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Official Newsletter of the Department of Health

Published Quarterly

Back Issues

July-December 2003
Volume 17, Issue 2 & 3

In this issue:


Third health review conference

The Third Health Review conference was held at the Songtsen Library, Dehra Dun from 16 to 18 October, 2003.

From its inception in 1981, the health department has held only two such conferences, first in 1981 and then in 1988.

Present in this conference were Health Minister Lobsang Nyandak Zayul, Health Secretary Tenpa Samkhar, Dr. Passang, Dr. Tsetan Dorji, Dr. Tsewang Tamdin and Dr. Pema Dorji. In all, 43 people participated in this conference, including five doctors of Tibetan Sorigpa (Indigenous System of Medicine), five allopathic doctors and five health secretaries of hospital.

The conference reviewed the overall state of health in the exiled Tibetan community.

During this conference, comprehensive discussion took place on old and new health challenges, its root and origin, prioritized need, and recommended suitable plan of action to remedy.

The conference also touched briefly on the draft National Health Policy lending new ideas and dimensions to it.

Finally, all conclusions were wrapped in resolutions, passed on various issues like TB control program, integration of allopathic and Sorigpa, etc.

One notable feature of this conference is participation by personnel from both allopathic and Sorigpa. Perhaps for the first time, in a conference this grand, personnel from various systems of medicine sat together to discuss, debate and propound ideas on wide ranging subjects of health.

The conference raised the horizon of one’s knowledge on other systems of medicine through constructive engagements leading towards greater mutual respect and understanding.


Substance abuse: Preventive and control measures

The problem of substance abuse is on the rise. Indications are that it has penetrated almost every bit of the exiled Tibetan community.

Although there is no denying that we face this problem, opinion may differ as to its actual extent for, we lack adequate information necessary to make a proper appraisal of the situation on the ground.

To tackle this problem, the focus of our action has been in these areas:

Earmarked Budget

Thus far, no separate fund has been appropriated exclusively for the prevention and control of substance abuse, as for others like TB control measures. However, this year a budget of Rs. 5 lakh has been sanctioned as proposed in the recent revised budget. This provides for sufficient resources to tackle this problem in a more comprehensive way.

Treatment Assistance:

Each year we assist hundreds of patients, financially and/or in any other way needed for medical (hospital) treatment. As is the case for various other medical treatments, assistance for the treatment of drug addiction is also provided by our Emergency Medical Relief Fund.

The fund provides financial assistance covering most of the times 75% of the total expenses of the treatment from a rehabilitation centre. The treatment takes six months to complete, at an average cost of Rs. 30,000-00 per person.

Health Education:

The department works to heighten public awareness on substance abuse and related problems.

Publication and distribution of wide ranging IEC (information, education, and communication) materials is carried out by the department. This year, (1) a manual on substance abuse related problems; (2) a chart on immediate and long-term ill-effects of various drugs; (3) a brochure of frequently asked questions on drug abuse related matters were published and distributed widely in schools, settlements, monasteries, etc.

Health personnel, from doctors to community health workers, provide regular health education to the general Tibetan populace.

Meeting drug addicts and families

Direct informal meetings with drug addicts and their families provide a good opportunity to get an insight of their problems, described in their own words. Measures evolved out of these meetings are far more effective, and are better adhered to by the people.

In Dharamsala, Health Minister and Health Secretary met with 11 drug addicts on Oct. 7, 2003. Already, with the department’s financial assistance, all but one of them have been treated at rehabilitation centre through Kunphen.

During the course of discussion they spoke in one voice when it came to their current, most pressing need-JOBS. Without jobs, even after treatment they become far more vulnerable to drugs and relapse easily. At their own request, the department: (i) asked for a job for Tsering Ngodup at the Tibetan Welfare Office, Dharamsala, and a monthly allowance from the Department of Home, for his elderly father (both these requests were granted); (ii) asked for a carpenter’s job at the TCV for Ugyen Gonpo; (iii) Kunchok Nyandak was sent to Mundgod for community health worker’s training; Nyima Tsering is sent to Ngoenga School for physiotherapy training; (5) Tenzin Kelsang is currently under treatment.

In Dehra Dun, on 13 and 14 of October, Health Minister met with 5 drug addicts along with their families. Upon their own request, the minister solicited the rehabilitation centre at Rajpur to admit these drug addicts. The centre very kindly agreed to admit four of them.

