Health is a basic and elementary need for the general welfare and development of any community, thus recognizing the importance of good health of the Tibetan Refugee Community, the Central Tibetan Administration established Department of Health in December 1981 to provide curative and preventative health care services by managing and financing health care centers, as well as by planning comprehensive health care system for the Tibetan refugees in India, Nepal and Bhutan.The Department is registered in the name of Tibetan Voluntary Health Association (TVHA) under the Indian Society Registration Act XXI 1860. And it is working as a registered charitable organization catering basic health care needs to Tibetan refugees.The main aim of the Department is to make Tibetan refugee settlements viable by improving basic health status of Tibetan in exile. It includes providing adequate, equitable, and holistic primary health care services to all Tibetan refugees through its Primary Health Care centers and to create and expand public health care program in the community for disease prevention, promoting healthier lifestyles, and a cleaner environment. And with its primary goal of “Health for All” Department extends its health care services to both Tibetans and local Indian residents.Currently, there are 7 hospitals, 4 Primary Health Centers and 43 clinics located in all the refugee settlements in India and Nepal with 174 medical staff and 68 administrative staff working under it.
“Health is a large word. It embraces not only the body, but mind and spirit as well; and not today’s pain or pleasure alone, but the whole being and outlook of an individual.”
“Public health subsists on the knowledge that health is a fundamental resource to the individual, to the community and to society as a whole and must be supported by soundly investing in living conditions that create, maintain and protect health.”-WORLD HEALTH ORGANISATION
Health for All
• To provide adequate, equitable and holistic primary health care services to all Tibetan refugees through Primary Health Care system integrated with the major traditional systems of medicine.
• To create and expand public health program in the community for disease prevention, promote healthier lifestyles and cleaner environment.
Health is a basic and elementary need for the general welfare and development of any community, thus recognizing the importance of good health of the Tibetan Refugee Community, the Central Tibetan Administration established Department of Health in December 1981 to provide curative and preventative health care services by managing and financing health care centers, as well as by planning comprehensive health care system for the Tibetan refugees in India, Nepal and Bhutan.
The Department is registered in the name of Tibetan Voluntary Health Association (TVHA) under the Indian Society Registration Act XXI 1860. And it is working as a registered charitable organization catering basic health care needs to Tibetan refugees.
The main aim of the Department is to make Tibetan refugee settlements viable by improving basic health status of Tibetan in exile. It includes providing adequate, equitable, and holistic primary health care services to all Tibetan refugees through its Primary Health Care centers and to create and expand public health care program in the community for disease prevention, promoting healthier lifestyles, and a cleaner environment. And with its primary goal of “Health for All” Department extends its health care services to both Tibetans and local Indian residents.
Currently, there are 7 hospitals, 4 Primary Health Centers and 43 clinics located in all the refugee settlements in India and Nepal with 174 medical staff and 68 administrative staff working under it.
Administration of Hospitals and Primary Health CentersAs said, there are presently seven Hospitals, four Primary Health Centers (PHC) and forty-three Clinics with two mobile clinics, one for remote nomadic areas in Ladakh and the other for the Doon Valley and Ngoenga School for children with special needs. There are total of 242 staffs (both medical and non medical) working at these health centers, these staffs are appointed and administered directly by the Department of Health as per stipulated rules and regulations of Central Tibetan Administration (CTA). Among the staffs the Department has appointed several Executive Secretaries to administer hospitals and primary health centers at local level, whereas clinics are concern, respective settlement officers under the Department of Home are local administrators. The Department is also responsible for the transfer of its staffs.
The Department with the financial assistance from its donors bears running expenses of these hospitals and PHCs including salaries of the staffs and other recurring and non-recurring expenses. On top of that, the Department also undertakes the implementation of special projects in the interest of primary health care services.
The Health Kalon and the Health Secretary on ex-officio basis are the Chairman and Vice-Chairman of the Board of Directors (BoDs) of both the Tibetan Medical and Astro Institute (TMAI) and the Tibetan Delek hospital, located in Dharamsala, Himachal Pradesh. And all the bills passed in the meeting of BoDs are thoroughly discussed and approved under the Chairmanship of the Health Kalon and the Health Secretary.
Men-Tsee-Khang, the Tibetan Medical and Astro Institute have 562 staffs including 144 Traditional Tibetan doctors and 23 Astrologists scattered all over India and Nepal, whereas under the Delek Hospital there are 42 staffs including 7 Medical Doctors and 12 Nurses.
Implementation, Monitoring and Evaluation
Prioritizing the importance of community participation in all the health care programs or projects, the Dept. of Health has formulated health committee in each settlement to workout and assesses the health care activities at their locality. The committee meets at least thrice a year, where they discuss various possibilities to improve community health care services. The committee comprises of settlement officers who are the chairperson on ex-officio bases and the executive secretaries or local health workers are the secretaries of the committee. Besides local group leaders are the members of the committee who are responsible for implementing as well as reporting on every health care activities carried out by the Health Department at the respective settlements.
Whereas the Department of Health as an overall administrator, monitors and evaluates the health care services through feedbacks and updates from local health centers in the form of periodic reports as well as during field visits. However, Department always prioritize the individual responsibility approach, which has helped establish “health” as the New Morality.
Training of Health PersonnelThere are numerous projects and programs undertaken by the Department of Health and training of personnel is one of the priority programs conducted. Due to lack of proper knowledge with the technical staff limp the programs/projects. However, if the problem is further analyzed it would land on shortage of think tank and human resources in the department. At present, majority of the CTA staff are only clerical not professional, working with their limited knowledge and therefore it is dire necessary to provide them with short-term courses, training and workshops to improve their efficacy. In short, Department continue to organize various capacity building workshops and training with the help of its generous sponsors.
Although the Department has made considerable progress in the past many years, there is still shortage of key medical and health personnel at health care centers and hospitals. Therefore, the training is not only given to the staff of the head office but the program also focus more on giving trainings/workshops/refresher course to the new health staff to improve the skills of all the existing health personnel in the field. Community Health Workers are critical in the Tibetan health care infrastructure and training to this cadre is one of the most important components of the program.
