In the Holy Land: The Lives and Activities of Tibetan Refugees in India
PART III
Amchi Rinchen Gyatso’s Story
This case report is the third and final in a series documenting the experiences of Tibetan refugees written in collaboration with the Sarnath International Nyingma Institute. Report I and Report II are also available.
Cover photo: Tibetan medicine at Amchi Rinchen's clinic in Chandigarh. Photo provided by SINI.
Location
Figure 1: Chandigarh, India. Base map imagery © Google 2022.
Introduction
Note from Dr. Karen Jacobsen, RIT Principal Investigator
This is not our usual RIT report in that it was not written by a refugee researcher, but rather is based on a series of interviews by a doctoral candidate as described below. These Tibetan refugees living in northern India do not speak English, and the interviews, conducted in Tibetan, were a way to capture their experience for our English readers. The report is also different from our other RIT reports in that we provide a general overview of Tibetan medicine, necessary to understand the refugee’s life and work in India.
A Note on Editor-Translator* Positionality and Methodology
I am a doctoral candidate in anthropology, focusing on Tibetic languages and linguistics. Prior to my doctoral training in linguistic and socio-cultural anthropology, I worked for several years in Tibetan-speaking communities in Asia.
I wrote this report based primarily on a Zoom interview with Amchi Rinchen Gyatso (pseudonym), on March 5, 2023, from his temporary home in New Delhi, India. Amchi (Tib. Aem rje) is the Tibetan word for “Doctor,” an individual who has trained in and practices traditional Tibetan medical science. At the time of the interview, Amchi Rinchen had recently moved to New Delhi after a year working as a medical physician to an exclusively Indian population in the city of Chandigarh, the experience described in this report. Unfortunately, bureaucratic and administrative issues forced Amchi Rinchen to shut down his practice in Chandigarh. Still, his experiences in Chandigarh tell the fascinating story of a refugee founding the first Tibetan medical clinic within this major Indian city.
Designed by a Swiss-French modernist architect, Chandigarh is a city of nearly 1.2 million people and one of independent India’s first planned cities. As an Indian Union Territory (UT), it is a federal territory governed directly by the Union Government of India, as opposed to a local state government. The city is bordered by Punjab and Haryana, and serves as the respective capital of both states. With the exception of a handful of Tibetan businesspeople and students who study in Chandigarh’s universities, the city has virtually no Tibetan population. Amchi Rinchen operated his practice within an area of the city known as Sector 14, where he, his family and the one other Tibetan Amchi at the clinic were the only Tibetans.
This report shows Amchi Rinchen’s dedication to applying traditional Tibetan medical knowledge to serve the local Indian community. The report offers a glimpse into the intricate world of Tibetan medicine, known as Sowa Rigpa (gso ba rig pa) or the ‘science of healing.’ Sowa Rigpa combines knowledge from Buddhist literature, the Indian medical science of Ayurveda, and indigenous Tibetan healing traditions to provide a holistic system of health and healing.
Prior to opening his medical practice in Chandigarh, Amchi Rinchen studied Tibetan medicine for six years at the Men-Tsee-Khang (sman rtsis khang) in Dharamsala, India. This serves as the central institute for the study of traditional Tibetan medicine and astrology in the diaspora. A full description of the rigors and complexities of traditional Tibetan medicine is beyond the scope of this report; nonetheless, Amchi Rinchen’s account provides some sense of the profundity of this indigenous healing tradition, how its educational system thrives within the Tibetan refugee community in India, and how this traditional Tibetan knowledge, in turn, can provide immense benefit to the local Indian population.
The rather unlikely story of a young Tibetan doctor opening a traditional Tibetan medical practice in the heart of an Indian metropolis sheds light on the distinctive contributions of Tibetan refugees in their adopted homeland. As the report details, Amchi Rinchen faced a number of challenges in both establishing a clinic and practicing in Chandigarh: bureaucratic, linguistic and cultural. Yet, rather than being discouraged or choosing to set up his clinic in a more culturally-Tibetan location that would have proven easier to his background, Amchi Rinchen saw these obstacles as opportunities for growth - in his words - “both as a doctor and as a human being.” In the process, he provided critical medical care to some of Chandigarh’s most disadvantaged and underserved communities.
