The Lhotsampa Hindus believe that reincarnation occurs after a period of 84 million years. Author(s): Maya Maxym, MD, PhD Reviewer(s): Pradeepta Upadhyay; Mitra Dhital Lhotshampas speak Nepali as their first language. [9], In 1988, the government census branded many ethnic Nepalis as illegal immigrants. The caste system creates a social hierarchy, identifying individuals position in society and influencing their choice of spouse, as well as other social relationships. In the refugee camps in Nepal, health care was limited and sometimes sporadic, depending largely on the availability of international aid agency volunteers and supplies; however, basic interventions were almost always available and were preferred over traditional medicine by the majority of the Lhotsampas interviewed for this article. The more educated and/or higher socioeconomic status members of the Lhotsampa community tend to prefer Western medicine to traditional, but this preference is not universal, and it is not uncommon to try one pathway first and then the other if the first does not achieve the desired results. Specifically, most Lhotsampas will not touch or eat beef or pork, as this is considered sin in the Hindu religion. According to the individuals interviewed for this article, infant mortality was significant, although statistics are not available. After initial resettlement in the U.S. in places like Seattle, Austin, St. Antonio, Houston, Syracuse, Rochester, and Atlanta, secondary migration of Lhotsampa refugees to other cities and states with large established Indian communities is happening. Sex education did not really have a place in Lhotsampa culture or education, but was standard in the refugee camps; therefore, most refugees under about the age of 35 have been exposed to a relatively standard, if limited, sex ed curriculum. Infants are typically breastfed exclusively for the first six months of their life. The resource provides general cultural information, while recognizing that every family is unique and that cultural practices will vary by household and by generation. Core methods of healing include incantations and reading rice, although they may also include prescribing special diets, sprinkling hot water on the patient, or touching the patient with a meaningful object, such as a yaks tail. Their skills include being able to enter into a trance and sometimes speak in languages they have not learned, reading leaves and rice to diagnose illness and recommend cures, and chanting incantations to heal their patients. Bhutanese Refugee Story - From Nepal to Seattle's Rainier Valley Children are usually given two first names at birth or within the days following. In the refugee camp, many Lhotsampas were exposed to Indian culture and language via radio and geographic proximity to India. Topics discussed included experience with traditional and Western medicine in Bhutan, in the refugee camps in Nepal, and in the USA, as well as common cultural beliefs and practices, particularly as they affect attitudes toward health, health care, and medical providers. At that time, the Brahmin formalizes the teaching a boy has received from his parents: he tells the boy never to tell lies, to be studious, never to steal, and to respect his elders. pitri and kul deota / The ancestors are not doing well; their spirits may affect you. Practices among Buddhists or Christians are largely dictated by their individual religion. By the late 1980s and early 1990s, a crisis had developed. On the eleventh day, the child is named, and a purification ritual, which consists of sprinkling a holy mixture of cows urine, yoghurt, milk, a seed named til, and grass on the mother and her home, will be performed by the Brahmin. Enlist the assistance of Hindi speakers, if interpretation services are limited, as most refugees speak Hindi (especially the younger generation) and have been exposed to Indian culture. Challenges facing the health care provider include patients limited familiarity with the concept and practice of preventive health care (e.g. The spirits must be propitiated to get them to a better place. Farm animals included buffalo, cows, and goats. Disclaimer:EthnoMedis designed for educational purposes only and is not rendering medical advice or professional services. If mourning is not performed properly, there is a risk that the deceased persons spirit will not be able to make the transition to the afterlife and will remain on earth in the form of a ghost to disturb the living. There has been no exposure to computers as the refugee camps do not have electricity. Currently, Nepali is the first language for most southern Bhutanese and most people use it in their home. People from Nepal were invited to populate the lowlands of southern Bhutan in the mid- to late- nineteenth and early twentieth centuries. However in the U.S., individuals may be more likely to prepare and eat meals alone in order to balance the demands of work and competing schedules. Based historically on customs from Western Nepal, typically when a Lhotsampa boy reached the age of 7 or 8, his parents would begin seeking his bride. Read about efforts, resources and tools developed by the Refugee Health Technical Assistance Center in response to reports of suicides among Bhutanese and other refugees resettled in the U.S. in RHTACs , including a webinar and suicide prevention workshop, and a suicide prevention training model being used with Bhutanese refugees. [9] Liberalization measures in the 1970s and 1980s encouraged intermarriage and provided increasing opportunities for public service. Children are generally taught by guidance explanation and example and are rarely subjected to physical punishment. The new brides priority must be to keep her mother-in-law happy by preparing food, doing her washing, and massaging her legs in the evenings. It is important to give refugees the opportunity to ask questions. This website is a collaboration between PhotoVoice and the Bhutanese Refugee Support Group, two organizations which have worked closely with the Bhutanese refugees. [10] Local Lhotshampa leaders responded with anti-government rallies demanding citizenship and attacks against government institutions.