Final proposal

Diet changes among Tibetan refugees in McLeod Ganj, India and how they perceive health

A Field Study Proposal

Statement of Intent

I want to study how the diet of Tibetan refugees in McLeod Ganj, India has changed since their translocation from Tibet. I also want to study how they perceive health and if diet is related to health.

I hope that through this field study experience I can gain a further understanding of a culture that is not my own. I believe that through this cultural immersion experience, I will gain a better understanding of Tibetan people by learning about their culture and traditions. I believe I will grow as a person and learn to love and accept people despite their culture.

Another thing I hope to gain from this experience is an advantage. I have to apply for an internship after I graduate from BYU and having a background of research may help me stand out from my peers. I will also have an advantage when I plan to apply for graduate schools.

Tibetan refugees have been living in McLeod Ganj for over 50 years. They are trying very hard to preserve their culture so it is not lost. However, often when populations move to a new geographic area and live in an area that is home to a different culture, their own culture can slowly diminish. This can be seen greatly as their traditional diet changes to include foods from the culture they are now living among. In most studies, the immigrants’ traditional diet changes to a more Western diet. A study in a rural Tibetan village even noted that the traditional Tibetan diet is changing to include more Western foods.

This is not going to be a scientific study. It very easily could be, but I won’t have the proper tools to conduct it as one. Instead I’m going to be asking more cultural questions. I plan on performing 20-30 informal interviews asking Tibetan refugees what kinds of foods they ate in Tibet and what kinds of foods they eat now in India. By doing this I’m hoping that I’ll learn if their diet has changed significantly and what has influenced the changes.

There are not many studies on the diet of Tibetan refugees and how it is changing. I hope that this study will provide some insight on this subject

Background and Significance and Literature Review

Tibet is a breathtaking plateau about 12,000 ft. above sea-level and is surrounded by mountains and full of valleys and some rivers. The people that live here are hardy from the overall cold and dry climate and many of them are nomads who raise livestock. Other populations in Tibet consist of monks, nuns, farmers, and people who live in towns or cities. (Grunfeld 1996 p. 7)

Because of the arid climate, not much vegetation commonly grows in Tibet. Farmers grow barley and some vegetables, mainly root vegetables such as potatoes and radishes. Nomads are a vital part of food production because they provide a lot of animal products, like milk, butter, yogurt, cheese, and meat. (Grunfeld 1996 p. 16) The farmers and nomads will trade their crops and animal products for goods made by people in towns and cities so everyone can get the food they need. According to Dickerson et al “…most food consumed in rural Tibet is produced locally and the staple Tibetan diet consists mainly of barley flour (Tibetan tsampa) and animal-source foods, especially milk, butter, cheese, yogurt and meat obtained from yak.” (Dickerson et al 2008 p. 234)

When China took control of Tibet in 1959, many Tibetans fled to surrounding countries and a great population found refuge in India. These Tibetans are in exile and are no longer able to return to their homeland. Since they are living in a different country, there are many different dietary options available to them. This can greatly affect their normal diets.

For instance, in Mcleod Ganj eating beef is culturally unacceptable because it is a Hindu state. Thus, Tibetans living there have to eat a different kind of meat instead, like goat. There are also many foods available in India that were not available in Tibet, such as more fresh fruits and vegetables. There is also a great influence to eat Indian food because there is an Indian population.

There is not much literature on the diet of Tibetans or Tibetan refugees; however I was able to find one study performed by Dickerson et al. Dickerson et al went to a rural Tibetan community called Kundro to investigate the traditional Tibetan diet and how it may be changing. I used this paper to understand the traditional Tibetan diet. I’m also planning on using some of their same methods in my field study.

Dickerson et al hypothesized that the Tibetan diet is being “westernized” in a rural Tibetan community called Kundro and that commercial foods are becoming more popular while locally produced foods are not. They also wanted to research the children’s food preferences. During their small study of three days, they interviewed 17 people and performed a 24-hr recall on each person. The participants were also asked where they obtained food and perceptions of their children’s diets (Dickerson et al 2008 p. 229-253)

Based on the 24-hr recalls, the researchers found that “seven unique food items: butter, salt, black tea, oil/fat, barley flour, wheat flour, and rice were consumed by half or more of subjects”. Black tea and salt were consumed by nearly all participants and butter and cereals were consumed by all. Only 12% reported consuming meat. The “western” foods reported being eaten were instant noodles, soft drinks, and sweetened snack items. (Dickerson et al 2008 p. 229-253)

