Exile, Social Change and Medicine Among Tibetans in Dharamsala
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E x il e , So c ia l Ch a n g e a n d M e d ic in e A m o n g T ib e t a n s in D h a r a m sa la (H im a c h a l P r a d e s h ), I n d ia Audrey G. Frost Thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy Date Submitted: 30/06/03 ProQuest Number: U641839 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest U641839 Published by ProQuest LLC(2015). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract E x i l e , S o c i a l C h a n g e a n d M e d i c i n e A m o n g T i b e t a n s i n D h a r a m s a l a , H im a c h a l P r a d e s h , I n d i a This thesis is a study of the predicaments of exile among Tibetan refugees in Dharamsala. It examines the ways in which structural and cultural factors linked to exile underpin local understandings of health and the provision of healthcare. The study demonstrates tin at exile uncertainty is reflected in illness explanatory models put forward by Tibetan refugees, and in the organisation of healthcare provision in Dharamsala. The first part of the thesis (Chapters 2-3) is an account of changes in social organisation and economic strategies as a consequence of exile. Chapter 2 looks at transforming social networks in relation to exile identity politics and economic strategies. I discuss societal tensions within the Tibetan refugee community, principally in relation to the group of ‘newcomer’ {gsar 'bjor bd) refugees, and the local Indian community. Chapter 3 focuses on two examples of economic strategies linked to dependency and the predicaments of exile: firstly rogs ram, or the sponsorship offered to Tibetans by foreigners, and secondly, ‘grogspa, or mutual help and reliance on intra-communal networks of solidarity. The second part of the study (Chapters 4-6) examines how the physical and psychosocial hardships of exile, in addition to social uncertainty, have influenced individuals’ understanding of health and disease, and, consequently, the activities and status of the two most prominent exile medical institutions, the Delek Hospital and the Tibetan Astro-Medical Institute (Men-Tsee-Khang). Chapter 5 discusses the rise and institutionalisation of Dharamsala’s Men-Tsee-Khang and the systématisation of traditional medical teaching as linked to the predicaments of exile. Chapter 6 provides individual case studies of Tibetan exiles’ experiences of illness. Chapter 7 is given over to a discussion of the political significance of discourses relating to physical suffering in the context of exile. Table of Contents Abstract 2 Table of Contents 3 Table of Illustrations 5 List of Tables 5 Acknowledgements 6 Note on translitération and the Wylie system 7 Glossary 7 Introduction 8 1. Theoretical and Methodological Background to the Study 11 1.1. The etlinographic setting: Tibetan settlements in India, Dharamsala, Gangchen Kyishong 11 1.1.1. Dharamsala: a multi-layered community 14 1.1.2. The Indian exile 16 1.2. Tibetan exiles: literature review and critical issues 17 1.2.1. Re-evaluating Dharamsala 18 1.2.2. The question of Tibetan exile‘modernity’ 21 1.2.3. Tibetan refugees and diasporic identities 24 1.2.4. Health and refugees: critical issues 26 1.3 Methodology and etliical concerns 32 2. Social Organisation, Sociality, and the Uncertainties of Exile 38 2.1. Elements of exile sociality and kinship 40 2.1.1. Nuclear families, kin networks and social support 43 2.2. Households and marriage strategies 45 2.2.1. Do you have relatives in Tibet? 52 2.3. Three exile homes 55 2.4. gsar ‘bjor ba\ the newcomers 60 2.5. A Tibetan ‘Raj’: Indians and Tibetans 62 2.5.1. Richard Gere’s road 70 2.5.2. rgyagar skjib shos red. India is the happiest [place] 72 2.5.3. The hosiery and sweater trade 75 2.6. Going abroad and returnees from the West 77 2.7. Summary of social and structural constraints on health 83 3. Social and Economic Strategies for Exile: fogs ram, ‘grogspa and the Modem sku zhogs 84 3.1. rogs ram 84 3.1.1 The value of rags ram: re-enchanting sponsorship 92 3.2. Rogpa Cgrogspa): mutual aid and sociality 94 3.3. Hung tshapo: short-tempered injiy% and benevolence 98 3.4. Modem monks: monastic social capital 102 3.5. Exile social and economic strategies: some conclusions 111 Medical Pluralism in Dharamsala: Institutions and the Treatment of Prevalent Diseases 113 4.1. Introducing medical pluralism in Dharamsala 113 4.2. ma ni ril bu, byin rden and medicinal substances 117 4.3. Diviners and mo 120 4.4. The Tibetan Delek Hospital 125 4.5. The Men-Tsee-Kliang and Tibetan medicine 128 4.5.1. Roots of Tibetan medicine 130 4.6. Tibetan medical knowledge transmission outside the Men-Tsee-Khang 137 4.6.1. 