Land Of The Thunder Dragon:
A Visit To Bhutan’s National Institute Of Traditional Medicine Services
The Landscape
Bhutan, the Land of the Thunder Dragon, has been on my list to visit for several years. As an avid adventure traveler I was eager to experience firsthand the culture of this mysterious land, steeped in mythological lore of gods, spirits, and demons, and I had the opportunity to do so in December 2005.
Bhutan is roughly half the size of Indiana, bordering Tibet to the north and India to the south. The great majority of an estimated population of 800,000 still engages in subsistence farming. Closed to the outside world for centuries, Bhutan was opened to foreign tourists in 1960, due mainly to King Jigme Dorji Wangchuck’s modernization efforts. My guide, Kuenley, informed me that almost 8,500 tourists visited Bhutan in 2004.
Also known as Menjong Gyalkhab, or “land of medicinal plants,” one can only marvel at the diverse landscape, which gradually rises from lush, tropical jungle and foothills about 150 meters above sea level to the central hills and valleys, ascending more than 7,500 meters above sea level, to the majestic snow–capped peaks of the Himalayas. This range in elevation has enabled diverse flora to grow and flourish under a variety of environmental and climatic conditions.
Approximately three quarters of the country is blanketed in forest–cover supporting rich biological diversity and harboring more than 5,500 species of plants, 165 species of mammals, and 700 species of birds. Conservation International and the World Wildlife Fund have included Bhutan on their lists of 18 hotspots of global diversity. These hotspots occupy only 0.5 percent of the earth’s total space and are home to one fifth of the world’s plant species and an estimated two thirds to three quarters of the most endangered species of plants and animals.
Eschewing the wealth it could derive from the exploitation of its natural resources, Bhutan has chosen instead to preserve its natural treasures. A prime example of its resolve was demonstrated through a 1995 resolution of the National Assembly mandating that a minimum of 60 percent of the country be maintained under forest cover in perpetuity. To date, more than 600 medicinal plants have been identified in Bhutan; close to 300 of these plants are commonly used by practitioners for preparing medicines.
Traditional Medicine in Bhutan
The highlight of my trip was the time I spent at the National Institute of Traditional Medicine Services (NITMS). The time spent here was both educational and inspirational. In addition to an overview of the history and philosophy of traditional medicine in Bhutan, the NITMS staff provided a comprehensive tour of their facilities and shared their thoughts on the present and future state of traditional medicine in their country. They also described their roles in supporting Bhutan’s vision of effectively integrating traditional medicine with the modern system (allopathic) of healthcare.
I learned that Sowa Rigpa (So–ba Rig–pa), originally developed in Tibet, is still practiced as the traditional medical system of Bhutan, and it also blends Indian and Chinese traditions along with local healing practices, intertwined with magic and religion used since ancient times.
Buddhism has endured as the prevailing influence. Health and spirituality are inextricably linked and in tandem they reveal the causes of disease or illness. Buddhism teaches that the existence of phenomena and suffering is rooted in ignorance, which is the source of the three moral poisons of desire, aggressiveness, and mental darkness. The three moral poisons produce three pathogenic agents, or humours — air (lung), bile (thrip), and phlegm (badkan) — which are the origins of sickness. Attaining enlightenment through knowledge is the only means through which a person can be freed from a painful existence.
Indian Ayurvedic medicine, revealed through vedic sages, identified the parallels between the human body and the three doshas (vata, pitta, and kapha). These parallels contributed to the theory of humours, a fundamental principle practiced in Bhutanese medicine.
One of Chinese medicine’s most important contributions to the healing arts is the examination of the pulse. The state of the pulse may reflect an excess or shortage of yin–rest, or yang–movement, which may indicate an imbalance or disorder.
The Bhutanese tradition of So–ba Rig–pa has developed independently from its Tibetan origins, although the basic texts used are the same. Introduced to Bhutan in 1616 by the legendary Shabdrung Ngawang Namgyal, So–ba Rig–pa has been an integral part of the national health system since King Jigme Dorji Wangchuck directed the health department to establish a traditional medicine system for the Bhutanese people.
The National Institute of Traditional Medicine Services
The NITMS is organized by three divisions: National Traditional Medicine Hospital, National Institute of Traditional Medicine, and the Pharmaceutical and Research Unit. Situated in Thimpu, Bhutan’s capital, the campus of NITMS serves as the training facility for drungtshos (traditional physicians) and menpas (clinical assistants/compounders) through the National NITM. The Institute has become a federated college of the Royal University of Bhutan, and it adheres to University academic requirements. Training for drungtshos is five years beyond grade 12. A bachelor’s degree in traditional medicine is awarded upon successful completion of the training program. The menpa course is three years in duration and can be taken after completion of grade 10. A diploma in traditional medicine is awarded after successful completion of the program.
