So Close to Heaven (30 page)

Violence has been rare in Bhutan, murder almost nonexistent, which is why the new rash of crimes around Thimphu has thrown legal experts into a quandary over whether the old systems can go on working effectively in a new environment. “From our religious values, we believe our body is the embodiment or edifice of many other unseen gods and other beings, so we were constantly reminded, you are not hitting just a person, but you are hitting other things,” the chief justice said. “Resorting to violence has never been our Bhutanese culture and it is not appreciated. So therefore, we do not normally do that.” Most of the cases that come to court, he said, are land or property disputes.

In his large private chambers, the chief justice asked me to look at the High Court’s coat of arms, which dominated one wall. “Right in the center you see the circle, which is His Majesty,” he said. “Basically that concept came from Lord Buddha’s time; the circle was the embodiment of Lord Buddha. Then you see a rod covered with a silken knot. The rod is a yoke: it’s called a golden yoke. The yoke represents the penal offense, and the silken knot the religious law. In other words, the more crimes you commit, the more you carry the yoke. The longer you carry it, the heavier it becomes. But law must always be tempered with compassion, because a silk knot can always be untied, however tight it is. So therefore compassion and forgiveness are of primary importance to our legal system.”

Not far from the High Court, another major ingredient of Bhutanese life and culture is under cautious scrutiny at the National Institute of Traditional Medicine. When I first went there, before they had mechanical desiccators for drying medicinal plants, the buildings and courtyards of the institute were fragrant with the pleasing and healing scent of herbs drying in the morning sun. Great carpets of medicinal leaves were spread over concrete floors in the pure air at an altitude of over 7,500 feet. A woman sitting on a low wall watched over the herbs, her back to a large prayer wheel with a gilded mantra painted on its revolving drum. The
wheel is turned by anxious patients and their relatives as they wait outside the pharmacy and the doctors’ consulting rooms nearby.

Paolo Morisco had been in Bhutan a decade when I met him at the institute, where his office is perched at the top of several flights of steep monastic stairs. An Italian doctor working for the nongovernmental Italian aid organization DISI, Morisco was deep in an ambitious effort to elevate traditional Bhutanese medicine to the level of a science without altering age-old remedies or supplanting them with modern drugs. Like the legal system rooted in Buddhist concepts, the ancient medical remedies of the Bhutanese—known to the world as Tibetan medicine—are very important to them, and the government is pledged to save and enhance the system.

“The Bhutanese are trying to strike a balance here, taking the things they need from modern, technological society while keeping a pace that is humane, that is livable, that is based more on spiritual than materialistic values,” Morisco said. “Now whether they will succeed or not in the long run, that’s a different problem. The fact that they are trying is, I think, very good.”

Once on the way back from Punakha to Thimphu, I was drawn to a local clinic on a hill above the road that seemed to have attracted a long line of patients. It was winter, when respiratory infections were at their worst. The clinic had two sections, one for modern medicine and the other for traditional cures. On that day, everybody wanted to see the traditional doctor, Tshering Tashi, a dispenser of herbal medicines and an expert in a particularly Bhutanese kind of acupuncture using a gold needle heated over a flame or a burning herb. I watched him treat an elderly woman, said to be eighty-one years old, who complained of giddiness. If she really was eighty-one, this was an amazing age for Bhutan, where average life expectancy probably still hovers around fifty. Finding the right spot on her skull through a measurement based on the length of one of her fingers, he touched her small white-haired head several times with the hot needle. He also talked with her quietly, reassuringly, about her health in general. After the treatment, she left content, and the line of waiting patients inched eagerly forward.

“There’s no fear in Bhutan of losing the culture,” said Morisco, who was wearing wool gloves with the fingers cut off as he fiddled in his cold garret office with an Apple computer that had blown its fuse. His work quarters at the Institute of Traditional Medicine, a teaching, treatment,
and research center on a hillside above Thimphu, were primitive, dark, and chilly. But his years of work among the Bhutanese had made him optimistic, and his enthusiasm warmed the room. “The work we are doing is not at all to try and save the culture. The culture is pretty much saved. It’s pretty much alive here. What we are trying to do, especially in medicine, is to help the Bhutanese to approach traditional science and traditional knowledge with a more modern mentality, so that they can make the best out of it. That’s really the idea.”

