Conceiving diseases of modernity : a qualitative study on environmental adaptation, identity formation and notions of health among different generations of Tibetan refugees in Nepal

(1)

‘Conceiving diseases of modernity’

A qualitative study on environmental adaptation, identity

formation and notions of health among different

generations of Tibetan refugees in Nepal

(2)

Master thesis written by Nienke Terpstra

Master Medical Anthropology and Sociology

Graduate School of Social Sciences

University of Amsterdam

August 2014

Student number: 10617841

Supervisor: Dr. Sebastian Abrahamsson

Second reader: Dr. Rebeca Ibáñez Martín

(3)

Dedicated to Tsetan, Jampa, Tenzin, Tenzy and Kunga, who did

everything to make me feel at home

(4)

FOREWORD

Almost one year ago I was about to start the master Medical Anthropology and Sociology, a perfect synergy between my two biggest passions, anthropology and health care. Doing fieldwork that involved both disciplines turned out to be the icing on the cake. There are a few people who I would like to thank for this opportunity. First and foremost, I would like to thank all the people living in Tashi Palkhiel for their unlimited generosity, kindness and hospitality during my stay in their settlement. Without all of you being so open hearted I would not have been able to successfully conduct my research. In the two months that I spent in the settlement you truly captured my heart.

Secondly, I would like to thank the monks of the Pema Tsal Sakya Monastery for the pleasant stay there during my research and introducing me to the people of the Tibetan settlement Tashi Palkhiel.

Thirdly, I would like to thank my parents, sister and David who

unconditionally supported me during the preparation of my research, my time in the field and the two months of writing my actual thesis. Without their help I would not have been able to write my thesis and I am very grateful for that fact.

Fourthly, I would like to thank my supervisor, Sebastian Abrahamsson, for his useful feedback and suggestions during the whole process of writing my proposal and actual thesis.

And last, but surely not least I would like to thank Annelore Beukema and Lennard Kooijman for always being there for me, for pulling me through the whole process of writing my thesis and for constantly giving me new energy to continue writing.

(5)

ABSTRACT

Background: Since 1950, when the Chinese People’s Liberation army took over Tibet, approximately 120.000 Tibetans followed the Dalai Lama in his flight from China. Currently 20.000 Tibetan refugees are living in Nepal. These refugees can basically be divided in three generations of refugees. Since about two decades it seems to become more difficult to live a life as a refugee in Nepal. The focus is put more and more on the poor physical health status of Tibetan refugees and they are increasingly restricted by the Nepalese government in their freedom to practice religious and cultural events, which is very much linked to their identity. Objective: This thesis researches the complex situation of Tibetan refugees living in exile, by exploring the main points of tension that affect Tibetan refugees in Nepal with regard to their living situation, identity formation, and health status as refugees. This thesis offers information and arguments that are mostly based on stories from an emic point of view and therefore functions as a contribution to the already existing literature. Design: A qualitative study using in-‐depth interviews, informal conversations and participatory observations in Tashi Palkhiel, a Tibetan refugee settlement in Nepal. In total, 25 Tibetan refugees were interviewed, divided on both the three different groups of refugee generations and the different genders.

Conclusions and results: In general it can be stated that there are many things going on among Tibetan refugees in Nepal. The relevant points of tension seem to be heavily overlapping and interdependent. Based on the findings from the field in combination with the existing literature I will emphasize the main points of tension for the different generations of refugees. Things that are being discussed are the origins of food habits, forming an identity while living in exile and the encounter between Western notions of health and Tibetan notions of health.

Keywords: Tibetan refugees, diaspora, environmental adaptation, identity

(8)

I. INTRODUCTION TO THE DAILY LIVES

OF TIBETAN REFUGEES IN NEPAL

“We, the youngest generation of Tibetan refugees, often don’t like to eat Tibetan food anymore. You know, we now live in Nepal so we try to integrate in the Nepali culture. But when we get sick our parents give us Tsampa (Tibetan porridge) because it is known for its healing power” says Jampa Phuntsok, a 27-‐year old Tibetan refugee who is born in Nepal.