Due to the scattered nature of the Tibetan refugee community in India and Nepal where many health centers located in remote areas, so well trained Community Health Workers are the most essential resource department that can provide primary health care services to the community.
The Department’s training unit provides trainings such as, First Aid, HIV-AIDS, Lab., Dental, TB, RH-MCH, Refresher Course, and Mental Health and so on.
Ngoenga School for Tibetan Children with Special Needs
His Holiness the Dalai Lama in 1997 expressed his benevolent desire to establish a special school for Tibetan children with special needs, and thereby in year 2000, the department of Health with the seed money from His Holiness the Dalai Lama established Ngoenga School for Tibetan Children with special needs with 26 students. Since then the school has been one of the cherished projects of the department.
There are presently 39 teaching and non-teaching staffs headed by a director. The capacity of the school is for 50 children and there are 50 students with multiple disabilities ranging from the age of 6-18 years old. Children are provided with normal school education with special attention given to each child to meet their educational, physical, psychological and medical needs. A curriculum of special education has been developed in accordance to the needs of children and students are grouped in classes according to their age and special needs. Most classes have academic lessons, including Tibetan, Mathematics and English. Practical activities viz. music, cookery, gardening, candle making, stitching and arts are also emphasized to develop skills and understanding concepts. Apart from this, the classes also focus on developing basic communication skills and activities of daily requirement. Physiotherapy segment has also been introduced for the children who require such services.
The school also provides homely environment for the children trying to substitutes their own home for the students remain away from their family for most of the year. There are five homes, three for boys and two for girls with its respective foster parents. The school also has its own clinic staffed by registered nurse and health worker to look after children’s regular medical needs. Besides a regular nurse and health worker, the school invites visiting doctors on a regular basis.
Our health care projects cover the health care needs of entire Tibetan refugee community in India, Nepal and Bhutan. Your generous help will help us in our altruistic operation to improve the overall health of Tibetan refugees and the surrounding local Indians/Nepalese also.Please make donation by cheque/bank drafts, IMO payable to Tibetan Voluntary Health Association towards project(s) of your interest.
- Ngoenga School for Tibetan Children with Special Needs
- Hospital & PHC Maintenance
- Tuberculosis Control Program
- Drinking Water & Sanitation Projects
- Emergency Medical Fund
- Immunization Program
- Mental Health Program
- Training of Health Personnel
- School Health Program
- Health Education & Media
- Health Data & Research
- Tibetan Torture Survivors‘ Program
- Reproductive Health & MCH Program
- Hospital Ambulance
- HIV/AIDS and Substance abuse Program
- Tibetan Medicare System
United Commercial Bank
CTS Branch Dharamsala 176215
H.P. – INDIA
Bank Account No.: 11510100000519
Swift Code: UCBAINBB002
Registration No.: 425/C/H/R.C
FCRA No.: 182450016 dated 29/4/1985
Income Tax Exemption No.: CIT/SML/80-G/9-9/3129
- Lobsang Dhargyal Shewo November 1988 – May 11, 1990
- Mrs Jetsun Pema May 17, 1990 – June 28, 1991
- Kelsang Yeshi August 1991 – January 1993
- Mrs Rinchen Khando Choegyal February 1993 – August 1993
- Sonam Topgyal September 1993 – July 1994
- Tashi Wangdi August 1994 – May 1996
- Mrs Yangkyi Samkhar June 1996 – April 01, 1997
- Ven Kirti Lobsang Tenzin April 02, 1997 – April 07, 1997
- Mrs Yangkyi Samkhar April 08, 1997 – September 18, 2001
- Lobsang Nyandak Zayul September 20, 2001 – March 06, 2005
- Thupten Lungrig March 07, 2005 – August 14, 2006
- Prof. Samdhong Rinpoche August 15, 2006 – May 25 2007
- Mrs Kesang Y Takla May 26, 2007 – November 28, 2007
- Chope Paljor Tsering November 29, 2007 – August 8th 2011
- Dr Tsering Wangchuk September 16, 2001 – 31 May 2016
- Choekyong Wangchuk (1 June 2016 – Present )
- Mrs Kesang Y Takla January 12, 1983 – January 01, 1989
- Mrs Namgyal Lhamo Taklha November 15, 1988 – July 14, 1994
- Desang Tsering June 15, 1994 – July 31, 1996
- Tsering Dorjee July 16, 1996 – April 18, 2002
- Tenpa C Samkhar April 19, 2002 – June 30, 2007
- Pema Damdul Arya January 07, 2007 – March 19, 2008
- Topgyal Tsering (Officiating) March 20, 2008 – May 22, 2008
- Sonam Choephel Shosur (Officiating) May 23, 2008 – August 06, 2009
- Mrs Kalsang Y Dagpo September 06, 2009 – November 16, 2009
- Sonam Cheophel Shosur (Officiating) November 17, 2009 – January 19, 2010
- Wangchuk Phasur January 20, 2010 – March 12, 2012
- Sonam Choephel Shosur March 13, 2012 – October 6 2014
- Tsegyal Chukya Dranyi October 2014 – April 2016
- Chemi Rigzin (Acting Secretary) April 2016 – 25 July 2016
- Tsegyal Chukya Dranyi (1August 2016 – Present)
|S.No||Division||Designated Job||Dealing Staff Name||Designation||Official E-Mail||Head of the Division|
|1||Health Kalon||Choekyong Wangchuk||Health Kalonemail@example.com|
|2||Health Secretary||Tsegyal Chukya Dranyi||Secretaryfirstname.lastname@example.org|
|3||Head of Administration Division, Tibetan Medicare System, Ngoenga School||Additional Secretaryemail@example.com|
|4||Head Of Planning/Project Division||Joint Secretaryfirstname.lastname@example.org|
|5||Head of the Public Health and Medical Servicce||Ms Trinley Palmo||Deputy Secretaryemail@example.com|
|6||ADMINISTRATION||Audit and Laydhom||Mr Sonam Topgyal||Under Secretaryfirstname.lastname@example.org||Tsegyal Dranyi|
|7||Tibetan Medicare System (TMS Coordinator)||Mr Nyima Gyaltsen||Under Secretaryemail@example.com|
|8||TMS Dealing Staff and Proposal Writer||Ms Tsering Dolkar||Section Officerfirstname.lastname@example.org|
