Nancy Harris, MD, a California internist, has learned a lot of things during her 15 years of working in remote regions of Tibet. She’s learned how to connect on a human level with people from a vastly different culture. She’s learned to endure physical and emotional hardships few in our comfortable world could even imagine. She’s learned how to thread bureaucratic needles and finesse complex international politics to get comprehensive medical care to people in desperate need. She’s learned about the power of nutrition to transform lives.

Dr. Harris is director of the Terma Foundation, a non-profit medical outreach organization that brings nutrition-based medical care to poor, often displaced families in Tibet. Named for a set of ancient sacred wisdom texts, which, according to Tibetan legend, have been buried and await rediscovery, the Terma Foundation is a non-sectarian group committed to providing ongoing nutritional support and basic medical care to ethnic Tibetans living in the Tibetan Autonomous Region, governed by China.

In the communities where Dr. Harris works, the altitude is high, the climate is harsh and unforgiving, and the politics can be equally so. Malnutrition and infectious diseases, including tuberculosis, are all too common. Living and working there took her “way beyond my comfort zone,” she told Holistic Primary Care in an interview.

She chose to work in Tibet in 1990, after spending several months studying traditional Chinese medicine in Beijing. “I went to Tibet and became captivated by the place. I also saw that the people in Tibet were in a lot of trouble. The situation was unbelievably hard, but I felt that I had to do something. Because no one else will do this if we don’t.”

“Unfortunately, starving women and children are not on the top of the priority list for any governments or agencies. I feel that it is a medical imperative to take action. If we have the technology(simple, inexpensive things like multivitamins, antibiotics, worm medicines and basic human compassion(we cannot simply stand by and let an entire culture go extinct.”

Dr. Harris had a very conventional medical training, and when she began planning how to work in Tibet, her vision was shaped largely by an allopathic viewpoint. She envisioned bringing in all sorts of modern medical technology and state of the art drug therapies, all of which are virtually nonexistent in Tibet.

Once she began living on the steppes, though, she realized that what the people really needed was far more basic. “We found that under conditions of extreme stress, starvation and upheaval, what the people needed most was better nutrition. We started testing their blood, and we found that people were deficient in almost everything, especially the children.” She estimated that between 50% and 60% of children in Tibetan regions of China are in states of moderate to severe malnutrition.

“I realized that what we needed to do was not build big hospitals or bring in CT scanners, but bring in multivitamins, antibiotics, blood pressure cuffs, things that can form the foundations of village-based care. The idea is to keep the people out of hospitals, which are very, very poor in Tibet.”

Terma is a small organization, funded entirely through donations and grants, and it can move very quickly. In her experience, Dr. Harris has found that larger non-governmental organizations, with their massive bureaucracies and internecine politics, are seldom able to reach the remote villages where the medical need is greatest.

While Tibet has become something of a cause-celebre in the US and Europe in recent years, organized efforts are steered by and largely focused on Tibetan populations living in exile. Unfortunately, little of the attention and funding reaches Tibetans still living in Tibet because since the annexation by China, it is essentially illegal for Tibetans in exile to connect with those living in Tibet, and vice versa. “People in Tibet can go to jail for having any contact with Tibetans in exile.”

Following the Chinese occupation in the 1950s, Tibetans faced tremendous disruptions in their agricultural and dietary practices. “In the past, the Tibetans had a much broader and much healthier diet than they now do. They ate a lot of barley, which can grow well in Tibet’s fragile ecology, as well as dairy, meat and wild indigenous greens, which they gathered freely.”

During the 1960’s and ’70’s, all that changed drastically. “Many Tibetans were forced to grow wheat, a monocrop that depleted the soil. And they were suddenly faced with having to feed 100,000 occupying troops. They were unable to store foods, and because many were forced from their lands, they stopped foraging for the wild plants. Basically, many of them were left in a nutritionally depleted state, from which they’ve had difficulty recovering.”

Part of Terma’s approach is to look at what was adaptive about traditional Tibetan ways of life, and try to revive these practices. In relation to sanitation, agriculture, conservation of water and the land, much of what they used to do was really quite well adapted to the environment. So a lot of it is a matter of re-introducing old practices.”

Multivitamins are also a mainstay of Terma’s community based care. Through an affiliation with the Vitamin Angel Alliance (www.vitaminangel.org), a California-based natural products industry philanthropy dedicated to providing vitamins and nutritional supplements to poor, medically underserved and disaster-struck people worldwide, Terma has been able to funnel a steady stream of nutritional products to tens of thousands of Tibetan families.

“We’re giving multivitamins to just about everyone we treat,” said Dr. Harris. “It is a very smart thing to do. You can make a huge impact with multivitamins. It is the single most important intervention that we can make.”

Through better nutrition, the Terma team has been able to reverse rickets, blindness, goiter, neurodevelopmental problems, and also improve maternal and fetal survival during childbirth. “Right in front of our eyes, kids who were barely able to walk start to walk normally, and begin to flourish.”

In 2001, Terma’s work was the subject of an article in the New England Journal of Medicine. The article directly contradicted a long-held belief that Tibetans were inherently predisposed to short stature because of the extreme altitudes at which they live. “We showed that if you feed the kids three meals a day and give them vitamins, they grow as tall as any American kids.”

Dr. Harris believes conventional allopathic medicine has given short shrift to the importance of good nutrition. “In our training, nutrition is really not emphasized at all. Yet it can really change lives.”

Multivitamins can have a major impact in helping people fight off infectious disease. Dr. Harris told Holistic Primary Care that currently, a widespread epidemic of tuberculosis is sweeping the Tibetan countryside. Chinese public health officials and international aid groups deny the problem, but Dr. Harris said the dozens of coughing kids that show up in her clinics every week tell a different story. “We started testing our patients for TB, and something like 30% are showing drug-resistant strains.”

The TB problem is global in scale. As the world fixates on avian flu, TB is killing roughly 400 people worldwide every day.

“It only costs about $40 to cure TB per person. We’re talking about simple antibiotic courses along with comprehensive nutrition. Extinction of an entire culture from malnutrition is simply inexcusable. I can’t sit and allow that to happen, not on my watch.”

Terma’s work is a long-term effort, and the main focus is to try and establish self-sustaining community based primary care that is in synch with Tibetans’ culture. Dr. Harris endeavors to combine modern allopathic medicine with traditional Asian medicine whenever possible. “It is not about dismissing Western technology or allopathic medicine, it’s about using appropriate technology that really meets the needs of the people.”

One of the major lessons she’s learned over her years in Tibet is that the healing intention is far more important than the specific treatments. “No matter what modality we’re using, we’re only agents of something else. It is important to remember that.”

Part of Terma’s success in Tibet has to do with Dr. Harris’ guiding philosophy, which is to be, “an agent of relief, creating a chain of healing. We didn’t come in there as colonialist doctors with big egos telling them what to do.”

The flow of healing clearly flows both ways. “The people there really give back to me so much. They’ve taught me how one can walk with dignity, even though some may try to strip one of it and try to reduce one to walking in rags.”

To learn more about Terma and to support its efforts, visit www.terma.org.