most commonly used Tibetan herbal medicines, a bag, and a set of instruments to begin producing new medicines.
Trinlé returned to Rongpo where he began practicing medicine out of a small room. Taking advantage of the training he had received in medicinal herb recognition, Trinlé was able to broker a deal to exchange herbs for pills with the Sok County Tibetan Medicine Hospital, a strong supporter of the Foundation’s efforts to improve healthcare. Despite initial success, Trinlé still had bigger dreams.
In 2005, while overseeing the construction of a new primary school, Trace staff met up with Trinlé once again. It was then that he described his plans for a new clinic. This clinic would serve not only the residents of his village, but also the residents of the surrounding villages. Relying on the collection and manufacture of Tibetan medicines, the clinic would provide free services to the poor while investing in its own future development. Eager to see his vision realized, Trinlé turned once more to Trace Foundation. In 2009, construction on the new clinic began with support from Trace.
In Trido, Künzang had also met with success. Through the support of the local government and community, Künzang was able to open a nine-room clinic in Trido and recruit four doctors to work together with him. By collecting herbs from the surrounding grasslands and buying additional plants from local residents in 2008 the clinic was able to produce sixty Tibetan medicines for the treatment of various illnesses. Seeing the potential for much-needed self-sufficiency, Künzang applied for a grant in 2008 for machinery to produce Tibetan medicine. The medicines produced by the machinery not only provide a source of income for the clinic, which is now supporting two more students at Lhasa Medical College, they ensure that even when the township is cut off from the outside world, basic healthcare is still available.
Through the continuing efforts of Trinlé and Künzang, and others like them, the millennia old traditions of Tibetan medicine are offering new hope for the future for rural residents across the Tibetan plateau.