We are sitting in front of his home, while his sister Tenzin is cutting the

vegetables to prepare Dal Bhat, a typical Nepali dish. Jampa Phuntsok and his younger sister are not ‘real’ refugees in the sense that they never actually fled their home country Tibet, but, instead, they are born in Nepal. Their grandparents made the forth-‐ nightly gruelling journey through the Himalayas from Tibet to Nepal already in 1959. Even though most young Tibetan refugees and sometimes even their parents are born in Nepal, the Nepalese government still will not consider them for a Nepalese

citizenship. Tenzin Wangmo, Jampa’s sister, continues the conversation: “If my grandparents or parents get sick they go to the Tibetan doctor. They get some disgusting pills and they take them faithfully every day. If their medical problem is remedied they continue the same way they did before, harming their own bodies but often pleasing their minds. Tibetans don’t look that much forward, they live in the moment, you know. The mind is equally important as the body. You never see young people going to Tibetan doctors, maybe only to assist their grandparents, but not for themselves. Young Tibetans go to the Nepali doctor because he gives us Indian

medicines, which are much stronger for the body’s health than the Tibetan medicines.”

(9)

Jampa Phuntsok and Tenzin Wangmo’s statements, taken from their everyday life and of which these two are just a fraction, seem to touch upon some of the key elements in the lives of young Tibetan refugees. What firstly emerges is the way in which the last generation of Tibetan refugees is coping with its refugee status. Having a permanent refugee status can certainly be a factor influencing the process of forming an (new) identity. Most of the latest generation Tibetan refugees are born in Nepal and are not recognized as Nepali citizens. Many of them neither feel like real Tibetans, since they have never been in Tibet, nor do they regard themselves Nepali, as they have no chance to obtain Nepali citizenship (Adams 2005: 217). The second observation that can be distinguished from the quote above is a rooted awareness of the Tibetan culture, which might not be so visible at first sight, but still seems to be alive in their minds. This tension in forming a new identity is clearly described by the concept of living in ‘median state’. Communities in exile are often regarded as living in a ‘median state’, which means that they have never fully integrated in the new situation, in this case the host country, nor have they been detached from their old life. Elaborating on this concept of ‘median state’ is the notion of ‘refugeeness’, created by anthropologist Malkki (1995). This term is used to indicate an identity, which is not only defined by a shared ethnicity. The term represents the process of the formation of identity by balancing between the ‘old’ and the ‘new’ identity (Malkki 1995: 236-‐238). The concept of identity could

therefore be argued to include a constantly changing compromise between the past and the present (Ilcan 2002: 2).

As this thesis is about the link between identity and food I will try to explore the concept of identity mainly in this context. In this thesis I refer to the concept of identity as in being an expression of the self and very much linked to the concept of ‘home’. The idea of ‘home’ used to be a quit static concept, by Rapport and Dawson (1998) described as “a safe place to be and to go to and a fundamental point to refer to” (Rapport & Dawson 1998: 6). John Berger (1984) argues that this idea of ‘home’ also can be seen as ‘plurilocal’, which means that it is not bounded to one certain place but that it can move, as people do. As Berger says “We regard home as it comes down to a routine set of practices, a repetition of habitual interactions, in styles of clothing, memories and myths and in stories preserves in one’s head”

(10)

(Berger 1984: 64).

During the fieldwork many of the first generation of refugees told me that their main reason to fled China was that they were no longer were able to express their Tibetan identity. Due to the Chinese occupation Tibet no longer felt as home to them and fleeing to other countries might give them a chance to feel at home again. To link the concept of food with the concept of identity David Sutton (2001) argues that food from home not only was something they were proud of, but also

something they often longed for. Fernandez (In Sutton 2001: 121-‐125) calls this process ‘returning’ to the whole’. This means that migrating people, in this case Tibetan refugees, often feel displaced and estranged from their homeland and try to regain their feeling or experience of being at home by consuming nostalgic food (Sutton 2001: 121-‐123). Using the concept of identity comes along with difficulties and I am very aware of the shortcomings of using this term. I decided however to use the concept of identity as constant a changing process and linked to the concepts of ‘home’ and being able to express oneself and the (shared) cultural identity.

