Dr. Tsering Norboo was born on 16th April 1944 in the beautiful village of Spituk. After completing his schooling from Leh, he did FSc. from Sri Pratap College Srinagar in 1962 and MBBS from Medical College Srinagar (1962-1967). From 1969 till 1972, he served as a Medical Officer in many villages of Ladakh especially in Nyoma and Medical Officer District Hospital, Leh from 1972-1978.  After doing his MD (1978-1980) Dr. Norboo was appointed as a Physician Specialist in SNM Hospital Leh from 1980 to April 2002.

Presently he is Founder member and Hony Secretary Ladakh Institute for Prevention for the study of Environmental, occupational, lifestyle-related and High Altitude disease and Consultant Physician Mahabodhi Karuna Charitable Hospital Choglamsar. Currently is on the expert review committee of DRDO (DIPAS) in high altitude studies; was a member of the expert committee panel of Government of India, Ministry of Health to impart training to medical officers attending Shri Amarnath Yatra 2013. He is a life member of the Association of Physicians of India, Indian chest society and an associate member of the International society of mountain medicine and physiology and Indian Mountaineering Foundation.

Q. Tell us something about your journey and achievements from your student life till you became a specialist.

I lost my father (Ishey Paldan) when I was just 10 years old. He was a famous teacher of that time and a very talented person. Though I lost him at a very young age but he played his role well as every father does in the life of a child. My father taught me to be strong, pursue learning and struggle without despair in life. As poverty was the centre at that time so like every other student I didn’t get much financial support.

I was an average, easy going and fun loving kind of a person who never took life seriously. Somehow, had a keen interest and always used to participate in Co-curricular activities like sports and debates etc.  Admission in MBBS was not by choice but by chance, I somehow fell into it. But that was a turning point in my life; I had to leave all my extra activities and devote myself in studies because medicine is a very serious subject.

Q. Why did you choose Physician as your specialization?

Physician (Internal medicine) was the most sought-after specialty during those times and there is a vast scope that opens the door for new opportunities. After MBBS I had no plans of doing MD but due to frequent postings in the far-flung areas, I thought of doing Post-graduation in one of the disciplines of medicine and joined as the first Ladakhi Physician in SNM Hospital in 1980. When I joined as a Physician, I felt that the idea of the health of the individual and health of the community needs to get bounded and noticed that 60% of the patients in the medical ward were suffering from Respiratory Diseases. Since I was born in the same area, it was easy for me to come out with a hypothesis on this disease. In this regard wrote a letter to International Labour Organisation (ILO) about my hypothesis that inhalation of respirable particles of environmental dust, and domestic air pollution (silicon dioxide and carbon particles) may be responsible for causing respiratory diseases in the Indus belt. The ILO in a nicely worded letter stated that since they have access to all the literature in the world on the subject, and nobody till then had reported such a thing in an open environment and therefore they did not take my hypothesis seriously.

Nevertheless, they sent me the literature I had asked for and advised me to work in collaboration with the National Institute of Occupational Health Ahmadabad. (NIOH Ahmadabad) an Indian council for medical research (ICMR wing). Dr. Keith Ball of London and Dr. SR Kamath of Mumbai who have done remarkable work in reducing pollution in London and Mumbai respectively supported my hypothesis. Our group did a very well designed environmental, epidemiological, radiological and histo-pathological study from 1986-1999 resulting in three publications in reputed international journals proving beyond doubt that mixed dust pneumoconiosis and silicosis can occur in a non-industrial set up in an open environment as well. This was indeed a path-breaking findings recognised internationally. The most important outcome of this study is the intervention that followed leading to a much cleaner air in home and work environment. It helped us to let the community realize the importance of avoiding passive smoking in any form.  Being the only physician in this remote district with no colleague or access to literature to consult in times of dealing with difficult cases in those days of poor communication, it was a very challenging job which demanded utmost dedication, hard work and clinical skill. Thinking retrospectively, such difficult situation was perhaps one of the reasons which made me to combine clinical medicine with community/preventive medicine.I am grateful to the community I served who had great confidence in my service and made my life worthwhile and interesting.  

Q.You are one of the founder members of ‘Ladakh Institute of Prevention’. Could you tell us about it?

Ladakh Institute of Prevention (LIP) is a research institute for the study of environmental, occupational, life style related and high altitude diseases. The main objectives of LIP are:

1.To promote and encourage changes to create clean and healthy home and work environment.
2.To lead the population in practicing “healthy lifestyle”.
3.To mitigate high altitude related health problems.
4.To establish state of the art laboratories to analyse and monitor air, water and noise pollution.
5.To conduct epidemiological studies to control non-communicable diseases including cancer.

LIP dreams of an institution where by doing basic science we will discover specific health and environment related problems; we  will  develop state of the art laboratories to facilitate diagnosis and management and we will deliver the benefit accrued from our activities to the population enabling them to enjoy improved quality of life and well being. I like to call it a “centre for lifelong learning”. Here we continue to probe, profess and practice evidence based medicine. The centre is open for anybody who wants to contribute to improve the health and environment of the high altitude natives and sojourners.

