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No. 4, 2008

TB Education and Training Network Updates

Cultural Competency Update: Resources on Ethnic Nepalese Refugees from Bhutan

Summary of Bhutanese Refugee Background and Demographics
Nepal and Bhutan are small, neighboring countries lying between China and India. Despite their proximity, they are divided by cultural, linguistic, and religious differences; Nepal is predominantly Hindu, while Bhutan is a Buddhist kingdom.  For 16 years, up to 100,000 Bhutanese have been living in refugee camps in Nepal. They are descendants of ethnic Nepalese who migrated to southern Bhutan around 1900 to find farm land. These ethnic Nepalese, known in Bhutan as the Lhotsampas, are a minority in Bhutan, but have increased in numbers and influence over time. In the 1980s, the Bhutanese government redefined citizenship so that most Lhotsampas were excluded due to ethnicity, language, and religion. Thousands of Lhotsampas were expelled from Bhutan; the majority fled to Nepal, with most arriving between 1990 and 1995.  The U.S. Department of State agreed to accept at least 60,000 refugees from Bhutan over the next 5 years.

Nepali is the first or second language of the Bhutanese refugees, although some speak Dzongkha (the language of indigenous Bhutanese, written with Tibetan script).  About 35% have a functional knowledge of English (day-to-day tasks).  Some refugees are literate in Nepali, Dzongkha, or English, with women having about 30% literacy and men about 60%.

Religious practices vary, with about 60% Hindu, 27% Buddhist, 10% Kirat (an indigenous animist religion), and 1%-7% Christian.  Some people may have more than one religious practice.

Bhutanese refugees are grouped into castes (similar to South Indian castes), as they were in Nepal.  They live in extended families; for example, an adult son would live in his parent’s household with his wife and unmarried children. There is some polygamy and also arranged marriage—mostly within same caste—and early marriage.

Bhutanese Refugees in Nepal—Background Documents
1. Bhutanese Refugees in Nepal—Anticipating the Impact of Resettlement .  Susan Banki. June 2008.

2. Bhutanese Refugees in Nepal , produced by the Cultural Orientation Resource Center (COR) of the Center for Applied Linguistics (CAL). 2007

3. Bhutanese Refugees in Nepal, Supplement. COR/CAL. Important information about caste considerations.  2 pages, January 2008.

4. Bhutanese in Nepal, PowerPoint presentation by the UNHCR.

5. Map of Eastern Nepal and Bhutan, showing the Bhutanese refugee camps , UNHCR.

6. Bhutanese Community Profile , Commonwealth of Australia, Department of Immigration and Citizenship, June 2007.

7. A New Life for Refugees from Bhutan.  Video, can be watched online. UNHCR, 2008.

8. Adjusting to American Way of Life: Tips for Visitors, Students and Immigrants from Nepal .  Bal Krishna Sharma, Ph.D. and Anita Adhikary, Association of Nepalese in Midwest America, 2001.

9. Nepal and Bhutan: country studies. Federal Research Division, Library of Congress; edited by Andrea Matles Savada.  Washington, D.C.: Headquarters, Dept. of the Army, G.P.O., 1993.

10. Bhutanese Refugees—Highlighted Resources . BRYCES (Bridging Refugee Youth & Children’s Services). July 2008.

TB and Health among Bhutanese Refugees in Nepal

1. High Success Rate of TB Treatment of Bhutanese Refugees in Nepal, IJTLD 2007.

2. Malnutrition and Micronutrient Deficiencies Among Bhutanese Refugee Children—Nepal, 2007.  MMWR, April 11, 2008 / 57(14);370-373.

3. Refugee Health in Nepal: Joint UNHCR-WHO evaluation of health and health programmes in Bhutanese refugee camps in Nepal, 2005. 

TB Health Education Materials in Nepali

Pictures Promoting DOTS in Nepal (Nepali)

Tuberculosis brochure. Nepal Ministry of Health. Click on Publications / Health IEC Materials / Brochure / Tuberculosis.

—Submitted by Stephanie S. Spencer, M.A.
Program Liaison, TB Control Branch
CA Department of Public Health


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