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“For complex surgical procedures, you’re generally better off at teaching hospitals, which usually stay at the forefront of health research. Medical students and residents ask questions, providing more eyes and ears to pay attention and prevent errors. Teaching hospitals have lower complication rates and better outcomes.” —Evan Levine, MD, a cardiologist and the author of What Your Doctor Can’t (or Won’t) Tell You.“Those freestanding ERs popping up all over? They typically don’t have anywhere near the resources of hospital ERs, yet they cost just as much. Go there for small bumps and bruises. For something serious (chest pain, a badly broken bone), get to a trauma center where specialists and surgeons work.” —James Pinckney, MD, an ER doctor, founder of Diamond Physicians in Dallas, Texas. Check out these other 50 secrets an ER staff won’t tell you.Epidural steroid injections for back pain has risky potential complications like neurological problems or paralysis. “Generally, epidural steroid injection isn’t very useful for treatment of chronic back or neck pain,” says Steven Severyn, MD, an anesthesiologist at the Ohio State University Wexner Medical Center.No unnecessary scans. Studies have shown that radiation from CT scans could be responsible for as many as two percent of all cancers in the U.S. “CT scans are much quicker and tend to be less costly than an MRI, but does have the added radiation that MRI’s lack,” says Todd Sontag, DO, a family medicine physician with Orlando Health.Practically all surgeons have an inherent financial conflict of interest. That’s because they are paid approximately ten times more money to perform surgery than to manage your problem conservatively.” —James Rickert, MD, an orthopedic surgeon in Bedford, Indiana.No-certified specialty. If an airline told you that their pilot is the best but he’s not FAA-certified, would you get on the plane? "For the same reason, always check if your surgeon is board-certified in his specialty. Many are not.” Tomas A. Salerno, MD, chief of cardiothoracic surgery at the University of Miami Miller School of MedicineSome surgeons won’t mention procedures they don’t know how to do. "I’ll see patients who were told they needed an open hysterectomy, even though it could be handled laparoscopically. That’s one reason it’s good to get a second opinion.” —Arnold Advincula, MDYears ago, a patient sent his slides to three different pathologists and got three different answers. "I got very upset on hearing that. Now I never rely on just one pathology exam. If your doctor finds something, ask him to send your slides to a nationally recognized reference lab—not just one or two slides but the whole lot—and get a second interpretation.” —Bert Vorstman, MD, a prostate cancer specialist in Coral Springs, FloridaIn medicine, you can get a DUI, go to jail for a couple of hours, and walk out at 7 a.m. the next morning and do a surgery. "You can be accused of sexual misconduct and drug and alcohol abuse in one state and pop over to the next one and get a license. Some state medical boards don’t even thoroughly research your background; they argue that the less-than-$10 fee to access national data is too expensive.” —Marty Makary, MD.Surgeons are control freaks. "When things don’t go our way in the operating room, we can have outbursts. Some of us curse, some throw instruments, others have tantrums.” —Paul Ruggieri, MD, author of Confessions of a Surgeon: The Good, the Bad, and the Complicated ... Life Behind the O.R. DoorsMistakes are probably more common than you would think. "But most of them don’t actually hurt people. I work with residents, and I don’t let them do anything that I can’t fix if they screw it up. If there’s an error that I fix that I’m sure won’t affect the patient at all, I’m not going to say anything about it. That would accomplish nothing except to stress out the patient.” —An orthopedic surgeonSome problems just don’t fix well with surgery, like many cases of back pain. "My advice? Grin and bear it. Some surgeons vehemently disagree. They say, ‘Oh, you have a degenerative disk, and that must be the culprit. Let’s fix it.’ But many people have a degenerative disk with no pain. There isn’t a lot of evidence that we’re helping very many people.” —Kevin B. Jones, MDAlways ask about nonsurgical options and whether there’s anything wrong with waiting a little while. "Surgeons are busy, and they like to operate. A professor from my residency would say, ‘There is nothing more dangerous than a surgeon with an open operating room and a mortgage to pay.’” —Kevin B. Jones, MDTalk to your doctor about donating your blood or asking your family members to donate blood before an elective surgery. "Banked blood is a foreign substance, like an organ, and your body can potentially react adversely. If you can use your own blood or blood from your family, there’s less chance of those reactions." —Kathy Magliato, MD, cardiothoracic surgeon at Saint John’s Health Center in Santa Monica, CaliforniaResidents have to learn how to operate, and it’s required that an attending physician be ‘present'. But ‘present’ doesn’t mean he has to be in the operating room scrubbed in. At an academic institution, ask whether your surgeon will be actively participating in the surgery or just checking in every hour." —Ezriel “Ed” Kornel, MDDuring my six weeks as a surgical intern in the ER, I inadvertently stuck myself twice with contaminated needles...... briefly nodded off in the middle of suturing a leg laceration, accidentally punctured a guy’s femoral artery while trying to draw some blood, and broke up a fight between the family members of a guy who’d come in with a stab wound to the abdomen. I was slugged in the head by a delirious patient in an alcoholic rage, spat upon, coughed on, vomited on, farted on, bled on, and mistaken for an orderly.” —Paul Ruggieri, MDYour doctor should not push you to make a speedy decision about prostate cancer surgery. "Most prostate cancers are extremely slow-growing, and there is so much misleading information out there, so you should take your time.” —Bert Vorstman, MDIf you have pain in your calf after surgery, or if it swells and looks red, call your doctor right away. "Those are the main symptoms of a blood clot, which is a risk of just about every surgery.” —James Rickert, MDThis is what really keeps us up at night. "It’s not making a mistake in the operating room; it’s the noncompliant patients. When patients don’t do what we tell them, bad things can happen.” —Kurian Thott, MD, an ob-gyn in Stafford, VirginiaDon’t ask too many questions. If you ask too many questions, you can be branded as a pain in the neck. "When one extremely hostile relative bombarded me every time I walked in, I developed a tendency not to go in the room. If you have three pages full of questions, show them to the nurse. Say ‘How many of these should I wait to ask the doctor about? How many can you help me with?’” —General surgeon who blogs under the name Skeptical ScalpelAbout 25 percent of operations are unnecessary, but administrators e-mail doctors telling them to do more. "This is not an insurance company putting pressure on doctors; this is not a government regulation. This is private hospitals pushing doctors to generate more money by doing more procedures. It goes on at America’s top hospitals. The Cleveland Clinic has said this system of paying doctors is so ethically immoral that it started paying its doctors a flat salary no matter how many operations they do.” —Marty Makary, MD.Fatigue and impatience have undoubtedly contributed to some mistakes I’ve made in the operating room. "But unless you ask, your surgeon is not going to tell you that he was up all night on call before your procedure and that he may not be in tip-top form.” —Paul Ruggieri, MDI always ask at national conferences of doctors, ‘How many of you know of another doctor who should not be practicing medicine because he is too dangerous?’ "Every hand goes up.” —Marty Makary, MDVery often, plastic surgery patients don’t admit to a previous surgery, and I don’t find out until I’m in there. "I’ll go in on an eyelid or a nose, and it’s just a mess. If you don’t tell us you had lipo, there will be scar tissue, and the fat won’t come out normally. So please be 100 percent honest. There’s no need to be embarrassed. We’ve heard it all, and we don’t judge.” —Andrew Ordon, MD, cohost of the television show The Doctors and a board-certified plastic surgeon.The biggest mistake during recovery is not giving yourself enough of a break. "Give yourself time to heal. If you don’t, you can cause complications and prolong your recovery."