|9||Maintaining the Record of TVHA Staff and with regards to this all the correspondence||Mrs Nyima Dolma||Office Assistantemail@example.com|
|10||Personal Assistant, Telemedicine Incharge, Coordinator for Medical Doctor’s, Interns andMs. Students||Tenzin Dolkar||Office Assistantfirstname.lastname@example.org,email@example.com|
|11||Ngoenga School For Tibetan Children With Special Needs and Care of Tibetan People||Mrs Tashi Yangzom||Senior Clerkfirstname.lastname@example.org|
|12||Accounting and Budget of all branch hospitals and health centres||Ms Tenzin Palkyi||Senior Clerkemail@example.com|
|13||Receptionist||Mrs Tashi Dekyi||Junior Clerkfirstname.lastname@example.org|
|14||PLANNING, PROJECT & ACCOUNTS||Water and Sanitation Program and Proposal Writer||Mr Karma Namgyal||Office Superintendentemail@example.com||Thutop Namgyal|
|15||Ambulance Fund and Project Accountant||Mr Tenzin Choephel||Office Superintendentfirstname.lastname@example.org|
|16||Health Media (Bulletin,Website and DoH Brochure), Training Coordinator||Ms Tashi Yangzom||Office Superintendentemail@example.com|
|17||Chief Accountant||Mr Namgyal Gedhun||Under Secretaryfirstname.lastname@example.org|
|18||Accountant||Ms Phuntsok Dolma||Office Superintendentemail@example.com|
|19||Accountant||Ms Tenzin Dolma||Office Assistantfirstname.lastname@example.org|
|20||Cashier||Ms Kunga Namdol||Office Assistantemail@example.com|
|21||Plumber||Mr Tenzin Choephel||Plumberfirstname.lastname@example.org|
|22||PUBLIC HEALTH||Mother and Child Health Program, Reproductive Health , Oral Health and Hygiene Programme||Ms Ngawang Tenzin||Section Officeremail@example.com||Trinley Palmo|
Essential Drugs and
Emergency Medical Fund
For CTA/TVHA Staff and
Nyamthak B&D People in
India, Nepal and Bhutan
|Mrs Tenzin Kunchok||Office Superintendentfirstname.lastname@example.org|
Medicare and Welfare of Tibetan Torture Survivors Program (TTSP)
|Ms Sonam Dolma||Office Superintendentemail@example.com|
Health information system
|Mr Tenzin Sonam||Office Assistantfirstname.lastname@example.org|
Health Education Program.
|Mr Kapsang||Office Assistantemail@example.com|
TB and MDR TB Prevention and Control Program
|Mr Migmar Tashi||Section Officerfirstname.lastname@example.org|
HIV/AIDS Prevention and Care Program, Subtance abuse and Prevention and Rehabilitation
|Mr Tenzin Jinpa||Dealing Officeremail@example.com|
Mental Health, TTSP and Integration of Tibetan Sowa Rigpa and Western Medicine Program
|Mrs Tsetan Dolma||Senior Clerkfirstname.lastname@example.org|
|Last updated on 17 May 2013|
Department of Health
Central Tibetan Administration
Gangchen Kyishong, Dharamsala-176215
Himachal Pradesh India
Phone: 0091-1892-223408 / 0091-1892-223486
Health Data and Research Program
In the year 1990, health data and research program was launched as an introductory phase to analyze and understand the importance of comparing figures while working for the eradication of diseases, controlling and improvement of health and health care system. After giving intensive training to the concerned staff, we were able to implement full-scale data collection in 1994. The first analyzed report of the community-based Health Information System (HIS) was released in the form of a book called “The Demographic and Health Surveillance of the Tibetan Refugee Population in India” in 1998. This book highlights the basis of any comparison towards the success and failure of projects, plans and programs in the health sector. Also acts as a guiding tool while innovating, implementing and revising any programs, projects and plans to fight against various hazardous health problems of the community.
However, due to the lack of expertise epidemiologist, Department of Health is facing many challenges to give clear cut picture of Public Health and couldn’t able to produce any newer version so far.
It is important to have accurate and up-to-date health data of the community in order for the Department to tackle any urgent health issues that may arise and for their prevention and timely control. In this light the data recording and analysis program was launched in 1990 in an introductory phase. Further staff training and broader data collection was implemented in 1994. The first analyzed report of the community-based Health Information System (HIS) was released in the form of a book called “The Demographic and Health Surveillance of the Tibetan Refugee Population in India” in 1998.
The data collected by the Department of Health is from our hospitals and Primary Health centers (PHC) and Clinics in various Tibetan settlements throughout India and these data reports form the main source of our health information on the settlement populations. The Department of Health has trained each health worker stationed at local health centers in data collection and reporting to improve the disease surveillance in such a way that we can better respond to the needs of the Tibetan community in exile and are better able to provide sufficient feedback for all the stakeholders in a timely manner.
Furthermore, in 2005, in collaboration with the Centers for Disease Control, Atlanta (CDC), the Department of Health focused on enhancing the existing data collection system. A staff member of CDC, Mr. Ondrej Mac visited India to lend assistance to enhance the data collocation system. The new data collection format recommended by Mr. Ondrej Mac was implemented in 2008 after training all the related health workers. However, the existing data collection system is manually operated; therefore, a more efficient electronic system is desired, to redefine the basis and the purpose of the public health delivery services through a policy framework, which guides the smooth transition from short-term curative healthcare system to a holistic and preventive based health care. Ergo, this new Tibetan Health Information System (HIS) has been developed and proposed to the Tibet Fund as a component of the US Humanitarian Assistance grant in FY 2009.
