CHAPTER TWELVE

Why Are They Laughing?

Lhasa’s independence demonstrations in the fall of 1987 alerted the world to Tibetan nationalism. China promptly responded by closing Tibet to reporters, parliamentarians, and international human rights organizations. A trickle of overland travelers brought out stories of brutal torture and repression, and of continued demonstrations occurring throughout the country. Although the world press reported the Chinese atrocities in “Shangri-La,” their interest in Tibet’s plight was fleeting. Even more distressing was the Reagan/Bush Administration’s tolerance of Chinese oppression.

What John and I had witnessed in Lhasa changed our lives. John went to work for the International Campaign for Tibet in Washington. I postponed my residency to write a narrative account of our trip. Two years went by quickly. Devoting ourselves full-time to advocacy work, we wrote a dozen articles for magazines and newspapers. We presented testimony to several congressional committees and the German parliament, and gave fifty talks to university and human rights groups in North America. To help foster new Tibet support groups after our talks, we developed a pamphlet with useful information for fledgling activists on fundraising, literature tables, sample letters to elected representatives, and civil disobedience.

At times, both of us wondered if our memories of the explicit violence that we had witnessed in Lhasa were becoming exaggerated, and if the violence implicit in the daily lives of the Tibetans had subsided. If the Tibetans continued to live under extreme repression, we felt that we owed it to ourselves and to the Tibetans to document these conditions to the best of our professional abilities.

In the fall of 1988, John and I traveled separately to India to interview Tibetan refugees. We had developed a questionnaire to investigate prison conditions and China’s family-planning policy in Tibet, and hoped to write a report if we gathered enough information. I also wanted to know more about Tibetan medicine. I already had established a written correspondence with Namhla Takla, the director of the Mendzekang in Dharamsala. Now I would have the chance to speak with her in person.

Mrs. Takla’s office at the Mendzekang looked out over forested mountains that rolled onto the arid Indian subcontinent. Mrs. Takla served tea and explained the major problems facing the Mendzekang. First, there was a lack of money. Second, they did not have the facilities to make enough medicine. Third, they had a difficult time getting the necessary herbs; the Chinese had pressured the Nepalese to forbid all exports of herbs.

“Musk comes from Tibet,” Mrs. Takla explained. “The Chinese are taking all the musk that enters Nepal for themselves.”

Mrs. Takla also said that Tibetans in exile needed to train more menlops (Tibetan medical students). They were currently building accommodations for visiting scientists, doctors, and medical students. “The older doctors are very traditional and stubborn,” she said. “I often have to side with the younger doctors, which makes trouble for me.”

Mrs. Takla smiled broadly as Dr. Choedak stepped into the room. This was the Dalai Lama’s personal physician, a slightly stooped man in his sixties. “His ears must be ringing,” Mrs. Takla said to me. She explained to Dr. Choedak in Tibetan that I had treated wounded in Lhasa. Dr. Choedak held my hands as he talked. Mrs. Takla translated the information that Tibetans had excellent medicines for asthma, hypertension, adult-onset diabetes, arthritis, cancer, and multiple sclerosis.

Dr. Choedak was equally forthright about the shortcomings of Tibetan medicine. Newly trained Tibetan doctors didn’t focus as much on diet and behavior. Even before 1959, there was less focus on meditating, massage, and medicine baths. These things needed to be revised. Western and Tibetan doctors should do research together and take the best from both systems.

“All of this depends on training the young menlops,“ Mrs. Takla said. “Most of our medical students learn to speak English at the Children’s Village, but they do not know the Western medical terms. Dr. Choedak would be honored if you would stay here with us, and give a series of lectures on Western medicine to the students while you are here.”

Dr. Choedak took me to my room. It had the simplicity of a monk’s quarters, with bare walls, a bed, and a desk. I sat down to begin outlining my first lecture and he returned in a few minutes with Lobsang, a young monk who had just arrived from Lhasa. Neither Dr. Choedak nor Lobsang could speak English, and my Tibetan was still restricted to the social amenities. I drew a crude map of the world in my journal with the U.S. and Tibet prominently featured. I asked Lobsang how he left Tibet and he answered “Yes,” as he did to all subsequent inquiries. Although it was frustrating not being able to communicate, I was struck by how forcefully he spoke. Half an hour and many cups of butter tea later, I realized that I needed a translator.

At Dharamsala’s Office of Information I met Norbu, a Tibetan who had grown up in Switzerland. Norbu was the most staid Tibetan I had ever met, and spoke English with a Swiss-German accent. He agreed to translate during my three-week stay, during which I would be interviewing Tibetan refugees. On our way to have tea we met Kelsang, the Jokhang scribe I had treated the previous year. He was taller than I remembered. He also had sixteen stubbleless scars on his shaved head.

Kelsang was brimming with details of the special torture teams that came to Lhasa in the fall of 1987. Individuals were first stripped and beaten. The torturers screamed, “Tibet’s freedom will be your food,” as they crushed one man’s testicles; another man died from being beaten with a bayonet. Hearing about these victims of torture brought back a flood of horrific memories. I wanted desperately to leave, even before I’d started the work I’d come for, but struggled to record all of the details.