Identity should be seen as a constant changing human product, rather then something that people possess (Adams 1996: 20, 241).

Finally, the first mentioned quotes by the young Tibetan refugees

demonstrate the influence of the refugees’ identity on their perception of health issues and a healthy life. Among Tibetan refugees in exile the amount of health issues is growing. Heart failure, high blood pressure and obesity in particular are common health problems among Tibetan people in exile. One of the main things that came forward during my research in the settlement and also in the existing literature on it is the high consumption of fat and carbohydrates. Tibetans are used to maintain a diet that is relatively high in calories, and mainly contains fat,

carbohydrates and proteins. Tibetan staple food consists of barley (in Tibetan called tsampa), yak yoghurt, butter and cheese, meat from big animals and butter tea. The biggest contributor in the high consumption of fat is among others the Tibetan butter tea. Several studies have shown that drinking butter tea has a great negative effect on the health status of Tibetan People in exile (Gupta 2006: 80; Giles & Dorjee 2005: 138-‐142).

(11)

similar amounts of butter tea as they or their ancestors did in Tibet. This can add up to forty cups per day, which they drink in order to stay warm and to maintain a certain level of energy (Mayhew & Michael 2005: 75). Butter tea is made from black tea leaves that have been boiled for several hours. After leaving it for one day, it is mixed with yak butter and salt. Drinking forty cups of butter tea daily, each with an average of 70 calories per cup, is good for the daily consumption of 2500 calories from tea alone (Mayhew & Michael 2005: 75, 76; Pieroni & Price 2006: 40). There are several environmental reasons for drinking this tea in places where Tibetan people originally come from. Their home-‐country Tibet is a high altitude area, with an average altitude of 4000 meters, while the eight biggest Tibetan refugee settlements in Nepal vary in altitudes between 827 metres till 1300 metres above sea level (Bera 2004: 175,177). In high altitude areas, people need twice the daily nutritional intake compared to sea level. The main reason for this relatively high energy consumption is a combination of unforgiving cold

temperatures and low air pressure. Another reason for the high-‐energy intake of the refugees is that they use a lot of energy to collect sufficient amount of food, which is hard to get in the mountains. Tibetans also usually walk a lot in the mountains to trade their animal products for whole-‐grain food and they burn a lot of energy during these activities too (Pieroni & Price 2006: 41).

Even though the Tibetans moved from places with a high altitude (4000 meter) and the necessity to walk a lot in order to collect enough food, to places with a significantly lower altitude (varying between 800 and 1300 metres) and more food available and thus a lower need for food, they continued to drink the butter tea for various reasons. Beside the practical use of butter tea it nowadays is seen as a national beverage and it is very common for Tibetan people to drink it daily and in great amounts (Gupta 2006: 80; Giles & Dorjee 2005: 138-‐142).

As identities of peoples alter due to their changing living situations so do food habits. Food habits are often influenced by environmental factors, social and personal identities as well as changing perceptions on health and health risks. This research explores the interconnectedness and the main tensions of the concepts of

(12)

SOCIAL RELEVANCE, RESEARCH QUESTION AND THESIS

STATEMENT

In this section, I will present my main research question and the related sub-‐ questions. First I will discuss the social relevance of this research and its aim, from which the main research question will follow.

Several studies have shown the troublesome condition of the health status of Tibetan people in exile due to their insufficient dietary intake, which has become a concern for the Nepalese government. The prevalence of tuberculosis among Tibetan refugees for instance, is four times higher than among native Nepalese people (Nelson et al 2005: 1019-‐1021). This has been attributed to a number of reasons beyond their diet as well; a lack of diagnosis, which enables the bacteria to spread rapidly, a below par quality of care and also unfavourable genetic factors of Tibetan people (Marras et al 2003: 915, 916).