Unlike the previous two reports published in this series, the present work may seem to end abruptly. Unfortunately, this reflects the unexpected closure of Amchi Rinchen’s clinic, which brought his wonderful work in Chandigarh to a premature end. For confidentiality purposes which are required due to his delicate status as a refugee within India, a full accounting of the clinic’s closure cannot be described in this report. I am at liberty only to note that the closure was due to external, bureaucratic pressures that were outside of Amchi Rinchen’s control.
This highly regrettable change of circumstances reflects a daily reality for many Tibetan refugees, whose lives are marked by various forms of precarity. While there are no prospects for reopening his Chandigarh clinic in the foreseeable future, should circumstances allow, he hopes to re-establish a medical clinic elsewhere in India. We can only hope he will again be able to apply his precious training and skills to benefit his surrounding community.
The initial interview and all subsequent communications with Amchi Rinchen occurred exclusively in Tibetan. While I am highly proficient in the language, I clarified any points of confusion in the story through both spoken and written communication with Amchi Rinchen via voice and written WhatsApp messages. All communications with him occurred with free, prior and informed consent. He understood the aims of this report and my purpose in writing it, before he shared his story. For readability, the transcription has been lightly rearranged and edited.
*The editor-translator authored both the background and the introduction in addition to editing and translating this report.
Background
There are a wide range of opinions concerning the pre-modern relationship between China and Tibet. The Chinese government maintains that Tibet has been a part of China since the Mongol-led Yuan dynasty (1271-1368), while the Tibetan Government in Exile, based in Dharamsala, India, maintains that Tibet was an independent state until the communist People's Liberation Army (PLA) began their invasion in 1949.However, broad scholarly consensus agrees that Sino-Tibetan relations radically changed with the communist takeover and the annexation of Tibet into the newly formed People’s Republic of China (PRC). Since then, there have been severe, and occasionally violent, restrictions on traditional Tibetan education, religion, and culture.
From 1959-1960, an estimated 80,000 Tibetan refugees fled to India, a number that increased to around 100,000 in subsequent years, constituting the first wave of Tibetan migration to South Asia. A 2009 survey found that around 128,000 Tibetans lived outside of Tibet, with the largest number, more than 94,000, living in India.[1]
Historically, Tibetans have fled Tibet for a number of reasons: political, economic, educational and religious. In the case of the refugees interviewed for this project, their primary motivation for migration was the religious freedom and educational opportunities afforded by India. Tibetan Buddhism remains highly restricted within Tibet, and the interviewed refugees all desired the opportunity to study and practice their religion free from authoritarian government control.
Tibetans in India face a number of difficulties, ranging from basic survival, integration with local society, and the preservation of their culture. While many Tibetans express heartfelt gratitude to India for offering them political refuge, their position is precarious. They are not officially recognized by the government as refugees. They are instead designated as “foreigners,” who must annually renew their permission to stay in the country. India has never signed the 1951 United Nations convention on refugees, adding to Tibetans’ tenuous, uncertain status.
Tibetans are scattered throughout India, with large settlements in the northwestern Himalayan state of Himachal Pradesh, as well as in the southern state of Karnataka. Though many Tibetans feel obligated to preserve their language, religion, and culture because of their freedom in exile, such expertise provides very few economic opportunities, which necessitate an understanding of local Indian languages or English. Such problems have led to increasing Tibetan immigration to North America and Europe.
Inaugurated in the winter of 2013, the Sarnath International Nyingma Institute (SINI) offers an important center for the preservation of Tibetan cultural and religious knowledge. Located in Sarnath, India, the site of the Buddha’s first sermon, SINI’s mission is: “to sustain the roots of the Dharma; to advance the study of classical Buddhist languages; to empower the transmission of the Dharma; and to promote interdisciplinary collaborations.”[2] SINI works towards their vast goals by working with Tibetan refugees throughout India, as well as Tibetan Buddhists who are citizens of Bhutan, India and Nepal.