When researchers analyzed where participants obtained their foods they found four main answers: crop-source (grown at home), greenhouse-source, animal-source, and store-source. All the households reported growing some of their own foods, mainly barley, potatoes, and rape seed (used for oil). Those with a greenhouse grew and enjoyed many vegetables, while those without a greenhouse were envious. Livestock was also a very important component of their household because they provide animal-source foods, such as yak milk which can be processed into butter, yogurt, and cheese. Some households raised chickens and sold and consumed the eggs. Meat is consumed during the winter months and not consumed as much during the summer months. Foods found in stores included rice, vegetables, wheat, and salt. A great deal of processed foods and drinks were also found in stores. (Dickerson et al 2008 p. 229-253)

When participants were asked about the perceptions of the changes in their diet and their children’s diets many people reported differences. One thing they reported heavily was the fact that when they were young they ate a lot of tsampa, butter, and meat and now their children love instant noodles and Pepsi. However, most of the adult reported that they didn’t like instant noodles and soft drinks and they thought they were unhealthy. (Dickerson et al 2008 p. 229-253)

This study found that the dietary intake of these participants in rural Tibet has improved over the years because there was more variety of foods available. The “western” foods, such as processed sweetened treats, soft drinks, and instant noodles are especially popular among younger Tibetans. They also found that their intake overall was inadequate and methods should be taken to improve dietary diversity. (Dickerson et al 2008 p. 229-253)

From this study, I learned some very important methods of research, such as the 24-hr recall. Along with the 24-hr recall, I learned that it’s important to code my notes of the interviews. With these codes I can find patterns that can help me with my research. I also researched other studies looking for more methods.

Although no studies have evaluated how Tibetan diets have changed as they’ve become refugees in India, many studies have focused on immigrant populations that have moved to other countries, such as the United States, Australia, and Spain. These studies have focused on a change to a more Western diet and how this change has increased the susceptibility of the immigrants to chronic disease. Examples of these diseases are heart disease, type II diabetes, and cancer, all of which have been shown to be affected by a diet high in fat and protein (a Western diet).

One study in particular focused on African refugees settled in Australia and researched their dietary habits. They found that the first year of living in Australia was crucial for the refugees to find grocery stores near them that held food that was familiar to them. The researchers also found that the refugees ate these foods that they were familiar with, but they also ate “extra” foods. Most of these “extra” foods were eaten outside of the home and not inside the home. These refugees were still not eating their recommended levels of nutrients, even though they had plenty of access to them. The researchers concluded that the refugees were at a risk to develop unhealthy habits “…of sedentee Australian dietary patterns, because of their previous nutritional experiences and because of the likelihood of cohabitation with low SES groups and consequent unfavourable dietary habits” (Pereira et al 2009 p. 934-941).

This study is one of many that show that immigrant populations are at risk for developing unhealthy dietary habits. Immigrant populations in Western countries over time adopt Western foods into their diets. With the adoption of Western foods comes the risk for developing chronic diseases that are more prevalent in Western countries, such as type II diabetes and heart disease. By studying how the immigrant populations’ diets are changing, perhaps trends can be found that will prevent them from adopting this Western diet. Maybe if the immigrant populations’ views on health are understood, they can be taught other healthy practices that will prevent them from adopting a Western diet and Western diseases

In the United States, health is viewed as something very tangible. We need to have a BMI between 18.5 and 24.9, our cholesterol should be below 200 mg/dL and our blood pressure should be 120/80 mmHg. We need to eat according to the food guide pyramid, which can be tailored to our specific needs based on our height, weight, age, and activity level. We should also exercise 30-60 minutes 3-5 times a week. By doing all this we can be “healthy” and decrease our risks for cancer, heart disease, type II diabetes, and other chronic diseases.

What do Tibetans view as “healthy”? Do they have values for their cholesterol and blood pressure? Do they have a food guide pyramid? Do they have certain foods they eat/don’t eat in order to be “healthy”? These are all things I’m interested in exploring through my study.

As Tibetans are now living in India, it is natural that their diet is changing. Studies have found that not only is the traditional diet in Tibet changing, but diets of immigrant populations in Western countries are changing. These changes are in the direction of a more Western diet. With the adoption of a Western diet, Western diseases are accompanying them, such as type II diabetes and heart disease. Perhaps if we can understand immigrant populations’ original views on health, we will be able to teach them new nutritionally healthy practices they can use to combat these changes and diseases.

Methodology

Plan for Entry

I plan on entering the community by living with a host family. This host family will be set up for me by our field facilitator and they are who I will be living with during the 90 days I’m in India. I hope they will be a great resource for me to learn from and that they can introduce me to other people who can help me with my study.

There is the Tibetan Women’s Association that I would like to volunteer at. After I’ve been in McLeod Ganj a few days to a week I will go to their office and ask if I could volunteer in their office. I will do whatever they would like me to, such as cleaning their facility or serving at a social function they’re holding. I hope that by volunteering there I will be able to get to know more people in the community. This possible exposure could offer a lot of opportunities and contacts for my study, perhaps the women I volunteer for will agree to participate in my study or know someone who will. I chose the Women’s Association because it seemed like an easy and effective way to offer service to the community. I think that by serving their community the Tibetan people will accept me better.