“Kelsang was inside the Jokhang Temple during the March 5,1988, demonstration,” Norbu translated. “At 11:00 A.M., 700 Chinese police stormed the monastery. They used ladders to climb the walls. Nine hundred Tibetans were sheltered inside, including a hundred women and children. Another thousand Tibetans stood outside the main door. The police used tear gas and beat everyone with clubs. Many people were bleeding. Nine people died in the first hour. Kelsang does not know how many died in prison afterward. Sixty-four people were taken to prison. Tibetans attacked a Chinese policeman taking photographs from the roof. They hit him on the head with stones and threw him down onto the street. He died in the ambulance on the way to the People’s Hospital.

“Kelsang was bleeding profusely from wounds all over his body,” Norbu continued, speaking without emotion. “He went to the Mendzekang in an ambulance, and spent two months there. The police came in every day to interrogate and photograph the wounded. They wanted to take Kelsang to prison but the doctors complained that Kelsang was too ill to move. Then the doctors discharged him secretly. When he went back to the Jokhang the Chinese police tried to capture him and he escaped.”

Besides the scars on his scalp and the rest of his body, Kelsang still had headaches and had not regained his previous energy level, but he smiled as he told me this and posed for pictures. “He has a message from Champa Tenzin,” Norbu said. “Champa Tenzin was in the Mendzekang for one month, then the police kept him in Sangyip prison for four months, but he is alive. He sends his regards.”

I heard many eyewitness accounts of other demonstrations throughout Tibet. Twenty-nine nuns from the Shongsey and Garu nunneries were arrested for demonstrating outside the Jokhang on March 4,1988. The next day fifty-three monks from Ganden Monastery started another demonstration that resulted in the police using tear gas and bullets to break up the crowd. Although the estimates of deaths and arrests varied, it appeared that the police used increasing force to quell each successive uprising. I also found the individual Tibetans I interviewed to be credible.

Individual descriptions of torture at Lhasa’s Gutsa, Sangyip, Titchu, Utitod, and Drapchi prisons were remarkably similar. The prisoners were beaten while their captors forced them to denounce the Dalai Lama and Tibetan independence. Women were raped with cattle prods at several facilities. The most severe treatment involved attack dogs ripping flesh from prisoners’ legs and genitals.

I struggled through each interview. One man who had fought in the resistance told me that he had seen Chinese soldiers kill his wife and three children. He fought in Tibet until 1959 and left with the Dalai Lama. He became bored with life in exile and enlisted in a special regiment of Tibetans in the Indian army who were known for their endurance and determination.

“The Indians lost six battalions trying to free Bangladesh,” the man said. “The Gurkhas also failed. Our commander told our regiment that the Chinese were in the swamps. We waded through those swamps with our rifles over our heads. In a month we liberated Bangladesh.”

Dr. Dorje Gyalpo took me to give my first lecture to the menlops the following morning. I knew that Tibetan medicine had a detailed knowledge of fetal development, and I had outlined a lecture on human embryology. At first my room at the college had seemed very comfortable, but something biting my ankles had prevented me from sleeping. I slapped but heard nothing. Something bit my neck. Again I slapped, but no culprits could be found. This biting and slapping continued until dawn.

That morning I faced sixty Tibetan medical students sitting upright at their desks with the sort of undivided attention I had never seen in U.S. schools. Dr. Gyalpo sat in the front row with Mrs. Takla and Dr. Namgyal, the head of the pharmacy. “The Buddha taught that a questioning mind is a lifelong endeavor,” Dr. Gyalpo said in concluding his introduction to my talk, asking the students to save their questions for the end.

I began with an evolutionary perspective: “One billion lifetimes ago, one-celled organisms formed in the oceans. As these organisms became more complex they developed specialized organs for things like eating, locomotion, and reproduction. After millions of years amphibious beings crawled onto land.” I drew pictures to illustrate the phylogenetic explosion of plant and animal species, including dinosaurs, on the chalkboard. This thoroughly confused and interested everyone. “All of the animals on the planet have much more in common than we might think, and all come from the union of cells,” I said.

Dr. Gyalpo excitedly handed me a box of multicolored chalk. “Where do babies come from?” he asked. The menlops laughed nervously. Dr. Gyalpo listened politely to my answer that human beings came from the union of the father’s sperm and the mother’s egg. The students talked while I drew egg and sperm cells and said that the fertilized egg evolved through amphibious and mammalian stages before it developed into human form.

“What is the nature of the developing fetal conscience?” Dr. Gyalpo asked.

“How are they joined?” Mrs. Takla asked.

“Why is it dangerous for a pregnant woman to take an X-ray?” Dr. Namgyal asked.

