By:

Trinley Palmo (MPH)

Department of Health, CTA

HEALTHCARE SYSTEM OF THE TIBETAN COMMUNITY IN EXILE

INTRODUCTION

1959- His Holiness fled to India with about 80, 000 Tibetan refugees

Major health challenges in the early resettlement era:

• Emotional trauma, grief and physical exhaustion• Adjustment to new climate and diet• Sickness and death due to illnesses like diarrhoea,

Tuberculosis, malaria and malnutrition• Water and sanitation problems due to congested locations

in tent based temporary refugee camps in north India.

Major Health Challenges at present.

Tuberculosis Hepatitis BChronic conditions like cancer and cardiovascular diseases.Substance abuse in youthRisk of HIV AIDS due to high mobility and low health awareness.

Health system in the early resettlement era: 1960s and 1970s

Before formation of refugee settlements: (1959-1962)

Provision of medical care by Indian Government hospitals to Tibetan refugees working as road laborers.

Few Tibetans, who knew Hindi and English, worked as social workers and translators.

Tent based medical camps were set up by humanitarian agencies and CRC at key focal points near the road construction sites in Northern state of HP.

Early health system in the refugee settlements in 1960s and 1970s

Relocation of refugees to different settlements in early 1960s.A small dispensary was built in each settlement with one

community health worker (tents/buildings)These dispensaries were managed by TIRS and supported by local

and international donors.Health center at Bylakuppe Tibetan settlement, Karnataka was

established in 1961 by Walter Judd Function and MYRADAThe social workers/translators worked as community health

workers.

Department of Health, CTA

Established in December, 1981. Registered as Tibetan Voluntary Health Association. The administration of health centers were formally

handed over to DOH in 1981. Aims to provide primary healthcare services to all Tibetan

refugees through a network of primary health centers with a goal of “health for all”.

Aims to create and expand public health programs for health promotion and disease prevention.

Administrative structure of DOH

29 CTA staffs at the Head Office.Health Minister and secretary are the administrative heads.Organizational structure, DOH.pdf

Administration of DOH

Head office: 29 health staffs including health Kalon.

Organizational structure, DOH.pdf

MAP_Health centers..pdf

Network Health Centers of DOH

DOH manages 54 health facilities in India and Nepal.7 hospitals (20-30 health staffs)5 primary health centers (5-13 health staffs)42 health clinics (1 health staff)2 mobile clinics in LadakhNgoenga school for children with special needs The hospitals and PHCS have a administrator and the

clinics are managed by the settlement officer. Hospitals and PHCs in India.pdf

Regionwise distribution of health centers State No of health facilities

Himachal Pradesh ( HP) 16

Delhi 1

Uttranchal (UT) 6

Nepal 12

West Bengal 4

Sikkim 2

Arunachal Pradesh 4

Uttar Pradesh 1

Jammu and Kashmir 2

Maharashtra 1

Madhya Pradesh 1

Orissa 1

Karnataka 4

Total 54

Healthcare workforce under DOH

216 field health staffs ( medical and administrative)Medical staffs:92 community health workers4 doctors26 nurses The health staffs have multiple roles: social worker,

mental health counselor, health educator, data collector besides providing treatment services.

Role of community health workers

Community health workers are the backbone of this well functioning refugee healthcare system.

A community health worker’s training program was implemented since 1981, through a collaboration between Delek Hospital and DOH. Until now, about 256 CHWS have been trained through a 3 month CHW training.

“Where there is no doctor” formed the main teaching and practice manual. ( translated into Tibetan)

They have filled the gap of acute shortage of qualified health care providers in our community.

Health Programs Carried by Department of Health

Infectious Disease Control & Treatment.

TB Control ProgramMalaria & Leprosy

programDrinking Water and Sanitation Program

RH/MCH ProgramHIV/AIDS

Program

Mental Health and special projectsMental Health and special projects

Mental health programMental health program

Tibetan Torture Survivor programTibetan Torture Survivor program

Hepatitis B projectHepatitis B project

Tibetan Medicare project Tibetan Medicare project

Telemedicine projectTelemedicine project

Health PromotionHealth Promotion

Substance Abuse prevention & Rehab. Program

Substance Abuse prevention & Rehab. Program

Health Information systemHealth Information system

Health Education and TrainingHealth Education and Training

Disability and Destitute supportDisability and Destitute support

Monitoring and Evaluation of Programs

The ground implementation is carried out by field staffs.Monitoring and evaluation is done both at field and central

level in form of routine phone calls, site visits, quarterly and annual reporting system.

The staffs of the project section of DOH works in planning of annual projects/proposals based on needs of the respective locations.

Some new health projects in 2013-2014 Cervical cancer prevention and screening project in Miao.Gynecological visit program in 12 settlementsReproductive Health awareness in 10 nunneries.TB mobile project in 6 health centersInfant disability project in 2 settlementsSchool health workshop and adolescent health booklet.Strategic health communication workshop.Stomach cancer screening project.

Telemedicine is a rapidly developing application of the clinical medicine where medical information is transferred through the phone or the internet and sometimes other networks for the purpose of consulting, telemedicine allows patients to visit with physician live over video for immediate care. It captures Video / still image and patient data are stored and sent to physician for diagnosis and follow - up treatment at a later time.

TELEMEDICINE PROJECT IN MAINPAT

Ngoenga School for children with special needs

Ngoenga School for children with special needs

A Health education talk by CHW

Water and sanitation projects

Providing TB education to students

I Am Stopping TB Badge

Leprosy patients at Leprosy Home Palampur, H.P

Talk on RH/MCH provided to settlers by nurses

HIV/AIDS Awareness poster

HIV/AIDS Awareness Talk

SA Rehabil itat ion Centre (Nishant & Astha) at Delhi

Future implications

Using health data to make more evidence based health policies and programs.Improving the vaccination coverage among infants.Promoting healthy behavioral change interventions to reduce the incidence of chronic conditions.Formulating sustainable financing solutions to address funding shortages to manage health centers.Finding ways to fill the gap of shortage of doctors.

Final thoughts:

This refugee healthcare system has evolved as a unique community based healthcare model over a period of five decades.

Strives to provide compassionate and holistic health services to all, both Tibetans and non Tibetans.

Other displaced populations in humanitarian settings can learn from our practical experience including well organized healthcare settings, holistic care and realistic use of manpower (stood and sustained difficult periods of displacement and rehabilitation)

Questions?