The Department of Health has first created an electronic health data collection system with the voluntary initiatives by Mr. Nigel Griffith & Mr. Tenzin Lhadhar (software (IT)) experts from Australia, and even trained some selective departmental staff and launched the software in two different locations viz. Bir and Dekyiling on trial version.
System was further reviewed by the Department’s epidemiologist consultant Dr. Lobsang Tsering and Senior-level (PhD) Epidemiologist from John Hopkins, Dr. Bill Weiss, Dr. Alex Vu, Dr. Tia Ling and Dr. Kiemanh Pham. Together they provided technical assistance in strengthening and modification of the system, epidemiological study of selective diseases, creating new disease classification and indicators for monitoring and reporting mechanisms within the CTA health system.
This new data system includes a user-friendly data entry design, unique patient ID number for each hospital or clinic and complete list of health conditions with disease classification. A watch-list of important health conditions such as TB, hepatitis and diabetes is included. Tables and graphs can easily be created to inform the public, and enable health decisions and intervention planning. It will thereby be possible to access all the health database information with this new software without having to wait for postal services. The software is designed in such a way that it can also check the duplication of any information if the input is correctly performed.
After the successful installation of the software and when it is functional at all levels, comprehensive HIS data will be available, which is then analyzed. Policies and procedures to address the service needs of the Tibetan community will be driven by the results of the HIS data. Variable for monitoring will also be determined then, which will include evaluation of completeness and accuracy of data submitted.
The installation of this computerized ‘Health Information System’ in all our health centers mark giant step in our service to the community. It is no exaggeration to say that we have now emerged into the 21st century, steering the Department of Health towards achieving its goal – ‘Health for All’.
Control and Treatment of Infectious Diseases
Department of health is striving to control and eliminate the following infectious diseases, including drug abuse among the Tibetan youth:
1. TB Control Program
Tuberculosis (TB) continues to remain one of the major health problems for exile Tibetans in India and Nepal. Unhygienic surrounding, refugee life, low nutritional diets, lack of awareness, stress and most of all changes in the habitation from high altitude Tibet to tropical hot weather of the Indian subcontinent are some of the primary cause of high incidents of TB cases in Tibetan community.
The Department’s TB control program practice its assignments in conformity with the treatment guidelines laid down by the World Health Organization (WHO) and that of the host nation, India. As per the guidelines, Directly Observed Therapy Short course (DOTS) strategy is the practice applied to keep TB under control in the settlements. The PHCs and hospitals serve as first referral centers for patients within the settlements and the hospitals provide basic diagnostic and treatment facilities. To further reduce the risk of spreading the disease, isolation TB wards for positive smear is constructed at hospitals with special diet and recreational facilities for the patients.
2. Leprosy Control Program
Leprosy is an infectious disease caused by the bacteria Mycobacterium leprae. Most people have a natural immunity to the disease and those that do develop leprosy can be cured with modern Multidrug Therapy Treatment (MDT). The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and the eyes, apart from some other structures. Leprosy has afflicted humanity since time immemorial. It once affected every continent and has left behind a terrifying image in history and human memory – of mutilation, rejection and exclusion from society.
The department is struggling hard to eradicate the disease. At present, it is working with Palampur Leprosy Home where Tibetan Leprosy patients are admitted. We have currently 13 patients on roll. They are provided with medical assistance, monthly stipend, dry ration subsidy and clothing for their living.
3. HIV/AIDS Control Program Prevention
Like any other citizens of the world, Tibetans in exile are no different when it comes to HIV/AIDS pandemic. Due to a highly mobile refugee community, Tibetans are at higher risk of the pandemic. The department not only have a moral responsibility to shoulder world’s endeavor to control the disease but is making extra effort to create awareness about it among the unawares. It has established a special program/desk at its head office, whose primary objective is to educate the public about the disease. The department does this by making free distribution of pamphlets, posters, charts and audiovisual CD & DVD on HIV/AIDS. It also conducts mobile mass awareness campaigns in Tibetan community, including free HIV testing and distribution of condoms on large scale. The department, in collaboration with local NGOs like CHOICE (HIV/AIDS) and Kunphen (Substance abuse), observe international days of AIDS and Substance Abuse respectively, during which promotion activities such as mass marathon and signature campaigns are carried out.
Treatment and Medication
The program, though prioritizes the preventive measures, also focus on medications, and with the generous policies of the host nation, medication of the pandemic is free of cost. Usually HIV positive patients do not come forward readily to seek help due to social stigma associated with the disease, such as discrimination, lack of family support and knowledge. In order to encourage individual patients to come forward and seek treatment, the Department of Health organizes various workshops and training on HIV counseling to the local health workers, who deal directly with the patients. Given the individual financial crises as well as to encourage patients to take the medication, the Department of Health provides financial assistance and those who come forward are referred to Delek Hospital or other local Indian hospital for diagnoses. Their immediate families are also encouraged to conduct the test. The Department of Health has been able to support the traveling cost of the patients to obtain medication, room rent and a daily allowance of Rupees 180 per day. It also bear costs of other people who might accompany the patients to help them in visiting the Integrated Counseling and Testing centre (ICTC) & ART centre.
4. Substance Abuse Control Program
Drug users and alcohol drinkers are not only more susceptible to getting infected with HIV/AIDS, but they are also more likely to suffer faster disease progress than those who do not drink or use illicit drugs. Therefore Substance Abuse control program of the department work hand in hand with the HIV/AIDS desk. Apart from integrating HIV/AIDS and Substance abuse, the program also focus on treatment and rehabilitation of the patients abreast creating mass awareness and health education.
The Department of Health in coordination with the Tibetan schools has initiated special committee comprising of both staff and students to control substance abuse in schools. And the Department organizes annual inter-school committee meeting to discuss the issues. The department also organizes various activities such as inter-school drawing competitions and awareness lectures are given during which rehabilitated persons share their experiences.
