We sat in the back of Tar Village’s small gompa, watching our amalay, Tashi, bend to the floor in prayer. She came and sat down, laughing and taking selfies with the two of us and Tsewang, who was the amalay of Isabel and Caroline. Tashi and Tsewang started talking in Ladakhi, and we watched as Tashi got out her bag and dug around inside for a dusty blood pressure monitor and stethoscope, and conducted a tiny medical exam right there on the gompa floor.
Tashi is the medic of Tar village. She had a year of training in Leh, the nearest big city (with big being a relative term). In villages that are larger than Tar, the Indian government has installed small health centers, usually comprised of two or three doctors. Tar, which had just twenty residents when we visited, had only Tashi to provide medical assistance. She giggled as she told us getting the role was competitive — with a fixed income of one thousand rupees a month, she was lucky to have been chosen. People go to Leh with most medical problems, such as surgeries or x-rays, and Tashi is then in charge of distributing prescriptions and monitoring the health of the older community members. Once, she told us, a young man fell from a second story window, injuring his spine, and she helped keep him stable as he was carried on a makeshift stretcher of sticks down the six kilometer path to the main road and then on a multi-hour bus ride to Leh.
Tashi puts in an order every six months, and the medicines she requests are sent to her. She fills prescriptions, and also stocks up on cough syrup, antibiotics, and painkillers, all provided for free by the government. When these run out, they are left with traditional remedies, some medically sound and some based on superstition alone. Turmeric on a cut can prevent infection, and drinking mint tea can help with digestion, but we laughed when we heard that nausea can be curbed by wrapping lots of scarves around one’s stomach.
Last week, before going to Tar, we did a two day workshop with an organization called Local Futures. We discussed the impact globalization has in areas like Ladakh, and how the influx of money and corporations is dramatically challenging communities here and changing systems such as agriculture and education. Before Ladakh opened to tourism in 1974, most people lived on subsistence farming, growing everything they needed (but meaning the GDP was low). Seeing this metric, the Indian government began subsidizing and shipping in foods like rice, which were less nutritious and unnecessary but that people have now come to rely on as they shift away from old methods of sourcing food. Now, brands like Lays and Coca Cola are common here. Local Futures helped us understand that rather than a more globalized world, we should try to create more localized communities where food, waste, and industry are managed on smaller scales between neighbors.
When we left Leh for Tar, we were all really excited to see this in action — all of us are used to eating food grown hundreds of miles away and relying on companies rather than our communities for life’s necessities. In Tar, we harvested our food right before cooking it and gave the scraps to the cows and sheep that lived under the house. But it was initially hard for us to imagine how other societal functions could be localized as successfully, and healthcare was one of those. Seeing Tashi in action, however, helped us realize how it could be done. Rather than needing companies to manage insurance payments and restrict access to medicine, bringing medical knowledge into a community and then allowing people to rely on each other as they have always done was the most practical solution. A check-up in Tar didn’t involve a copay or waiting room; instead, Tashi met people where they were and helped address their problems with the jokes and sincerity that only a close friend could provide.
Tashi gave us Ladakhi names within minutes of arriving — Marka is Chasmo and Darci is Chu Chu. On day three of our time in Tar, Chu Chu came down with a stomach bug and we were glad Tashi was right there to help, bringing tea with honey and extra blankets. Word spreads fast in such a small community, and within a few hours everyone who saw Chu Chu would pat their stomach, questioning if she was okay. This went both ways. When we asked Tashi about common afflictions in the village, she told us exactly who had diabetes and who had bad knees. It was clear that the level of confidentiality around health we are used to in the US is not nearly the same in Tar. But rather than feeling invasive, the concern and onslaught of “medical” suggestions from everyone was reassuring. Having a village medic like Tashi brought healthcare to a local scale, where medical attention can be provided without an interruption to life in Tar. And as we measured Tsewang’s vital signs in Tar’s gompa, we were glad to see Tashi give her patient the OK while “om, mani, padme, hum” continued to sound around us.