—Andrew Ordon, MDIf your doctor wants to give you a stent, always ask: Is this better than medicine? "If you’re not having a heart attack or an unstable angina, you will do equally well with a stent or medicine, studies show. Having something permanently implanted in your body is not a risk-free proposition. There is evidence that thousands of people have had stents they likely did not need." —Marc Gillinov, MD.If I had any kind of serious medical condition, I’d go to a teaching hospital. "You’ll get doctors involved with the latest in medicine. Even for simple cases, if there’s a complication that requires an assist device or a heart transplant, some hospitals may not be able to do it. At a university hospital, you also have the advantage of having a resident or physician bedside 24-7, with a surgeon on call always available." —Tomas A. Salerno, MDBefore any operation, always ask what’s broken and how fixing it will help. "Just because you have a blockage in an artery doesn’t mean you need it fixed, especially if you don’t have symptoms.” —Marc Gillinov, MDSpecialists quietly pad your bill. “Less-well-trained physicians will call in an abundance of consults to help them take care of the patient. If those specialists check on you every day, your bill is being padded and padded. Ask whether those daily visits are necessary.” —Evan Levine, MD.Ask how to recover faster. “Since each day in the hospital costs $4,293 on average, one of the best ways to cut costs is to get out sooner. Find out what criteria you need to meet to be discharged, and then get motivated, whether it’s moving from the bed to a chair or walking two laps around the hospital floor.” —James Pinckney, MD.Second-guess tests. “Fifteen to 30 percent of everything we do—tests, medications, and procedures—is unnecessary, our research has shown. It’s partly because of patient demand; it’s partly to prevent malpractice. When your doctor orders a test, ask why, what he expects to learn, and how your care will change if you don’t have it.” —Marty Makary, MD.“Your surgeon may be doing someone else’s surgery at the same time as yours. We’re talking about complex, long, highly skilled operations that are scheduled completely concurrently, so your surgeon is not present for half of yours or more. Many of us have been concerned about this for decades. Ask about it beforehand.” —Marty Makary, MD.“Hospital toiletries are awful. The lotion is watery. The bars of soap are so harsh that they dry out your skin. There is no conditioner. The toilet paper is not the softest. Come with your own.” —Michele Curtis, MD.Being transferred? Speak up. “If you go to a smaller hospital and it has to transfer you to a different medical center, demand that it ship you to the closest one that can handle your care. What’s happening is that community medical centers are sending patients instead to the big hospital that they’re affiliated with, even if it’s farther away. It happens even when a patient is bleeding to death or having a heart attack that needs emergency care.” —Evan Levine, MD.“Don’t assume the food is what you should be eating. There’s no communication between dietary and pharmacy, and that can be a problem when you’re on certain meds. I’ve had patients on drugs for hypertension or heart failure (which raises potassium levels), and the hospital is delivering (potassium-rich) bananas and orange juice. Then their potassium goes sky high, and I have to stop the meds. Ask your doctor whether there are foods you should avoid.” —Evan Levine, MD.On weekends and holidays, hospitals typically have lighter staffing and less experienced doctors and nurses. Some lab tests and other diagnostic services may be unavailable. If you’re having a major elective surgery, try to schedule it for early in the week so you won’t be in the hospital over the weekend. —Roy Benaroch, MD, a pediatrician and the author of A Guide to Getting the Best Healthcare for Your Child.“Many hospitals say no drinking or eating after midnight the day before your surgery because it’s more convenient for them. But that means patients may show up uncomfortable, dehydrated, and starving, especially for afternoon surgery. The latest American Society of Anesthesiologists guidelines are more nuanced: no fried or fatty foods for eight hours before your surgery and no food at all for six hours. Clear liquids, including water, fruit juices without pulp, soda, Gatorade, and black coffee, may be consumed up to two hours beforehand.” —Cynthia Wong, MD, an anesthesiologist at University of Iowa Healthcare“Get copies of your labs, tests, and scans before you leave the hospital, along with your discharge summary and operative report if you had surgery. It can be shockingly difficult for me to get copies of those things. Even though I have a computer and the hospital has a computer, our computers don’t talk to each other.” —Roy Benaroch, MD.“One time, I ran into a patient I had performed a simple appendectomy on. He thanked me for saving his life, then told me it almost ruined him because he couldn’t pay the bill. Four hours in the hospital, and they charged him $12,000, and that didn’t even include my fee. I showed his bill to some other doctors. We took out an ad in the newspaper demanding change.” —Hans Rechsteiner, MD, a general surgeon in northern Wisconsin.We're Impatient. Your doctor generally knows more than a website. