Donna Caplan, top second from left, has been teaching midwifery skills to this group of women in Tibet Photo: Courtesy Photo

Millennia-old Egyptian hieroglyphs depict midwives assisting mothers in the birthing process.

The book of Exodus ascribes sacred value to obstetrics, proclaiming "God dealt well with the midwives: and the people multiplied, and waxed very mighty."

The art of midwifery dates to the dawn of birth itself. But the oldest medical practice in the world never took root in the high mountain regions of Tibet, where discussion of women's bodies is rendered taboo by a strict patriarchy.

The absence of midwives or basic concepts of hygiene and sanitation in Tibet have combined for some of the world's highest child mortality rates. One in every six to 10 babies dies during birth, according to the World Health Organization; one in every 33 births result in the death of the mother.

Slowly, Donna Caplan is helping to reshape perceptions of midwifery in the country from which her personal spiritual beliefs have sprung. The practicing Tibetan Buddhist and naturopathic doctor has traveled twice to the isolated Asian enclave of Gargon, bringing with her a team of medical doctors and years of experience as a midwife.

"It's probably the most important problem facing the people there," says Caplan, who made her first trip to Tibet in 2004 after a conversation in 2003 with Buddhist mentor Garchen Rinpoche. "He told me of his concern with the high rates of women and babies dying in childbirth."

Caplan, a 43-year-old Wellesley, Mass., native, earned her B.S. in environmental studies from the University of Vermont. She later attended the National College of Naturopathic Medicine in Portland, Ore., where she earned a doctorate in naturopathic medicine and became certified in natural obstetrics.

"I decided to see what I could do to help," says Caplan, who started her own homeopathic clinic, Vermont Integrative Medicine, in Montpelier six years ago. She specializes in holistic obstetrics and has been practicing in Vermont since 1995. "I practice Tibetan Buddhism and have an interest in the culture. And since the interest stemmed from my conversation with Garchen Rinpoche, I went to his village, his monastery."

The remote village of Gargon rests among Himalayan peaks three miles above sea level. Average residents make about $30 a year and subsist almost entirely on roasted barley flour and yak milk.

Caplan witnessed firsthand the deplorable conditions under which women give birth during her first trip to Tibet in August 2004. Soon-to-be mothers endure labor alone and outside, often birthing infants onto yak dung-covered snow outside family tents. One Tibetan woman recalled severing her own baby's umbilical cord with a rock.

"I was very surprised," Caplan said. "They didn't seem to have any concept of midwifery whatsoever. What became apparent to me when we first got there was that childbirth and women's bodies are taboo. Women aren't very highly regarded in that country. They feel if someone is at the birth, that person will get contaminated. It's a cultural fear."

Less than a year later, Caplan returned to Gargon with a 10-member team of volunteer medical doctors, homeopaths, certified nurses and midwives. They slept on cots at the local school and set up a makeshift clinic at the local monastery. Residents of Gargon and neighboring villages flocked to the site for basic medical care. When not tending to the ailments of locals (they had 900 patient visits during the two-week trip), Caplan and her colleagues taught local women basic midwifery skills.

"At first they didn't want to talk. They were afraid to talk about it," Caplan said. "By the end of the two weeks, even teenage girls, who were very, very shy, were more open and knowledgeable about assisting in the birthing process."

Using baby dolls and a plastic snap-on placenta, Caplan versed women in birthing methods and sanitation. The medical team handed out birthing kits that included supplies as simple as a sanitary sheet of plastic used to protect the newborn from bacteria on the ground.

"Sepsis of the baby or the mother can be a problem. Infection is the number one killer worldwide," Caplan said. "Many times a huge difference can be made when someone is there to try to keep everything clean and encourage the mother. With these classes, we're not only trying to train midwives, but also teach the general population about proper hygiene and the importance of having a safe birth."

As perceptions change, so too are the experiences of new mothers. "You can't really change much in two weeks. What needs to happen is for the people to take what we're teaching, embrace it and pass it on," Caplan said. "That's happening. The women we worked with on the first trip remembered almost everything we taught and were passing it on to other women in the village."

Tibet's austere village life didn't dent Caplan's appreciation for the small country. She moved to Vermont in 1981 for its rural environment and friendly people, qualities she says Tibet shares with her adopted home state. Caplan is pursuing nonprofit status for her Gargon Healthcare Project and in the coming years plans to facilitate the construction of a basic medical clinic in Gargon. She and other health professionals are analyzing data and interviews with Gargon women to gauge which services and medicines the villagers will use most. At www.vermontintegrativemedicine.com., people can find links to information on how to donate to the project.

"When you look at community healthcare at the village level, it's so basic what's needed. We're not talking about X-ray machines and ultrasounds and MRIs," Caplan said. "You wouldn't be able to run the machines or find doctors who knew how to use them. We're talking about first aid. We're talking about soap."



Peter Hirschfeld is a Times Argus writer.