Tsering Sangmo Lama is 60 years old and from Bihi in North Gorkha. She never went to school, and neither did her two sons and one daughter, although they at least studied for a few years in the village gumba (monastery). There is a primary school in Bihi but it has remained closed for many years.
“Bihi is a remote place, and poor. It’s difficult for people here to get education or to acquire new knowledge.”
Tsering remembers what it was like for her as a child, growing up in Bihi.
“My family were low status and we had very little. My childhood was mainly spent away from my parents, working and sleeping at the gote (the sheds where the animals are kept) several hours away from my house. When I was very young I started to chew and smoke tobacco – it kept out the cold when I was tending to the animals. I burned wood fires in the sheds for the same reason. As I had no education, even at the time of my marriage I was still mentally a child. I knew nothing about the dangers of tobacco or other health issues.’
After the birth of her third child, Tsering began to find herself getting more and more out of breath. She found things like physical work and walking uphill difficult, and she had a continual chesty cough.
“It came on slowly and I never thought it was bad enough to seek medical treatment. Besides, where would I have gone? This village is really remote and I can’t get to a hospital. I assumed it would go away on its own, so I just stayed at home. But it became more and more debilitating, and what is worse, my husband, who is older than me, started becoming increasingly physically disabled and confined to his bed. During this time I spent most of my day in the kitchen, cooking over a smoky wood stove, and when I wasn’t cooking I was smoking or chewing tobacco!
“My illness became so bad that I was forced to seek some help for it. I went to the gumbato ask the lama (holy man) and jhakhri (shamanistic healer) to help. But when I got there, I found that the PHASE healthworkers were there doing a health education session! I knew who they were, they were from the organisation who gives us medicine, but I had never been to the healthpost in my life as it is a few hours walk from my home.
“I told the healthworkers about my problem, and they said that as they had come for education they didn’t have the right instruments to check me or any medicine with them, but they looked nervous when I told them my symptoms and they said I had to go to the health post the next day. I was convinced so I decided to go.”
Tsering found out that she had asthma, made worse by tobacco smoking and by the smoke from her cooking stove. She was given a sabultamol inhaler.
“When I found out that my illness could be controlled I literally cried with happiness,”she admits. “I use that medicine every day now. When it runs out I just go back to the healthpost to get more. I find my daily work so much easier. My husband and the rest of my family are pleased – I feel I will be able to take care of my home and family for a good many years to come.”
Unfortunately many of the inhabitants of Bihi and the surrounding villages have lung and breathing problems due to smoke. Not only is tobacco very common, but all cooking is done on wood fires and women especially spend many hours a day, every day, inhaling smoke. Some of the houses in the community, however, have put special chimneys in their houses that channel most of the smoke outside. The healthworkers note that these houses have fewer cases of asthma, COPD and other respiratory diseases.
“Although I can’t change the fact that I inhale smoke when cooking,” says Tsering, “the PHASE healthworker told me that I had to discontinue my tobacco use. These days I have cut right down, and I have to say I feel better for it!”