Gaden Jangtse Hospital, Doeguling Tibetan refugee settlement ,
Clinical interest: Anaesthetics
My elective took place in a Tibetan refugee settlement called Doeguling in India, about a 5-hour train ride inland from Goa. I wanted to combine my desire to travel in India, my interest in Buddhism and in humanitarian work. The hospital I was attached to belonged to a monastery and so I spent 5 weeks living amongst a Tibetan community of predominantly Buddhist monks in the south of India. The people I met there were some of the kindest people I have ever met and even though I had come on my own, I was made to feel extremely comfortable straight away with the addition of all my accommodation and food catered for. If you are interested in humanitarian work, Buddhism including meditation and mindfulness and want hands-on practical experience in terms of conducting clinical examinations, interpreting X-rays and have an interest in research – this is the elective for you. Although, it is very flexible with you being able to pick and chose your interests to focus in on during the elective.
As Doeguling is a settlement for refugees, I was not expecting much but was surprised by how developed it was and by the rich Indian countryside that surrounded it. The history behind this settlement is fascinating; it was created over 50 years ago after Tibetans followed their leader the Dalai Llama and fled Chinese repression in Tibet. Tibet is no longer a country in its own right and Tibetans have been restricted and suppressed in every considerable way within their own country. They are not taught their own language in schools or universities, it is a crime to have a photo of their leader His Holliness the Dalai Llama even in the privacy of their own homes and if they attempt to leave Tibet they risk being shot or tortured. Despite this, many still took this risk and fled Chinese repression for freedom and a good education for their children and resettled in India.
The mayor of Karnataka state in the south of India offered Tibetans land to farm off and one of these settlements was Doeguling. It was dense jungle when they were given this land in 1969 and it has taken many years to transform Doeguling into what it is today. During my stay, I visited the many monasteries that have been recreated from the monasteries that were burnt down in Tibet. The hospital I stayed in was also impressive with an ultrasound scan and an endoscopy clinic. The doctor I was attached to was incredibly hard-working, conducting an out-patient clinic every single day for his community. The prevalence and treatment of diseases was very similar to the UK and I saw the doctor, who is a GP by profession, treat diabetes, hypertension, heart failure and COPD on a daily basis, much like a GP in the UK. The differences lay in the high prevalence of hepatitis B, tuberculosis and dengue fever. The most common reason for an outpatient clinic appointment was a hepatitis B check up. The reason for hepatitis B being so common was because at least 90% of patients were Buddhist monks or nuns; many years ago Tibetan monks used to shave their head with the same razor blade without washing it thousands of times and transmitting hepatitis B – a chronic, life-long condition to each other.
Tibetan medicine is also very popular in Doeguling and I was able to trial some of the many therapies such as acupuncture, cupping and learn about the many herbal remedies. It was fascinating to spend time with the Tibetan doctor and compare it to my placement at the Western medical hospital. Also the majority of the population of Tibetans in Doeguling are very poor with the lay population working primarily as farmers and there also being high levels of unemployment. This makes it hard for them to afford treatments for TB or Hepatitis B, despite the treatment being subsidized by the hospital. I was glad to be able to raise some money for the community of Doeguling by running a marathon in April. It also was amazing to be able to get involved in humanitarian work at the settlement and help in the development of the settlement. This was mainly through the organisation described below.
During my stay, I also got involved with an organisation called “Reimagining Doeguling” that aims to develop Doeguling further into a self-sustainable, successful place to live and work. There are still many problems with the education and levels of unemployment in Doeguling and the majority of young people emigrating out of India to work in Western countries. This risks Tibetan culture and tradition not surviving if there are no people to practice it in Doeguling and because the Chinese have crushed Tibetan culture and tradition in Tibet itself. The lack of young people remaining settled in Doeguling also risks this settlement not being able to survive itself if there is no longer a younger generation to work and live in Doeguling. I was able to offer advice and get involved with plans to encourage tourism, volunteers and even try and set up a programme so more elective medical students will return in the future. I was the first ever medical student Doeguling had hosted on their elective.
I spent time at the outpatient clinic with the doctor and was able to practice clinical examinations, present X-rays of TB patients and review medications. I visited the different hospitals within the settlement and was able to shadow the alternative Tibetan medicine doctor. I was given some training by the Western medical doctor I was attached to in how to perform an ultrasound scan. He also allowed me to get involved with endoscopy and minor surgeries that he carried out such as draining an abscess from a monk’s lip. I am very interested in Buddhism and so stayed at the nunnery in the settlement, which is where the female Buddhist nuns live, for a week. They taught me a lot about meditation and Buddhist philosophy and so in return for their kind hospitality, I gave them a short talk on first aid, hand hygiene and the importance of a balanced diet. It was an amazing experience and I was so glad to be able to give something back to them.
I was amazed at how intelligent these Buddhist nuns were and how they study for over 12 hours every single day. But what was incredible was that they did not know the simplest things about health and hygiene such as washing your hands after going to the toilet. During my stay, I also conducted some research of my own to explore the prevalence of dementia in elderly monks compared to the elderly lay population. It was approved by the settlement officer and deemed ethical because it only involved a short questionnaire. Although it was a small study, it exhibited a clear increase in cognition in the monastic population. However, there were many challenges with the assessment because not a single candidate had been to school and so I was unable to draw any finite conclusions from this research.
To conclude, it was a very enriching experience to live amongst such friendly, kind and inspiring people for 5-weeks. I learnt about the history of Tibet and Tibetan culture and even got to enjoy 3 days of Tibetan dance, sport and singing when we celebrated the Dalai Llama’s birthday. Not only this but I gained a valuable insight into what medicine is like in India, about Tibetan medicine and also about Buddhist philosophy, mindfulness, meditation and yoga. This paired with the opportunity to contribute towards the development of the settlement and to give back to this wonderful community that escaped repression to live as refugees in a foreign country, yet are still some of the happiest people I have ever met was very fulfilling. I hope this can interest medical students planning their elective in the future.
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