Dr. Lobsang Dhondup, born in Kalimpong, India, graduated from the Tibetan Medical and Astro Institute, Dharamsala as Kachupa in 1988. He worked as Chief medical officer in TMAI branch clinics in Calcutta (1993-96), Shillong (1996) and Salugara (1997-98). In September 1998 he moved to Spain on invitation of the Tibetan Medical Centre in Bilbao, where he now is the resident Tibetan doctor.

Dr. Lobsang Dhondup is a qualified Tibetan physician, who, along with his Western medical colleague, Dr. Pedro J. G. Arteagoitia, administers a Tibetan medical clinic in Bilbao, northern Spain. In the following interview, conducted by Barbara Gerke at ITTM, in Kalimpong, in August 1999, both doctors discuss the situation of Tibetan medicine in Spain and the problems they face when treating their patients.
 

Dr. Pedro Jose Garcia Arteagoitia, born in Bilbao, northern Spain, graduated in medicine from the U.P.V. (Universidad del Pais Vasco = Bask Country University). He holds certificates in various healing arts:’Re-education posturala Global’ (Method according to P. Souchand), ‘Method Kousmine’, ‘Corp et Conscience’ (the study of body & consciousness), and ‘Karaterapia’ (therapeutic techniques for working with physical disabilities based on karate and sophrology). He also works as a Qigong teacher and is President of the Association of Acupuncture and Manopuncture of Euskadi. Presently, he practises ‘Koryo Sooji Chin’ (Korean manupuncture), Qigong and Naturopathy (‘Method Kousmine’). He is a disciple of Prof. Kim Kuk Chu whom he assists during Korean acupuncture courses.

Barbara: Both of you are working as a team, Pedro, you being an allopathic physician trained in Spain, and Lobsang, you being a Tibetan doctor trained in India. Tell us about your teamwork and how you combine the two systems of medicine.

Pedro: Actually we are not combining allopathic with Tibetan medicine. I am licensed as an allopathic physician, but even before I started my career I was inclined to alternative and natural medical systems.

The first Tibetan doctors, who had been invited to the clinic in Bilbao, had their first experience with purely allopathic doctors and it was very discouraging. The allopathic doctors did not respect the Tibetan ways of diagnosis and treatment. It finally came to arguments and quarrels with the Tibetan doctors.

If you want to combine the two systems, the Western doctor must have a vocational interest in Tibetan medicine. He should be aware of different naturopathic systems, because the allopathic system has a completely different approach towards the human body and its illnesses. Only from this common base of understanding can they work together. Without such a base it will be impossible to collaborate, for Tibetan and allopathic medicines are two worlds completely apart from each other.

Lobsang: We Tibetan doctors are not allowed to practise in most of the European countries without a qualified Western doctor. Working together with a Western physician is essential. But it is important that the allopathic doctor knows the basic principles of Tibetan medicine.

Barbara: How do you actually work together?

Pedro:  Right now, I see the patients after Lobsang has seen them to check their allopathic diagnosis, and to determine which Western drugs they have been taking. I have to carefully examine whether the present symptoms have been produced by the drugs or by their actual illness. Secondly, I have to see if they are following their Western treatment correctly, if they are taking drugs without medical advice, or if they had undergone surgery previously. I also have to question patients about their diet. Essentially, I give the legal cover to the Tibetan doctor.

In the future, we want to receive the patients together, interrogate them together and discuss the therapy together.  I will check the allopathic side and Lobsang will conduct the Tibetan part of the diagnosis and treatment. It may also be important to be in contact with the patients’ general physicians and the hospitals where they have been treated. My task would be to ensure such a communication.

Barbara: You have talked about the general problems the Tibetan physician faces working with a Western doctor. What about the problems faced by the Western physician working with a Tibetan doctor?

Pedro: The problem with the Tibetan doctors is that they generally do not have enough basic knowledge on Western medicine, physiology, pathology and pharmacology. This makes them sometimes feel confused about what the patients are telling them and unable to understand the aetiology of the case. One could avoid this problem by introducing basic Western medical knowledge into the training courses at the Tibetan medical colleges.

Barbara: What kind of patients come to your clinic in Bilbao?

Pedro: The typical patient in the West may not be the same as here in India. We mostly treat very chronic diseases. Most patients come to us as a last resort with a long history of surgery, unsuccessful allopathic treatment, and when their bodily energies are in a complete mess. Sometimes it is very difficult to distinguish the actual disease from what has been caused by secondary effects of drugs, psychological or family problems. This is something the Western doctor has to examine very carefully. Also some drugs that the patients would like to give up are impossible to put away, such as insulin and hormone therapies.

