Saving Lives in Ladakh through Healthcare

Primary health care project in Zanskar, Ladakh, Northern India

Introduction

The region of Zanskar in Ladakh is one of the most isolated regions of the Indian Himalaya. A rugged land enclosed by high mountains and snowbound passes that preclude travel to the outside world for seven months of the year. Zanskar supports Buddhist villages and monasteries that share a common cultural history to Tibet.  
 
However although much has been documented about the almost Shangri La lifestyle of the people, Even a minor accident may prove fatal in a land where medical facilities are almost non-existent. Zanskar also has one of the highest rates of infant mortality in the world. 

Project Background
 

In 2005 we commissioned a local NGO the ‘Servants of Society Association’ from Leh, the capital of Ladakh to undertake a comprehensive survey in Zanskar.

The survey’s aim was to identify health issues in the villages in Zanskar. This included identifying the number of women in childbearing age and the number of children less than five years of age. The research also drew to our attention to the unacceptably high rate of child mortality. In some villages it is as high as 50%. On questioning this we were informed that this figure was not an error. Compare this to the rest of the Jammu and Kashmir state where the figure is in the vicinity of 15% and the rest of India, which hovers just below 9%. By comparison in Australia the figure is around 0.6% of children i.e. less than 6 in a 1000 children not surviving to the age of 5. 

The survey also highlighted that primary health care was very much the province of the Amchi – the traditional medical workers – and that we would need to gain their confidence and co-operation if any health project was to succeed. The Amchi have overseen health care in Zanskar for as long as people have lived there. Yet this time hounoured practice is not beyond criticism. Simply put, because the Amchi is based on inheritance there can be ‘good’ and ‘bad’ amchis and even among the best in the most remote rural communities there is still an acute need for training.    

Training Seminar September 2006

After consulting with the villagers during their survey in 2005, two members of the ‘Servants of Society’ returned to Padum the following year to oversee a two-day primary health care course. Between 20 to 30 Amchi attended the course and as a result it was decided to support an annual week long seminar.

Training Seminars September 2007 - 2009

Both seminars have been an unqualified success. Between 50 and 60 Amchi attended both of the week-long courses. Some had trekked the best part of a week to attend, while the ages ranged from early 20’s to one very senior Amchi who was 89. Both courses were conducted by the head Amchi in Ladakh who travelled from Leh with the immediate past president of the Ladakh Amchi Association. Members of the ‘Servants of Society’ also travelled with them in order to administer the course. 

The seminars included traditional medical techniques and herbal remedies as well as ways to incorporate other medical practices including prenatal, birth and early childhood health care. Apart from the Amchi instructors, doctors from the local government hospital in Zanskar also attended and gave instruction. Garry Weare, AHF director, also attended both seminars.

In September 2008 Garry was accompanied by an ABC TV crew from "Foreign Correspondent" who filmed the seminar as well as the health care facilities in Zanskar.  The segment was shown on ABC TV in April 2009. Click here to go to the Foreign Correspondent website to view the program.

The Outcomes

• An arrangement was put in place whereby 6 female Amchi now undertake further training for 5 months in the government hospital in Leh, Ladakh. As the hospital is not a training hospital the training had to be formally approved by the Minister for Health, Jammu & Kashmir government. This is a significant step as up until now the state government have not officially recognised the vital role of the Amchi in Zanskar.
• The Amchi requested that a further week-long course be held the following September in 2010.
• A consignment of herbal plants and medicines will be sent to Zanskar prior to each course
• The provision for ongoing support for the Amchi and medical health centre, Padum, Zanskar. 
• Support for seminars in the nearby regions of Lahaul and Spiti in Himachal Pradesh, in order to develop medical facilities in similar regions of the Himalaya

Assessment

We are implementing procedures to encourage the Amchi to work with the local doctors in Padum to monitor the health of mothers and young children. We will draw up a profile of each village and compare this with anecdotal evidence over the last decade. After taking these factors into account we will be able to gain a realistic idea of what we can achieve and how to quantify it.   

Budget

We are committed to a ten-year project. We envisage a budget in the vicinity of $20,000 pa that will include:

• Our annual one-week medical seminar held in Padum, Zanskar
• Provision for an annual consignment of herbal plants to be transported to Zanskar
• Provision for 6 female Amchi to train at the state hospital in Leh, Ladakh
• Ongoing support for the Amchi medical centre in Padum
• Ongoing medical seminars in Lahaul and Spiti

AHF Expertise

Garry Weare, one of our directors, has been a regular visitor to the Ladakh and Zanskar for the past 30 years. During this time he has formed a close friendship with Wangchuk Shamshu a highly respected Ladakhi and a director of World Expeditions (India), one of India’s leading adventure travel companies. In Ladakh Wangchuk works in consultation with a team from the ‘Servants of Society Association’ in order to generate community support as well as ensuring the success of the project.

Dr Jim Duff, a medical doctor is our medical adviser. Jim has had a long history of working in remote communities in the Himalaya. He is also an eminent climbing doctor (on the famous British Everest SW Face expedition in 1975 and a member of the first Australian Everest expedition in 1984).
 
In addition Garry Weare travels to the Indian Himalaya regularly and helps to oversee the project. Garry has also attended the medical seminars in 2007 and 2008. Garry’s expenses when travelling to and from India are covered as part of his normal business activities, not by Foundation donations.  Costs incurred by our Sydney office are minimal.

Political Overview

While the Jammu and Kashmir state government administers Ladakh and Zanskar, the regions have not been subject to the political disturbances experienced elsewhere in the state. Ladakh and Zanskar are separated from the rest of the state by the Himalaya range while their representatives are Buddhist with little affinity with the culture, religion or political aspirations prevalent in Kashmir.  Similarly the regions of Lahaul and Spiti in the state of Himachal Pradesh are also politically stable.

NGO & Government Involvement

Although other N.G.O’s have supported Amchi training programs (mainly in Leh, Ladakh) they have not been conducted on a regular basis. Neither has there been any major inroads made in Zanskar. Until now, medical seminars have been conducted in Leh. This has been a major problem for traditional health care workers from Zanskar who would sometimes need to travel for up to two weeks in order to attend the course.

Ladakh is administered as part of the state of Jammu & Kashmir state government. This includes health administration. However the level of services – the need gap - provided in the government health care centres leaves ample room for the AHF project.
 
We are also fortunate that one of the state government ministers, Rigzin Jora is from Ladakh and also a long time friend of Garry Weare. In 2008 the ministers, as well as the state government Minister for Health have voiced their support for the project.

Thank you to

The Planet Wheeler Foundation for fully funding this project in 2009/10.