I answered each question to the best of my knowledge, which led to more questions. It was decided that I would give a lecture every other day. My one-hour lectures to the menlops evolved into a dependable three hours; no matter what I started talking about, the students inevitably asked two hours of questions. Most of the males asked about sex. Many passed me notes: “If I do whole night intercourse, about five to six times, is it possible to recover sperms on that particular night?” “In Tibetan medicine, food is the essence of sperm. Is it the same in Western medicine?” “If someone licks sperm, is it good for the body? (DON’T ASK WHO HAS ASKED THIS QUESTION).” “What is the difference between 1) taking sperm purposefully without a partner 2) sperm coming while having sex with a partner? I have heard that the first one is not good, whereas in the second case the male gets some nutrient from the female.”

One man, Dokpa, looked like a beatnik astrology student with his crew cut and goatee. He asked the most difficult questions, such as, “What are the merits and demerits of the Tibetan and Western medical systems? Please state them honestly.” I replied that both systems had excellent pharmacopoeias. I added that because Western doctors relied heavily on technology, they relied less on their clinical skills to diagnose an illness. Dokpa also offered his own intriguing insights. During a talk on the central nervous system he likened the function of the brain to a bird on a tree. “When the tree falls,” he said, “the bird flies away.”

“Exactly what is adrenaline?” Dokpa asked in the middle of my explaining about our endocrine glands. “How can we know its effects?” I could not resist whispering, “Do you want to know what adrenaline does?”

“Please tell us,” I heard Dokpa say. I waited for the menlops to lean forward and become silent. Then I screamed. The menlops jumped back in terror, knocking over chairs and tables. Fortunately, no one was hurt. For once I, who often seemed to strike them as an inexhaustible source of amusement, was able to laugh at them.

I spoke with a Tibetan nurse named Chimi who had worked for three years at Lhasa’s People’s Hospital. She explained to me China’s family-planning policy for urban Tibetans. Chimi had learned English well and we were able to speak without a translator.

“Tibetan women are allowed to have two children,” Chimi said, “but if they have one this is considered best. The work unit leader is in charge of enforcing the central government’s policies. In public meetings that everyone is required to attend, women are told that it is best to have one child. If they are sterilized after the first child, praise will be given for being a good citizen.

“If a woman has a second child,” she continued, “the child will have rights. But this is discouraged. Sterilization is done automatically on many women delivering their second child at Chinese hospitals.

“Having a third child is strongly discouraged. An illegal child has no ration card for the monthly allotment of Tibetan dietary staples at government stores: seven kilos of tsampa, one-half kilo yak butter, and cooking oil. Without a ration card a child cannot go to school, do organized work, travel, or own property.

“In villages there are thousands of illegal children. Tibetans would rather have their own way.” When asked how these children survived, Chimi said that such “illegal persons” had to do things like collect dung.

“Women also are fined for having a third or fourth child,” Chimi said. When asked if she could list individuals’ names, Chimi said that she did not know any women in Lhasa who had more than two children. Since 1983, there had been a new policy that all women living near Chinese hospitals had to deliver their babies in the hospital birth control units.

When asked if there were differences in the way Chinese and Tibetan patients were treated, Chimi first said that Tibetan and Chinese women were treated equally. Then, in her next sentence, she outlined two systems of health care: “There are two sections in the hospital: one for government officials and people with good jobs, another for ordinary people. The difference is better food and a cleaner environment. Most Tibetan women have babies at home. The Chinese officials and their friends always get the best food, the best medicines, and the best care. The Chinese also have the best jobs and look down on the Tibetans, who have menial jobs, smell, and are not clean.”

My stomach felt queasy as Chimi described how “unauthorized” pregnancies were routinely terminated with lethal injections. Chimi said that she herself had given hundreds of these injections.

“There must be some improvements in health care since the Chinese came?” I asked her.

Chimi shook her head. “The Chinese brought tuberculosis, for which Tibetans have no natural resistance and Tibetan medicine has no cure. Unemployment and alcoholism are also higher, especially among young Tibetans. Infant mortality is one in six babies, one of the highest in the world. Life expectancy for a Tibetan is ten years less than for a Chinese living in Lhasa.”

Chimi seemed on the verge of politely excusing herself. I thanked her and asked if she would list women she had seen get abortions or sterilizations at the Lhasa People’s Hospital. In less than an hour, Chimi furnished me with a list of the names, ages, dates, procedures, and complications of twelve women who had abortions by D&C during the first trimester; four women given injections to induce abortion during their second and third trimesters; and six women who had been sterilized. Before leaving, Chimi asked if she could keep the list. She knew of more women but did not have time to write them all down.

Two nights later Chimi handed me three sheets of paper that listed fifty-three women who were sterilized after an abortion. I asked how she could remember so many names and dates from four years ago. She replied that both of her parents were doctors and taught her to have a good memory. I quizzed her on individual details until I was convinced that they were internally consistent. This appeared to insult her.

“Even if a woman is forced to have an abortion,” Chimi said, “she will feel guilty for the rest of her life. We are seeing families break up because of this. For these reasons, Tibetans have nicknamed the People’s Hospital ‘The Butcher’s Place.’”