Both training programs’ mediums of instruction are the languages of Dzongha (official language of Bhutan) and Choekye (classical Tibetan), limiting the recruitment of foreign students. The curriculum consists of classroom instruction and on–the–job training. Before the inception of the NITMS approximately five years ago, nearly all of the drungtshos trained at the Institute were former monks because of their monastic school education in Choekye. Within the last five years, only two women have graduated the drungtsho program, while one other is currently in training.
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Buddhism has endured as the prevailing influence. Health and spirituality are inextricably linked and in tandem they reveal the causes of disease or illness. |
Part of the curriculum for drungthsos and menpas is devoted to learning Choekye in order to work with the classic Tibetan texts. English is the medium of instruction in elementary and secondary schools and the Institute staff is hopeful that a future international program in So–ba Rig–pa will be developed for attracting foreign students and revenue to the country. Pharmacy technicians and research technicians are presently being instructed in English and must have completed grade 10 before beginning the two–year certificate program.
Since 1971, the Institute (Formerly National Indigenous Hospital) has trained 36 drungtshos, 43 menpas, 12 pharmacy technicians, and 11 research assistants. The NITM is also responsible for organizing and conducting in–service training programs for traditional medicine practitioners.
The Pharmaceutical and Research Unit (PRU) produced all of its medicines manually before mechanized production began in 1982. The unit has three main sections: research and quality control, production, and marketing. In concert with the government’s drive for sustainable development in all sectors of Bhutanese life, the Institute is focused on improving technical and organizational methodologies that will further enhance the collection, production, and marketing of herbal products.
Approximately 85 percent of raw materials are available within the country, and the remaining 15 percent are imported from India and Nepal. The PRU produces 103 compounds of which 98 products in the form of pills, tablets, capsules, syrups, ointments, medicated oils, and powders comprise the essential traditional medicine list.
The National Traditional Medicine Hospital (NTMH) offers a full range of traditional medicine services, which include acupuncture with gold and silver needles, stone heated herbal baths, steam baths and applications, cupping, moxabustion, nasal irrigation, and oil massage. These therapies are considered more effective for common chronic health problems such as sinusitis, asthma, arthritis, rheumatism, liver ailments, and disorders of the digestive and nervous systems. I can personally vouch for the stone heated herbal bath after hiking — heavenly! The main methods of diagnosis are taking the person’s medical and lifestyle history, pulse reading and urine, tongue, and eye examinations. At present, the NTMH lacks adequate space for providing other therapies.
Gross National Happiness
In view of the national health policy of integration, traditional medicine units have been established in all 20 districts of the country. For rural communities and remote areas, drungtshos and menpas provide services through visits on a monthly basis. The traditional medicine units and modern medical service groups are housed in the same hospital buildings by design, and they complement one another through cross referrals and collaboration between the two systems. This arrangement offers a choice of consultation and treatment; traditional medicine appears to be more popular among the older population at this time.
It was the opinion of several drungtshos and menpas that preference for traditional medicine services will increase over time due to population growth and demographic changes within the country, as well as the growth in popularity worldwide for alternative medicine. Currently, about 20–30 percent of patients visiting district hospitals seek out traditional medicine.
I asked professionals at the Institute about the relationship between traditional and modern medicine practitioners when addressing the needs of patients. Unanimously, the reply was a resounding, “Gross National Happiness (GNH)! ” First introduced in 1972 by King Jime Singye Wangchuck, GNH calls for the people of Bhutan to embrace well–being in life as opposed to economic consumption as a means to achieve prosperity. Sustainable economic development, conservation of the environment, promotion of national culture, and good governance participation by everyone are pillars of Gross National Happiness designed to create conditions for the successful pursuit of happiness.
One young woman, the first female drungtsho in the kingdom, remarked to me, “I want to give a good example to our younger generation.” She stated that individual commitment to moral and ethical values is very strong in Bhutan and is a significant force when applied to strategies for ensuring a better life, including quality healthcare.
Although the government currently provides free healthcare to everyone, it is anticipated that privatization and private practice policies may change in due course. Will these changes create more competition and sidestep the moral and ethical values connected with GNH? This question sparked a spirited discussion among a small group of drungtshos and menpas who finally arrived at the conclusion that mutual cooperation and caring was in the best interest of the patient, as well as the healing profession in general.
I contemplated our own history, replete with its unfortunate contentiousness between the medical establishment and alternative healthcare providers. On the surface, it may seem that transcending the three poisons of greed, ignorance, and hatred is too daunting a task for a society focused on competition and materialistic rewards. However, there is now more openness and interaction than ever before between allopathic practitioners and alternative providers, and many medical schools in our country have adopted at least some form of instruction in alternative healthcare. Alternative healthcare organizations and practitioners have become increasingly aware that their practices need to be confirmed through research in order to gain more acceptance.
Perhaps the guiding principle of GNH from a small Himalayan kingdom can inspire a new paradigm in the United States. based on further encouraging and developing cooperation and collaboration among all healthcare providers. May the medicine Buddha, Sangye Menlha, bestow upon you love, wisdom, and contentment. Tashi Delek!
George Yuhasz,
Doctor of Naturopathy Graduate
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