title: Making Hospitals in Tibet--The Lives of Medical Professionals at the Intersection of Two Medical Modalities
Creators: name: Chen, Ruonan
Publisher: name: The Australian National University
Year: 2024

description: The State of China has invested heavily in the health sector in the Tibet Autonomous Region (TAR), in terms of finance, infrastructure and personnel. The State not only supports biomedical healthcare services, represented by the services delivered in the People's Hospitals, but also fosters the local health system, namely Sowa Rigpa, Tibetan medicine. The government built new hospitals containing one or both health systems. Special programs and policies are tailored to develop and improve healthcare service delivery capabilities. However, the health outcome goals for the population in the TAR have not been fully achieved. The average life expectancy in the TAR is significantly lower than the average life expectancy in China. People continue to seek healthcare services outside of the TAR. Puzzled by the Chinese State's heavy investment in the health infrastructure of the TAR and the unsatisfactory healthcare service outcomes there, for this thesis I carried out ethnographic research with a focus on two public hospitals in S County in the Region: one People's Hospital, which provides comprehensive healthcare services, and one Tibetan Hospital, which specialises in Sowa Rigpa treatment. I sought to understand what hinders the medical professionals in those institutions to adequately deliver healthcare services. I observed the medical professionals' everyday work experiences and their struggles in the respective public hospitals. Over time during my research, I began to understand how the two medical modalities--biomedicine and Sowa Rigpa--coexist and cooperate in providing healthcare services in the TAR. I also began to understand the role medical professionals play in the healthcare provision there. I conducted 22 months of fieldwork from 2019 to 2020 (pre- and during the COVID-19 health crisis) in the two hospitals. In this thesis, I explore how the world of the medical professionals in the two hospitals is shaped by social engineering programs and policies; how being part of quasi-government service institutions impacts their work and their role in a medical apparatus what I suggest is the precarisation of themselves and the local community; and how their clinical decisions are informed by politics and different value systems. I also analyse the medical professionals' endeavours and strategies of practicing and transmitting Sowa Rigpa knowledge. I suggest that the lives and work practices of hospital medical practitioners are shaped by contesting forces. These forces include China's social transformation after the Open Up and Reform policy implementation, China's health reform policies, the State's discourse of development, and the government's desire to impose a stable social order in the TAR. Meanwhile, other forces, such as the friction between biomedicine and Sowa Rigpa, and traditional Tibetan values and Buddhist cosmology, also inform the medical professionals' everyday practices. These forces contest in the minds of medical professionals there and interfere with the provision of medical services to the local community. Medical professionals amid these contending forces balance the various values through their practices in the pursuit of a good life for both themselves and service users. Nonetheless, being part of what I call a 'medical apparatus', they are expected--at the behest of governmental policies--to govern the people and the local society while they are also expected to provide healthcare. This impacts their healthcare responsibilities and impedes their service delivery outcomes.