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HEALTHCARE SYSTEM OF THE TIBETAN COMMUNITY IN EXILE
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Transcript of HEALTHCARE SYSTEM OF THE TIBETAN COMMUNITY IN EXILE
By:
Trinley Palmo (MPH)
Department of Health, CTA
HEALTHCARE SYSTEM OF THE TIBETAN COMMUNITY IN EXILE
INTRODUCTION
1959- His Holiness fled to India with about 80, 000 Tibetan refugees
Major health challenges in the early resettlement era:
• Emotional trauma, grief and physical exhaustion• Adjustment to new climate and diet• Sickness and death due to illnesses like diarrhoea,
Tuberculosis, malaria and malnutrition• Water and sanitation problems due to congested locations
in tent based temporary refugee camps in north India.
Major Health Challenges at present.
Tuberculosis Hepatitis BChronic conditions like cancer and cardiovascular diseases.Substance abuse in youthRisk of HIV AIDS due to high mobility and low health awareness.
Health system in the early resettlement era: 1960s and 1970s
Before formation of refugee settlements: (1959-1962)
Provision of medical care by Indian Government hospitals to Tibetan refugees working as road laborers.
Few Tibetans, who knew Hindi and English, worked as social workers and translators.
Tent based medical camps were set up by humanitarian agencies and CRC at key focal points near the road construction sites in Northern state of HP.
Early health system in the refugee settlements in 1960s and 1970s
Relocation of refugees to different settlements in early 1960s.A small dispensary was built in each settlement with one
community health worker (tents/buildings)These dispensaries were managed by TIRS and supported by local
and international donors.Health center at Bylakuppe Tibetan settlement, Karnataka was
established in 1961 by Walter Judd Function and MYRADAThe social workers/translators worked as community health
workers.
Department of Health, CTA
Established in December, 1981. Registered as Tibetan Voluntary Health Association. The administration of health centers were formally
handed over to DOH in 1981. Aims to provide primary healthcare services to all Tibetan
refugees through a network of primary health centers with a goal of “health for all”.
Aims to create and expand public health programs for health promotion and disease prevention.
Administrative structure of DOH
29 CTA staffs at the Head Office.Health Minister and secretary are the administrative heads.Organizational structure, DOH.pdf
Administration of DOH
Head office: 29 health staffs including health Kalon.
Organizational structure, DOH.pdf
MAP_Health centers..pdf
Network Health Centers of DOH
DOH manages 54 health facilities in India and Nepal.7 hospitals (20-30 health staffs)5 primary health centers (5-13 health staffs)42 health clinics (1 health staff)2 mobile clinics in LadakhNgoenga school for children with special needs The hospitals and PHCS have a administrator and the
clinics are managed by the settlement officer. Hospitals and PHCs in India.pdf
Regionwise distribution of health centers State No of health facilities
Himachal Pradesh ( HP) 16
Delhi 1
Uttranchal (UT) 6
Nepal 12
West Bengal 4
Sikkim 2
Arunachal Pradesh 4
Uttar Pradesh 1
Jammu and Kashmir 2
Maharashtra 1
Madhya Pradesh 1
Orissa 1
Karnataka 4
Total 54
Healthcare workforce under DOH
216 field health staffs ( medical and administrative)Medical staffs:92 community health workers4 doctors26 nurses The health staffs have multiple roles: social worker,
mental health counselor, health educator, data collector besides providing treatment services.
Role of community health workers
Community health workers are the backbone of this well functioning refugee healthcare system.
A community health worker’s training program was implemented since 1981, through a collaboration between Delek Hospital and DOH. Until now, about 256 CHWS have been trained through a 3 month CHW training.
“Where there is no doctor” formed the main teaching and practice manual. ( translated into Tibetan)
They have filled the gap of acute shortage of qualified health care providers in our community.
Health Programs Carried by Department of Health
Infectious Disease Control & Treatment.
TB Control ProgramMalaria & Leprosy
programDrinking Water and Sanitation Program
RH/MCH ProgramHIV/AIDS
Program
Mental Health and special projectsMental Health and special projects
Mental health programMental health program
Tibetan Torture Survivor programTibetan Torture Survivor program
Hepatitis B projectHepatitis B project
Tibetan Medicare project Tibetan Medicare project
Telemedicine projectTelemedicine project
Health PromotionHealth Promotion
Substance Abuse prevention & Rehab. Program
Substance Abuse prevention & Rehab. Program
Health Information systemHealth Information system
Health Education and TrainingHealth Education and Training
Disability and Destitute supportDisability and Destitute support
Monitoring and Evaluation of Programs
The ground implementation is carried out by field staffs.Monitoring and evaluation is done both at field and central
level in form of routine phone calls, site visits, quarterly and annual reporting system.
The staffs of the project section of DOH works in planning of annual projects/proposals based on needs of the respective locations.
Some new health projects in 2013-2014 Cervical cancer prevention and screening project in Miao.Gynecological visit program in 12 settlementsReproductive Health awareness in 10 nunneries.TB mobile project in 6 health centersInfant disability project in 2 settlementsSchool health workshop and adolescent health booklet.Strategic health communication workshop.Stomach cancer screening project.
Telemedicine is a rapidly developing application of the clinical medicine where medical information is transferred through the phone or the internet and sometimes other networks for the purpose of consulting, telemedicine allows patients to visit with physician live over video for immediate care. It captures Video / still image and patient data are stored and sent to physician for diagnosis and follow - up treatment at a later time.
TELEMEDICINE PROJECT IN MAINPAT
Future implications
Using health data to make more evidence based health policies and programs.Improving the vaccination coverage among infants.Promoting healthy behavioral change interventions to reduce the incidence of chronic conditions.Formulating sustainable financing solutions to address funding shortages to manage health centers.Finding ways to fill the gap of shortage of doctors.
Final thoughts:
This refugee healthcare system has evolved as a unique community based healthcare model over a period of five decades.
Strives to provide compassionate and holistic health services to all, both Tibetans and non Tibetans.
Other displaced populations in humanitarian settings can learn from our practical experience including well organized healthcare settings, holistic care and realistic use of manpower (stood and sustained difficult periods of displacement and rehabilitation)