AMchi Rinchen Gyasto’s story
Childhood in tibet and escape to india
I was born in Golok, in an area very close to Tarthang Monastery (dar thang dgon pa). As a child, I didn’t go to Chinese school. I come from a nomadic family, so as a young boy, I stayed at home and cared for our many animals. When I was about ten or eleven, I went to Tarthang Monastery, where I began my Buddhist training. I completed the 500,000 accumulations of the foundational practices (sngon ‘gro)[3] as well as my studies of inner yoga (rtsa lung) and the Great Perfection (rdzog chen). During this time, I also studied Tibetan culture more broadly. I studied at Tarthang Monastery, a branch of Pelyul Monastery (dpal yul dgon pa); I feel tremendous gratitude for all that I learned at Tarthang.
When I was 18, I decided to travel to the holy land of India. I first went from Golok to Lhasa, and stayed there for just under one month. In Lhasa, I met the guide who I would pay to help me escape from Tibet. There were 18 people in our group fleeing Tibet. We walked for a total of one month and 27 days through Tibet and across the Himalaya to Nepal. By the time we arrived in Nepal, we were extremely exhausted. We had been without food for several days and had only limited water.
But after we arrived in Nepal, all 18 of us were arrested by Nepalese soldiers and eventually thrown in prison in Nepal’s capital of Kathmandu. We hadn’t committed any crime, but as Tibetan refugees, they told us we were criminals. Anything we had of monetary value they stole, and otherwise they threw away all our possessions we had carried from Tibet. The police were planning to send us to the Chinese authorities, who would pay them for our capture. But fortunately, an American mother, who must have been a bit older than 50, learned about our situation. She gave money to the police [offered a bribe]: 13,000 Nepalese rupees per person (at the time, approximately $180 USD per person). She was able to buy all of us our freedom. Every person in our refugee group will always be grateful for the kindness shown by this American mother in securing our freedom.
After our release, I went to the Tibetan Reception Center in Kathmandu, where I stayed for around five months. When I left Kathmandu, I traveled to Dharamsala, where I received an audience with His Holiness the Dalai Lama. I then knew that I should go to the monastery of Kyabjé Penor Rinpoche. My parents and all my family in Tibet had told me about Penor Rinpoche, and his connection to our home monastery Tarthang. So I traveled to Namdroling Monastery (rnam grol gling dgon pa) in South India to study the Dharma under his guidance.
I enrolled in Namdroling Monastery’s monastic college (bshad gra) and began in Year One. I studied Buddhism there for a total of eight years, only one year short of graduating and completing the Lopon (slob dpon)[4] degree. However, I stopped before becoming a Lopon in order to fulfill my father’s wishes and study medicine.
Decision to Pursue Medicine, Course of Study and First Placements
After I left Tibet, I had very little connection with my family. This was before WeChat[5], so it was nearly impossible to speak with my family regularly. However, shortly before my father died, we had a conversation on the phone in which I told him about my life in India. I told him that I was at Penor Rinpoche’s monastery in South India, studying Buddhism at the monastic college. And my father was not entirely happy about this.
My father was an Amchi in Tibet. He helped many people through his work. During his lifetime in our area in Tibet, there was no specialized school or university for the study of medicine. Instead, he learned medicine in a very practical way. He studied with the expert Amchis in our area, who were responsible for taking care of both the people and their many animals, as we were in a nomadic area. The Amchis themselves were the entire medical system in our region of Tibet; they were the ones who cared for the health of all sentient beings - both humans and animals - so they shouldered great responsibility. By apprenticing with these great Amchis, my father developed a deep knowledge of the Science of Healing but in an entirely hands-on way. Through this work, he knew just how important Amchis were for ensuring the health of an entire population.
When I told him about my Buddhist studies at Namdroling, he told me that his greatest hope and aspiration was that I would follow in his footsteps—studying medicine and becoming an Amchi. I am the youngest of five children. My three older brothers are all monks, and one of my sisters is a nun. As the youngest child, my father placed great hopes in me. He told me that if I were to study medicine and become an Amchi, I could be of benefit to many people in a very direct way—I could heal those who were ill, and I would spend my precious human life helping others much more concretely than if I just studied Buddhism alone.