Feldman et al. (in Wangmo 2011: 332, 333) describe that it takes time for refugees to find appropriate health care and to build a trust relationship with their healthcare practitioners. Especially Tibetan elderly people don’t speak Nepali, so for them it is a big step to visit a Nepali doctor. The Nepalese government however pays more and more attention on the reduction of Tuberculosis infections and other health issues, also among Tibetan refugees, inter alia by holding public health campaigns (Wangmo 2011: 332,333).

The poor health status of Tibetan refugees is obviously not only a concern of the Nepalese government, but also in a way for the Tibetan refugees themselves. Their high intake of fat and calories has resulted in increasing obesity and this leads to a higher risk for other health problems, such as digestive disorders, tuberculosis, joint pain, gastric problems and arthritis. The Tibetan refugees interviewed in this study do recognize their physical complications as gastric problems, diabetes and arthritis as a problem but they often don’t link it to their health behaviour. Beside the physical health problems they repeatedly speak about a holistic approach to their health rather than focussing on their bodies only, on which I will elaborate

(13)

later. Also, as described above, their eating habits have a lot to do with their cultural habits, which might be of great importance in their lives and in their identity

formation process, as they are living in exile.

The social relevance of this thesis stems from two different factors. Firstly, although the Nepalese government acknowledges several health problems among Tibetan refugees and a lot has been written about these so called ‘health problems’, it has not been questioned to what extent these ‘health problems’ actually play a major role in the lives of the Tibetan refugees themselves. The second factor results from the fact that Tibetan refugees are often incorrectly perceived, especially in the literature, as being a homogeneous group. This notion of homogeneity among all Tibetan refugees often leads again to an overall assumption that health behaviour and then especially their eating habits and needs are identical throughout the whole population (Kulick 2012: 2,18). This seems anything but the case for Tibetan

refugees in exile. There seem to be many differences between the first, second and third generations of refugees, so in order to specify certain health problems among Tibetan refugees, first the different interests and current matters of health problems as well as identity formation among the different generations should be indicated. Especially for governmental and non-‐governmental organisations when it comes to health research and health promotion it is important to take into account these emic views among Tibetan refugees on topics concerning health, identity and culture. From a scientific point of view this thesis is interesting since it is about the tensions in the whole process of adapting to new living situations, forming a new identity and notions of health while living in exile. As there are currently 18 million refugees around the world, let alone the number of 32 million Internally Displaced People, it is interesting to research the impact of the interconnectedness between these three different concepts (UNHCR 20131_).

1_{The
UNHCR
uses
the
term
refugee
for
people
who
actually
leave
the
country,
people
who}

(14)

The main research question in this thesis is therefore: What are the relevant points of tension that affect Tibetan refugees in Nepal with regard to their living situation, identity formation, and health status as refugees?

Thesis statement

The aim of this research is to bridge the gap between the widely discussed health issues among Tibetan refugees and the actual perception of the different

generations of Tibetan refugees on their own health status by researching the tensions with regard to the three concepts mentioned before. I sought to capture an image of these actual perceptions when I spent two months in Tashi Palkhiel for field research. Before the actual fieldwork started, I decided to form an idea of the current health situation in the settlement by assessing the existent literature on the theme. I also decided to apply a ‘grounded theory approach’ in the field, which means that the data were collected prior to the formation of a hypothesis or theory (Nath et al 2013: 422). Apart from choosing for this approach I also wanted to explore the emic views of Tibetan refugees from different generations on concepts as food habits and taboos, cultural values, identity and notions of health, since all these concepts seem to be interdependent there.

THEORETICAL FRAMEWORK, THESIS STRUCTURE AND

RESEARCH THEMES

In this section I will follow the way of the formation of the three sub questions which together will contribute in answering the main question. In the four latest chapters, the first one being a description of the research area and group of people that I research, and the following three each a chapter devoted to one of the three themes, I will combine different theories with findings from the field. The most important concepts will be touched upon in this section, the first two chapters, as well, but will elaborately be described in the four chapters.