In Delhi, on 27 Oct. the minister met with 10 drug addicts. Of these, four have been admitted in the Ankush Drug Rehabilitation Centre; upon their own request, the Department of Home was asked to admit Rigzin Namgyal in one of their elderly people’s home; Dechen Wangmo (female) is under the care of the Regional Tibetan Women Association of Delhi.

During the recent annual settlement officers’ meeting at Dharamsala, Health Secretary Tenpa C. Samkhar spoke at length on the urgency of prevention and control of substance abuse and related problems.

Upcoming Projects

The department has requested Kunphen (centre for drug abuse and HIV in Dharamsala) to provide resource persons for generating mass awareness on substance abuse in Tibetan settlements in South India. All expenses incurred on this effort will be borne by the department. From January 2004 the health education section of the department will conduct a study on the prevalence of drug abuse and related problems in the Tibetan community, especially among the young, in 10 places/schools located throughout India. The study is to throw light on not only how far and wide drug abuse is spread, but what actions of various quarters is necessary to combat this problem in way that is comprehensive, feasible and appropriate to our setting.


Substance Abuse: Prevention and Rehabilitation Policy of the Tibetan Government in Exile

Substance abuse is caused not only by the availability, or the "supply" of psychoactive drugs, but also the social conditions that create the "demand" or the need for consumption of such substances.

Following this approach, the Tibetan Government-In-Exile has been active in three major areas of focus:

Target Groups in order of priority:

1. Users: Group of individuals already using drugs.

2. High Risk Group: Group of individuals at increased risk of drug misuses e.g. school children, college students, unemployed young people, etc.

3. General Tibetan Populace.


Extracted from the interview with Health Minister published in the Tibetan newspaper, Bod-Kyi-Dus-Baab, issue 257, dated January 20, 2004.

Q: In the recent budget, special funds have been appropriated for the prevention and control of substance abuse in our community. Could you elaborate on that?
A: We have appropriated Rupees five lakh in this year’s budget. This provides for treatment of drug addicts, and also to the non-governmental organizations working in this field. In next year’s budget, we have doubled the amount to Rs.10 lakh. In addition to treatment, this will fund projects that generate employment opportunities for drug addicts. One main reason that drives people into drugs is the state of being jobless-this I found unanimous in every meeting I have had with drug addicts in Dharamsala, Delhi and Dehra Dun.

Q: How wide is substance abuse spread in our community?
A: Although we are not unaware of this problem, we don’t know yet how far and wide it is spread. Soon we will conduct a close study by gathering adequate necessary information from different groups of people in schools and settlements/places to make a proper appraisal of the situation.

Q: What kind of measures?
A: All our actions will be directed towards three target groups of people. First of course is the treatment of current drug addicts. Then preventive and promotive measures in high risk groups, or those who are at increased risk of using drugs like those in school. Finally, universal measures like raising awareness among the general populace on substance abuse and related problems.

Q: What are the main reasons behind drug abuse?
A: Inability to cope with mental pressures appears to be the main cause behind getting into drugs. Besides, ignorance about the ill effects of drugs can also be a major cause.

Q: Despite years of effort, why have we failed to curb the increasing substance abuse?
A: Although the department has successfully undertaken various measures to curb this problem, we need to bring more space to our approach and go beyond what is usual and customary. Based on sound planning, our actions should have the capacity to respond effectively to different requirements of various groups of people. Just to raise awareness of substance abuse is not an end. We must address this problem from its roots.

Q: What drugs are used most commonly?
A: Solvents and cough syrup are most common of all, especially among school children.

Q: There are rumors on drugs being used in monasteries.
A: Although, we have had no information yet, should this be the case I am not surprised.


New community health workers’ training

A group of 11 people, after three months of intensive training from Aug. to Oct. 2003 were appointed community health workers.

A vast network of primary health centers established in almost all the Tibetan settlements, provide basic primary care to not only Tibetans, but also the local indigenous population, is staffed by a large cadre of community health workers trained by the department.

As and when needed, the department provides community health workers’ training with technical assistance from the Delek Hospital. The training is deemed to qualify a person to perform basic primary health care services in a community.

All these 11 trainees have successfully completed training, and are now providing health care in various places/settlements in India and Nepal.


Introducing local rehabilitation committee for persons with disabilities

Nine places/settlements with highest number of persons with disabilities form local rehabilitation committee.

Since its inception, the department has gradually introduced and sustained various programs that respond to various fundamental needs of persons with disabilities.