Figure 2. Tibetan medicine at Amchi Rinchen’s clinic in Chandigarh. Photo provided by SINI.
Soon after we had this conversation, my father died. I felt a great responsibility to fulfill his greatest aspiration: to study medicine and become an Amchi, just as he had. In 2013, I took the entrance examination and enrolled in the Men-Tse-Khang in Dharamsala. I was only one year from becoming a Lopon, but I felt obligated to fulfill my father’s wish, so I left the monastic college before I was able to complete my studies.
For the first six months at the Men-Tse-Khang, all the incoming students undergo an intensive course of study in Tibetan grammar and an overview of the history of Tibetan medicine and astrology. The Tibetan language alone holds all this immense knowledge, so it is important for students to have an excellent command over Tibetan.
After this six-month period, the students divide into their respective tracks to begin their Year One coursework. Those who study medicine (sman) begin their studies in medicine, and those who study astrology (rtsis) begin their studies as well. For those of studying medicine and training to be Amchis, we begin with the study of the Four Tantras (rgyud bzhi).[6] The medical science contained in the Four Tantras is extremely vast and profound, and there are more than a thousand volumes of commentaries written on the Four Tantras alone.
We study the five elements—earth (sa), water (chu), fire (me), wind (rlung) and space (nam mkha’) —and how these elements constitute all physical matter. We learn about three humors—wind (rlung), bile (mkhris pa) and phlegm (bad kan)—and their relationship to the three poisons—attachment (‘dod chags), aversion (zhe sdang) and ignorance (gti mug). We learn how to restore and maintain the balance of these three humors to ensure health, and we study the deep relationship between mind and body.
We learn the art of diagnosis through the analysis of pulse, the tongue, and urine. We also learn anatomy, physiology, embryology and the science of treatment. For each of the six years of our study, we have two major exams—one in June and one in December. These exams ensure we have mastered the preceding content and are prepared for the next phase of our study.
In November of 2019, after six long years of very intensive study, I graduated from the Men-Tse-Khang as an Amchi. However, in March 2020, just after I graduated, the COVID lockdown began, so my wife and I had to remain in place, and I was not able to begin my work. At this time, we were living just outside of Dharamsala in a room that cost 2500 rupees per month (at the time, a little over $30 USD).
After the lockdown became less stringent, the Men-Tse-Khang sent me to Dehradun (the capital of the Indian state of Uttarakhand, near the Himalayan foothills). I was in Dehradun for close to a year, doing research for the Men-Tse-Khang’s Pharmacy Department. Since Dehradun is so close to the Himalayan foothills, there are many important medicinal plants and herbs nearby and I did pharmacological research. It was while I was in Dehradun that I first had the idea to open a Tibetan medical practice in Chandigarh.
Opening Tibetan Medical Clinic in Chandigarh and Practicing Medicine
It may sound strange that I wanted to open a Tibetan medical clinic in Chandigarh. After all, there is no real Tibetan community in Chandigarh. Except for a few Tibetan businesspeople that live on the other side of the city and a handful of Tibetan students who study at the universities, there are basically no Tibetans at all in Chandigarh. But it is for this reason that I wanted to open a clinic there. I wanted to gain new experiences and to be of benefit to the citizens in India, my adopted homeland.
For my whole life, I had only lived in Tibetan society. Even though I had been in India for nearly a decade and a half, I was always within the Tibetan community: first at Namdroling Monastery, then at the Men-Tse-Khang in Dharamsala, and later, working for the Men-Tse-Khang in Dehradun. I knew that opening a clinic in a place like Chandigarh - with only an Indian population - would be very difficult; there would be difficulties with language, with culture, with customs. But I saw all these difficulties as incredible opportunities for gaining experience, increasing my intelligence and bettering my practice of medicine. I believed there was far more potential for me to grow - both as a person and a doctor - if I opened my own medical practice in an Indian city than if I just remained working in the Tibetan community.