The main illnesses we have to face in Spain are auto-immune, allergic, chronic and mental disorders. Stress, family and work conflicts produce depression, anxiety, paranoid or negative ideas, decrease of self-esteem, lack of concentration, skin problems and asthma.

Barbara: How many of your patients depend on allopathic drugs and at the same time want to start a Tibetan treatment?

Pedro: Most of them. For instance, patients with chronic diseases, such as diabetes Type I, need insulin and cannot stop taking this drug. Only the endocrinologist can decide about decreasing the amount of insulin in course of time when he sees that the patient is improving with the Tibetan treatment.

 In case of anti-inflammatory or analgesic drugs, we can reduce or remove them without problem. Regarding  pharmaceutical treatment for mental disorders, it depends on the case. Some patients have been taking anti-depressive drugs for ten or more years. Everybody knows that these drugs affect the brain and removing them will  lead to a very violent counter-effect. We advise those patients to continue taking their medicines as prescribed by their doctors. As they are improving with Tibetan medicine, their psychiatrists will reduce the doses, step by step.

 Sometimes, patients take sleeping pills throughout their adult lives. We are usually able to correct such habits within two to three months.
 The problem is that we do not get the patient in the very beginning but only after they have tried everything else. Finally, as a last resort, they come to Tibetan medicine.

Lobsang: Most patients have to keep taking their allopathic drugs along with Tibetan medicine for a period of time. We advise them to leave at least a two-hour gap between taking the allopathic and Tibetan medicines.

Barbara: What are the main problems that you are facing with your patients?

Pedro: Firstly, more than 20% of the patients complain about the taste of Tibetan medicines. I remember, my father shouting at me at 9 o’clock in the morning whether I wanted to kill him, after having taken his first dose of Tibetan medicine. Especially with children we often have to use some unorthodox methods, like giving the medicines along with food that will hide the taste.

 Secondly, patients are not very disciplined. We usually suggest a diet, avoiding pork, vinegar, tomatoes, lemon, cakes, strong tea and coffee, aerated cold drinks, frozen and cold food directly taken from the refrigerator, smoking, drugs, or even a more specific diet in certain cases. Most patients find it difficult to follow such advice.

Lobsang: I remember while working with Indian patients for ten years, we often had very good results, and one reason for this was that the patients usually strictly followed our advice. With Tibetan patients we faced problems: they just would not stick to the prescribed diet. Many of them fall sick in India because they keep to the high-fat and protein diet of Tibet.

 Pedro: Our patients in Spain are unfortunately very undisciplined: they don’t take their medicines regularly ( i.e., 3-4 times daily), they leave out doses or forget them altogether for two days, and do not keep to the prescribed diet. Prescribing warm clothing in winter is not likely to be followed by young girls who want to follow the fashion of wearing miniskirts rather than their doctor’s advice.

 In the West, one of the main problems is that no one uses natural foods. Most foods are preserved, and have additives of colour and taste. Most foods have suffered through a process of freezing or other preservation methods. The energetic qualities of the foods are low. I feel that unnatural food, pollution and mental disturbances are the main sources of illness in the West.

Most Western naturopaths agree that the main problems are mental disturbances, unnatural food and pollution. There are thousands of synthesised molecules in the food, and by now in the water and in all foods. That’s why we have so many allergies and auto-immune problems and, I would say, even some types of cancer. Even biological products cannot be completely free from such substances because we cannot control the rain and air. Because of this, nearly all people have some kind of disease. Even the children have some type of illness. And this is unusual. It did not happen before in the history of mankind. Previously, people died of epidemics or infectious diseases, but nowadays you can observe that all people have some kind of symptoms, and allergies, auto-immune problems, and also cancer cases are increasing each year.

Barbara: How successful have you been in spreading Tibetan medicine in Spain?

Pedro: I think, Tibetan medicine has succeeded in cases of depression and anxiety, even in chronic cases with intake of drugs over a long period of time. Also in cases of skin problems, asthma and auto-immune diseases such as arthritis, we have good results. That does not mean that all such cases can be cured.

 Some people come with strange ideas about Tibetan medicine. They think it is supernatural, some kind of magic, and they want results immediately. Even those who have had symptoms for ten years want to be cured within a week. The expectations are sometimes very high and strange.