I plan to meet people by going to the local stores and buying things there so the local people see me. I plan to build rapport with storekeepers by asking questions about foods that are unfamiliar to me. I hope they will answer my questions and we will form a formal friendship in which we can both feel comfortable exchanging information. Perhaps then the storekeepers can introduce me to other people in the community who can help me with my research.

Description of Informants

I will focus on subjects 18 and older, both male and female, who are Tibetan refugees living in McLeod Ganj. I will focus mainly on refugees who were born in Tibet and have lived in India for at least 5 years. I am focusing on these individuals because they have lived in both Tibet and India and know what foods are eaten in Tibet and what foods are available to them in India. Many of these subjects may be elderly, but not all because people are emigrating from Tibet all the time. These subjects are daughters, sons, mothers, fathers, grandmothers, grandfathers, etc. who buy their food from stores and markets and cook in their homes.

Plan for Sampling and Recruitment

I want to start talking to store keepers and simply ask questions about different products. I will also volunteer at the Tibetan Women’s Association. Hopefully, I can be introduced to people who can help me with my research. I want to build relationships with these people and through them meet more people.

Description of Method

I plan to conduct informal interviews with 20-30 people. In these interviews I will ask people what kinds of food they ate while they lived in Tibet. I will have them free list as many foods as they can think of while giving descriptions of more complicated foods. I will ask questions about the food they eat now in India. For a more detailed list of questions, see appendix A.

I will conduct a 24-hr dietary recall, which consists of me asking people what they’ve eaten on the previous day. I will ask them questions about breakfast, lunch, dinner, and snacks, including questions on what they ate and how much of each food they ate. I have conducted many of these for class assignments, so I know how to ask people about their day in order to find out what they’ve eaten.

In these informal interviews I will also ask what they believe makes a person “healthy”. I will also ask them what foods they view as “healthy” versus “unhealthy” and what makes these foods good or bad.

I will also perform some mapping activities. This includes asking the subjects to list where they obtain their food. This will allow me to see what stores/markets and restaurants are most popular among the Tibetan refugees. I will also map the town specifically showing the marketplaces and restaurants. I will write a concise list of what foods are available at each store/market and restaurant in order to see what foods are available and what foods are most prevalent in the community. By mapping the stores/markets and restaurants in the community I will be able to see the variety of foods available to the Tibetan refugees.

Ideally, after I interview a subject and interact with them in the community I will ask them if I could participate in a future meal. By participation I mean that I would like to be a part of the meal planning, shopping for the food, cooking the meal, and ultimately eating with them. I would really experience their food as a culture if I could be a part of this whole meal experience. I understand that this is a lot to ask, so I will only do this with subjects with whom I have built strong relationships and feel comfortable asking this much of. I am not making these relationships in the explicit purpose of trying to participate in a meal with them, but hopefully participating in a meal with them will be one advantage of our relationship. I will offer to buy the ingredients for the meal or offer to cook something for them in return.

By performing all these different research methods, I hope to find patterns. Patterns in what people tell me what they ate in Tibet and patterns in what they tell me they eat in India. Hopefully these patterns will point me in a rather distinctive direction of how the Tibetan diet has changed. I also hope the direction will also roughly show me how most Tibetans view health.

Ethics

I will record my notes in a notebook that I will carry with me most of the time and lock in my suitcase the rest of the time. In this notebook I will jot observations I have while performing interviews and interacting in the community. I will also use the jottings to write more expanded notes if I feel I need more explanation on a certain subject or situation. The audio tapes will be locked in the suitcase at all times. All personal identifiers will be changed. After the study the notebook and audio tapes will be stored in a locked locker that only I will have access to. After December 2011 all hard copies and audio recordings will be destroyed.

I will obtain consent by having a consent form written in Tibetan and English that they can read and sign. If subjects are unable to read the consent form I will read it out loud to them and then have them sign it.

There are minimal risks to the participants involved in this study. There will not be any benefits to the subjects of the study. As far as benefits to society, it is hoped that this will provide information about Tibetan refugees’ diet. It may help other students or researchers who are also interested in this subject.

I don’t plan on compensating any subject of this study, but I will establish proper reciprocity by showing proper respect for the Tibetans I interact with and hopefully becoming friends with them.

Preliminary Plans for Post-field Application

I plan on taking a post-field writing course in order to write all my research into a proper paper that will hopefully be published in the BYU Inquiry Journal. I may present in the Inquiry Conference.