So, I started to do some research about where I should open a medical practice. I had actually never been to Chandigarh but had heard lots of good things about it. I knew that the second-best rated hospital in India, PGI (Post Graduate Institute) Hospital, was located there, but I also knew this hospital was very expensive, so many local people could not afford it. Through my research, I realized there were quite a lot of patients in need of good medical care in Chandigarh. Many of the most common ailments in India respond extremely well to Tibetan medicine. I would say around 80% of the Indian patients that I have seen suffer from diabetes and high blood pressure, both of which Tibetan medicine treats very well. Arthritis is also very pervasive in India, particularly among those who do manual labor, and Tibetan medicine is very effective in treating this, without all the negative side effects of pain killers and other allopathic treatments. Since I learned there was no access to Tibetan medicine in Chandigarh and knew there would be many people suffering from these ailments, I thought that this would be an ideal place to open a Tibetan clinic.
Figure 3. Amchi Rinchen showing his medical supply to two visiting Tibetan monks. Photo provided by SINI.
Eventually, I received permission from my supervisor at the Men-Tse-Khang to begin working toward opening my own practice. I arrived in Chandigarh in June of 2021 and began all the preparations for opening the clinic. There was a lot of paperwork that needed to be filed to open a new clinic, so this was time-consuming work. I also oversaw the shipping and transportation of all the medicine, supplies and other necessities we needed to open; the vast majority of these materials were not locally available. Finally, on January 5, 2022, we officially opened our practice. We only had two Amchis: myself and another Amchi, a woman who graduated from the Men-Tse-Khang the same year as me.
You may be surprised to learn this, but I hardly knew Hindi at all when we opened the clinic. My whole life, I had only studied and been exposed to the Tibetan language. Even to this day, I have never studied Hindi in a structured, systematic way, and I still cannot read or write Hindi very well. This was part of why I wanted to open a medical practice in a place like Chandigarh—I knew it would immerse me in the language and force me to use it every day.
But the language barrier was never actually a problem; if anything, it was an advantage, because it ensured I took a lot of time to engage deeply with my patients. I spoke to them very slowly and in a very relaxed way to ensure they understood, and they likewise spoke very slowly and clearly to me to make sure that I understood. Through such communication, my Hindi improved exponentially, and I established deep, meaningful relationships with my patients of the kind they had never before experienced with other doctors.
Before coming to our clinic, many of our patients had only received treatment at government hospitals, where the doctors spend next to no time listening to or caring for them. Of course, the patients come for medicine, but they also come for treatment, holistic treatment—to have a doctor really listen to what ails them, and to look into their eyes and tell them how the treatment will heal them. Just as taking medicine is important, the care that they receive from the doctor is a hugely important component of the treatment.
I think this was the primary reason that patients came to us as opposed to the allopathic hospitals and clinics in Chandigarh—it was simply a matter of the quality of care that they received. At government hospitals, patients must wait an extremely long time to be seen by a doctor, and when they are finally seen, the doctors often do not provide very good care. They disrespect and look down on patients such as ours just because they are poor and are of a lower socio-economic status. We never treated our patients in this way.
Private hospitals usually provide better care, but they are extremely expensive. They charge 500-1000 rupees just for the doctor’s consultation alone—tests, screenings and medication are all expenses on top of this initial fee, so many less affluent people cannot even think to receive such private care. At our clinic, we only took 100 rupees for a consultation, and this often included medicine, too, especially when we knew the patient was poor.
Finally, Tibetan medicine works extremely well for many of the most common ailments that our patients suffered from, and with far fewer negative side effects than with allopathic medicine. For example, many of our patients suffered from diabetes and high blood pressure. With allopathic medicine, patients must take medication for years and years on end, and as soon as they stop taking the medicine, the problems immediately return. Tibetan medicine is not like this. In addition to being extremely effective in treating these problems, all components of Tibetan medicine are herbal, so there are far fewer negative side effects. We also don’t just give medicine alone. We provide guidance for physical and mental fitness, proper diet and a healthy lifestyle, which addresses the underlying problems for issues such as diabetes and high blood pressure. In many cases, we have been able to completely cure our patients, and they no longer need to rely on medicine. This more holistic approach is much more effective than taking allopathic medication on its own.