 Up to 80% of our patients feel some kind of improvement. 50% feel a great improvement or even are cured. We cannot cure every patient but we are aware that the patients who report such improvements are all chronic cases that could not be cured with allopathic treatment before. We wonder what we could do if the patients would come to us in the beginning of their illness! Perhaps this will change in the future. How is it here in India? Do patients immediately go to the Tibetan doctor?

Lobsang: I worked for four years in the Tibetan clinic in Calcutta and there it was similar: patients would only come after having tried everything else unsuccessfully. Perhaps it is due to the lack of knowledge and unawareness. What is the situation here in Kalimpong?

Barbara: Only a small section of the Tibetan community visits the Tibetan doctor. Many now believe more in Western medicine, and that their own traditional medicine is ‘too slow.’ This is a typical response when I ask Tibetans about Tibetan medicine. But generally, the poorer sections in India still prefer traditional medicine because it is more economical for them.

Pedro: In Vietnam and Cuba, for instance, traditional medicine is practised officially. People are attended by the traditional doctor from their first symptoms onwards. The results can be very good. This is something to think about.

Barbara: Please tell us how Tibetan medicine was first introduced to Spain?

Lobsang: Eleven years ago, a Spanish business man went to Dharamsala and requested the Office of the Dalai Lama and Men-Tsee-Khang to send Tibetan doctors to Spain. First, Dr. Pema Dorjee went for two months, and then Dr. Karma Dolma went just for one month. Afterwards Dr. Tsewang Dadun came, and he is still working in the centre in Bilbao. Now there are three Tibetan Medical Centres in Spain: in San Sebastian, Vitoria and Bilbao. The main clinic is in Bilbao. In the future we want to open clinics in Madrid and Zaragosa. I joined the Bilbao clinic one year ago. We are three Tibetan doctors now in Spain: Dr. Jigme Norbu, Dr. Tsewang Dadon and myself.

Barbara: Are all three centres supported by Men-Tsee-Khang, Dharamsala?

Lobsang: There was a good relationship with Men-Tsee-Khang which later declined. Recently, I visited Men-Tsee-Khang and talked to the director. We want to have good relationships with them, also with centres like yours, with Chakpori, and with the doctors in Ladakh. We need to help each other and not work separately.

Barbara: Do you already have a network in Spain? Are you publishing a newsletter?

Pedro: I think the interest in Tibetan medicine is related to Tibetan Buddhism. First, Tibetan Buddhism was introduced to the West, and only then we came to know about Tibetan medicine. Countries like France, Germany or Italy have a good development of Tibetan Buddhism, and thus the interest in Tibetan medicine is quite high. Spain has very few Tibetan Buddhists. I don’t think there are more than a thousand. After ‘Kundun’ and ‘Seven years in Tibet,’ Tibetan culture has become better known in Spain, but before, it was completely unknown. It is difficult to publish anything in Spain related to Tibet. There are no magazines about Buddhism, Yoga or Hinduism. There is not even one university with a scholar on Tibetan language, culture, Sanskrit or Mongolian Studies. There are some extra-academic courses where you can learn Chinese, in private institutes. Spanish scholars are more interested in Arabic countries and languages, and there is not much inclination to the East and Far East.

 Only in Barcelona is there now the Tibet House. The resident Lama of the Gelugpa school is Ven. Lobsang Tsultrim. There is a resident Lama of the Sakya school, but there is no resident Geshe of the Kagyupa school in Spain, though they have centres. There is another resident Geshe in Menorca, and a Kagyu Lama in a monastery in Guesca. From Bilbao four people went through a seven-year retreat in France with Gedun Rinpoche, and that is all.

 Although the Dharma entered Spain just after the beginning of democracy by the end of the 1970s, I think the development has been very slow because Spanish customs are not suitable to Buddhist thought. Not only the bull fighting, but also local village feasts have as the centre of their celebrations some kind of torture of animals. That happens every year in summer, from June to September, yes, at the end of the 20th century.

 We need scholars in Tibetan language, Tibetan doctors who translate and give lectures, but right now there is no one.

Barbara: How do you integrate the spiritual side of Tibetan medicine into your clinical practice? How do your patients respond to spiritual advice, if at all?
Lobsang:  Actually this is a difficult question. I practise mediation in the morning for 15 minutes every day. I recite the Medicine Buddha prayers and the lineage of the medical practitioners, then I recite the Medicine Buddha  Mantra. When I see the patients, I feel more confident.  If I do not do my practice and chant even for one day, I feel more insecure. The confidence is the benefit that I receive from the practice.