'Styles’ of Tibetan medicine as practised for/on foreigners 139 4.6.2. Tibetan institutional dilemmas 141 4.7. Prevalent diseases, significant illnesses 143 4.8. Meetings and miscommunications 154 4.8.1. In between; transit diseases 157 4.9. Summary 160 5. The Men-Tsee-Khang: Construing Traditional Authority 161 5. 1. Tibetan medical institutionalisation: a historical perspective 165 5.2. Making traditional Tibetan doctors 168 5.3. The Curriculum: studying the r^ud b^hi selectively 176 5.4. Biomedical equivalence and problems in translation 184 5.5. Researching traditional medicine 186 5.6. Experimenting with dija bi tis (diabetes) 189 5.7. Summary 192 6. Diseases of Exile 195 6.1 Tuberculosis, TB na tsha, glo nad 196 6.2. Perspectives from the hospital 208 6.3. Dolma and 'girl’s TB’ 209 6.4. Karma and the problematic aetiologies of suffering 212 6.4.1. Thagpa 213 6.4.2. Dawa and her aunt Tsering 217 6.4.3. Lobsang 220 7. Conclusion 225 7.1. Hierarchies of suffering: instrumentalising the Tibetan exile body 226 7.2. Palden Gyato’s story 229 7.3. The significance of rlung disorders 231 Endnotes 234 Bibliography 242 Appendix A. Health Questionnaire (Tibetan and English, phonetic) 259 Appendix B. Tibetan Delek Hospital Guidelines on TB treatment (Tibetan)262 Table of Illustrations: Figure 1.1. 15 Gaiikyi’s main square and its stupa, with the Assembly of Tibetan Peoples’ Deputies and the Dauladar range in the background. Figure 2.1. 28 Young Tibetaji newcomers from Amdo with a teacher outside the Tibetan Reception Centre in Dharamsala on tlie day before their ‘relocation’ to local exile schools (2000). Figure 2.2. 59 Montage photograph depicting the Dalai Lama and in the background, Bodh Gaya, site of the Buddha’s enlightenment. Figure 2.3. 64 Young entrepreneurial Amdo newcomers, and a fellow Amdo newcomer monk. Figure 2.4. 74 Photograph of a young female Tibetan exile in a rented Path an costume on Landour Hill, near Mussoorie in 1980. Figure 4.1. 116 Tibetan woman peddling medicinal substances in Dharamsala: tree barks, gingerroots, garlic, cuttlefish bones, etc. Figure 4.2 Plural medical cultures of Dharamsala (diagram). 124 Figure 4.3 Possible Therapeutic Management Schemes (diagram). 124 Figure 4.4 125 Plaque propped against the outer wall of the Tibetan Delek Hospital, outlining its credo. Figure 5.1 172 Medical Student on pilgrimage to the sacred meditation caves of Guru Rimpoche in Rewalsar {mtsho pad ma), (H-P). Figure 5.2 182 Anatomical drawings from gso rig snying hdus skya rengs gsar pa (the ‘new dawn’- skya rangs- compendium of ancient healing knowledge), manual published by the Lhasa Men-Tsee-Khang in 1978. List of Tables Table 1. Perception of newcomer groups. 66 Table 2. Medicinal and protective substances. 120 Table 3. Health problems reported by patients from Delek Hospital 148 (December and July 2001) from 60 patients (30 male; 30 female). Table 4. Illnesses reported by patients from Men-Tsee-Khang 148 following their consultation. Table 5. Prevalent diseases as reported by Tibetan patients 150 in Delek and the MTK. Table 6. Explanations of Prevalent Disorders 152 (36 from MTK and 38 from Delek). Acknowledgements I would like to express my deepest gratitude to the many people who have helped me through and out of fieldwork. All have contributed in rich and varied ways to this thesis. Its shortcomings, however, remain entirely my own. In Dharamsala, Dr. Dawa, the late Dr. Tenzin Choedrak, Dr. Dickyi Tsomo and her family. Dr. Tseten and tlie nurturing staff at Delek Hospital, and Men-Tsee-Khang's former director, Mr. Pema Dhamdul, offered help and insights. For their support and humour, I wish to thank friends Tenzin Lhawang, Jamyang Tenzin, Tsering Tendel, Tenzin Tsultrim, Migmar Yangchen, Lobsang Gyatso and the HADC team, Lhamo Dorjee, and the nuns of Shugseb nunnery. I am grateful to Norzum and her family for looking after me during the first half of my stay.