[10]. For instance, the tendency of American families to retreat into the privacy of their own homes is quite different from the Lhotsampa practice of welcoming anyone into their home without advance notice. The caste system is at the root of this belief, intended to keep persons of lower caste from entering. The reluctance to seek care may be exacerbated by the fact that refugees receive seven months of Medicaid coverage upon their arrival, but are unlikely to have adequate employer-sponsored health insurance coverage after that time. Due to the fear, trauma and persecution they have undergone with the Bhutanese government and the fear of the police, Lhotsampa refugees are afraid and fearful about calling the police for assistance or seeking any help from them. Pennsylvania, Baltimore, Chicago and Indiana are some of these places. Some Lhotsampa refugees, particularly young- and middle-aged adults, are finding it difficult to access affordable health care coverage and services, once their resettlement benefits run out. It is therefore essential to be respectful of these dietary restrictions when counseling Lhotsampa patients about nutrition. During this time, other women in the household may take over her work, men may cook and clean, or, where economically feasible, the family may choose to pay a woman from outside the family to prepare meals and help keep the house in order. Staple foods include rice and lentils, known as dal. [11] In the wake of this unrest, thousands fled Bhutan. The first name is given to the child by a priest. Approximately 25,000 Lhotsampa refugees have resettled in the U.S. overall,with thousands more expected to arrive. Historically, among more traditional Lhotsampas, members of different castes did not visit each others homes, pray together, or share meals. While each suicide occurred under unique circumstances, some community leaders suspect resettlement issues may have influenced decisions. They are in Kent, Maple Valley, and Bothell. This age group does not usually qualify for other assistance as may be available to children and seniors. Read more about health/mental health related issues at Center for Disease Controls Bhutanese Refugee Health Profile and HealTorture.orgs Bhutanese Refugees Mental and Physical Health Resources. [9] However, the most divisive issue in Bhutan in the 1980s and early 1990s was the accommodation of the Nepalese Hindu minority. The concept of privacy, and the value that is placed on it in American culture, is new and may be perceived as somewhat strange. The Nepali-speaking Bhutanese, also called Lhotsampas (People of the south), are Bhutanese citizens of Nepali origin, a large number of whom are refugees from Bhutan. In Bhutan, most Lhotsampas were exposed to both traditional medical practices and Western medicine, available through the government-run health care system. A Lhotsampa person is generally known by a first name and a family name. The World Food Program (U.N. food agency) supplies food rations to tens of thousands of Bhutanese refugees in Nepal. In the refugee camps in Nepal, and now in the U.S., caste may no longer an issue for some people, while still having importance for others. At home, Nepali (a language related to Sanskrit) is spoken, but most Lhotsampas also speak the Bhutanese language, Dzongkha. However, significant minorities among the Lhotsampas are Buddhist or Christian. An exception is the four-day period during each month, at the time of the womans menses, when she is expected to rest. The ritual mourning activities are believed to assist in the purification of the deceased family members soul, allowing a smooth transition to heaven, where he or she will await reincarnation. There is limited understanding of the concept and value of preventive health care, particularly among women, many of whom may never have had a mammogram or pap smear in their lives. Family is one of the highest priorities among the Lhotsampa people. They have many responsibilities in the community, including teaching the next generation, leading ceremonies such as weddings and baby-namings, and providing prayer leadership to members of the community on a regular basis. Social circles commonly included Indian friends who didnt understand Nepali language and so communication would happen in Hindi. Life in the United States represents an almost unimaginable change for most refugee immigrants, and it is no different for the Lhotsampas interviewed for this article. CDC Report on acute and chronic malnutrition and micronutrient deficiencies found in Bhutanese children in refugee camps in Nepal. The elders, in turn, may decide to involve additional community elders to deal with the situation and/or find solutions to the problems. Malnutrition and Micronutrient deficiencies Among Bhutanese Refugee Children The number of those who are deaf or hard-of-hearing represent only a small percentage of the Bhutanese refugees but caseworkers say it is an unusually large number compared to other refugee groups.