Treatment and Rehabilitation
Concerning the treatment of a substance abuse patient, the Department of Health financially support them to get admitted into de-addiction centers and those rehabilitated are further provided with live skill trainings to reintegrate them in the wider society.
The major difficulties the department faces in extending its help to the substance abuse patients are lack of willingness and motivation on the patients’ side to accept their disease and seek treatment. Under such circumstances, the Department of Health organizes and provides counseling training to its existing medical health workers to improve their capacity to deal with the substance abuse cases.
Emergency Medical Relief Program
One of the vital programs being undertaken by the department is the emergency medical relief program and treatment in referral hospitals in various parts of the country. Our hospital services are limited to primary health care facilities, as we are unable to provide advanced medical facilities due to lack of qualified and duly skilled staff and financial constraints. Despite all this, we have been sincerely supporting patients for advanced treatment in other hospitals that cover major surgeries and other allied health services, which are currently lacking in our settlement hospitals. Emergency Medical Relief Program is provided to following three categories:
Under the first category fall the underprivileged Tibetans, who are selected and registered under the three concerned CTA departments: department of home, education and health. This program looks after the health of the underprivileged and bears 100% of their medical cost, including medical service, surgery and other operational costs.
Under the second category falls the staff of CTA, who provides a monthly contribution of 2% of their monthly gross salary towards CTA medical fund.
Under the third category are those who are not registered under above two categories. They are granted some percentage of medical recompense based on the scrutiny and recommendation of the settlement officer, camp leaders and the executive secretaries of department of health hospitals in various Tibetan settlements.
Health Education desk of the department strives to increase awareness on preventive measures on various diseases concerning mother and child health care, water borne diseases, TB, STD, HIV/AIDS and Substance Abuse etc. The desk has produced numerous booklets, pamphlets, posters, charts, and even audiovisual kits like CDs and DVDs. All these materials are produced in both English and Tibetan versions and freely distributed among the general public.
The desk also published David Berner’s book entitled “Where there is no doctor” in two different Tibetan versions, one for the exile community and the other for Tibetans within. The desk also publishes annual report of the department, which contains all the activities implemented during the year, and a brief financial report.
An important aspect of this program is to continue developing appropriate media for health education. Materials from WHO and other organizations, which include various pamphlets, books, comics, posters and films are translated into Tibetan and adapted for use in our community. In addition, it prepares health information systems from time to time and in the event of any outbreak of (disease).
Integration of Traditional Tibetan Medicine and Allopathic Medicine
Central Tibetan Administration has always expressed the need of equal responsibility of Traditional Tibetan Medicine on World Health and urges them to serve humanity to fight against various diseases cropping along century’s fast life.
Tibetan traditional medicine with its more than 2000 years long history, has been serving Tibetan in Tibet concealed from the eyes of World. However, in 1959 with the unfortunate turn out in Tibet’s political status. The school of Traditional Tibetan Medicine is rewarded with the opportunities to explore and extend its practices all over the world. Especially with the modern techniques and development in the infrastructure gave Traditional Tibetan Medicine entirely a new face under widely known as Mentse-Khang (Tibetan Medical and Astro Institute – TMAI). Today there are hundreds and thousands of patients world wide consulting Tibetan Doctors at TMAI and benefits from its traditional prescriptions. TMAI has so far proved its effectiveness over many chronic diseases and continue to earn appreciation from the patients worldwide.
On the other hand, fast development of the science has boosted allopathic medicine to such height that it is futile arguing its achievement. And since 1982, H.H the Dalai Lama has expressed for a holistic medical care through combination of two medicines in the right course, which might serve the human kind more than ever. And besides, the Department of Health with its ultimate goal to serve humanity in the best interest and to provide maximum benefits to the patients, tries to bridge two approaches to walk abreast.
The Department has organized joint meetings between the practitioners of two schools and discussed in the length on various means to meet the requirement. Doctors from the both approaches shared their personal experiences whilst the Department received many positive feedbacks.
Resulting from these meetings the Department has so far been able to formulate special committee where scholars from both the approaches work hand in hand to improve and adopt a comprehensive policy to integrate the approaches.
As of now Tibetan refugees in the settlements are provided with both the facilities, where equal number of patients avail services from their choice of medicine.
Reproductive Health & Mother and Child Health Program (RH/MCH)
Major wings under the RH/MCH program of the department are Immunization, Pre-Post Natal care, Mother and Child’s Nutrition Prevention and control of STI and UTI
Through constant awareness created by the department, many mothers are now well aware of the need to immunize their children to prevent diseases and for their proper growth. The program has achieved outstanding results with pregnant women, taking extra care in getting them immunized well in time. Before launching the program, situation was not as good as today. Ignorance and conventional household delivery were usual, putting risks to both mother and child. The department now has many service packages to further improve the health of community. It provides services under both traditional Tibetan and allopathic medicines.
The immunization program under the RH/MCH is designed to offer free vaccinations to all Tibetan children under the age of five to protect them from major communicable diseases. Vaccinations given are MMR, Hep-B and A vaccinations, BCG, Immunoglobulin, anti-polio drops, Typhoid, while all the pregnant mothers are provided free micronutrients for a period of nine months and free Hep-B and VDRL tests. The project also includes free distribution of traditional Tibetan medicines such as life-prolongation pills and intelligence-enhancing pills to the students from class I to IV.
Reproductive Health Care
Reproductive Health care aims to provide comprehensive, culturally acceptable and accessible services to all the Tibetan refugees of reproductive age. With the introduction of MISP (Minimal Initial Service Package), the Reproductive Health project has expanded the primary health care services to include safe motherhood, STI/UTI management and sexual/gender violence counseling and establishment of referral network for higher-level care. MCH desk of the department organizes public health talks and seminars; health workers are given trainings to upgrade their knowledge, special subsidy for the poor and destitute mothers are provided also.