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don't), "So why don't you get the website to take over your care?"--James Dillard, MDNinety-four percent of doctors take gifts from drug companies, even though research has shown that these gifts bias our clinical decision making. Internist, Rochester, Minnesota Those so-called free medication samples of the newest and most expensive drugs may not be the best or safest.--Internist, PhiladelphiaDoctors get paid each time they visit their patients in the hospital, so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten. Evan S. Levine, MDWhen a parent asks me what the cause of her child's fever could be, I just say it's probably a virus. If I told the truth and ran through the long list of all the other possible causes, including cancer, you'd never stop crying. It's just too overwhelming. Pediatrician, Hartsdale, New York60% of doctors don't follow hand-washing guidelines. Source: CDC Morbidity and Mortality Weekly Report96% of doctors agree they should report impaired or incompetent colleagues or those who make serious mistakes, but ...94% of doctors have accepted some kind of freebie from a drug company.Source: New England Journal of Medicine58% doctors would give adolescents contraceptives without parental consent. Source: New England Journal of MedicineYour doctor or nurse may have messed up your meds.Doctors in training look the same as doctors in charge.Your medical records are not confidential. If your charts are an open book, it boosts the odds that sensitive details about your health will slip into the hands of people who could use them against you—employers, ex-spouses, or medical identity thieves, says Deborah Peel, M.D., founder and chairwoman of the nonprofit advocacy group Patient Privacy Rights.Your doctor's hands may be filthy.Toronto doctor reveals secrets of hospital slang. Obese patients are “whales” or “beemers”. Old people are known as FTDs, or “failure to die”ER doctors want you to know ER is just like a horror movie. At first you're excited for every day, then there's lots of blood and screaming and crying and it's terrifying. And there's plenty of riddles, like, 'What exactly did you shove up there?!'" It takes an entire team to make an ER run. They work around the clock with little to no breaks. They care about you and they will fight for you.These are some secrets regarded to doctors including surgeons. They are also human beings and make mistakes. We need to collaborate with them to get the best results for your care. Understand them more.Thanks for reading.Sources:50 Secrets Hospitals Don’t Want to Tell You (But Every Patient Should Know)41 secrets your doctor would never share with you8 Secrets Your Hospital Keeps23 Things ER Employees Want You To KnowToronto doctor reveals secrets of hospital slang

#Residency rights of Tibetan refugees, including the requirements and procedures for Tibetan refugees to obtain a Registration Certificate; rights to employment, education, health care, and other social services; consequences for Tibetans without a Registration Certificate, including instances of refoulement, 2 January 2015, IND105009.E, available at: Refworld | India:1. OverviewEstimates of the number of Tibetans living in India vary by source, ranging from 100,000 (IANS 22 Oct. 2014) to 150,000 people (US 27 Feb. 2014, 31).#In correspondence with the Research Directorate, a representative of the Department of Home of the Central Tibetan Administration (CTA) [1] explained that after 1959, when Tibetan people followed the Dalai Lama into exile in India, Indian authorities provided Tibetans with settlement land that is leased to them by the Indian government (CTA 8 Dec. 2014). Sources indicate that Tibetans have settlements in 10 Indian states (The Statesman 28 Aug. 2014; TJC Sept. 2011, 60): Himachal Pradesh, Ladakh, Arunachal Pradesh, Karnataka, Uttar Pradesh, Madhya Pradesh, South Sikkim, West Bengal, Maharashtra, and Orissa (ibid.). In a 2011 report entitled Tibet's Stateless Nationals II: Tibetan Refugees in India, the Oakland, California-based Tibet Justice Center (TJC) [2], states that there are 37 formal settlements as well as 70 informal communities scattered throughout India (ibid.). This source states that approximately 75 percent of Tibetans live in Tibetan settlements and approximately 20,000 Tibetan monks live in approximately 200 monasteries (ibid., 61). The same source notes that 40 percent of Tibetans who live in settlements reside in the southern state of Karnataka. (ibid.).