Exile, social change and medicine among Tibetans in Dharamsala (Himachal Pradesh), India
This thesis is a study of the predicaments of exile among Tibetan refugees in
Dharamsala. It examines the ways in which structural and cultural factors linked to exile
underpin local understandings of health and the provision of healthcare. The study
demonstrates that exile uncertainty is reflected in illness explanatory models put forward
by Tibetan refugees, and in the organisation of healthcare provision in Dharamsala.
The first part of the thesis. (Chapters 2-3) is an account of changes in social organisation
and economic strategies as a consequence of exile. Chapter 2 looks at transforming social
networks in relation to exile identity politics and economic strategies. I discuss societal
tensions within the Tibetan refugee community, principally in relation to the group of
`newcomer' (tsar `hyor ba) refugees, and the local Indian community. Chapter 3 focuses
on two examples of economic strategies linked to dependency and the predicaments of
exile: firstly rags ram, or the sponsorship offered to Tibetans by foreigners, and secondly,
`grogsp a, or mutual help and reliance on intra-communal networks of solidarity.
The second part of the study (Chapters 4-6) examines how the physical and psychosocial
hardships of exile, in addition to social uncertainty, have influenced individuals'
understanding of health and disease, and, consequently, the activities and status of the
two most prominent exile medical institutions, the Delek Hospital and the Tibetan
Astro-Medical Institute (Men-Tsee-Khang). Chapter 5 discusses the rise and
institutionalisation of Dharamsala's Men-Tsee-Khang and the systematisation of
traditional medical teaching as linked to the predicaments of exile. Chapter 6 provides
individual case studies of Tibetan exiles' experiences of illness. Chapter 7 is given over to
a discussion of the political significance of discourses relating to physical suffering in the
context of exile.