At the west end of the village is a gompa with a health post right next door. On the ground floor is a consulting room and kitchens. Upstairs is another very different consulting room. There are two, because this health post offers both allopathic (western) and amchi health care. It was so obviously a good idea that I immediately wondered why we hadn’t seen this approach elsewhere.
However, not all good ideas get the support they deserve and need. Lama Tenzing is the amchi. Providing health care to the village has been part of his role as an amchi lama throughout his life. His daughter trained in Kathmandu as a nurse and returns home to run the allopathic clinic downstairs. In the past, funding from international donors built and equipped the clinic and paid for a doctor and a nurse. The nurse, the amchi daughter, is still here. The doctor is not.
As we walked through, our porters were taking advantage of our afternoon in the village to seek medical advice from the nurse. It was very quiet otherwise. Upstairs the traditional consulting room was welcoming with a wall of dried herbs in plastic pots facing a computer at the other end of the room. Herbs are collected locally, processed and then combined into medicines for common complaints like coughs and colds. Ingredients that cannot be collected locally are purchased in Kathmandu and then combined into medicines back at the clinic. Plastic chairs line up against the window, next to a large, low cushion where the amchi examines patients and prescribes treatment, reading their pulse and asking about symptoms.
Amchis do not generally accept payment for their consultations. Traditionally they were paid with gifts of barley or other commodities they needed to live. With the food they can grow themselves, this could be enough to live on. Although today, some people do pay amchis a small amount for their services, ingredients from Kathmandu cost real cash. Real cash is hard to come by if you do not charge for your services and the people you serve are poor.
There are other issues too: the allure of allopathic medicine is strong. Its results can be instant; it is modern and comes from the city. It treats symptoms if not always the cause. Of course, there are some diseases that allopathic medicine treats well – infections and cancer for example. But traditional medicine too has its place treating both symptoms and cause of both minor and chronic ailments.
What’s more, young people are not attracted into the life of an amchi. Apprentice amchis are rare and even where they are keen, they do not necessarily have access to training. Unless they have a mentor who is willing to train them up, there are few amchi schools in Nepal and as yet degree courses have to be pursued abroad.
And then of course there is access to the medicinal plants themselves. Older amchis find it difficult to get into the mountains to collect the plants they need. There is strong competition for the plants themselves from traders who collect to generate cash income. While amchis collect sustainably, traders often do not with the net result that the medicinal plant resources are under threat of over harvesting, impacting both the environment and the local health care system.
This is where the Himalayan Amchi Association is important. It aims to provide local communities with reliable health care, to safeguard amchi knowledge, to improve the educational opportunities for amchis and to contribute to the conservation of medical plants and the ecosystems on which amchi medicine depends. There are several areas where this overlaps with the aims of ESON, particularly in the conservation of medicinal plants, the protection of indigenous knowledge associated with them and the sustainable livelihoods and healthcare of rural communities. With both organisations based in Kathmandu and run by local people and with both organisations having extensive and well developed partnerships within and outwith Nepal, the opportunities are significant.