 Whether I talk to patients about spirituality depends on the patient. With patients who do not believe or think meditation is something like magic, I don’t talk about spirituality. But with patients who are open to the spiritual aspects of Tibetan medicine, I talk and give advice on simple meditation practices for calming their minds. They usually find it very helpful.

Pedro: To be a doctor is a  profession that can well be combined with the practice of Buddhism.  One can motivate one’s practice of medicine from generating the Boddhichitta mind, in the Hinayana as well as Mahayana paths. Buddhist practice inspires me to offer better advice and to better understand my patients, because, through the spiritual practice, I feel emotionally and mentally more stable. I look at my patients as my teachers because I learn a lot from them, not only about the aspiration of compassion but also about my own self and my own weaknesses, all of which I see reflected in my patients. This realisation inspires me to practise more seriously.

 Only a few patients are interested in Tibetan Buddhism, but even without talking about Buddhism I can give spiritual advice, even from the Christian point of view. Interestingly, the practice of Buddhism has given me a fuller understanding of Christianity. I also use some sophrology exercises (sophrology is the study of consciousness,) to develop certain qualities of the mind. I can give psychological advice without mentioning Buddhism, just using logic and common sense, talking about causes of suffering and impermanence. These concepts are universal and can be applied beneficially with patients from various backgrounds. Some patients believe in karma and reincarnation, but often have misconceptions about the topic. Then, I recommend books or places for further information. So, somehow the practice of medicine is a spiritual path. I have also received teachings on this topic from my acupuncture teacher, Professor Kim Kuk Chu, as well as from my Buddhists teachers. Medicine has plenty of opportunities to turn it into a spiritual path. You can practice patience, ethics, generosity, wisdom and compassion.

 To be even more specific, if you are a practitioner of Buddhist Tantra and Sutra, ideally you practise your mediation for generating a pure motivation, before seeing the patient. You can visualise yourself as an instrument of your Guru or the Buddhas. In the higher path of Tantra you can visualise yourself as the Yidam, you can recite mantras while performing therapy, for example, while setting acupuncture needles. You can visualise patients receiving the blessings of your Yidam and the Buddhas.

 You cannot, however, give advice which you are not following yourself, like advising not to drink or smoke, when you yourself drink or smoke. Then your advice has no power.

Barbara: What are your personal goals  regarding Tibetan medicine?

Pedro: My personal goals lie in Tibetan Buddhism. I want to learn the Tibetan language and more about Tibetan medicine. But it is no so easy for us to come to India for seven years. I am not in my twenties anymore, and even after seven years in India, there will be the question of money to establish oneself again in the West and the problem of how to get the medicines.

 In the future, we could for instance send young doctors who just graduated from their university to India to study Tibetan medicine. They would return to Spain by the time they are in their early thirties and could still do a lot. But of course the problem of language remains. I hope, that we will have a small institute for Tibetan language in Bilbao, in about two years from now.

Lobsang: I would like to write about my practical clinical experience in Tibetan medicine, perhaps after ten more years of practice. First I want to work in the West, and then later I will settle in Kalimpong where I was born.

Pedro: What I would like to do I cannot do alone. Traditional medicines, especially Eastern medicines, are at a difficult stage. The East now wants to be like the West, and in course people are losing a lot of things, one of which is their traditional medical knowledge. I want to research this development. Most of my money I spend in this research and study. I think many Tibetans do not think about the future. It happens also in the rest of Asia, also in Africa and South America. If we destroy nature we destroy the source of a lot of natural medicines. I advise traditional doctors to go to the West and show their skills. That, I feel,  is the way to preserve them. The same with Tibetan Buddhism: it will survive because it is now in the West. The same with Chinese medicine and Qigong: I know of Chinese that now learn Qigong from Western teachers. It is incredible, but it is true -  a paradox.
 
 In 50 years there may not be any good lamas in India, and we have to search for them in the West. There also are not plenty of Lamas, but we can find one if we search. I know from the Kagyu school that the best centre for retreats is now in France, where more than one hundred people are in intensive retreats for three to seven years. Perhaps Tibetan medicine will meet with a similar fate in future?

Barbara: Thank you for sharing your thoughts and experiences.
 

Pedro Jose Garcia Arteagoitia Perez Galdos - 20- 3 °C 48010-Bilbao Spain Phone: (0034)-94-4270059

Dr. Lobsang Dhondup Tibetan Medical Centre General Concha, 9-Bis Bilbao Bizkai, Spain Phone: (0034)-94-4104352 (office)