I hope that by doing this research I will have an advantage when applying to internships and graduate schools. I will be able to show interviewers that I have experience performing my own research. This will be especially helpful if I apply to a graduate program focused on research, in nutrition or anthropological areas.

Qualifications and Limitations

I am a junior in the dietetics program at Brigham Young University. I have been taught to properly analyze diets in my dietetics classes, specifically Beginning Nutrition, Nutrient Metabolism, Clinical Nutrition I and II, and Nutrition through the Life Cycle. I have learned how to conduct a 24-hr recall and analyze it to see if people are meeting nutrient requirements. If they are not meeting these requirements, I know how to plan meals for them so that they can meet them. I know how to talk with someone about what they’ve eaten in one day in order to find out everything they’ve eaten. I am able to follow along when someone is describing a recipe and understand the descriptions of methods in order to recreate a recipe on my own.

I am limited in the fact that I do not have an anthropology background. I haven’t studied cultures and what forms them, what changes them, etc. I do not understand all the ethnographic research tactics, although I am trying to learn what I can about them.

Another limitation is the fact that I am a 21 year old American female. Tibetan refugees may not feel completely comfortable around me. They may not want to talk to me about what they eat and they may not want to share recipes with me. I understand that I will not fit in, despite how much I want to.

Faculty Mentors and Coursework

Primary Faculty Mentor

Dr. Rickelle Richards is a professor in the Nutrition, Dietetics, and Food Science department of the College of Life Sciences. She has a BS in Nutritional Science from Utah State University, a Masters of Public Health from Tulane University, and a PhD and her Registered Dietitian’s degree from the University of Minnesota. Her research focuses on low-income populations and their food choices, access, intake and health.

Course Contracts

I will be taking the Field Studies Required Course (IAS 201R) with the help of Ashley Tolman. This course will help me focus on my field work better. I will also be taking NDFS 494R, which is research credit in the Nutrition, Dietetics, and Food Science. This course will help me learn to perform research tactics better. I will learning about different ethnographic research methods and I will be reading a book about Tibetan refugees, which will help me understand their situation better. I will also be taking Sociology of International Development (Soc 340) from Dr. Brown. This course will help me learn more about development and can help me apply new principles to my field study. The last class I will be taking is IAS 380R, Cultural Proofs. This course will help me get more immersed in the culture and build rapport with the community. This course will help me with my project because building rapport in the community will help me find people who will be willing to help me with my research.

Schedule

I will be using a weekly schedule:

  • Week 1: build rapport
  • Week 2: build rapport
  • Week 3: perform 2 interviews
  • Week 4: perform 2 interviews
  • Week 5: perform 4 interviews
  • Week 6: perform 4 interviews
  • Week 7: perform 4 interviews
  • Week 8: perform 4 interviews
  • Week 9: perform 4 interviews
  • Week 10: perform 4 interviews
  • Week 11: performing more interviews if I don’t have enough
  • Week 12: wrapping things up to get ready to come home

Budget

  • Paid Expenses
    • Airfare: $1600
    • HTH Travel Insurance: $120
    • Passport/Visa: $94
    • Vaccinations: $136
    • Application fee: $25
    • Acceptance fee: $100
    • Future Expenses
      • BYU tuition: roughly $2100
      • Living Expenses: estimated total $1000
      • In-country travel: estimated total $500

I will be using student loans to pay for my tuition, living expenses, and in-country travel.

Works Cited

Dickerson, T et al. From butter tea to Pepsi: A rapid appraisal of food preferences, procurement sources, and dietary diversity in a contemporary Tibetan township. Ecology of Food and Nutrition. 2008;47(3):229-253.

Grunfeld, A. The Making of Modern Tibet: revised edition. United States of America: M. E. Sharpe, Inc; 1996.

Pereira, Carolina A.N. Larder, Nicolette. Somerset, Shawn. Food acquisition habits in a group of Afrian refugees recently settled in Australia. Health & Place. 16 (2010) 934-941.

Appendix A– Questionnaires, Surveys, Instruments, Interview questions, etc.

Interview questions

1)      Can you tell me a list of foods you ate while you lived in Tibet?

2)      What foods did you eat specifically for ceremonies?

3)      Where did you find those foods?

4)      Can you tell me a list of foods you eat now living in India?

5)      What foods do you eat specifically for ceremonies?

6)      Where do you find these foods?

7)      Do you enjoy Indian food or Tibetan food more?

8)      Which kind of food do you cook most often in your home?

9)      Do you have children? If yes, ask question 10, if no, skip question 10

10)  Do your children’s food preferences affect what kinds of food you make/eat in your home?

11)  What do you think it means to be “healthy”?

12)  What kinds of foods are healthier than others?

13)  Are there foods that can help you when you’re sick?

14)  Are there foods that can make you sick?


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