#The 2011 TJC report further explains that many Tibetans live in inadequate shelters in overcrowded settlements, since additional land was not provided by the Indian authorities after the first influx of Tibetan refugees arrived (ibid.). Approximately 16,000-18,000 Tibetans live in Dharamsala and its surrounding area (IANS 22 Oct. 2014), which is the headquarters for the Tibetan Administration in Exile [1] (ibid.; Professor 3 Dec. 2014; Open 15 Mar. 2014).#According to the Times of India, Tibetans are required to inform local authorities before leaving the settlement area (The Times of India 20 Nov. 2012).#The TJC report notes that the CTA appoints a settlement officer for each Tibetan settlement in India, while residents choose a "deputy leader" (TJC Sept. 2011, 62). The Indian government retains authority over the settlements, but according to the TJC report, the government "allow[s] the CTA to manage most of their internal affairs" and "seldom interferes with the internal governance of the settlements" (ibid.). Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.#Sources indicate that India is not a signatory to the 1951 UN Refugee Convention (Open 15 Mar. 2014; TJC Sept. 2011, 59) nor does it have national laws regarding refugee protection (ibid.). The TJC report also notes that Tibetans do not have "permanent legal status in India" (ibid., 47). Sources report that officially, Tibetans do not have refugee status and are classified as "foreigners" (Open 15 Mar. 2014; Professor 3 Dec. 2014). The US Department of State's Country Reports on Human Rights Practices for 2013 notes that India's Foreigner's Act, 1946 does not contain the term "refugee" and does not distinguish refugees as being treated differently than other foreigners (US 27 Feb. 2014, 30).#2. Residency RightsSources indicate that the right to residency in India for Tibetans is contingent on the possession of a Registration Certificate (RC) (BDL 2 Dec. 2014; The Times of India 24 Aug. 2012), which is similar to an identity card (ibid.).#In correspondence with the Research Directorate, the Secretary of the Bureau of His Holiness the Dalai Lama (BDL), which is located in New Delhi, functions as "the nodal agent of His Holiness the Dalai Lama and the Central Tibetan Administration," and liaises with Indian government agencies, foreign embassies, NGOs and other bodies on behalf of the CTA (BDL n.d.), explained that with an RC, a Tibetan can work and study in India (BDL 2 Dec. 2014). The Indian English-language daily newspaper the Statesman notes that an RC is needed for employment, to open a bank account, to obtain a driver's license and to obtain a travel document (The Statesman 22 Apr. 2012).#2.1 Issuance of Registration Certificates (RCs)#The TJC report explains that India began issuing RCs to Tibetans en masse in 1959 when they began arriving in India, following the Dalai Lama into exile, and continued a policy of issuing new RCs to new Tibetan arrivals until 1979 (TJC Sept. 2011, 45). The same source said that in the 1980s and early 1990s, despite a national policy to no longer issue RCs to new arrivals, "India tended to turn a blind eye to the absorption of new arrivals into existing Tibetan communities and to the issuance of unauthorized RCs" (ibid., 46). The TJC report further noted that beginning in the early 1990s, the CTA and the Indian government began a policy of voluntary repatriation of new arrivals and most new arrivals found it "exceedingly difficult" to obtain an RC (ibid.).#According to the Secretary of the BDL, Tibetans born in India can obtain an RC upon graduating from high school (BDL 2 Dec. 2014). Similarly, the representative of the CTA's Department of Home said that Tibetans who are 17 years of age and older can obtain an RC, provided that their parents have an RC (CTA 8 Dec. 2014). The same source said that Tibetans who are orphans must have a recommendation letter from their school administration to obtain an RC (ibid.).#The representative of the CTA's Department of Home explained that, in order to obtain an RC, applicants must fill out a form issued by the Foreign Registration Office (FRO) and submit it at the FRO (ibid.). Similarly, a Times of India article indicates that Tibetans must go to the Foreigner Regional Registration Office (FRRO) to be issued or to renew an RC (2 Mar. 2014). The TJC report includes a sample copy of an RC as an appendix to its report, which is an attachment to this Response.#Sources indicate that as of 2012, an RC can be renewed for a maximum of five years (The Statesman 22 Apr. 2012; The Times of India 24 Aug. 2012). To renew an RC for five years, the person must have lived in India for 20 years (ibid.; The Statesman 22 Apr. 2012; Professor 3 Dec. 2014), or must have been born in India (ibid., The Statesman 22 Apr. 2012). The Times of India explains that all other individuals must continue to renew their RC annually (The Times of India 24 Aug. 2012). The CTA Department of Home representative indicated that prior to 2013, RCs needed to be renewed every six or twelve months for all Tibetans (CTA 8 Dec. 2014).