Unidentified insect bites continued to plague my nights. I could not sleep until I had scratched each bite raw. After ten nights I finally found my first bedbug. It was as large as a raisin and made a splotch on my pillow. A second bedbug clinging to the wall next to my head also made a stain. I soon found dozens of plump raisin-sized bedbugs clinging to the underside of the bed’s wood frame. I dragged the mattress to the far side of my room and slept soundly.

In the. morning I told Mrs. Takla my first complete Tibetan sentence: “Ngai nang-la deshik mangbo du” (“There are a lot of bedbugs in my room”). That afternoon I returned to find all of my possessions, mattress, and bedding airing out in the sun. “The deshiks (bedbugs) will not be returning to your room,” Mrs. Takla said. “We sprayed everything with DDT.”

Norbu arranged for a Land Rover to take us to the Bir refugee camp, a four-hour drive from Dharamsala. The Tibetans at the camp had come from all parts of Tibet, and most had left their native land within the last year. They would be excellent sources of information, Norbu reasoned. Chimi came along, but she refused to get into the passenger seat. “The doctor must be comfortable,” she said and squeezed into the back seat next to Norbu and two other Tibetan travelers. A hefty woman who joined us also refused my offer to share the spacious front seal and squeezed on top of Norbu’s lap. Norbu’s polite smile belied a strained expression.

“What are you doing?” Norbu shouted as I forced my way into the entanglement of elbows and knees and moans. I said that either some one had to sit in the front seat with me or I would ride with everyone else in the back seat. This was not altogether altruistic; if an accident on a steep mountain road didn’t kill me, I would have been crushed by their weight.

“Amchi-la, nyön-ba” (“Crazy doctor”), the driver said, and pulled the woman off Norbu’s lap to sit in the front seat with us.

British volunteer teachers at Bir welcomed us and passed the word that an American doctor was documenting torture and sterilization. Anyone who had something to say about this should come to the meeting house. Young Tibetans started lining up outside the door. We interviewed refugees sixteen hours a day for two days. An average interview took two hours. Most provided me with hard firsthand information.

For an hour one young nun named Dechen would talk only about her nun friend who was taken to Drapchi Prison for participating in the October 1 demonstration. “Tamdy is twenty years old,” Dechen said. “I visited her in prison.” I interrupted to ask how she had been allowed to visit a prisoner. She said that prisoners were occasionally allowed visits by family and friends.

“Tamdy received daily beatings and torture,” Norbu translated. “The police forced Tamdy and eleven other women to run for hours while they beat them with cattle prods. The dogs attacked Tamdy many times. The dogs must have had very sharp teeth because there is one place in her right thigh with a large hunk of flesh missing.”

I asked for more details about the torture, and for the names of the police who beat Tamdy. Dechen looked insulted and would not answer questions for a long time. I apologized for asking so many questions, and explained that they were essential for my report.

“After the October 1 demonstration,” Norbu said when Dechen began talking, “the police came to Dechen’s workplace and took her to the police station. There they produced a thick book that she was told contained all of her crimes. The police never opened the book. She told the police that she had not done anything bad. She was then taken to a different room where they touched her mouth with an electric stick many times. This felt as though her mouth had exploded. She lost consciousness.

“Later Chinese policemen stripped her. She cried as the men ripped her clothes off with the help of women police. She was beaten over her body with the electric stick on her breasts, mouth, and head, and lost consciousness many times. She feels that since this she has had difficulty remembering things and learning new words. She thinks this is from the electric sticks. This lasted three days at Drapchi Prison. The male police were Chinese. The women were Moslems, from Pakistan or Kashmir. They had been living in Lhasa for a long time.”

Before being released from Drapchi, Dechen was told not to say anything about what had happened to her in prison. She was also warned that if she ever participated in another demonstration, she would be treated much worse.

The next day we interviewed Jigme, a Tibetan policeman from Lhasa who said that he had tortured his own people. I began by asking about China’s family-planning policy and was surprised to hear him say that it was the birth-control teams, not the police, who were responsible for bringing recalcitrant women to the hospital for abortions and sterilizations,

“As soon as a woman gives birth,” he said, “she has to register the baby with the local police. The police say, ‘Be careful you don’t get pregnant again. If you do, you won’t get a ration card for the child.’”

I changed the subject and asked why he became a police officer. Jigme said that he thought police training would teach him to be versatile. He learned how to drive a motorcycle, jeep, and truck, to fire pistols and machine guns, and to detect and interrogate criminals. His face saddened. “If he did not do what he was told, the officers would ostracize him at public meetings. The police are very nationalistic,” Norbu said.

Jigme answered questions about his police work. “For political reasons,” Norbu translated, “the police have a special unit called the gong an jü that arrests suspects and takes them to prison. A separate unit, the jing ca yuan, does interrogation. Most officers in both units are Chinese. In general, the jing ca yuan finds out if the prisoner is involved in the underground or demonstrations. They extract confessions and get prisoners to denounce the Dalai Lama.