Telemedicine is a confluence of Communication Technology, Information Technology, Biomedical Engineering and Medical Science. The Telemedicine system consists of customized hardware and software at both the Patient and Specialist doctor ends with some of the Diagnostic Equipments like ECG, X-ray and pathology Microscope/Camera provided at the patient end. They are connected through a Very Small Aperture Terminal (VSAT) system. Telemedicine facility thus enables the specialist doctor and the patient separated by thousands of kilometers to see visually and talk to each other. It can be described as “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities”. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.
Therefore in consultation with the KLES (Karnataka Lingayat Education Society’s Hospital & Medical Research Centre, Belgaum) located in Karnataka, south India, where telemedicine facility is available and is fully functional. The Department wishes to install the technology in its own health care centers with the technical assistance from KLES hospital to over come its major shortcoming of human resources, i.e. specialized medical doctors in the Tibetan settlement.
In order to over come the lack of specialized Doctors, the Department of Health also hires local visiting Doctors but those visiting Dr. are only available during its scheduled time. Otherwise people have no access to them and people have to again travel miles to consult specialized Doctors. It is very difficult for the patients to re-consult the same Dr. or visit the hospital over and over again. However, with the installation of the telemedicine, it will fulfill the objective in the most cost effective ways.
For instance, Mother and Child Health/Reproductive health Care program (RH/MCH) is one program which is of top priority in Central Tibetan Administration policy, but the there is no Gynecologist in any of the Department’s Health Center. As such telemedicine will not only benefit the individual patients but will also heighten the efficacy of the overall policy of the CTA.
Types of telemedicine:
Telemedicine can be broken into three main categories: 1. Store-and-forward2. Remote monitoring 3. Interactive services
Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured Medical Record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The store-and-forward process requires the clinician to rely on history report and audio/video information in lieu of a physical examination.
Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and is cost-effective.
Interactive telemedicine services provide real-time interactions between patient and provider, to include phone conversations, online communication and home visits. Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-interactive” telemedicine services may be less costly than in-person clinical visits.
The Department’s telemedicine shall cover all above types but on a smaller scale, which means the Department will install tele-ECG, which will transfer the data from patient at our service centre to specialist Doctor’s end. The Department will also install digital camera, which will take digi-snap-shot of X-rays by putting it on X-ray view box and will transfer the image to required location through VSAT and ISDN.
To overcome lack of medical doctors, particularly specialist in our community and make the exile Tibetan community healthy and sustainable
To provide specialized medical care to the general public• To improve knowledge of existing Doctors and nurses • To heighten the efficacy of mass health awareness programReduction in Pathogenic, STI, Degenerative and lifestyle diseases
It is a holistic secondary and tertiary health care (hospital care) coverage for all Tibetans living in exile under the responsibility of Tibetan Voluntary Health Association (TVHA), registered under the Societies Act 1860. The system is built on Public Private Partnership model and creates a health fund across the entire Tibetan exile community. It will provide equitable and comprehensive health care coverage on yearly basis designed to serve the health care needs of the entire Tibetan exile community by creating a more sustainable financing source.TMS is a nonprofit and charitable programme that improves public health and well-being of the Tibetan community in-exile significantly through access to quality secondary and tertiary healthcare in partnership with well-known health care providers, while reducing financial insecurity and hardship associated with treatment of catastrophic conditions and hospitalization. TMS will contribute towards a holistic preventive and curative system integrating both ‘SORIG’, the Tibetan traditional herbal medicine, and allopathic medicine system in order to deliver effective and efficient health care services tailored to the needs of the Tibetan community in-exile.
Why do we need it?•
It will provide financial security to the families and individuals when they face serious health problems• Tibetan Medicare System is a nonprofit and charitable programme intended to improve the health care services of the Tibetan community in-exile.• It will provide equitable and comprehensive health care coverage to families and individuals who are enrolled in this system• CTA will not provide any other subsidy for health after this scheme starts
Who are eligible to receive the benefits?
All Tibetan people in exile in India can enroll in the TMS and are eligible to receive the benefits.
How much to pay and what is covered?
For a family up to five, you would have to pay INR 3565 and INR 713 for each additional member on yearly basis as contribution, which will cover up the family floater for hospitalization with cashless benefit upto INR 100,000. This includes the cost of the medicines prescribed and bought within one month of the discharge from the hospital. Individuals who are without a family can opt for individual coverage by paying a contribution of INR 950 for a year. For this contribution, an individual would get a cashless benefit upto INR 50,000 for hospitalization expenses at selected hospitals. This includes the cost of the medicines prescribed and bought within one month of the discharge from the hospital.
How to enroll?
You can enroll at the hospital or the health care center of the Department of Health, CTA, in your settlement. If there is no health care center, enrollment can be done at the office of the Representative or Welfare Officer. A TMS member has the following responsibilities:• Attend meeting or get information on Tibetan Medicare System• Make a decision on enrollment• Fill the enrollment form with help of enrollment officer who could be any one of (Representative, Welfare officer, Doctor, Executive secretary, Health worker, camp leader etc.) • Submit the form with contribution amount and ID card charge to the enrollment officer• Verify the accuracy of the information given on your ID card and inform to the enrollment officer if there’s any mistake• Sign the “Received ID Card” sheet
How to claim for benefits?
In case of sickness, approach the hospital or health care center of the Department of Health, CTA, or traditional Tibetan medical center in the settlement. If there is no health centers at the settlement, then go to a designated primary care provider In case there is a referral, take the referral slip from the first health care center or hospital and must go only to the referred hospital.The cashless claim payment would be made to the empanelled or network hospitals on a regular basis for all the TMS member patients that they have provided the service to. But ensure that you carry your TMS ID card for the cashless transaction for the hospitalization. Claim reimbursement will be made only in case of emergencies, where an insured person is not able to reach a designated provider in time and goes to some other provider because of emergency. After discharge from the hospital, all the original documents should be submitted to the Representative/Welfare officer/Executive secretary of the settlement for the reimbursement of the claim. . Once you are admitted to any of designated hospital;• Show your TMS ID card to prove that you are a member.• The management in the hospital will match your finger print.• The cashless transaction will start once the identification is matched.• Please ensure that the treatment you receive and the treatment billed by the hospital match. Inform your primary care provider or settlement officer if you have doubts.• The balance amount in the card will be shown either on the screen or in the written form after each usage.• During emergency, enrolled member can be admitted in the nearest non network hospital to save life. But one has to inform the concerned enrollment officer within 24 hours of admission in that hospital.Claim will not be entertained in the following cases:1. Submission of unnecessary or excess bills.2. Any treatment related to alcohol and substance abuse.3. Cost related to birth control or pregnancy prevention.4. Vaccination (Included in primary health care services).5. Cost of injuries related with fighting.6. Treatment after attempting suicide.Any other health cost not covered under the TMS.