As of now the department has these programs in operation:

  1. The rehabilitation section of the department is main responsible for the welfare of persons with disabilities, which includes monthly allowance to those who are unable to provide for themselves, assistance of aids and appliances, works relating to the Ngoenga School for Tibetan Handicapped Children, disabled survey, training health personnel, and so on.
  2. The department’s Emergency Medical Relief Fund provides financial help, as it does for other groups of people, to those disabled who cannot afford expenses on their medical treatment.
  3. The mental health program has over the years developed a vast cadre of service providers, known as "field worker", and has placed one in almost all the settlements. These workers, along with other health services, help people with mental problems in various ways, ranging from day to day problem solving to specialized treatment at a hospital. As before, the department provides financial assistance to mental patients for treatment.
  4. Although primarily for new refugees who had to amputate their body parts, or are disabled due to frostbites sustained on way to India, the prosthetic section helps all those who need help for prosthesis.
  5. Ngoenga School for Tibetan Handicapped Children

  6. A complete new undertaking that first emanated from the enlightened vision of His Holiness the Dalai Lama, came to fruition on 8 March, 2000 as the Ngoenga School for Tibetan Handicapped Children became operational with 26 students. The school now has 50 students and 25 staff.
  7. Last year, a survey of disabled Tibetans in India, Nepal and Bhutan was successfully carried out. The survey, the first ever conducted in a Tibetan community, explored the population of persons with disabilities.
  8. Local Rehabilitation Committee

    The nine places/settlements with highest number of persons with disabilities (as found in survey) formed its own local rehabilitation committees. The department facilitated the whole process leading to the establishment of the committee, its operation, administration, etc.

    Rehabilitation is best done at the community level. The people who know most about what is needed in the settlements are the people who live there. Very often, the most important help for people with disabilities comes from people who live in the same community. Besides, the committee can approach the department when its help is needed.

    The local rehabi-litation committee aims to help communities improve the lives of their own people with disabilities.

    The committee makes broadest possible representation of the whole community by including various groups of people within the settlement, such as, persons with disabilities and their families, school teachers, health workers, members of parents’ association, members of Regional Tibetan Youth Congress and Tibetan Women Association, prefects of the settlement school, etc.

    In brief, the committee will work on:

    • Developing positive attitudes towards persons with disabilities
    • Helping adults with disabilities to manage better at home
    • Making home a safer place to be, for persons with disabilities
    • Helping persons with disabilities to socialize
    • Helping families caring for a disabled
    • Helping adults with disabilities to get work or training
    • Giving children with disabilities the same opportunities as other children
    • Help persons with disabilities to participate in social activities
    • Preventing disability from happening in the settlement


    Gist of the Standard Rules on Equalization of Opportunities for Persons with Disabilities

    1. Raise awareness in society about persons with disabilities, their rights, their needs, their potential and their contribution.
    2. Provision of effective medical care to persons with disabilities.
    3. Provision of rehabilitation services to persons with disabilities in order for them to reach and sustain their optimum level of independence and functioning.
    4. Development and supply of support services, including assisting devices for persons with disabilities, to assist them to increase their level of independence in their daily living and to exercise their rights.
    5. Recognize the overall importance of accessibility......For persons with disabilities of any kind, States should (a) introduce programmes of action to make the physical environment accessible; and (b) undertake measures to provide access to information and communication.
    6. Recognize the principle of equal educational opportunities for children, youth and adults with disabilities,
    7. Recognize the principle that persons with disabilities must be empowered to exercise their human rights, particularly in the field of employment.
    8. Provision of social security.
    9. Promote full participation of persons with disabilities at home and in community without discrimination.
    10. Collection and dissemination of information about persons with disabilities.
    11. Ensure that disability aspects are included in all relevant policy-making and national planning.
    12. Create legal bases for measures to achieve the objectives of full participation and equality for persons with disabilities.
    13. Recognize the right of the organizations of persons with disabilities to represent persons with disabilities at all levels.
    14. Adequate training of personnel, at all levels, involved in the planning and provision of programmes and services concerning persons with disabilities.
    15. Continuous monitoring and evaluation of the implementation of national programmes and services for persons with disabilities.


    Sterilization and anti-rabies vaccination camp

    Total of 259 dogs and 4 cats were sterilized in the dog sterilization and anti-rabies vaccination camp held from Oct. 14 to 25, 2004 in Dharamsala .