Girls are given their first sari before puberty and take increased responsibility for household work, while boys receive a symbolic holy thread from a Brahmin in their community. Then she will return home until she reaches the age of 15 or 16, at which time she will move permanently into the home of her husband and his family. Most Lhotsampas will have seen loved ones suffer or die from preventable causes. In more recent times, nuptial traditions have changed and even among elders, some unions were made by choice as love marriages as opposed to arranged marriages. In traditional Lhotsampa society, sexuality is a taboo subject, and the ubiquity of sexuality and sexual images in the American media is a cultural shock for many members of the refugee community, especially the elders. Since then, Nepali is only taught in the home and has become a spoken language in Bhutan. Also, Nepali is most commonly used in school outside of the classes. [10][11] The actual immigrants registered and settled through the agent from Kalimpong, Raja Ugen Dorji and (son) Raja Sonam Togbay Dorji started in the reigns of the second and third kings. Many are planning to go to community college but first need to take ESL classes in order to be proficient enough in English to enroll. The resource provides general cultural information, while recognizing that every family is unique and that cultural practices will vary by household and by generation. In the U.S. Lhotsampa women and men are adopting the American way of life, with women and men sharing family and household responsibilities and women working outside the home. See also: . At the time of writing, the majority of Lhotsampa refugees have been in the U.S. for between one and eighteen months. As of 2021[update] the number of Lhotshampa in Nepal is significantly lower than that in the United States and other countries where they have resettled. The second name is given by the parents, which is the name used on the birth certificate. Childbirth practices have changed with changing access to medical care. Typically, wherever available, medical care (either in-hospital birth or midwife-attended home birth) has been sought. Traditional gender roles significantly impact health care utilization. Since the late 1980s, over 100,000 Lhotshampa have been forced out of Bhutan, accused by the government of being illegal aliens. Patients have high expectations of medical doctors and may experience dissatisfaction when a provider seems rushed, impatient, or impolite in an encounter. Some members of the younger generation may not adhere to these restrictions. They will refrain from eating salt or meat, and generally will limit their intake to one meal of plain rice per day, as well as fruit, pickled ginger, lemon, and water. Bhutanese Refugees Mental and Physical Health Resources, Invisible Newcomers: Refugees from Burma/Myanmar and Bhutan in the United States, An Investigation into Suicides among Bhutanese Refugees in the US: 2009-2012, Bhutanese Refugees - Cultural Orientation Resource (COR) Center, Malnutrition and Micronutrient deficiencies Among Bhutanese Refugee Children, Bhutanese Refugee Story - From Nepal to Seattle's Rainier Valley. Bridging Refugee Youth and Childrens Services (BRYCS) and the Office of Head Starts National Center on Cultural and Linguistic Responsiveness (NCCLR) have partnered to create this cultural backgrounder focused on early childhood. [10] In 1990, violent ethnic unrest and anti-government protests in southern Bhutan pressed for greater democracy and respect for minority rights. This system is kept somewhat underground vis-a-vis interactions with Americans. This and offer a glimpse into the lives of hundreds of families from Bhutan who have been resettled in Maryland. Traditional weddings are great celebrations. Despite living in Bhutan for up to five generations, the Lhotsampas retained their highly distinctive Nepali language, culture, and religion. Many of them have either entered Nepal's seven refugee camps (on 20 January 2010, 85,544 refugees resided in the camps[10]) or are working in India.