“Political prisoners are put in a cold, dark cell,” he continued. “Depending on the case, prisoners are chained at the ankles and wrists. They often are kept for more than three months. During Jigme’s time they used an electric cattle prod with a battery. If they touch the head for fifteen minutes the person will be unconscious. There is also a special rope to tie the wrists and ankles that becomes tighter if the prisoner moves.

Jigme described how the treatment given to prisoners depended on how they cooperated with the police. His face bore no emotion when Norbu said, “If a prisoner is adamant and says that Tibet is independent, he will be stripped and beaten. If the prisoner dies during the beatings the police are not responsible. It is the prisoner’s fault if he dies. The police have the upper hand and are free to beat the prisoners to death.”

Jigme also said that he tried to do “good things.” He gave food and clothes in secret to the prisoners. Sometimes he was able to warn a family before they came to arrest someone.

“There is a special Chinese doctor for prisons,” Norbu said. “If a prisoner is about to die the doctor gives just enough treatment to keep him alive and lengthen the torture. If the prisoner dies easily, he cannot be tortured for long.”

I asked Jigme if he had seen any torture techniques. Tears streaked his cheeks. He spoke in choked sentence fragments about how he had beaten Tibetan prisoners with electric sticks, hung them by their thumbs and ankles over a heater, suspended them in ice baths, and given injections to make them “nyon-ba“ (crazy).

I asked about the dogs and Jigme said the owlies (attack dogs) were trained to bite prisoners on command. He laughed and said that prisoners told him many things at this time. “The dogs eat better than the soldiers,” Norbu translated. “They are allotted 300 yuan a month, more than a Tibetan makes in one year.”

Jigme said that the reason he left Tibet was to help the Tibetan cause. He felt that he had to tell the Dalai Lama what he had done. Perhaps this could help his people.

The most outrageous account came from a monk named Tashi who described a mobile birth-control team that came to his village in Amdo in 1987. “When the barley turned brown,” Tashi began, “I watched a mobile birth-control team set up their tent next to my monastery. First the villagers were informed that the team had arrived, and that all women had to report to the tent or there would be grave consequences, like fines of 1,000 yuan to women who did not comply. The team also said that sterilization was part of a world constitution; women all over the world have this done. The women who went peacefully received medical care. Women who resisted were rounded up by the police and taken by force. No medical care was given.

“All pregnant women were taken to the tent for operations,” Tashi continued. “Women nine months’ pregnant had their babies taken out. I saw many girls crying. I heard their screams as they waited for their turn to go into the tent, and I saw the growing pile of fetuses build outside the tent, which smelled horrible. I saw this in two villages. I arrived in my own village too late. The birth-control team had already been there.”

As a physician I believe that a woman has the right to choose if she wants to have an abortion. Such forced abortions and sterilizations were an outrageous breach of human conduct. What Tashi described was a mass sterilization that seemed designed to control the Tibetan population.

“The mobile birth-control teams were initiated in 1982.” Tashi continued. “Since 1987 there has been an increase in the number and frequency of the teams that move to remote towns and nomad areas. The mobile birth-control teams do not do abortions and sterilizations on Chinese women. Few Chinese live in these areas. Many Tibetans have been shamed by what has happened. All of the Tibetans in Amdo are talking about this. We are outraged that China is trying to end the Tibetan race. At the same time, we are helpless to prevent it.”

It took John and me one year to get our report of torture in Tibet published. We had wanted to include information about family planning, but we had not gotten enough firsthand accounts of abortion and sterilization. We had recorded eight firsthand accounts of torture. This was not a large enough number to provide a comprehensive accounting of Chinese prisons in Tibet, but it established that Tibetan political prisoners are routinely tortured, a point China had previously denied.

We sent a draft of our report to Physicians for Human Rights, a Boston-based group that had already published reports on human rights abuses in Chile, Czechoslovakia, Iraq, Israel, Kenya, Panama, and the Republic of Korea. After sending the manuscript to their external readers and board of directors, PHR published The Suppression of a People: Accounts of Torture and Imprisonment in Tibet in November of 1989.

The Dalai Lama received the Nobel Peace Prize that same month. Suddenly the world press exhibited a new concern for Tibet. The Dalai Lama’s extensive travels and speaking around the world increased awareness of the cultural genocide being committed in Tibet. It also made me realize that the torture and imprisonment of Tibetans was generally acknowledged by human rights organizations and the United Nations, as it was by the governments of more than a hundred countries around the world. At the same time these institutions seemed inured to the issue of torture. The issue of forced abortions and sterilizations, which I was determined to explore further, was potentially much more powerful; it was still very poorly documented.

I developed a questionnaire on family planning with help from Rinchen Kandala, the head of the Tibetan Women’s Association in Dharamsala. Mrs. Kandala volunteered to find and interview women. Nevertheless, the project had to be postponed for a year. The two years since I had graduated from medical school had slipped away; if I did not do my internship, I would not be able to get my license to practice medicine.