Q.What are the biggest health challenges that people of Ladakh are facing these days.

Life is fast changing in Ladakh like everywhere else and people are consuming unhealthy rich food, living sedentary life and spending disposable income on unhealthy habits that has resulted in many non-communicable diseases like hypertension, stroke, Heart Attack, depression, vehicular accidents, cancer and chronic respiratory diseases. Mother and child health problem is yet another issue that needs to be focussed in Ladakh and in this regard we are planning a mother and child examination system through well designed mother and child health care hand book whereby the health of the mother throughout pregnancy and 9 months post pregnancy and health of the child from 0-6 years will be recorded, monitored and treasured. This is being planned in consultation with District Health services (LAHDC,) the paediatricians and Gynaecologist’s expert panel.  Geriatric (old age problem) is becoming an area of concern as this population is on the increase due to increase in life span. We have already initiated a study to look into the cognitive and functional  disabilities of our elderly population that will guide us to plan timely intervention.

Q. Do you think that Ladakh has all the important and basic facilities in the hospital (SNM) for people? Do you think it could be better?

Things are improving particularly after the flash flood of 2010. The speed in different works and funds by the government has increased but the challenge is to bring those resources to optimum and best utility.  With all those equipment and infrastructure support, the quality of care, work culture and quality of services should improve and updating the knowledge of the health care workers and the facilities of the Hospital should be a continuous process. The doctors, nurses, Technical staff, ANM’s and above all the administration must keep themselves updated with the new developments in the field of medicine. “One of the virtues of medicine, in my view, is its self-critical nature” said Ludmerer at Washington University. Intrinsic dissatisfaction can lead to significant social good. One must therefore continue to evolve with ultimathete aim to improve qualitthe y of services.

Q. What is your contribution to applied research and public health intervention?

I set out with two aims for myself, one, to be a good clinician and others to contribute to the field of medicine/applied research. “As a founder member of Ladakh action on smoking and health (LASH), I played leading proactive role in reducing prevalence of tobacco smoking in Ladakhi men from 42% in 1988 to 8% in 2010. Initiated programme of Primary prevention of acute rheumatic fever in 1990’s which proved very effective in reducing prevalence of rheumatic heart disease that was the number one medical problem causing mortality until 1980’s”. However we cannot become complacent with this initial success. The department of health should ensure continuous proactive moment to keep the impact of the programme going. Educating the population for prevention of HIV, AIDS, Hepatitis B and hepatitis C are indeed very important in the present situation besides practice of healthy living to prevent Non-communicable diseases. At LIP, we have till date screened about 5000 subjects for Hepatitis B and motivated those with negative reports for vaccination and screened the spouse and children of those with HBsAg positive for further investigation and appropriate treatment. This is one of the intervention which can prevent cancer of the Liver and chronic liver disease. At LIP we have screened over 3000 rural subjects for Non-communicable disease, the data are being analysed and will be made available to health planners.

“Working on my Hypothesis, our group of investigators identified mixed dust Pneumoconiosis (Silicosis and coal worker’s type of pneumoconiosis) in the Indus Valley belt population. The work was published in the journal “Thorax” in 1991. This contribution is recognised worldwide in the occupational health discipline as well as in geo-medicine”.

My interest in the study of adaptation and mal-adaptation at high altitude has resulted in identifying chronic mountain sickness in the Himalayan population. The subject is of prime interest to high altitude researchers all over the world.   Presently we are trying to establish a state of art public health institute at Dambuchan, Leh Ladakh for studying environmental, occupational, life style and high altitude related diseases. Travelling with our small team and equipment to remote regions of Ladakh for doing health awareness campaign, screening for Non-communicable disease and cancer to facilitate timely treatment at appropriate referral centres and treating the disadvantaged section of the society for treatable conditions at their own places is another passion we desperately do at LIP. We continue to probe, profess and practice evidence based medicine. All these efforts have resulted in nearly 50 scientific papers (publications) which have found place in National and International Journals.  I have had the opportunity to read my papers in international conferences in places like New York university school of medicine; Tokyo women’s university; Post graduate institute of Exeter England, Third world congress on mountain medicine and physiology in Motsumoto Japan; Research Institute of Humanity and Nature Kyoto Japan, National Institute of occupational health Ahmadabad(NIOH), and International conference on environmental and occupational health in Lucknow besides many other conferences held in Leh and other parts of India.

Message to the readers

Working in a very coordinated and collaborative way, we should try to identify various health problems in Ladakh. Most of which I have already mentioned and develop objectives for developing result oriented projects.  Until and unless we do not recognise the root cause of the disease, we can’t prevent and treat them effectively. Social sectors like health and education that are the basics for development should get equal attention if not more from the authorities concerned with development and planning. Medicine involves knowledge itself and should be included among the autonomous prerogatives of the Doctor. However,  health care involves broader field of application of medical knowledge and is the appropriate domain of all professionals with an interest in public policy and of every person affected by public decision. Public and non-medical involvement in health care policy is a legitimate social action and not an illegitimate incursion with the realm of doctors.