Based on Tibetan Buddhist cosmology and originally influenced by Asia’s own medical tradition, the ancient Amchi system of medicine was imported into the isolated, mountainous region of Ladakh long, long ago. Tradition has it that this complex system of healing was approved by Buddha himself 2,500 years ago.
In Amchi medicine, the cause of all sickness is an imbalance between three "humours" — rlung, mkris-pa and badkhan (wind, bile and phlegm) — and diagnosis is made by asking questions of the patients, examining their body wastes and by taking their pulse. There are strong similarities to ancient Ayurvedic medicine — used in parts of India and now becoming fashionable in some industrialized countries — and, to some extent, to ancient Greek medical practices that have been replaced in Western culture by the biological medical system.
While surgery is not performed by the practitioners — in cases of severe illness Ladakhis are sent, whenever possible, to doctors qualified in biological medicine — Amchi medicine has effective remedies for the vast majority of Ladakhis’ health problems — such as respiratory problems caused by the high altitude and the smoke in their dwellings, and hypertension caused partly by the salty, buttered tea they frequently drink. And, most important of all, astrology and centuries-old rituals are used in conjunction with Amchi remedies, so that patients experience psychological healing. "When they need to stay in a modern hospital, Ladakhis do not necessarily feel at their ease," Laurent Pordié explains. "When a rural Ladakhi goes to hospital, the medical milieu is very foreign."
A Vital Social Role
For Pordié, Amchi medicine is first of all "a centuries-old system of health" vital to Ladakhis, but also "a remarkable and irreplaceable part of our world heritage".
He insists that "Amchi healing must survive because of its vital social role in village life." Because of changes in Ladakh since the 1960s — the presence of Indian military forces, modernisation and increasing social mobility — traditional community life is gradually being fragmented. As a result, the skills of Amchi practitioners are no longer being passed from practitioners to their sons, as had been done for centuries. As the efforts of India’s central government to provide modern medical care to the region had not been able to cover the needs of the widely dispersed population and as Amchi skills were disappearing, Ladakhis risked having no health system at all for their needs.
Remarkably, Laurent Pordié — a soft-spoken person who, in 2000, at the age of 29, became the youngest-ever Rolex Awards Laureate — has put in place a process that should ensure the Amchi tradition will long survive in Ladakh.
As planned just over three years ago, when he won his Award, 22 Amchi health centres in remote parts of Ladakh are now being established. These centres will ensure that about 75 per cent of Ladakh’s population of more than 250,000 citizens have access to Amchi health care — a major challenge in most sparsely populated regions.
To staff them, Pordié, with assistance from Nomad RSI, a French-based, nonprofit international research and development agency he co-founded in 1997, set up a medical school to train practitioners — called simply Amchis — of this ancient healing system. To become a fully-trained Amchi takes four years of study at the residential school, including one year of practical work.
Youthful Students, Ancient Skills
The first 10 students graduated from the medical school in November 2003. The young graduates will supplement the pool of a couple of hundred Amchis, many of them quite old, already practicing traditional medicine across Ladakh — though Pordié points out that in this remote region, about three times the size of Switzerland and divided by mountain ranges of the Himalayas, it is not possible to have precise statistics for the number of Amchis.
Half the 22 students in the medical school are women, a new development in the history of Ladakh, as previously most traditional healers were male, with women having no time to study as they were busy with domestic work. "As Ladakh has one of the highest rates of infant mortality in the world, it’s extremely useful to have women Amchis," Pordié points out. All of the 22 students will eventually be sent to a health centre in or near their villages. All the students were chosen by their villages to attend the medical school, often in consultation with local Buddhist monasteries, which have strong influence on all aspects of life in Ladakh.
Vital ingredients of Amchi health care are the plants that make up the remedies used by practitioners. In previous centuries, Amchi relied on their fellow villagers to take on their communal duties, such as ploughing, harvesting and raising of livestock. In return, the healers provided medical care at no charge and gathered medicinal plants and minerals. The changes in communal life have brought an end to that friendly system of exchange, meaning that Amchis have to do their own farming and have little time for foraging for plants.
Thanks partly to Pordié, a new system has been devised by which each of the 22 new health centres will grow a big supply of three or more medicinal plants. These can then be exchanged with plants grown at the other centres.
Another important means of support for Amchis is a magazine, published in Tibetan, the common language of Amchi practitioners along the Himalayan chain of mountains. In articles written by Amchis, the magazine provides explanations of remedies and other useful advice for practitioners as far away as Mongolia. Distributed free to Amchis, the magazine has until now been published every three months, but, because distribution is difficult over such a wide region, it will soon begin to appear every six months in an expanded format with more articles. Before the magazine was established, says Pordié, "there was almost zero communication between Amchi practitioners in the region as a whole. The magazine has changed that."
Another important instrument in the transmission of information between the healers are recently instituted annual seminars. "For the first time in Ladakh history, Amchis now gather in a group of 100 or more practitioners to discuss Tibetan medicine," explains Laurent Pordié.
A vital element of the involvement by Pordié and by Nomad RSI has been a strong emphasis on local implementation of the work. "From the beginning, the Nomad RSI programme in Ladakh has been managed and implemented by a local team, with technical assistance from the French organisation," Pordié says. This was taken a step further in 2002, with the establishment of the Ladakh Society for Traditional Medicines, an independent organisation made up entirely of Ladakhi officials and former members of Nomad RSI in Ladakh.
According to Pordié, "the only major involvement of Nomad RSI from now on will be to give guidance on fundraising". Finding resources to support the Amchi system will be necessary for a long time to come. "The Amchi healing system has been saved, but there is a need for funding to support it," Pordié says. However, he is optimistic that more funds will come from India’s federal government.
Pordié, who insists that such projects must be run by local people, has often said that he was looking forward to the day when he would visit Ladakh simply "on holiday" after living there full time between 1998 and 2001 and now gradually spending less of his time in the region. However, he will always retain his interest in Amchi medicine, and, as he spends most of his time as a researcher on the anthropology of traditional medicines for the French Institute of Pondicherry, in south-east India, he is certain to return to Ladakh often.
Pordié gained a certificate in Amchi medicine in 1998, but is still learning the skills. "I am still in training, and this may last many, many more years," he says. "I’m surprised when people introduce me as an Amchi. It would be very pretentious of me to claim that. I’m just a pupil."
Laurent Pordié won his Rolex Award for his plan to "revive traditional Amchi medicine and improve health care among the inhabitants of Ladakh". By strengthening the number and network of Amchis, he is now in the process of achieving that objective. A strong sign of his success is growing enthusiasm in nearby Nepal to duplicate his accomplishment by reviving that country’s own Amchi tradition through the establishment of a school similar to that in Ladakh.
Asked to what he attributes his success, Pordié replies that a large part of the answer is that in his work he bridges the gap between research and development, normally two separate domains. Nomad RSI is in fact trying to encourage a rethink of the relationship between development work and the application of research in social sciences.
The funding from the Rolex Award and the strong sign of support that the Award gave, were also of major assistance, Pordié says. "The Rolex Awards help projects that are a bit different, and projects of that kind always have trouble getting funds from traditional sources."
But as his project reaches its successful end, Laurent Pordié’s heart is with the Ladakhis, for whom he clearly has great affection. "It’s important for them to see that a key element of their culture and religion is surviving, and is indeed well worth saving. The Buddhist paintings in the monasteries that Western visitors come to admire are not the only important things."
Published in 2004