I chose Saint Vincent’s Hospital in New York City’s Greenwich Village at which to do my internship, because it offered one of the few programs in the country that trained general practitioners with rotations in obstetrics, pediatrics, psychiatry, surgery, internal medicine, radiology, cardiology, intensive care units, and the emergency room. I also liked the nuns who ran the hospital, and appreciated their mission to serve the poor and the indigent.

During my internship I worked a hundred hours a week, with thirty-six-hour shifts every second to fourth night, for one year. Even when I was exhausted I still felt grateful for the times I could get away. I loved staying up all night in the emergency room surrounded by life-saving technology and highly skilled personnel. I learned to appreciate the nuns even more, especially when they let me do an extra month of trauma surgery. Nowhere is Western medicine as intense as it is in the resuscitation of people with multiple trauma. Although I was impressed with our incredible array of medical technology, I never forgot the Tibetans, whose health-care needs were more basic: freedom.

After my internship, I started to work part-time at a walk-in clinic that provided primary care to eastern Long Islanders. I was determined to revise my nonfiction account of traveling to Tibet (which eventually became this book) and to investigate China’s family-planning policy in Tibet.

In December of 1990, the Dalai Lama gave the Kalachakra initiation at Sarnath, Northern India, where the Buddha gave his first sermon after his enlightenment in 600 B.C. Kalachakra is system of meditation that Tibetan Buddhists call the “wheel of time.” Historically, the Dalai Lama confers the initiation for this practice only a few times during the course of his life, usually during periods of great strife. Tenzin Gyatso, the Fourteenth Dalai Lama, has already given more than twenty Kalachakra initiations.

A quarter of a million Tibetans came to Bodh Gaya, the site of the Buddha’s enlightenment, when the Dalai Lama gave the teachings there in 1985. In 1990, only 2,000 Tibetans from Tibet managed to evade Chinese border patrols in order to attend. Sarnath, nevertheless, was overwhelmed when more than 100,000 Tibetan refugees arrived from settlements in India and Nepal. For lay Tibetans and monks the Kalachakra was an opportunity to see a living god. For me, it was an opportunity to interview recent arrivals on China’s family-planning policy in Tibet.

Traveling overland on a low budget meant that I could not afford to pay a translator. Then I met a boy named Tenzin on the train to Varanasi, the nearest city. He was a shy eighteen-year-old, a recent graduate of the Tibetan Children’s Village in Dharamsala, who volunteered his services when he found out that I was going to interview women about China’s family planning in Tibet. He turned as red as the betel nut juice the Indian men spit on the floor when I wrote down a list of relevant medical terms he would need to use. “Personally,” Tenzin told me, “I am not knowing the vagina.”

Tenzin turned out to be an excellent translator. Because he had grown up in Lhasa, he spoke fluent Tibetan and Chinese. As an exile, he learned English at the Tibetan Children’s Village. His mother worked for the Tibetan Women’s Association, and she let us sleep outside her temporary office at the monastery in Sarnath.

Tenzin and I went to the new arrivals’ camp twice a day for two weeks. Our first visit proved to be a good orientation. We found the reception committee inside the registration tent. Wearing coats and ties, they were easy to distinguish among the horde of new arrivals who were ecstatic to have made it to India. Namgyal, the head of the committee, offered to screen all women for firsthand knowledge of China’s family-planning policy. He also led us to a women’s tent, where twenty-eight women shied away from us when we entered. Namgyal introduced us to a woman with dozens of well-scratched bites on her face, arms, and bare feet beneath her soiled chuba. He announced that it was her duty to tell us if she had ever experienced abortion or sterilization.

The woman demanded to see our identification and her friends started yelling at Namgyal. Tenzin explained that the woman wanted to return to her family and that she was afraid to talk with us: if any Chinese “spies” saw us together, she and her family would be in danger. I sensed that she wanted to talk with us, but that her friends clearly did not.

“Perhaps tomorrow,” Namgyal said.

Tenzin started walking back to the monastery. He complained that the reception officers were not working hard enough and said that he wanted to see if his friends from school had arrived. I said that we would get our best interviews on our own and likened the process to a hunt. Tenzin liked this metaphor. He said hello to the monks we passed and stopped to help a man draw a bucket of water from a well. At the end of a row of army tents we passed a couple boiling tea. The woman was obviously pregnant. Within minutes we were drinking tea and hearing at length about the Nepalese police who had extracted bribes at eight different checkpoints.

” Yangzum was five months’ pregnant when she went to the hospital for a checkup,” Tenzin translated. “The Chinese doctor told her to have an injection to kill her baby. Yangzum refused. “The hospital does not have the authority to force me to have an abortion,’ she told them. She went home and escaped before the police could bring her back to the hospital.”