:In the wake of the Chinese occupation of Tibet in 1959, His Holiness the Dalai Lama, the Spiritual and Temporal Leader of Tibet, and about 85000 Tibetan followers, escaped from Tibet and sought refuge or political asylum in India. Later, with the strengthening of the Chinese policy in 1987-88, Massive Political Uprisings erupted in Tibet where Tibetan people took to the streets of Lhasa, the Capital City of Tibet, to voice against the hegemonic Chinese Regime, only to be crushed by them mercilessly resulted in mental and physical trauma. Therefore, this program initiated in response to the immense tyrannical and oppressive policies of the Red Communist China, leading to influx of a large number of Tibetans into India.
Year of Establishment
:The Tibetan Torture Survivors’ Program-A special Component under the Department of Health, Central Tibetan Administration-though started in early 1990s was launched as a full-fledged Program with proper staffing, only in October 1996 after the approval of the two major projects: Tibetan Danida Project and Tibetan IPSER/ TPO Project.
Interdisciplinary Approach (Composition and Primary Objectives):
TTSP is headed by a Program Officer who holds the managerial task to administer the proper functioning of the Program and it is a multi-disciplinary forum comprising a team of Tibetan Traditional Doctors, Spiritual Advisor/ Consultant, Allopathic Doctors, Expatriate Psychologists & Doctors and Social Workers to cater to the Psycho-social and Mental Health Care needs of Clients through a collective, integrated system of both the Tibetan Traditional Medicine and Modern Allopathic Medicine, aimed towards this end. The Program undertakes the overall responsibility of looking after the Tibetan victims of torture who have endured severe forms of trauma, and it seeks to reduce physical, psychosocial and psychological sequel resulting from organized violence and politically motivated torture in Tibet.
Main Activities (Treatment)
TTSP provides cost-free medical and psychological assistance to Tibetan victims of torture and other forms of political repression. The mode of treatment is both Tibetan Traditional Medicine and Modern Allopathic medicine, depending upon the choice of the Clients. The cases which cannot be handled by TTSP or in case of any complications, they are referred to more advanced Indian Hospital, after the recommendation of Consultant Doctors. All medical expenses, including traveling expense and daily allowances are borne by this Program.
One of the sole underlying objectives of this Program is to stabilize and rehabilitate these people in a new socio-cultural environment. In the process of rehabilitation, the clients are offered services/assistance such as social support in the form of monthly allowances, stipends, housing allowances and rehabilitation of tortured survivors who are too old to work, as well as vocational or skill training to physically able to make them capable of self-supporting and self-reliant after a few years of help from this program.
Health personnel are educated and trained regarding Counseling Methods and Psycho- therapy mainly focused on carrying out basic methods of intervention, Identification, Treatment and Management of traumatized people in general. The first round of training has been successfully accomplished during the last two years and our future endeavor will emphasize on Refresher Courses and training of Trainers, forming the core group of trainers to train the Community Health Workers (CHWs) in the Primary Health Hospitals and Centers in various Tibetan Settlements in India and Nepal. The team members also participate in scientific activities such as Seminars, Discussions and Conferences.
As the work began, treatment and medical requirements of newly arrived Tibetan Refugees were met by the “Emergency Medical Relief Fund, EMRF” of the Department of Health, Central Tibetan Administration of His Holiness the Dalai Lama. Besides securing sponsorships from some Organizations for individual torture survivors and funds from individual sponsors, the Tibetan Torture Survivors’ Program is able to obtain funds for treatment and livelihood training through two major projects funded by USAID (United States Agency International Development) and Les Amis DU Tibet, LUXEMBOURG. Besides these two projects, we have also some other donors who support torture survivors viz. Stitching Namgyal (Holland) who generously sponsor some of our torture survivors and Tibetan Snow lion Friendship Society of Japan has also donated used Clothes, which is a great help to the victims and their families.
Case Referral System:
Due to lack of financial resources, the services are available to those new arrivals from Tibet those who experienced mental and physical tortures. However, in the coming years, as we attain maturity or move towards self-sufficiency, we hope to expand our services to all traumatized refugees in general, irrespective of whether he/ she is a political prisoner or not.
The TTSP plans to take care of at least 40 torture survivors each year and is working towards gradually integrating this new system into a Community based Health Care System. Early efforts concentrated mainly on the treatment process, but it has now become increasingly evident that efforts must also focus on raising funds and providing social support. We are also planning for our Indigenous Treatment Method or Spiritual Healing session to have greater role to play in seeking to address the psychological problems of torture survivors along with religious or spiritual intervention. To this effect, the team has already established contact with one of the senior Buddhist monks to participate in the Group therapy.
Special project desk of the department include provision of safe drinking water, construction of public and individual toilets, provision of equipment at the health centers, construction of health centers, repair and maintenance of the health centers and provision of ambulance to the hospitals etc.
Water being the fundamental source of life can also be the key source of various infections. As per WHO guidelines, the department has made its top priority to provide safe drinking water. The Department continues to build water tanks, drill bore-wells, hand pumps and install pipelines to supply water to the public taking the local conditions into account. The department has been supporting drilling of bore-wells to set up underground water supplies in various settlements based on water sources showing every sensitivity toward the water-table. The department advocates recharge scheme and roof water harvesting as far as possible and constantly provide training on water management, cleaning system and chlorination of water from time to time to provide safe drinking water.