Many do not know how to drive, so transportation to places of work, clinics, and other sites is a great challenge. Caste also typically dictates an individuals choice of profession and role in society. Traditional medical practices vary by religion, region of origin, and socioeconomic status. Immigrants from Nepal and India continued to enter Bhutan with an increase from the 1960s when Bhutan's first modern five-year plan began, many arriving as construction workers. The first report of Nepalese origin in Bhutan was around 1620 when Shamdrung Ngawong Namgyal (a Tibetan lama who unified Bhutan) commissioned a few Newar craftsmen from the Kathmandu Valley in Nepal to make a silver stupa (monument) for his father, Tempa Nima. However, this changed during the 1980s when there was racial conflict between Nepali in Bhutan and Bhutanese. Develop culturally-appropriate elder programs. In the U.S., assistance from resettlement agencies typically ends just a few months after refugees arrive in the U.S., rarely enough time for individuals and families to successfully establish themselves in their new lives. The Politics of Ethnonym Ambiguity", "Background and History: Settlement of the Southern Bhutanese", "Country profile Bhutan: a land frozen in time", Bhutanese Refugees A story of a forgotten people, The Bhutanese Refugees Human Rights Watch, New wave from Bhutan settles in - Burlington (Vermont) Free Press,, Articles containing Nepali (macrolanguage)-language text, Articles using infobox ethnic group with image parameters, Articles containing Standard Tibetan-language text, Articles containing potentially dated statements from 2021, All articles containing potentially dated statements, Articles with failed verification from June 2021, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 24 June 2022, at 20:12. Additional and background information was obtained from the websites of Human Rights Watch, Amnesty International, and the Center for Applied Linguistics, as well as the official government website of the Kingdom of Bhutan. Date Authored: March 01, 2010. Whether they are Hindu or Tibetan Buddhist, most of them abstain from beef, notably those belonging to the orthodox classes who are vegetarians.

The Cultural Orientaton Center Resource Center has multiple resources including the history of the Bhutanese and environment in exile, resettlement background and information, characteristics of the population, and a 22- minute video of interviews with refugees from Bhutan talking about their refugee background. In the Seattle metropolitan area, there are three Hindu temples where Hindu Lhotsampas worship. Also see this 2013 article in The Atlantic: . Prior to that, prenatal care was limited (mostly by distance from a physician or clinic), but used when available. Upon marriage, the woman takes the family name of her husband. Pay special attention to vulnerable groups such as the elderly, widows, the mentally and physically disabled and those who have experienced torture. Parents may decide that only one name is needed if they like the priests name choice. The government traditionally attempted to limit immigration and restrict residence and employment of Nepalese to the southern region. When clinics require that patients make appointments weeks in advance to see a doctor, some patients then feel forced to seek more immediate care in an E.R. In the U.S., the demands of work on the younger generation make it difficult to care for elders in traditional ways. Doors are usually open, and members of the extended family, as well as friends and neighbors, will come and go quite freely. A Lhotsampa refugee community leader in Seattle expressed worry that his community will be facing these same issues. Traditionally, mental illness is known as a stigmatizing condition in which a person is considered crazy. Traditionally, marriages took place between members of the same caste and were arranged by the parents of the bride and groom. The wedding celebration occurs at the home of the bride and includes prayers and rituals led by a group of Brahmin (priests), as well as ceremonial drum playing, which is traditionally performed by members of the lowest caste. Their main festivals include Dashain and Tihar. Reportedly, there is some frustration with the health care system in the U.S. [12][13] Second, the government removed Nepali as a language of instruction in schools in favor of Dzongkha, the national language. Women typically worked in the fields and in the home throughout their pregnancies. Parents also decide which of the two names the child will go by. See also: Bhutanese Refugee Families, a cultural backgrounder focused on early childhood, created by Bridging Refugee Youth and Childrens Services (BRYCS) and the Office of Head Starts National Center on Cultural and Linguistic Responsiveness (NCCLR). Generally speaking, community members often avoid seeking medical services unless they are gravely unwell. The