Bhutan, known through its history as a land of medicinal herbs, still has these plants in abundance—so much so that there are hopes of an export market in the future, when herbs can be gathered in large enough quantities without endangering their existence, or be cultivated rather than just plucked from the wild. But first, the plants have to be catalogued. “The plants used in the traditional Tibetan and Bhutanese systems are written down in books, and the books have been preserved. So you have a list of six hundred to nine hundred ingredients that are used in Bhutanese and Tibetan medicine,” Morisco said. “But when you go to find the description in the original book, you see that the botanical description is not systematic. So you have diversity of interpretation in different parts of the Himalayas. Sometimes the practitioners know that it’s not the original plant and they use a substitute because they don’t find the original, which is okay. But sometimes they no longer know what the real plant is and they even have contests among themselves because one says this is the real plant and another one says no. So here we come in and say: Let’s do a botanical identification, a systematic botanical identification. We form a committee of traditional doctors who will sit together and talk and standardize. Now, we don’t mind whether under the same medicinal name they use two botanical species—as long as we know that under that name there may be two plants used.

“I’m sure we have here some resources that have already disappeared elsewhere, especially in Nepal and Sikkim,” he said. “That is why we are going into a project of cultivating medicinal plants, so that we avoid using the natural resources from the forests. One of the big aims of this project is conservation and protection. Then we will also be able to identify and preserve varieties of plants which are rare and which may be unique to Bhutan at this point.”

Morisco—a tropical medicine specialist who worked for five years in Thimphu’s General Hospital before moving to the institute, which gets
help from the European Community—said that the traditional systems of medicine common in Bhutan are also used in Ladakh and Nepal, “and these people don’t like the trend in Europe to call this all Tibetan medicine.” Bhutanese prefer to call it “the art of healing,” and they believe they have made unique contributions to it. One of their specialties is moxabustion, the treatment I saw used on the elderly woman at the rural clinic near Punakha. Moxa is the herb burned to heat the gold needle.

“The two big differences in Bhutanese acupuncture is that they won’t stick the needle beyond the derma; the puncture, it will be quite superficial,” Morisco said. “It’s not like the Chinese system, where they go quite deep. The second thing is that most of the time—actually all of the time—they heat up the needle with a type of fire, so there will be a little cauterization on the skin, which is actually very good because this is a good hygienic practice. The idea is that the meridians, the acupuncture points, can be stimulated not only by going deep into the flesh but also with just touching the point with the golden needle and heating it up. Even in some schools of Chinese medicine you will see now that they do pressure with their fingers, or scrape with horns on the acupuncture points. There are different things developing. It seems it doesn’t really matter what you do with the needle, so long as you catch the acupuncture point.”

Morisco, who like virtually every foreigner working in Bhutan spontaneously lauds King Jigme Singye Wangchuck for his enlightened but restrained attitudes toward progress and development, says that his experience in infectious diseases in Bhutan taught him that the greatest health threats to the country remain poor sanitation and smoky rooms. “Traditional medicine does not have concepts of public health,” he said. “One of the subjects we have just introduced in our five-year curriculum in traditional medicine is modern hygiene and health sciences. We are also introducing courses in botany and biology to give their work a scientific base.”