(15)

In the first chapter, this chapter, an introduction is given on the Tibetan refugees living in Nepal. The second chapter will be an overview of the methodology that has been used during the fieldwork. The third chapter will function as historical background of the current situation of Tibetan refugees living in exile in Nepal. Following on the introduction chapters the chapters four, five and six, which will all capture one of the three sub questions, related to the main question. The thesis will end with and discussion and conclusion, where all different theories will come together.

The three different themes, each to be discussed in different chapters are respectively 1) changing living situations, food habits and its consequences 2) forming an identity and 3) the relationship between food habits and perceptions on health. The themes and relevant concepts and frameworks will be introduces below. The first theme, changing living situations, food habits and its consequences, is about the impact that different factors had on the diet of Tibetan refugees.

Traditional patterns of consuming food were highly tailored to the harsh

environment of their home country. This resulted in a fat-‐rich diet, which might not be so suitable for the current conditions of the Tibetan refugees (Pieroni & Price 2006: 41). This theme, among others, explores the effect the altering environment has had on the food habits of Tibetan refugees living in Nepal and how this differs among the different generations of refugees.

On the basis of theories three distinct aspects of food habits and taboos will be analysed and discussed: the origin of food taboos, the influence of religion and the differences in life course between the three generations. Finally I will also briefly touch upon the concept of identity in this chapter as a link to the chapter that

follows after this one. These aspects will then be linked to the data collected in the field in order to explain the health effects of these changing food habits of the Tibetan refugees. The question that arrived from this theme is: To what extent are Tibetan food taboos religion based, influenced by the environment and/or strengthened over time to ensure a common identity?

The second theme is about the role of food in the formation of identity, and in this case about the formation of identity in a ‘median state’ (Malkki 1995: 236-‐238). The

(16)

diversity within the Tibetan refugee community in Nepal creates a big variety in cultural beliefs and needs. Differences are especially notable between the different generations of refugees. In this thesis, the people who fled from Tibet to Nepal are defined as the first generation of refugees. Their children are the second generation and their respective children constitute the third generation. The youngest

generation seemed, at first sight, to be much less connected with their Tibetan culture than the older generations. For example, the youngest generation don’t do their morning prayers, they don’t eat Tibetan food on a regular basis, they mostly wear Western clothes instead of Tibetan traditional clothing and they hardly ever visit the Tibetan doctor when needing medical assistance. And still there is

something that all generations seem to have in common: in almost all of the people there was a sparkle of Tibetan pride to be found. Despite this pride, most of the Tibetans of the youngest generation still seem to experience ‘being Tibetan’ as an slight obstacle. According to them being Tibetan and being a refugee restrains them in their daily lives and in their ability to realize their aspirations (Houston & Wright 2003: 67; Adams 2005: 217).

In the relevant literature, Tibetan refugees are often viewed as one single group with a shared identity, even though they vary, among other things, in age, birthplace and education. If we place this common perception of the Tibetan nationality as an obstacle in the framework of ‘being in a median state’ some interesting observations could be made. It could be argued that the youngest generation of Tibetan refugees is neither fully part of the Nepali way of living, since the Nepali government limits them in their options to get citizenship, nor do they fully connect with their Tibetan background, mainly for the reason that they are not born there and also slightly because ‘being Tibetan’ might remind them of their limitations in participating in Nepalese society, imposed on them by the Nepalese government. This is quite a problematic suggestion, because many researchers argue that communities in exile tend to fall back to the habits and cultural beliefs of their home country, especially when they are discriminated by the host country. This, however, seems not the case for the third generation refugees in Tashi Palkhiel. Especially for them, the whole situation of forming an identity as Tibetan refugee seemed to be an endless jumble of underlying and interconnecting reasons.

(17)

The question that resulted from the theory on identity that has been described above is as follows: How does living in a so-‐called ‘median state’ influence the way in which Tibetan refugees form and reform their identity. And what role does food play in this formation of identity?

