Healing at the Periphery

In Tibetan medicine, an individual's urine sample, which a Tibetan doctor (amchi) examines with acute attention to diagnose a patient's illness, is compared to a merchant in ancient times who goes from door to door to sell merchandise and who is well acquainted with everything happening in a town. This analogy implies that, in order to get a bigger picture of what is happening in a town, one should rely on someone who is on the ground all the time rather than on a leader. This collection of essays, edited by Laurent Pordié and Stephan Kloos, employs a similar tactic by paying close attention to “local microprocesses at the village level” (14–15) to study the large-scale transformation of Sowa Rigpa (Tibetan medicine) in the Indian Himalayas. Likewise, the introduction by Pordié and Kloos aptly supports their choice of the catchy main title, Healing at the Periphery, by stating that the volume's focus on peripheral or remote Himalayan villages is “not because of an imagined authenticity located in remoteness but because of the importance of the fringe in any endeavor to understand the center and indeed the whole” (10).By focusing on the nuances of amchis' everyday activities in some of the most remote and rural villages, exploring their interactions with villagers as well as with local administrations, the volume does a wonderful job of presenting the complexities of unprecedented changes happening in the scope and practices of Sowa Rigpa in the Indian Himalayas. It also sheds light on cultural actors that played important roles in facilitating the official recognition of Sowa Rigpa as Indian cultural heritage by the Indian government.The collection's interdisciplinary authors contribute to diverse scholarly fields such as social and medical anthropology, qualitative economics, development studies, transnational health, and Asian medicine. Using a comparative approach, the contributors nicely address complex issues by humanizing the tensions brewing at village, state, and national levels in relation to the “reconfiguration of therapeutic space and the sociopolitical reconstruction of Sowa Rigpa” (4) that happened in the early 2000s. In doing so, this volume engages with ongoing conversations about what Sienna Craig (2012) called “social ecologies”1 and about the rising competition between Himalayan amchi communities and their exiled Tibetan counterparts.2 They thereby illustrate how various practitioners navigate the issues of how to survive and maintain a hold on the continuation of Sowa Rigpa practice.Moreover, the rich ethnographies presented in the volume raise interesting and important questions about the sources or origins of Sowa Rigpa. Pordié and Kloos note in their introduction the close tie of Tibetan medicine with India. Historically, Tibetan medicine is depicted as deeply influenced by the Indian Ayurveda medical system when Buddhism made its way into Tibet across the vast Himalayan mountains in the seventh century.3 However, the scientific literature on the details of the interaction between these two medical systems then and how Tibetans integrated Indian Ayurveda into their indigenous medical system is scant. Now, after fourteen centuries, we are witnessing Tibetan medicine influencing the Indian indigenous medical system, primarily due to the Chinese invasion of Tibet in 1959 and the Indian Government giving refuge to hundreds of thousands of Tibetans. Against this backdrop, the volume's essays crucially document the changing ways in which Tibetan medicine is conceived, interpreted, and enacted by different actors in different contexts.The volume's seven chapters present rich ethnographies in seven remote and rural Himalayan regions as case studies to provide cultural accounts of sociocultural dilemmas surrounding the “proliferation and transformation” of Tibetan medicine (4). These ethnographies are grounded in research conducted among agricultural groups in the remote mountainous areas of Ladakh and Zanskar, nomadic pastoralists of Ladakh's Changthang plateau, an amchi lineage in Sikkim, and exiled Tibetans practicing in institutional contexts in the Himalayan foothills of Dharamsala and Darjeeling. According to the editors, each chapter's ethnography observes and analyzes the boundary between the “agency of individual amchi” and the “impersonal dynamics of larger social apparatuses” (11). This is reflected in the organization of the book: the first part of the volume focuses on rural amchi as key actors, and the second part examines Sowa Rigpa as an instrument of power that becomes more obvious in “liminal social situations” (11).In “Good Medicines, Bad Hearts: The Social Role of the Amchi in a Buddhist Dard Community,” Stephan Kloos asserts that the social roles of amchis and society's conception of them are directly informed by Buddhist moral values. For villagers, a good amchi is deemed to be a practitioner who does not exploit his status for social power by “showing one's selfless attitude and denying one's status” (33). He is one who “only thinks about others, not himself” (53). An amchi's ability to maintain the right balance of social status and power thereby contributes to a sense of social equilibrium. Thus, Kloos notes that amchi's social role and status is contingent upon both the practice of Tibetan medicine and a representation of an ideal amchi. Yet Calum Blaikie's contribution, “Where This Is No Amchi: Tibetan Medicine and Rural-Urban Migration among Nomadic Pastoralists in Ladakh,” demonstrates how, due to villagers' unrealistic expectations of amchis as upholding high sociomoral values as a “fair and selfless person” (78), as well as a loss of religious and social legitimacy and financial constraints for amchis in contemporary Ladakh, many amchis have left the region.Florian Besch and Isabelle Guérin's “The Monetization of Tibetan Medicine: An Ethnography of Village-Based Development Activities in Lingshed” explores a development project where villagers and amchis worked with the nongovernmental organization Nomad RSI to revitalize Tibetan medicine and healthcare. Although the development project aimed to create a new healthcare system with community funds to support the local amchi, the project had to incorporate “older values and norms regarding medical care and reciprocity” (95) between amchi and patients. In “The Amchi at the Margins: Notes on Childbirth Practices in Ladakh,” Laurent Pordié and Pascale Hancart Petitet examine the transformation of Ladakhi society and its impact on healthcare by looking at childbirth in two different areas in Ladakh: the isolated area of Shun-Shade and the urban milieu in Leh. The authors claim that besides strong traditional norms that restricts (male) amchi roles in intervening childbirth in a village, the biomedicalization of birth and technology development in Leh has marginalized amchis' role in childbirth.Conversely, Kim Gutschow's “A Case of Wind Disorder: The Interplay of Amchi Medicine and Ritual Treatments in Zangskar” argues that amchi in the Zanskar region enjoy social status and are revered by villagers. Gutschow illustrates her argument by illustrating amchis' role in treating rlung, or “wind disorder,” equivalent to mental illness, where the amchi helps by diagnosing and providing meaning through Buddhist philosophical concepts of “karma, interdependent origination, and the universality of suffering” (162). Barbara Gerke, in “Allegiance to Whose Community? Effects of Men-Tsee-Khang Policies on the Role of Amchi in the Darjeeling Hills,” presents an interesting take on amchis' social status in the context of the institutionalized centralization of Tibetan medicine, such as the Men-Tsee-Khang, the centralized Tibetan medicine organization in Dharamsala. Gerke argues that given Men-Tsee-Khang amchis' greater “allegiance” (171) to a centralized institute and their lack of local knowledge, their social status and views of their healing power are affected among the peripheral communities they are serving. Finally, Sienna Craig's powerful afterword spills gently into my thoughts as I read through this seminal ethnographic collection; she emphasizes again the importance of studying the periphery to comprehend the central

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