average family size ranges from 6 to 8 children. Samchi, Chirang and Geylegphug are southern dzongkhags that have a large Lhotshampa community where most people speak Nepali. The women in the immediate family will engage in similar rituals, but they must be separated from the men. In October 2012, The Centers for Disease Control (CDC) & the Refugee Health Technical Assistance Center (RHTAC) released a report An Investigation into Suicides among Bhutanese Refugees in the US: 2009-2012 . There are many aspects of American culture that are in stark contrast to some of the core practices and values of Lhotsampa culture. In Nepal and Bhutan, when babies begin crawling, they are massaged with mustard oil and are placed in the sun to give them strength. At the age of 7 for girls and 8 or 9 for boys, the formal transition to adulthood occurs. Thus, many Lhotsampa refugees feel relatively comfortable communicating in English, although they note that American English, especially when spoken quickly, can be very challenging for them to understand. routine well child care, mammograms, pap smears), as well as cultural factors that may impede delivery of reproductive and other health services. Household pets are rare, and dogs are considered to be worthless, to the point where it is an insult to compare a person to a dog. As a result, most members of the Lhotsampa refugee community are multilingual. [9] The Lhotshampa are generally classified as Hindus.

However, this is an oversimplification as many groups that include Tamang and the Gurung are largely Buddhist;[15] the Kiranti groups that include the Rai and Limbu are largely animist followers of Mundhum (these latter groups are mainly found in eastern Bhutan). This is a generally temperate area, with abundant, though imperfect, land for farming. After giving birth, a new mother traditionally rests for eleven days. This tradition is fading with the transition to life in the refugee camps, and now with the beginning of the transition to life in the USA; however, respect and courtesy will still define this relationship. satho janu / loss of soul, especially when very small: Dont shout loudly, the baby may lose his soul., aahar (from Ayurveda) / what you eat affects your body, aachar (from Ayurveda) / what you do (e.g., exercise, smoking, drinking alcohol) affects your body, behar (from Ayurveda) / how you live and the environment affect your body, jhar phuk / mantra chanting, blowing air into the mouth. Thus, some Nepali speakers from southern Bhutan cannot read or write in Nepali. Particularly in remote areas prior to the expulsion from Bhutan, however, home birth with or without a lay midwife was the norm, and some children were even born in the fields where their mothers were working. However, they did participate in public life and politics, even attaining positions of significant leadership. Like the Nepalese in Nepal, the Bhutanese citizens of Nepali origin in Bhutan (Lhotsampas) traditionally divided themselves into castes; a persons family name often denotes the caste to which s/he belongs. Contact between the Druks (Bhutanese) in the north and the Nepali-speaking Bhutanese (Lhotsampas) in the south was limited. By the end of 1992,more than100,000 Lhotsampas had fled or been forced out of the country, mostly into refugee camps in Nepal, where many remain to this day. The majority of the Lhotsampa economy in Bhutan was based on agriculture. Eye contact during conversation is standard and is not a sign of disrespect. Predominant crops included wheat, rice, oranges, lemons, sugar cane, peas, squash, soybeans, and especially lentils. For instance, women may hesitate to discuss their own health problems, but express deep concern regarding the health of their spouses and children. In the late nineteenth century, immigrants from Nepal began moving to the southern lowlands of Bhutan. The receipt of the holy thread and teachings has traditionally been taken very seriously and marks the transition from boyhood to manhood. Common health concerns among Lhotsampa refugees include malnutrition, depression and other mental illness due to forced displacement and cultural alienation, poor oral health, and reproductive and gynecologic care. Bhutanese Refugees