In the third and the last theme, the relationship between food habits and

perceptions on health will be analysed. A lot has been written about the ‘visible’2

health problems among Tibetan refugees, which are considered here as one homogeneous group (Dang et al. 2004: 938; Gupta 2006: 77; Adams 2005: 216; 2004: 175; Commission 2004). The following stats create an image of the daily intake and current average weight of the Tibetan refugees in India, which is

comparable with the stats of Tibetan in exile in Nepal. The average daily intake of fat among Tibetan people is approximately 60 percent higher than the RDA

(Recommended Dietary Allowances), their daily intake of sugar is 15 percent more than the RDA and their daily intake of proteins is 51 percent more than the RDA. The high intake of protein is mainly due to their high consumption of meat. The mean BMI (Body Mass Index) among Tibetan women in exile is 24.03, which is relatively close to the border of overweight, namely a BMI (Body Mass Index) of 25 (Dickerson et al 2008: 232; Bera 2004: 175; Adams 2005: 216)

Yet there is a surprising lack of data describing cultural and social beliefs of the Tibetan refugees with regard to a healthy life.. Instead the authors often

implicitly apply a Western notion of health, which is mostly focused on absence of diseases and physical pain and on longevity, as well as things that can be measured if equipment is available, such as BMI, RDA etc. (Metzl 2010: 7). Among Tibetans there is often a whole other notion of living a healthy life. The third sub question is therefore formulated as follows: How do traditional Tibetan food habits and notions of health conflict and interact with Western notions of health in Tibetan refugee settlements?

In short, on the one hand there was the clear presence of health problems in the Tibetan settlement and on the other hand there was a complex situation in

(18)

which different identities among different generations were overlapping and

repelling each other. These repelling and contrasting identities have a big impact on how people perceive their health status and what they regard as a healthy life. During the interviews conducted with the help of my main informant, I tried to follow the same division of the three themes in the questions that I asked as well. The sub questions largely determine the structure of the thesis, with a chapter devoted to each sub question, in which existing literature is combined with new findings and discoveries from the field.

(19)

II. METHODOLOGY

With an open mind I travelled to Tashi Palkhiel, a Tibetan Settlement that is home to approximately 750 people. When I visited the same settlement three years ago it on the one hand occurred to me that there were various issues when it came to the health status of its inhabitants, their way of coping with their refugee status and their worries regarding the retention of their Tibetan cultural heritage. On the other hand it also has struck me that most of the Tibetan people there had very different opinions on what would be a healthy life than me and that it also quit differed among the different generations. This inspired me to do research among Tibetan refugees in Nepal. This chapter will function as an overview of the methods and the analysis thereof that have been used during the research in Tashi Palkhiel.

STUDY TYPE AND DESIGN

The study among the Tibetan refugees is a descriptive and qualitative study on changing Tibetan traditions, environmental adaptation and identity formation and its interconnectedness with perceptions of and practices on health and food. It explores the emic views of the Tibetan refugees from different generations on food habits and taboos, cultural values, identity and the meaning of a healthy life. It should be noted that the preparation and duration of the actual fieldwork is short and this definitely influences the statements that I try to make in my thesis. This thesis will give an overview of the main health and identity-‐related problems that are encountered by the Tibetan refugees themselves in the particular research area and the problems that arise by an encounter of the Tibetan notions of health with the more ‘western’ notions on health.

The study is mainly based on participatory research, the use of semi-‐

structured interviews and informal conversations in which the involvement of local people is one of the basic principles (Crang & Cook 2007:148; Hosokawa 2009). For that reason especially, almost all respondents and informants came from one

(20)

particular research area where I was able to stay for two month in order to conduct participatory research. In total I conducted 25 interviews, divided on both the three different groups of refugee generations and the different genders. The informants for the research were Tibetan refugees that escaped between 1959 and 2014 as well as Tibetan refugees that were born and raised in exile. Most of the Tibetan refugees that I interviewed who originally came from Tibet turned out to be mainly the first generation of refugees. This is mainly because of the fact that there were not that many people present in the settlement that escaped from Tibet in the past recent years. Beside the Tibetan refugees I also gained permission to interview two

adolescent monks in the Tibetan monastery, where I stayed and an American nurse and a French doctor, who both spent several months in Tashi Palkhiel to improve the local healthcare facilities. A local translator, from the same refugee settlement, assisted with 15 of the 25 interviews. Despite of the fact that translated interviews come along with certain shortcomings, such as for example reduced accuracy of the quotes of the interviewees, the interviews with especially refugees of the first generation were of interest for the general research and translation was needed during those interviews.