The Department with the hired expertise from AFPRO, SPACE GEO TECH and other hydrological institutions conduct geophysical and hydrological investigation and survey to sustain any new project. The department also encourages all the settlements to conduct water quality analysis at the respective settlement as frequently as possible.
By the WHO definition, “sanitation is safe management of human excreta and includes the provision of latrines and promotion of personal hygiene”. Thus in the light to control infectious diseases such as diarrhea, malaria and so on, the department of Health funds numerous toilet projects, both public and household, in all the Tibetan communities. The desk also supports the sanitary infrastructures like construction of drainage system, septic tanks and garbage disposals. The main objective of the program is to prevent the diseases and support Tibetan people with the basic health care needs.
Department of health under the guidelines laid down by the Kashag collects some contribution from the beneficiaries to ensure individual’s ownership as well as sustainability of the project.
Disable and destitute welfare program
Under the guidelines laid down by the Kashag, Central Poverty Alleviation Committee was formed and conducted intensive survey among exiled Tibetan population. The reports of the committee were further reviewed by the Review Committee Members of the Tibetan Parliament in Exile. The destitute were categorized among four groups to be taken cared of by three concerned departments: home, education and health. So far, 568 cases fall under the jurisdiction of the health department.
As per Kashag’s policy and guidelines, department of health provides monthly stipend and bears all the medical expenses of the poor and needy Tibetan people identified by the committee.
Besides, the department undertook a major survey on physically challenged people in Tibetan community in exile in 2002. Survey identified 406 people facing severe challenges relating to speech, mental, visual, hearing, physical movement, and epilepsy. To look after the welfare of these people at their own respective settlements, the department has established 11 rehabilitation committees in 11 different settlements. To further elevate the capacity of the concerning staff to deal with such population, the department provides training to community health workers (CHWs) from different Tibetan Settlements on Disabled Management. The trained CHWs should be included compulsorily in the above said committees to give guidelines and idea to the members. The department provides stipends to around 200 disabled Tibetan people to meet their medical expenses and bears the expenses of aid and appliances devices like wheelchair, hearing aids, leg brace etc.
The department of health has recently introduced Community Based Rehabilitation Program (CBR) in our settlements to give extra care to our disabled people and to make them self-sustainable through rehabilitation.
The department of health is currently working towards the integration of traditional Tibetan medicine with the allopathic medical approach in order to provide maximum benefits. It works to increase the frequency of referral process between the two health care systems, the medicines of which run parallel to each other and are used equally by the people.
After a few studies regarding mental health in the early 1990s, the Department of Health felt need of implementing primary mental health care program to solve problems of individual or family in the community. Therefore, the community health workers are provided with basic training on mental health care and the selected mental health field workers are given intensive training on mental health. References are made to local Indian physicians and psychiatrists if further medication is felt necessary. In addition to psychotherapy, the Department conducts training, gives refresher course and mental health awareness talks in the communities from time to time.
Under this program, Department takes care of the mental and epilepsy patients. The Department Reimburse 50% of the mental expenses to all the patients and 100% to those registered under CTA destitute list. The Department also provides more than fifty percent of reimbursement to those having special recommendation from respective Representative Office. Till date 150 mental and 78 Epilepsy patients from various Tibetan settlements rolled up in the program and continue to benefit from it.
First of all, I would like to take this precious opportunity to extend my warm greetings to all the Tibetans inside and outside Tibet.As nominated by Kalon Tripa Dr. Lobsang Sangay and unanimously approved by the Tibetan Parliament, I accepted the post of Kalon and took the oath of office from the Chief Justice Commissioner on 16 September 2011. I officially took the responsibility to lead the department of health as its 15th Kalon on 19 September, 2011 followed by a brief welcome ceremony held at our office on 22 September 2011. It was an honor and privilege to succeed Kalon Chope Paljor Tsering-la. I look forward to lead the department of health and improve the health conditions of the Tibetan people with the best of my abilities. Scattered throughout the communities in India, Nepal and Bhutan, the total exile Tibetan population is around 130,000. Under such circumstances, the needs of human resources and facilities related with health are much greater. The department of health faces a tough challenge in terms of public health, particularly in improving human resources and ensuring health care access to remote Tibetan settlements.I am also looking forward for cooperation from Tibetan Medical and Astro Institute (Mentsekhang); the Delek hospital, TCV, Kunphen, Choice, Tibet Charity and etc as equal partners in carrying forward our common responsibility to improve the health of the Tibetan people.The department was first established in 1981. The first Kalon, Shewo L. Dhargay and first Secretary, Mrs. Kesang Y. Takla had joined their office on November 1988 and 1 December 1983 respectively. They and their teams and their successors had worked really hard to help the department and health status of the Tibetan people reached where they stand today. At present, the department has expanded greatly, supporting fifty five health centers in South Asia, out of which twelve are in Nepal. The department further administers and supports seven larger primary health centers, four smaller ones and 32 dispensaries in India, including one school with special needs in Dehradun.All these achievements could not have been possible without the blessings of His Holiness the Dalai Lama, the Indian government and her people, the various charitable organizations both in India and abroad and last, but not least, the dedication and hard work of all the former and present staff working in the health care centers in settlements and at the main office in Dharamsala. Thank you all for making a difference!At the same time, I realize that there is much more work to be done to improve the mechanisms for monitoring and ensuring further efficiency in health care deliveries. I am looking forward to work with my dedicated team in addressing these important issues. Since the health services are to help the communities, I believe we can be more effective through creating further awareness among the public, particularly in seeking cooperation of communities and their leaders, who need to take greater responsibilities. I request all of you who are involved in our health services and the public to be aware and also to consider how best to help us in our efforts to make a healthier Tibetan society.Finally, I would like to request all our health and medical professionals, particularly doctors to contribute at least few years in Tibetan health service. Central Tibetan Administration and your community need you all at this critical time. If not us, who will? If not now, then when?Dr.Tsering Wangchuk