Tenzin’s mother found a Tibetan woman, Dolma, who was an obstetrician from Amdo and had undergone an abortion herself. Because Dr. Dolma had been educated in Chinese and worked in a Chinese hospital, she spoke Chinese better than Tibetan. Tenzin conducted her interview in Chinese. When Dr. Dolma became pregnant for the second time the head of her hospital told her to have an abortion or lose her job. She had the abortion.

She described her abortion in medical detail: the dilation of her cervix; the insertion of the curette; the scraping of her uterus; the fetal parts clogging the suction tube. The doctor who performed her abortion was Chinese. No medicines were prescribed for her because she did not experience any complications other than back pain for one month. She returned to work the next day.

Tenzin was in tears. He had never heard of these things before, and his weeping clearly embarrassed him. At this moment I realized how much my medical training had changed me. Just like Dr. Dolma herself, I was distant from her pain. I had to be in order to treat critically injured and sick people.

Besides the D&C abortion, which was virtually identical to the technique used in the West, Dr. Dolma said that women from four to nine months’ pregnant were sometimes given an injection directly into their abdomen to induce abortion. During the five years that she had worked at the Chinese hospital, she said that she had seen 1,600 abortions by D&C, 400 by injection, and 800 sterilizations.

Tenzin laughed unexpectedly as he translated Dr. Dolma’s account of how the doctor performing a sterilization makes a small cut in a woman’s stomach. Dr. Dolma gave him a stern look. “They make a bigger cut if the woman is fat,” he said. It took longer for Tenzin to learn the medical terms for sterilization than it took Dr. Dolma to perform such an operation: fifteen minutes. When I asked how the operation could be done so quickly, Dr. Dolma replied that everything was done under local anesthetic. This was painful, but the woman could walk home afterward.

Tenzin chopped vegetables for our dinner on the dirty cement floor while ama-la, as he called his mother, sat on the bed. Her feet were tired from going to each camp to make sure the Indian officials brought people water. Ama-la and grandmother-la let amchi-la (doctor), as they called me, sit on the bed and write my notes. “Varanasi was closed today,” ama-la said. “There were two murders in the student quarter last night. I tried to go to the Ganges this morning but it was impossible. There is a curfew after the sun goes down.”

The grandmother watched me writing in my journal. Even though she could not read English I still felt self-conscious. A cockroach scurried across the floor. Without thinking I raised my foot to crush the insect. The grandmother shrieked and jumped up and grabbed my leg before it could come down on this defenseless creature. Tenzin and his mother broke into hysterics as the grandmother berated me.

That night, lying on a bed of straw, I wrapped a sheet around my head to tune out the mosquitoes’ buzzing. A truckload of Ladakhis who arrived in the middle of night kept everyone at the Sarnath Monastery up with their yelling and screaming. Between the Ladakhis and the mosquitoes I was kept awake worrying that I would not get enough interviews. This fear proved to be unfounded.

As the time approached for the Dalai Lama to deliver the Kalachakra initiation, Tenzin lost his fear of talking to officials and asking women intimate questions about their reproductive anatomy. Busloads of jubilant refugees arrived every night. Although the majority of new arrivals were monks, and most left the camp after breakfast to see the sights in Sarnath, we easily obtained eight firsthand accounts from women who had experienced abortions and sterilizations. One woman who worked in a Chinese bookshop had been given two abortions because she had not waited three years after her first baby. Two women were sterilized after they delivered a healthy baby, only to see a nurse kill it with an injection in the soft spot on the forehead.

Some of the reasons women gave us as to why they were sterilized included not wanting to pay a fine, coming from a poor family, having to obey the Chinese rules, and having husbands who worked in Chinese cadres and were not allowed to have more than one child. Regardless of the reasons, the emotional toll this policy wreaked was reflected in increased numbers of divorces and families separating.

From my perspective, it was apparent that all of these women attributed their abortions and sterilizations to social, economic, and political sanctions against unauthorized children that were coercive in nature and existed on a pressure continuum. Regional variation accounted for differences in the amounts of fines, the numbers of children urban and rural families were allowed, and the length of time women who worked in a cadre had to wait between their first and second children. However, the individual accounts were similar in their details, and these accounts were drawn from women who came from throughout Tibet.

Many of the interviewees said their local Chinese officials were corrupt, and gave examples of Chinese women who paid bribes to get ration cards for extra children. Tibetans could also bribe officials, but most of them thought this was easier for the Chinese immigrants.

As with any investigation, questions led to more questions. All of the six Tibetans I interviewed who were from Amdo (northeastern Tibet) knew of or had seen mobile birth-control teams; the question now was whether these teams operated outside of Amdo. While all of the refugees said that Chinese hospitals had a dual system of health care, this was difficult to prove. Without an on-site investigation, it was impossible to discern how extensively China was implementing enforced family planning in rural Tibet.

A train with people sitting on its roof ran over an Indian beggar as it passed the new arrivals camp one morning. Tenzin and I saw the one-legged beggar hobbling toward the tracks on homemade crutches. He did not seem to be paying any attention to the oncoming train— but I never would have thought he would attempt to cross the tracks. The conductor did not slow down or blow the horn. The man did not make a sound as he flew through the air, landing with his arms and leg crumpled in unnatural positions.