In a day, we would have anywhere between 10 to 25 or 26 patients come to the clinic, and they ranged in age from as young as five to as old as 90. As I mentioned before, upwards of 80% of them suffered from diabetes or high blood pressure, which Tibetan medicine treats with extreme effectiveness. We also received patients suffering from cancer, but our treatments could only help around 20-30% of them. Tibetan medicine can be effective in treating different types of cancer in their early stages, but it is much less effective once the cancer has spread. Most of our patients had already undergone chemotherapy and other allopathic treatments for cancer and were trying Tibetan medicine as a last resort, so we could not help them as much as if they had come at an earlier stage.
Many of our patients also suffered from mental health issues, such as depression and anxiety. In Tibetan medicine, these problems arise from wind (rlung) disbalances, and our medical tradition has a long history treating such ailments. Like the other health conditions, we provide holistic, comprehensive care, providing medicine alongside instruction on meditation and yoga techniques that help treat these issues. They learn that Tibetan medicine is very effective at treating mental health problems and does not have the extreme negative side effects prevalent with allopathic medications.
On the whole, our clinic made a great contribution to the health, well-being and happiness of our patients. We made certain to treat each of our patients as a complete human being - not merely a set of symptoms - and to provide them with holistic care that improved their entire lives. Giving medicine was obviously a large component of this, but far more important was the treatment and care. For the vast majority of the patients, we were the first doctors to take the time to look into their eyes and genuinely listen to the issues of their health. The importance of this care cannot be overstated. A patient should never be disrespected or ignored simply because they are poor or of a low socio-economic status, but this is exactly how most of my patients had been treated their entire lives. They knew that we sincerely cared for their well-being, and for many, this made a tremendous difference in their health and the course of their lives.
CONCLUSION
I am disappointed that we had to close our medical clinic after only a year, but I am extremely happy for the work that we were able to do there. In total, we saw thousands of patients, the vast majority of whom would not have received proper treatment without our care. Their well-being, in turn, increased the well-being and happiness of their families and communities, so every patient that we healed also contributed to helping far more people. Every day when I recite my prayers, I make aspirations for all the patients that I have treated; I pray that they will be cured of all that ails them, and that they will be happy and well, in both the short and the long term.
Whoever one is, whether they are extremely rich or completely destitute, whether they are a world-famous celebrity or a beggar on the street, becoming sick is an immensely difficult, terrifying experience. This is why compassion and empathy are among the most important qualities in a doctor. Sickness comes to nearly all people, so I always try to see myself and my loved ones in my patients as a way of cultivating compassion and empathy for them.
Figure 4. Amchi Rinchen checking the pulse of a local Indian patient at his clinic in Chandigarh. Photo provided by SINI.
References
[1] https://sfd.susana.org/about/worldwide-projects/city/203-dharamshala
[2] https://www.sos-usa.org/where-we-are/asia/india/dharamsala#:~:text=It%20is%20well%20known%20for,10%2C400%20people%20live%20in%20Dharamsala.
[3] A standardized set of practices in Tibetan Buddhism consisting of (at least) 100,000 accumulations of each of the following: prostrations, refuge prayers, bodhicitta prayers, the 100-syllable mantra of Vajrasattva, and prayers of Guru Yoga.
[4] The equivalent of an M.A. in the traditional Tibetan Buddhist monastic university system.
[5] A popular Chinese communications app now used widely among Tibetans both within China and the diaspora.
[6]The Four Tantras are the central texts of the Tibetan medical tradition. Many Tibetans believe these texts to be Indian in origin, taught by the Medicine Buddha Bhaiṣajyaguru (Tib. sangs rgyas sman bla), and later translated from Sanskrit in the eighth century with the introduction of Buddhism to Tibet. They were then compiled and redacted to the current form by the master Tibetan physician Yuthok Yönten Gönpo in the ninth century. Other scholars argue the texts are indigenous Tibetan compositions that incorporate medical knowledge from Indian, Chinese and Greco-Arab sources. In order, the Four Tantras consist of: Root Tantra (rtsa rgyud), Explanatory Tantra (bshad rgyud), Instructional Tantra (man ngag gi rgyud), and the Subsequent Tantra (phyi ma’i rgyud).