These changes negatively impacted the Lhotsampa people, because they did not wear the same traditional dress, practice the same religion, or speak the same language as the northern Bhutanese.

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Topics discussed included experience with traditional and Western medicine in Bhutan, in the refugee camps in Nepal, and in the USA, as well as common cultural beliefs and practices, particularly as they affect attitudes toward health, health care, and medical providers.

Additional and background information was obtained from the websites of Human Rights Watch, Amnesty International, and the Center for Applied Linguistics, as well as the official government website of the Kingdom of Bhutan.

The Nepali-speaking Bhutanese, also called (“People of the south”), are Bhutanese citizens of Nepali origin, a large number of whom are refugees from Bhutan.

The first report of Nepalese origin in Bhutan was around 1620 when Shamdrung Ngawong Namgyal (a Tibetan lama who unified Bhutan) commissioned a few Newar craftsmen from the Kathmandu Valley in Nepal to make a silver Century.

People from Nepal were invited to populate the lowlands of southern Bhutan in the mid- to late- nineteenth and early twentieth centuries.

Contact between the Druks (Bhutanese) in the north and the Nepali-speaking Bhutanese (Lhotsampas) in the south was limited.

Despite living in Bhutan for up to five generations, the Lhotsampas retained their highly distinctive Nepali language, culture, and religion.

However, they did participate in public life and politics, even attaining positions of significant leadership.

The Lhotsampas coexisted peacefully with other ethnic groups in Bhutan until the mid 1980s, when Bhutan’s king and the ruling Druk majority became worried that the growing Lhotsampa population could threaten the majority position and the traditional Buddhist culture of the Druk Bhutanese.