Hundreds of people ran to him simultaneously, including a Tibetan doctor from the clinic. Massive lacerations covered the man’s head. Part of his upper lip and nose were gone. Both arms were twisted backward like chicken wings. The remaining leg was severed below the knee, except for a shred of muscle that held the calf to the thigh. I put a tourniquet on the leg, which would have to he amputated. The Tibetan doctor wrapped gauze around the deeper lacerations. Tenzin recruited a rickshaw and five Indian men climbed aboard with the mortally wounded man and drove off. The man would probably die on the way to the hospital. I felt guilty for not going with him, but I had urgent work at the new arrivals camp.

We had our busiest day ever. In addition to a firsthand account of a mobile birth-control team, which took women by force for abortions and sterilization, we interviewed one woman who had been sterilized after her second child, and another who had an abortion because she had not applied for permission to have a child. Two nuns from Chudson nunnery in Lhasa recounted in horrid detail how dogs bit them at Gutsa Prison in April of 1988. Tenzin and I took turns staring blankly out of the tent over the parched fields.

Then, as we were about to leave, one of the nuns told us that she had been gang-raped. Immediately after her release from Gutsa she had returned to her nunnery, but they refused to take her back. Five Chinese men were waiting for her when she left the nunnery at dusk. Two of the men held her down while the rest took turns raping her. They put her clothes over her eyes so she could not see them. She was afraid to tell the police because she feared they might send her back to prison.

The Dalai Lama’s arrival was postponed from 11:30 in the morning of December 20 until late that afternoon. By noon 100,000 people lined the streets from Sarnath to Varanasi. The Indian police beat the crowd back with bamboo lakhis to clear a passageway for the Dalai Lama’s entourage. People fought to glimpse His Holiness waving from inside his car. The Dalai Lama’s arrival meant the end of my work. All of the Tibetans would be at the Kalachakra during the day. At night everyone would want to eat and tend to their own needs.

Some day, I thought, I too would see the Kalachakra initiation, but first I had to finish my report on sterilization. I longed to return home to my family for the Christmas holidays. Dust hung in the air like fog, a product of the overcrowding and lack of rain. Every day more Tibetans needed more water, food, shelter, and latrines. The tiny hamlet of Sarnath had turned into a disaster area. Soon contaminated water would begin causing widespread hepatitis and dysentery.

The man at the Potala Tours travel agency booth in Sarnath said that all of the train seats to Delhi had been booked for weeks. With Tenzin’s help, I learned that indeed all of the seats had been booked, but also discovered that a fifty-rupee service charge could get me a second-class sleeper on the Super Deluxe train to Delhi that left at 8:00 that night. It would be a race to get back to the monastery for my things and then return to the Varanasi station for my train.

In the midst of my good-byes to Tenzin’s family, a heavy-set Tibetan man carrying bags of apples and bananas walked into the room. At first I did not recognize him, but it turned out to be Tsering, the Nepalese man I had treated in Lhasa who had been shot through the leg. He was thirty pounds heavier than when I had last seen him— we both were. I had not been able to do anything about the bullet that had torn through his leg, but my antibiotics had saved his life. His uncle had recognized me in the recent arrivals camp. His mother insisted that he bring us the fruit.

“You look younger,” Tsering said, and I repeated the same to him. He said that he had no residual problems with his leg and jogged regularly He also told me I had a place to stay in Kathmandu any time. Tsering recounted how he had spent three more months in Lhasa. “My sister filed a lawsuit against China for shooting me,” Tenzin said. “The court confiscated my passport. It took months for them to find that I had been hit by a stray bullet. I had to write an extensive self-criticism before they let me go,”

Just as I was leaving for the train station, Tica Broch was arriving from Switzerland. I recognized her from the hearing at the German Parliament where I had testified. Tica lobbied for Tibet at the United Nations and became excited about the prospect of my report on coerced abortion and sterilization.

“Everyone in Geneva has copies of John Ackerly’s report on the suppression of religion,” Tica said. “China threatened to pull out of the anti-Iraq coalition because of it. Just wait until they get wind of this sterilization report. If you can get it to me by February, it could make an international scene at the United Nations High Commission on Human Rights. Your article in the Washington Post on the mobile birth control teams in Amdo infuriated China. The United Nations refused China’s report on human rights in Tibet because of it.”

Tenzin gave me the gift of a kata as we ran first to the wrong end of the train, then all the way back to the front car as the train started moving. People fought to get on and push their luggage through the windows. The aisle was so crowded that it took me ten minutes to maneuver to my sleeping berth, where a family from Calcutta was already ensconced. Despite the derogatory remarks directed at me from every one in the compartment, I was invigorated to know that a man I had treated three years ago had lived, and that my article on human rights violations in Tibet had put pressure on China. Individual travelers can make a difference.