Human rights violations, including detention, imprisonment without trial, and torture, were not infrequent. Meals are generally eaten together as a family. The Lhotshampa or Lhotsampa (Nepali: ; Tibetan: , Wylie: lho-mtshams-pa) people are a heterogeneous Bhutanese people of Nepalese descent. Women, particularly younger and/or more educated ones, do discuss sensitive topics amongst themselves, but almost never with elders, male friends, or family members. The community is generally patriarchal in structure; sons are expected to take care of their parents and provide for them financially and emotionally. They smear the floor with cow dung and then cover it with straw; this is the surface they will sit and sleep on for the duration of the thirteen-day period of mourning. [7][failed verification] People of Nepalese origin started to settle in uninhabited areas of southern Bhutan in the 19th century.[8]. Living arrangements typically include many members of an extended family, and the younger generation assumes the responsibility of caring for elderly relatives. Although they have largely been able to find the necessary ingredients to make foods they feel comfortable eating, shopping in an American grocery store can feel quite overwhelming. Also, some Nepali words are used differently in Bhutan than Nepali in Nepal. Sickness is generally seen as an imbalance of passions or a result of the influence of evil spirits, and the dhami-jakhri focus their attention and prescriptions on re-establishing balance to bring about cure. The deceased persons sons traditionally isolate themselves in one room of the house and are not allowed to speak to female family members or other friends, extended family members, or neighbors. Also, refugees will likely be unfamiliar with state and federal programs providing health care coverage and services for children, pregnant women, the disabled, and the elderly. Provide long-term case management services to vulnerable groups. Supply of other foods in the refugee camps was limited, whereas, in Bhutan, the season and farming practices determined other foods that were consumed at various times of the year. Examples of common home remedies include basil for the treatment of cough, colds, and certain kinds of pain; garlic, turmeric, ginger, and cardamom for stomach pains; and heated mustard oil for massages to relieve muscle pain in the elderly. There have been many changes in the Lhotsampa community especially in the last two decades, and the tradition of arranged child marriage is fading due to Western influences, displacement and refugee status, and improved education for girls and young women. Nepali in Bhutan is different in the rural areas and Thimphu. Refugees have high expectations of American clinicians.

Within a family, respect is owed to elders, particularly and regardless of age by a daughter-in-law to her mother-in-law. In addition, stringent and unrealistic requirements for proving citizenship were imposed on the Lhotsampa people, most of whom were denied recognition of their citizenship even when they were able to provide documentation. In Bhutan, if the mother did not have breast milk, babies were typically fed cows milk from a bottle; however, in the refugee camps, baby formula (known by its brand name, Unilitto) was widely available. According to U.S. State Department estimates in 2008, about 35% of the population of Bhutan is Lhotshampa.[14]. In 1989, the Bhutanese government enacted reforms that directly impacted the Lhotshampa. Because she is considered unclean during this time, she may not touch, prepare, or serve any food or drink, and there is a widely held belief that any fruit tree touched by a menstruating woman will become sick and cease to bear good fruit. Many times people will try one or two home remedies and seek external medical help only if their symptoms worsen or do not resolve. Families spend up to a month preparing food and drink, including rice, lentils, a kind of sweetened bread that resembles a doughnut, and a special kind of pickle, called dhulae achar. Very often family issues, health problems, and financial issues are first discussed with the elders in the family. Meals typically include anyone who happens to be at the house at the time. The kitchen of the home is traditionally considered a sacred space and should not be entered without permission. During this time, she will stay with the baby and nurse the baby, but she does not perform any work or prepare any food. Several refugees from Bhutan who have resettled in King County in recent years are deaf. Organize and conduct cultural competency programs for service providers and other personnel who need to come into contact with the community. After the wedding, the bride travels to the bridegrooms home for a few days. This video is the story of Khem Rizal and his family, Bhutanese refugees who after living in a UN camp in SE Nepal for 18 years, were recently resettled in Seattles Rainier Valley. Traditionally, the Lhotshampa have been involved mostly in sedentary agriculture, although some have cleared forest cover and conducted tsheri and slash and burn agriculture. Even younger Lhotsampas, who largely grew up in the refugee camps in Nepal, have been regularly exposed to English. The use of the Nepali language was prohibited in schools, many Lhotsampa teachers were dismissed, and textbooks were burned. This Twin Cities Daily Planet article features statistics about the refugee population and excerpts from a talk given by refugee community leader Mangala Sharma to members of the Minnesota refugee consortium, April 10, 2008.
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