Only a few of the interviewees were highly educated, as most of them only had primary education. Informants represented ages from the age of 18 to 89.3

The research preparation took place in the period from October 2013 till February 2014. The period that I actually stayed at the research site was 7 weeks from March 11th_{till
April
30}th_{.

In
these
7
weeks
I
have
lived
near
the
Tibetan
settlement,}

observed and participated in the ceremonies and rituals of its inhabitants in their homes and at their school, spent time with them during all meals of the day and even spent several nights in different houses with different families. Because I spent most of my time in the settlement I got the chance to establish a good overview of their daily practices and other things that happened in the village. As time went on, my relationship with the people in the settlement deepened and as I progressively

3_{It
should
be
noted
that
this
age
might
not
completely
correlate
with
‘Western’
age}

indications, since Tibetans additionally add up the nine months in the womb to the real age and beside that during Losar (Tibetan New Year) everyone turns automatically one year older. This creates situations in which babies, with an ‘Western age’ of 3 months all of a

(21)

gained their trust, it became easier to generate relevant information for my

research. This information was mainly gathered through the use of semi-‐structured interviews, in-‐depth interviews and informal conversations.

SELECTION OF THE RESEARCH AREA

The study was conducted among Tibetan refugees in Tashi Palkhiel, one of the four Tibetan Refugee Settlements close to the city of Pokhara. Most of the Tibetan Refugees that live in this settlement come from Ngari, which is one of the five historical provinces of Tibet. People coming from this region are mainly nomadic or semi-‐nomadic, which is called ndrogba in Tibetan (Miller 1998: 24,25).

In this region, a nomadic lifestyle was expressed in the Tibetan way of living, in which animals, especially yaks, played an important role. The animals of the Tibetans were both their sources of food and their means of transportation. Mainly to ensure their animals of fresh grazing plains, the Tibetans moved from one place to another. Some of them were purely nomadic and never returned to former places where they stayed, other groups were semi nomadic and moved back and forth between their summer and winter residence (Chhetri 1990: 48, 225).

The reason for selecting the Tibetan settlement Tashi Palkhiel for doing my research is threefold. Firstly, the settlement was relatively remote, a fact that I experienced as an advantage since the remoteness played a role in the fact that the settlement was mainly inhabited by Tibetans. Because of the majority of its

inhabitants being Tibetan, a lot of Tibetan rituals were still performed on a daily basis. In other Tibetan settlements, located closer to the city of Pokhara, there was more intermingling with Nepali people, and that created a whole different cultural environment.

Secondly, at 500 meters away, a big Buddhist monastery was located with possibilities to live for a longer period of time. During the research I brought my 2,5 year old son along and it seemed appropriate to live apart with him from the people I researched. Besides that, it was also very interesting to spend 7 weeks living in the

(22)

Tibetan monastery, since I got the chance to experience what life was like there as well.

Finally, I discovered, already three years ago, that most of the people turn out to be very friendly and willing to share their stories with me. This made it an easy choice to select this particular settlement because of the hospitable and friendly nature of the people living there.

SELECTION OF THE INFORMANTS

Mainly through the monastery it was easy to find people who were willing to perform as local supervisor and translator. Upon my arrival, I found a local translator, a woman of 28 years old, named Dolma Tsering. She is born in Tashi Palkhiel and went to school until she was 20 years old. After that there was not enough money to continue her study and she began to sell jewellery along the lake, in the city of Pokhara. Her first language is Tibetan and she has basic English language skills. Beside her language capabilities she knew the people in the

