behaviour is embedded in the emphasis on continuity of transmission in sowa

rigpatradition, not only of technical knowledge but of cultivating the proper mental
outlook. Even though this means the training of an amchi is much more demanding than
that of a biomedicine practitioner, making sowa rigpa uncompetitive in a newly
competitive world, the teachers of sowa rigpa are trying to maintain that continuity of
inner motivation training.[12] A conference at Oxford in 2014 on sowa rigpa transmission
was led by amchi Mingji Cuomu of the Tibetan Medical College in Lhasa, who argued that
based on the fieldwork funded by the Wellcome Trust between 2011-13 in three provinces
of China (Tibet Autonomous Region, Qinghai and Gansu), Dr Cuomu found that receiving a
sacred transmission involves incorporation into a living lineage (rgyud) and becoming
part of its trajectory of medical transmission. This learning comprises acquisition of
knowledge, ethics, practical skills and a sense of care and commitment not only to the
patients but also to the lineage and its future.[13]
This renewed emphasis on medical knowledge as sacred and profoundly liberating is all the
more remarkable at a time when the commodification of sowa rigpa reduces the
practitioner to a dispenser of formulaic pills manufactured on a huge scale, as the fame
ofsowa rigpa now encompasses markets among the Han Chinese and other nationalities.
The institutions providing sowa rigpa training are caught between neoliberal Chinas
commodification, and Chinas ongoing apprehension that institutionalised Buddhism
competes with the state for popular loyalties. These forces have greatly constrained
initiatives to maintain sowa rigpa as a central aspect of modern Tibetan life.
Most Tibetans are rural, although urbanization is accelerating. The sowa rigpa amchi is a
familiar, trusted part of local rural communities. Tibetan culture is not a monolith,
although it may seem so when viewed from afar through the lens of both the efficiency and
the SBA arguments. One abiding contested fault line entrenched in rural Tibetan society is a
widespread fear of the evil eye and malevolent spirits. One of the most careful and sensitive
surveys of such beliefs shows that they greatly inhibit nomad and farming women from
going for help, or accepting the interventions of strangers, for fear of attracting pollution
and danger.[14]
THE AMCHI AS COMMUNITY HEALTH WORKER
The amchi, often the most literate person in a remote community, has the potential to be
part of the solution, overcoming the barriers to eliciting timely care. Tibetan women know
that they, and their babies, are vulnerable. They vividly imagine that spirits can be
brought into the home by strangers. The spirits ride piggy-back on a person entering the
home, without them knowing it. Infants are particularly vulnerable to spirit attacks. If the
baby cries just before the arrival of a guest, this can mean that the infant sees or intuits
the arrival of some spirit beings. If the baby cries a lot when the guest arrives, this too can
be taken as a sign that the babys own soul or essence (bla) is uncomfortable with the
visitor, for reasons of spiritual incompatibility.[15]
This recourse to local spirits as causative agents of illness is pervasive. Anthropologist Stan
Mumford tells a story of his landlady: When her daughter had a toothache, she concluded
that it was the goddess of water (chu-gi lha-mo) living in the stream who had caused the
affliction. She seized a stone in the stream and tied a string around it, gradually pulling it

out of the water and saying, If you feel this pain, then dont send pain! Nyima Drolma
[the landlady] interpreted this to mean, If the water goddess agrees to stop causing the
toothache, we will stop doing the same to her, using the model of reciprocity in negative
form. The model was dramatized by hanging the stone over the hearth (to feel heat) and
wrapping prickly leaves around it. After a few days the goddess seemed to get the
message: the toothache subsided, and the stone was put back into the stream.[16]
A standard scientific response to such stories, which keep women from seeking help when
giving birth, is to smile at the superstitious explanation of toothache. But religion and
science are very modern concepts, as is their supposed mutual exclusivity. In the
nineteenth century Japanese, subsequently Chinese, and then Tibetan languages had to
come up with neologisms to convey each of these imported categories which modernity
treats as natural.[17] There is no traditional Tibetan word for Buddhist, other than one
who goes within.
The amchi, having trained in not only medical arts but also in a Buddhist understanding
that all phenomena are empty of substance, is aware that traditional Tibetan beliefs in earth
and water spirits is just a story. But, having also trained in active compassion,
theamchi refrains from denouncing the water goddess aetiology of toothache as nonsense.
The amchi is in and of the local community, yet also apart.
The local amchi, having trained for many years in a Buddhist monastery, is aware that these
easily offended local spirits are creations of the mind, and not to be taken too seriously.
These spirits are personifications of human jealousies and anger projected onto rivers,
rocks, trees and mountains. Far from bluntly contradicting the villagers and camp-dwellers,
the amchis participate in rituals to placate, tame and subdue these ghosts and demons, but
they also do what they can to loosen their hold on fearful minds.

NEW ALTERNATIVES ONE: MODERN MOBILE AMCHIS

In these situations, the familiar amchi can ease the entry into modernity, and add to the
value of prenatal health checks by visiting health workers. The amchi is a bridge between
tradition and modernity; and need not be dismissed as another brick in the androcentric
wall of Tibetan tradition, necessitating the invention of an entirely new CHW profession.
The amchi is both insider and outsider, accepting of conventional realities and of
transcendant ultimate meanings. This is the epistemological subtlety, the coherence and
permeability of sowa rigpa. Even though sowa rigpa has not yet had much to offer a
woman in imminent danger of postpartum haemorrhage, and even has some distaste for
the polluting blood of birth, it is adaptable, available and widely trusted.
The all-encompassing sowa rigpa system has obvious potential to go beyond its customary
role in the management of chronic conditions, to also detect signs that a woman nearing
term is likely to experience complications that necessitate quick emergency access to
clinical care. Rather than inventing a totally new vocational specialisation of skilled birth
attendant, the amchis could train in prenatal diagnostics. Given the scatter of Tibetan
population, its low fertility rate and declining population growth rate in recent years, it is

hard to see how professional birth attendants could make a living, unless they travelled far
from home regularly, which undermines the whole concept of the TBA as part of the local
community.
Sowa rigpa, although banned altogether during Chinas revolutionary era, has revived,
and ethnographers have observed close collaboration between amchis and biomedicine
practitioners in the leading Lhasa sowa rigpa institute: In the womens division, a
biomedically trained physician worked alongside Tibetan doctors. Among these doctors
we observed an easy mapping of one set of names for disorders onto others. For example,
of the nine types of growth in womens reproductive tract, there were seven that
corresponded to known biomedical conditions: cervical cancer, fibroids, ovarian cyst,
endometriosis, polyps, ectopic pregnancy, and molar pregnancy. The non-matched
diseases were considered so rare that they were largely ignored.[18] However, this
compatibility of disease categorization is predicated on a unidirectional logic, of sowa
rigpa adapting to fit with biomedicine, in keeping with the anti-religious bias of both the
ruling party-state and of science. Tibetan sowa ripgpa tradition is acceptable insofar as it
conforms to the categories of biomedicine, and downplays its origins as a tantra of
liberating the mind. As the anthropologist Vincanne Adams notes: the direction of transfer
was almost always toward use of biomedical knowledge to expand Tibetan understanding.
forcing Tibetan medicine to conform to biomedical standards rather than the reverse, even
while publicly advocating and advertising the alternative qualities of Tibetan
medicine.[19]
*********************************************************
A version of this blog series will be published in 2015 by Nova Science Publishers, in a
global textbook called Maternal Mortality: Risk Factors, Anthropological Perspectives,
Prevalence in Developing Countries and Preventive Strategies for Pregnancy-Related
Death, edited by David Schwartz.