    A huge increase in the total of stray dogs in Dharamsala has been of serious health concern for sometime, the chief amongst these being rabies ("mad dog"). Not a year passes by without news of deaths, especially of minors due to rabies. In extremely poor state of living they are just too many to be well fed, and cared for in the manner they usually have.

    Until a year ago, the customary solution was poisoning. Upon request, the local municipal committee sent men to poison stray dogs in the areas specified. When poisoned, dogs die slowly in great agony. This of course is extremely painful not only to dogs but also to humans, as those who chance to see it happening, are left with a deep sense of remorse and guilt.

    An alternative then was to transport stray dogs to a distant land, from where they cannot find their way back. This obviously is not a healthy thing to do, especially for the residents of the place where they are unloaded.

    Search for alternative measures resulted in the sterilization and anti-rabies vaccination as the best short- and long- term remedy.

    Thus, the first of such camps took place last year in Dharamsala. With technical assistance from Palampur College of Veterinary & Animal Sciences and Blue Cross Society of Himachal Pardesh, and logistics arranged by the department, 83 stray dogs were vaccinated against rabies and 8 male stray dogs sterilized.

    This was followed by a similar camp at Mundgod Doeguling Tibetan Settlement later that year, with technical assistance from veterinary surgeons from Denmark and Sweden, through the Denmark Tibet Charity Trust. In this camp nearly 300 dogs were either vaccinated against rabies or sterilized. Logistics for the camp was arranged by the Doeguling Tibetan Resettlement Hospital.

    The sterilization performed in Mundgod was in many ways more advantageous than what was done in Dharamsala. In Dharamsala only male stray dogs were sterilized, while in Mundgod all stray dogs, irrespective of its sex were sterilized. The former needed a minimum one-week of intensive care after sterilization, the latter for only an hour or less. The former was performed mostly by students, the latter by veterinarians.

    Thus, the need to replicate the Mundgod project in Dharamsala.

    A team of Scandinavian professionals consisting of five doctors, two veterinarian nurse, and four helpers agreed to work voluntarily, and to bring along all the necessary veterinarian equipment and medicine.

    Medicines and equipment left behind in Mundgod last year, were transported to Dharamsala. Refrigerator for the storage of medicine was purchased here in Dharamsala.

    The department and Dharamsala Welfare Office was to arrange logistics such as tents, power, water, furniture, and to hired people to pick up stray dogs. Furthermore, the department was also responsible for finding appropriate sites in Mcleod Ganj, Gangchen Kyishong and the Tibetan Children’s Village for the camp and to assign adequate staff (three) of its own to coordinate throughout the camp.

    The department now is exploring if the same could be replicated in some other places.


    Refresher training on data

    Refresher training on health data collection was held at Songtsen Library, Dehra Dun from 23 to 25 Sept., 2003. Community health workers in Doon valley and Himachal State, 13 in all, attended this training. Mr. Kelsang Tsering, of the department’s data unit, was the resource person.

    The training was to address the inadequacies found in the collection, entry, and reporting of health data. Besides, it also introduced the participants to the revised TB data form.

    Evaluation conducted at the end of the training reflected well on its benefit.


    Training in detection of disabilities

    Health workers in North India and the region of Doon Valley, 23 in total, were trained for early detection of various forms of disabilities found in people in general, and in particular of new born babies from Oct. 14 to 16 for three days at Songtsen Library in Dehra Dun.

    Particular mention must be made of Ms. Nicola Tansley from England, who not only provided this training to health workers, but also has been instrumental in the making of comprehensive strategy to promote the welfare of persons with disabilities. The department deeply appreciates her benevolent voluntary service. We look forward to many more years of her continued support.


    Workshop on treatment of the traumatized

    A workshop on the treatment of traumatized refugees was organized at the Songtsen Library, Dehra Dun from 21 to 23 Oct., 2003.

    Two doctors of Tibetan Sorigpa (Indigenous System of Medicine), two allopathic doctors and 13 health personnel of various capacities attended this workshop.

    Ms. Anne Viveke from Denmark was the resource person for this workshop.


    Dental refresher training

    From October 7 to 16, a dental refresher training was organized at Upper TCV, Dharamsala.

    Attendees were 10 health personnel of various capacities from Mundgod, Orissa, Bir, THF Mussoorie, Dekyling, TCV Ladakh, TCV Suja, Delek Hospital, and Upper TCV. Dr. Daryll Andrews was the resource person.


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