settlement by heart, which made it a lot easier to get in contact with my informants. Also by choosing for a local translator and local research assistants it was possible to stay as close as possible to the people that were the focus of the study. By taking along a local supervisor it seemed to be easier to gain peoples’ trust and to be able to interview them. In order to act upon the basic principle of participatory research I lived for a long continuous period as close to the research area as possible. During the research I brought my 2,5 year old son with me. This made the whole research a very interesting experience in a variety of ways, as well as challenging and very positive, which is also something I will elaborate on later (Crang & Cook 2007:128). My local supervisor was a man of 29 years old and was one of the few people of my age who were actually born in Tibet. His name is Jampa Sangpo and he fled Tibet when he was 14 years old. He left his whole family behind and attended

boarding school in India. After that he studied Buddhist philosophy in India and two years ago he started to teach the monks in the monastery where I stayed. He knew many people of the Tibetan settlement and whenever I had questions about Tibet,

(23)

the rituals or anything that had to do with my research, he helped me out. I had several in-‐depth interviews with Jampa Sangpo and he has been my main informant in questions regarding facts and figures about Tibet during the research.

There were several advantages of having a local translator from the village, but there were also some disadvantages. For example, since Dolma Tsering knew so many people in the village she did not randomly chose them. Since I had to make sure that my informants were not all family or befriended I had to intervene in the choice of informants several times. This resulted more than once in disappointed people, who did not understand why I did not want to interview them. To keep everybody satisfied I did many more interviews than originally planned.

DATA COLLECTING TECHNIQUES

With the aim of creating an idea about the research area that was as clear as possible and to be able to answer the research question as accurately as possible, the method of triangulation was employed during this research. With this method, several different techniques are used to verify the insights from different subjects (Crang & Cook 2007:128). The main techniques that were used to collect the data were semi-‐structured interviews, in-‐depth interviews and follow-‐up interviews. In addition to these interviews I also collected a lot of information from the informants by doing participant observations and having informal conversations with the local people. Participant observations included preparing meals with the inhabitants of the settlement, eating together, going to the city or festivals, participating in rituals at the monastery and sometimes staying overnight with them in their houses. In order to orient on life in the settlement and the current important issues where people were dealing with, I did four in-‐depth interviews with both my translator, my local supervisor and two other people of different generations. By doing this I came to understand the important issues for the people in the village, in the field of health, culture and identity, which became very useful in the process of re-‐structuring the research questions.

(24)

Semi-‐structured, in-‐depth and follow-‐up interviews

Although it seems a simple task to hold semi-‐structured interviews with Tibetan refugees, the opposite is true. Every time I tried to start an individual interview with an informant, other people started to enter the room and mingle in the discussion. Since most of them speak Tibetan it was quite a challenge for me to transcribe the interviews and for my translator to translate during the interviews themself. I divided the interviews into three sections. The first part was about food, taboos religion and life course, the second part was about about food and identity and the last part was on different views on a healthy life in relation to food. The purpose of the semi-‐structured interviews was to get an overview of the main thoughts and ideas of the Tibetan refugees in the settlement.

An advantage of this particular research method was that the data I collected was very detailed, since people often shared a lot of information with me. The absence of a clear and closed structure in the interviews allowed me to ask them many questions in the course of the interview. Another advantage was that most of the people were very open and willing to share their ideas and insights. This created also possibilities for me to ask them to elaborate on certain topics in follow-‐up interviews. I experienced that especially the first and second generation were very eager to inform me on facts about Tibet and their individual lives. Even though I got a lot of information that seemed relatively off-‐topic at first, it was certainly

interesting to listen to their life stories.

A disadvantage of doing semi-‐structured interviews was that the informants often got distracted during the interviews because other people walked in and voiced their own opinions. This problem occurred predominantly during the

interviews with people of the first generation. Since most of them didn’t really mind that other people kept on entering the room, it was hard to convince them to

respond to my questions in private. In the village the people live closely together and privacy did not seem to be something they deeply cared about. I was afraid that informants sometimes did not dare to say things in front of other people and if I had the feeling that I had really missed something in an interview due to this common

Conceiving diseases of modernity : a qualitative study on environmental adaptation, identity formation and notions of health among different generations of Tibetan refugees in Nepal