It's love at first sight: breathtaking Shey Phoksumdo Lake, wind-swept rocky crags, high passes where the Snow Leopards and Blue Sheep roam. The wonders of Dolpo never cease.

Walking across this remote district at altitudes above 5,000m, the climate and terrain are harsh and unforgiving. Travellers have died of altitude sickness and starvation. Few city folks are prepared for the hardships, even if the reward is the most spectacular scenery on earth.

Here at Komang, a 10-day walk west of Jomsom, the local Dolpalis are used to living without modern basic necessities. There is no electricity, no running water, no telephone services. People travel to the Tibetan border for supplies and bring them back in yak caravans. Their only tenuous link with the outside world is Radio Nepal, but it broadcasts in Nepali which the Dolpali cannot understand. The nearest health post with a doctor is several days walk away.

The modern health care system is virtually non-existent and the one thing that has kept the people here healthy is the indigenous medical knowledge of the Amchis, Buddhist lamas who practice an ancient herbal medical regime.

Sowa Rigpa, the Amchi art of healing rooted in Tibetan medicine, has existed since the Bonpo civilisation. The most experienced Amchi of Dolpo, Karma Lhundup, who lives in Komang, traces his lineage to King Trisong Detsen of 8th century Tibet. The Amchis of today owe the survival of their practice to this king who invited nine of the most knowledgeable Amchis from Nepal, India, China and Mongolia to incorporate their medical knowledge in Gyushi text, which remains a valuable source for Amchis even today.

Mustang and Dolpa used to be a part of the Bonpo kingdom of Zhang Zhung, and has the most Amchis. Dolpo alone has about 64, one in each village so people don't have to travel to distant health clinics. Amchis help to heal common ailments as well as fractures and other physical wounds in combination of physical and spiritual skills. Most of the sick who opt for a town hospital never make it there. Many consider the undertaking suicidal.

Despite the invaluable and free medical service, the government in faraway Kathmandu has never accorded the Amchi any recognition. In China, Amchis have been given national acceptance and their profession is institutionalised. Practitioners receive allopathic and Western medical training as well. Many are dentists and cataract surgeons.

"The government needs to recognise Amchi training schools as medical institutions, so that Amchis get certified as real doctors in remote mountain districts," says Amchi Gyatso, chairman of the Himalayan Amchi Association (HAA). Unlike modern medical courses, the Amchi system is hereditary and knowledge is passed down from one generation to another. Despite financial difficulties in the villages, Amchis take long journeys to treat the sick in their homes and spend considerable time collecting and processing plants into medicines. Senior Amchis train pre-teen apprentices into adulthood.

Amchis now want the Health Ministry to recognise their ability based not just on spiritual healing but technically proven medical skills. At present, the government concedes two branches of health studies: allopathic medicine and Ayurveda. Amchi medicine or Tibetan medicine is not integrated into health studies. "Amchis are not able to receive licenses or certificates like other health professionals even though they are the ones who actually stay in the villages and serve people for free," says Amchi Nyamgyal from Do Tarap.

Most of the time, government funds for health never reach some villages. The annual budget allocation of Rs 55,000 for Dolpo district never got there. "The number of Amchis is reducing due to financial difficulties, and people in the mountains have no one else to rely on for health care," says Amchi Tsampa Ngawang Gurung from Jomsom.

Lately, there has been an Amchi renaissance with exchange of knowledge between the Tibetan, India-based and Nepali Amchis.

The WWF and Department of National Parks & Wildlife Conservation (DNPWC) in Dolpo have worked with local Amchis here to identify, harvest and conserve medicinal plants. Amchis are now taking matters into their hands. They established the Himalayan Amchi Association in 1998 to motivate and encourage Amchis throughout the country. They also held the first Nepali Amchi conference recently to share knowledge, problems and health issues. The association organises refresher training courses every year to revive the knowledge and practice of professional Amchis. They are now working towards establishing traditional hospitals in each district and are planning to start a medical college in Kathmandu and await government approval.

Meanwhile, Amchi Karma of Komang is caught between providing for his eight-member family and the need to provide free medical service to his community. "Compassion is the first lesson that an Amchi possesses. My people depend on me and I will continue to do this till I die," he says simply.

The 55-year-old depends on his two young nephews and a niece to propagate Amchi knowledge. Sixteen-year-old Pema Bhuti is the only female undergoing Amchi training in Dolpo. She is well-versed in Chimagyud, the Amchi medical text, and adept with the techniques of pulse and urine analysis. Currently studying the identification and preparation of medicine, Pema looks up to her uncle as her role model and plans to become a fully accomplished Amchi one day.