By Dr. Dhundup Tashi and Dr. Tenzin Desel
While following the ongoing development, discussion and debates on the upcoming Sikyong and Chithue elections, we are witnessing a wearing evolution of exile democracy where, sometimes, manipulative opportunists and pseudo-intellectual accusations overtake the social-servants and credible intellectuals’ opinions. Yet remorsefully, none of them ever raised any authentic issue related to the health of Tibetan people such as the outbreak of Tuberculosis in schools, increasing substance abuse among youth and what our leader could do to create a better health care system. This article is an appeal to future policy makers and to the people electing them to think about the health of exile Tibetans, which is a basic requirement for nurturing a politically and culturally vibrant community.
His Holiness the XIV Dalai Lama and our elders have worked tirelessly to educate us to become responsible future seeds (Sontsa) of Tibet. We are now at a critical juncture in our struggle and we will be failing His Holiness and our elder’s vision and mission if we keep silent and stay indifferent when we see the system breaking down right under our very nose.
Many of our well-meaning young Tibetans might say, “I am not interested in politics”. The only way, however, to sustain our struggle at this time is to actively participate and be united even though we may have to agree to disagree on many issues.
The Department of Health (DoH) is one of the seven departments of the Central Tibetan Administration, primarily looking after the basic health care needs of Tibetan refugees through a network of hospitals, primary health centers and clinics across India and Nepal.
The health care delivery system in Tibetan exile community, as it stands today, is so fragmented and haphazard that it requires special attention. There is an urgent need to devise a better health care delivery system for Tibetan people. Until now, we have failed to develop a comprehensive system to tackle major health related problems like Tuberculosis, Hepatitis B and stomach cancer.
Men-Tsee-Khang and Delek Hospital serve as the department’s two supporting wings, catering traditional and allopathic medical care. These two bodies run autonomously with Health Kalon as the chairman of the Board of Directors. Besides the two institutions, we have many other autonomous health care institutes like Chakpori, LAMA, Gajang Hospital, Namdol-ling Hospital, Sera Hospital, Palpung Hospital etc.
The menace of Tuberculosis affecting Tibetan people is well known fact, and the scale of the MDR TB is threatening younger population, especially students in various institutes in Tibetan community. WHO studies confirmed that one TB patient could spread the disease to 10-15 people in a year.
In last four and half years, Kashag (cabinet) couldn’t improve the health system in the various Tibetan settlements. Instead, it has gone for the worse. TsoJhe Khangsar Hospital in South India remained almost nonfunctional for months due to corruption controversy and incompetent investigations. Under the impetuous supervision, the Kalon has consistently failed to strengthen and coordinate TB control program. It is evident from the rising MDR (multi drug resistant) TB cases among students, the weakening relation of DoH with other Tibetan Hospitals, and in the DoH’s social media campaigns, the Tibetan Medical System’s publicity received more priority than Tuberculosis awareness. In 2015, Delek hospital alone has registered 35 MDR with 11students, almost three fold compared to the previous year.
Due to the lack of public awareness about Tuberculosis, some of these patients were dwelling in community for weeks and months with TB symptoms like cough, chest pain, fever, loss of appetite, night sweat, weight loss and blood in sputum without knowing it could be TB.
Previously when a fresh MBBS graduate joined the DoH, they were offered opportunity to gain experience for some time under guidance of senior Doctors at Delek Hospital so that they could understand the health conditions of the Tibetan people and health system of Tibetan community better, especially in the management of Tuberculosis. But this practice is not encouraged anymore, and more alarmingly, Health Kalon discourages Tibetan doctors from joining other Tibetan hospitals, for the simple reason that those hospitals’ administration are autonomous and not directly under him. He has also adopted a divisive policy, where doctors and nurses from such hospitals were excluded from the opportunities to participate in workshops, conferences and training organized by the Department of Health.
Premature and politicized forced retirement of many senior community health workers is professionally demoralizing and over-burdening the existing healthcare providers, who are but forced to take up multiple tasks, leaving the hospitals and clinics in the settlements in a very sorry state. These senior health workers have served the Tibetan community for their whole lives, especially during the hours of need, in remote and far-flung areas. Their sentiments hurt can’t be undone or amended. The system of ‘Directly Observed Treatment’, where a TB patient is given medicine under the direct visual observation of a nurse or a health care provider, got weakened in many settlements.