With certain inevitable variations, the general system of traditional medicine practiced across the Himalayas focuses on identifying symptoms springing from a broad range of causes. Yeshi Donden, a Tibetanborn master who became the Dalai Lama’s physician in Dharamsala, recalled in his book
Health Through Balance
that Buddha had listed 84,000 afflictive emotions alone that can lead to disorders in the body, even before we get to physical malfunctions. Yeshi Donden looked closely at
404 disorders, dividing them into 101 caused by the accumulated karma of earlier lives, 101 linked to something in this life that has taken a while to manifest itself, 101 involving the interference of spirits, and 101 superficial problems linked to bad diet or behavior. In other words, each person’s whole being and history (material, psychic, and karmic) must be considered in diagnosing symptoms and prescribing treatment. This holistic approach has begun to attract attention in the West, where a growing number of physicians and scientists are looking for ways to adapt the philosophy to vastly different settings.

“Holistic medicine is quite a new approach for modern medicine, but of course it’s an ancient approach, and it’s an approach with which we’ll have to deal very soon, because there are many diseases that modern medicine cannot cure, could not cure ten years ago, twenty years ago,” Morisco said. “We’ve had very little in breakthroughs in the last ten, twenty years, I think. Of course, antibiotics was the big thing, surgery’s a big thing. But beyond that, in any diseases that are related more to human behavior—not only psychotic and psychosomatic diseases but even diseases that are kind of less easy to pinpoint to one specific agent, like a bacteria—modern medicine hasn’t really gone anywhere. Modern medicine may not be doing very much with holistic medicine yet. But doctors say, yes, immunity and immuno-stimulation have something to do with the will of life, spiritual values, and internal qualities. All these things have been de facto recognized. Holistic medicine says that everything that you do in your life has a consequence, and can be the cause of suffering or disease—I’m talking about spiritual behavior or social behavior; killing somebody or behaving badly or being too jealous or too backbiting or those kind of things—all those have a direct influence on your health, which might come immediately or after years. According to Buddhist belief there are effects even in the next life, which is a little bit less easy to prove. But definitely there is relevance in this life; it is true.”

For Morisco, who says he changed a lot of his own thinking on the role of traditional medicine during his decade in Bhutan, a few adjustments still need to be made in the Bhutanese system. Traditional practitioners must recognize when a patient may need modern surgery or another type of Western diagnostic test or treatment, a campaign Bhutanese doctors themselves have taken on by linking traditional and modern wings of clinics and hospitals. The well-educated and affluent already pick and choose from the best. When Rigzin Dorji, head of the National
Cultural Commission, became ill with abdominal cancer, he was first treated in Bhutan, then in a state-of-the-art hospital in New York City, and later by Buddhist priests in Japan. He extended his life for several years, though no one would venture an opinion on what form of medicine helped him.

Morisco says—as do many Bhutanese—that the rural lamas to whom many Bhutanese first go for medical help must open their minds to a few new ideas, especially in promoting sanitation and healthier community living. But there is not much else in the Bhutanese system Morisco would change at this point, he says. “Here you are a traditional doctor and you know everything from taking the pulse to doing a diagnosis to going into the forest and taking your ingredients to making medicine and giving it to the patient. Now you find one doctor in the West who can do that and you would have Nirvana.”

If the Buddhist Bhutanese still live in harmony with a holistic past—not just in matters of medicine but more generally in a culture that has no special compartments for religion, law, music, art, or environmental protection, all of which grew up and still revolve around the monastery—they are also, almost paradoxically, more adaptable to new ideas than many people encountered elsewhere by international development experts. Learning English in childhood because it has become the language of instruction in all Bhutanese public (but not monastic) schools, young men and women are prepared to navigate smoothly through the world beyond the Paro airport—and to meet foreign tourists and aid experts with great poise and confidence on their own turf.

When Bhutanese young people return from education abroad, especially those who want to enter government service, they are sent for a course in
driglam namzha
, or national culture. This includes how to dress, talk, eat, and behave toward others in a traditional society. The training includes visits to historical sites and classes in how to conduct ancient ceremonies. “We want college graduates to know the Bhutanese way,” Rigzin Dorji told me. “We want to make sure our cultural backbone is there, that manners and etiquette should not be neglected. How to love your parents. How to treat your masters or servants. Not to kill. Not to harm. All these are Buddhist concepts. Children should actually grow up on this system of ethics from the age of six or seven.”