Mainstreaming Marginality

This article examines the “mainstreaming” of Sowa Rigpa (Tibetan medicine) into primary healthcare in Ladakh, Himalayan India. It explores fields largely overlooked by existing studies of medical integration, such as the social dynamics of public health facilities, the effects of limited drug supplies, and changes in medicine production. Although Sowa Rigpa practitioners experience aspects of their integration as positive, it is also forcing approaches toward prescription practice, patient care, and pharmaceutical production that are at odds with their clinical, social, ethical, and practical grounding. The article argues that integration is exacerbating existing inequalities while creating new forms of hardship and marginality. However, paradoxically, only by occupying such marginal spaces can the amchi continue practicing Sowa Rigpa in a recognizable form. The article later reflects on what the Ladakhi case tells us about the Indian government’s policy of “rational integration” and contributes to debates concerning subaltern therapeutic modes and medical pluralism.