It is a well known fact that Hepatitis B infection is highly prevalent in our community. The loss of life and strain on resources due to this debilitating disease requires no explanation. A person living with Hepatitis B infection knows how difficult it is to deal with the costly test and even costlier medication. The nightmare of liver cancer related to chronic hepatitis B is always frightening. There are many Tibetans living without any financial aid for this ailment from DoH. Even those who are enrolled in TMS are excluded under the rule of outpatient treatment.
Health Kalon has failed to develop a Programme for the Management of Hepatitis B when Gaden Jangtse Hospital in Mundgod, which is run autonomously by the monastery, has developed an efficient and simple Hepatitis B Management Programme.
Stomach cancer is another most common cause of death among Tibetans. Besides sporadic cancer screening, what did the current Health Kalon do to really alleviate this problem in last four and half years? H.Pylori, a bacterium, which causes stomach cancer, is highly prevalent amongst Tibetans. The treatment is available for this. DoH has failed to provide H.Pylori testing facilities at its clinics across the settlements, when a small health clinic at Gyutoe Monastery has been successfully providing the service to monks there and to Tibetans living in and around Dharamsala. By treating this bacterial infection, a large number of stomach cancer cases could be potentially prevented.
Apart from the diseases mentioned above, Tibetan youngsters are increasingly succumbing to alcohol and drug addiction. It is more prevalent among students, unemployed youth and Jawans of the Special Frontier Force. Since youth are the backbone of our community, the Kalon should have taken initiatives to address this problem by implementing effective prevention programme.
The Tibetan Medicare System (TMS) is sadly reduced to a fund draining propaganda. The current Kashag, coincidentally started it on April fool’s day in 2012. TMS is advertised in a way corporate company would publicize its policies. Every gathering is flooded with TMS posters, in sharp contrast to lack of any posters on TB, Hepatitis B and Stomach cancer, which are the afflictions of common Tibetan people.
Many of the Tibetans suffering from Hepatitis B are put on treatment as outpatients and hence deprived of coverage benefits despite being enrolled in the TMS. Elderly patients face tremendous challenges in claiming TMS benefits due to complicated availing procedures. It has also changed the perception of people from being cared and looked after by their government to being covered under a plan they have invested in.
Kalon has thanked USAID for the granting 3.2 million dollars for Tuberculosis and Maternal & Child Health care. TB treatment is provided totally free of cost in many countries to reduce the public health risks an untreated case poses. While DoH can afford lucrative projects like TMS, why TB treatment is not provided free especially when most of our TB patients are young students and underprivileged. Many of them are staying in close- knit communities and congregated institutional settings with a high risk of spreading the disease.
It is a matter of fact that many of the Tibetans who are suffering from drug resistant TB are getting more or less 50% financial help from DoH only for TB medicine and are not covered for other expenses like investigation and nutrition which plays equally important role in treatment and recovery. Let’s break it down into numbers. While DoH covers 50%, the patient is on his/her own to pay for the rest. The treatment usually cost about INR 1.5-5 lakhs to treat MDR and XDR TB depending upon which and how many medicines that bacterium is resistant to. Moreover, there is psychological trauma, disability adjusted life and adverse drug reactions.
What this means is that TB patient has to shell out lakhs of rupees while the grant is being spent on some rich man’s knee replacement or gall stone removal surgery through TMS. Medically, a person with a stone in gall bladder or an elderly person with a poor knee doesn’t pose threat to public health. On the other hand, a drug resistant TB patient could cause major menace to the public health.
This should be our humble request and sincere question to the next Health Kalon.
WHY WE ARE NOT FINDING A DEFINITE SOLUTION FOR TUBERCULOSIS AND HEPATITIS ‘B’ IN OUR COMMUNITY RATHER THAN WAITING FOR UNCERTAIN SICKNESS TO STRIKE?
Kalons come and go but TB and health problems will not, especially if units and individual directly responsible for its eradication turn a blind eye to it. Let’s take care of our health, which will ensure a healthy discussion on Rangzen (independence) and Uma (Middle Way Approach)The writers are Tibetan doctors who completed their MBBS under Central Tibetan Administration’s medical seat quota from Indian medical colleges. Dr. Desel is currently posted at Delek Hospital as a resident doctor and Dr. Dhondup Tashi is Consultant Family Physician and Surgeon at the Gajang Medical Society's hospital in Mundgod.The views expressed in this piece are that of the authors and the publication of the piece on this website does not necessarily reflect their endorsement by the website.