Zanskar is a remote valley in the Indian Himalayas.
About 12’000 inhabitants live on a surface area of about 7000km2. The villages are at an elevation between 3500 and 4500m and the highest mountain peaks range up to 7000m. Politically, Zanskar is part of the district of Kargil, in the region of Ladakh, a union territory of Delhi.
Living conditions are harsh in this area classified as a high altitude semi-desert with temperatures varying from 30°C in summer to -40° in winter.
Nearly all Zanskari practice Tibetan Buddhism with the exception of some Muslims in Padum – the capital of Zanskar.
Most of the inhabitants are farmers and were self-sustainable until some years ago. In the past years a growing number of young Zanskari left the traditional agricultural lifestyle to join the Indian army, work in tourism or bigger Indian cities. There is an increasing access to highter education and increasing mobility which brings its advantages and challenges.
Zanskari people live in simple and comfortable mud brick houses. Some have solar or hydrolic energy. Most cook on gas or a wood stove but in remote villages they still rely on open fire cooking and heating. Traditional food includes mainly barley and pea dishes as well as butter and cheese. Now they also get rice, sugar, salt and wheat supplied by the Indian government.
There is no organized waste system since Zanskari didn’t produce waste with their traditional lifestyle. Now with the import of plastic items and packed food this has changed. Some villages took the initiative to dig holes and bury or burn the non-reusable waste. Human waste products end up in the dry toilets and are used as fertilizer on the fields.
Most villages are accessible by road in the summer. In winter the whole valley is disconnected from the rest of the world for 6 months, since the only high passes leading to the valley are closed by the important snowfall. The villages are also isolated from each other when there is abundant snowfall.
Children can go to public or private schools up to the 12th class. For further studies they have to leave Zanskar, which is often a financial burden for the families. In the most remote villages, parents even have to send their children away for primary school, an expense which cannot be met by every family, leading to some children still getting no basic education. These same remote villages have only limited access to mobile networks creating difficulties in communication with the rest of the valley. The medical system in Zanskar is pluralistic and composed of traditional Tibetan medicine, allopathic medicine, shamans and punctual NGO services.
Governmental Allopathic Medicine
There is a government health system composed of a network of 22 basic medical aid centers (MAC) in the villages and one central Community Health Centre (CHC) in Padum, the valley’s center and only town. The system is coordinated by the Block Medical Officer (BMO) – at present moment Dr Stenzin. There is no private practice in Zanskar.
A medical aid center is usually staffed by a nurse or a pharmacist, has one or two rooms, no running water and unreliable electricity. Some basic medicines are provided by the government, they also run vaccination and health education campaigns.
The central Community Health centre is where the block medical officer works, along with a few resident doctors in training, a dentist, several nurses and midwives. There is an X-Ray machine and the possibility to run a few lab tests. For surgical procedures and or specialist care, patients are referred to Kargil (24 hour car journey) or Leh, which in winter necessits a Helicopter transfer, which can be organized with the help of the army but is sometimes delayed for up to 2-3 days due to administrative and/or whether problems.
The price for a consultation is very low, the patients need to pay for lab tests, exams and for medicines if those aren’t available at the medical center.
Amchi Medical System
Introduction to Tibetan Medicine
Tibetan medicine is an ancient Buddhist science. There are four basic textbooks revealed by the Shakyamuni Buddha. This medicinal model is based on a three-humours theory (wind, bile and phlegm). The origin of the disease is explained by ignorance drawing the person into desire, hatred and obscuration, which brings imbalance into these three humours. The Tibetan medicine physician is called amchi. He makes the diagnosis by taking a history, the pulse and a urinanalysis. The treatment’s aim is to restore the balance by using diet, behaviour, medicinal therapies and accessory therapies like moxibustion, acupuncture and use of sucction cups.
The Situation in Zanskar
At present, there are around 50 amchis in Zanskar, of whom 20 are active. Most of them are over 50 years old. The amchi job is open for women and there are some young female amchi. Most work privately at home. Eight amchis are recognized by the government of whom four are on duty under the Natural Rural Health Mission. The other four get a small amount of money from the government but have to work on their own.
They prepare their medicines by picking local plants and buying the rest of the ingredients (plants and organic material) from Leh, Manali and Dharamsala. Traditionnaly this was a civil service, the amchi working for free and the population of the village helping him get food or working his fields, but this reciprocity is getting lost in modern times, leaving the many non-government Amchi struggling for money.
Traditionally the amchis transferred their knowledge by internship and study from one generation to the other. This curriculum takes four years. Now there is also the possibility to study for 5 years in Leh or Dharamsala in an amchi school and to get an official degree. In addition to amchi knowledge and Tibetan language classes, these amchis get also English and basic allopathic training.
There are still a few shamans – a tradition dating to pre-buddhist times in Zanskar. The whole system is therefore pluralistic, with many patients seeing different types of health professionals for different conditions, or sequentially for the same problem.