#The representative of the CTA's Department of Home said that an RC must be renewed or extended 15 days prior to expiration (ibid.). The same source indicated that those who do not renew their RC before the expiration may be denied renewal of the RC, although the FRO sometimes renews expired RCs "on humanitarian ground" (ibid. 31 Dec. 2014). According to the 2011 TJC report, renewal of RCs is "generally routine, but it remains subject to the discretion of the Indian authorities" (TJC Sept. 2011, 47). The Secretary of the BDL said that he is not aware of any cases in which RCs were not renewed (BDL 26 Dec. 2014). Neither the Secretary of the BDL nor the representative of the CTA's Department of Home had statistics on RC renewals (CTA 31 Dec. 2014; BDL 26 Dec. 2014), but the CTA Department of Home representative estimated that more than 90 percent of Tibetans in India renew their RCs on time (CTA 31 Dec. 2014).#2.2 Special Entry PermitsThe Secretary of the BDL said that Tibetans coming to India from Tibet are required to have a Special Entry Permit (SEP) issued by the Indian Embassy in Nepal (BDL 2 Dec. 2014). According to the TJC report, the SEP program began in 2003 (TJC Sept. 2011, 49). TJC notes that RCs issued to the bearers of SEPs must be renewed every six months or one year, depending on the district of issuance (ibid., 50). TJC notes that those with SEPs for the purpose of education are able to obtain RCs, while those who come for the purpose of "pilgrimage" are not eligible for an RC and typically cannot stay past six months (ibid.). In December 2014 correspondence with the Research Directorate, a professor of law at Touro Law Center, Touro College in Central Islip, New York, who specializes in legal issues related to Tibetan refugees in India and conducted field research for the TJC in India in June 2014, the "pilgrimage" category for SEPs has "just been eliminated" [3] (Professor 16 Dec. 2014). She also explained that Tibetans who enter with SEPs for the purpose of education "lack a legal basis for remaining and renewing their RCs" once they have completed their education (ibid.).#According to the Professor, some Tibetans avoid the reception center in Nepal because it "has become very dangerous for Tibetans," and try to find alternative routes to India (ibid.). She explained that if they are successful in reaching India, they do not have a way to receive an RC since they lack the SEP (ibid.).#3. Rights to Employment, Education, Health Care, and Other Services#According to the TJC, Tibetans have high rates of unemployment and underemployment (TJC Sept. 2011, 67). Open, a weekly current affairs and features magazine available across India (Open n.d.), indicates that Tibetans have limited employment opportunities (ibid. 15 Mar. 2014). Sources indicate that Tibetans are not allowed to start their own large-scale businesses (ANI 21 June 2014; TJC Sept. 2011, 67) and are ineligible for jobs with the government of India (ibid.).#The TJC report notes that Tibetans residing in India primarily work in the fields of agriculture, animal husbandry, manufacturing and selling sweaters and other textiles, and in the service industry (ibid., 65-66). Overcrowding in the settlements makes support from agriculture increasingly difficult (ibid., 66). The same source states that the majority of Tibetans who work outside the settlements work as "small shopkeepers, food-stand owners, and peddlers" (ibid., 67).#According to the TJC report, the CTA provides health services to Tibetans as well as an education system for Tibetan children (ibid., 62, 63). According to the same source, Tibetans without RCs "face difficulties obtaining benefits or services, including education and medical treatment that the CTA often supplied to Tibetans with RCs" (ibid., 47).#The CTA's Department of Health, which was established in 1981, states that there are 7 hospitals, 4 "Primary Health Centers" and 43 health clinics in Tibetan refugee settlements in India and Nepal (CTA n.d.a). According to the TJC report, Tibetans can also seek healthcare from village health centres under the jurisdiction of local governments, which provide free healthcare to rural populations (TJC Sept. 2011, 62). However, the TJC notes that these centres are understaffed and lack adequate resources (ibid.).#According to the TJC report, the CTA-operated school system in India for Tibetan children is under "severe stress" from growth and overcrowding in the settlements (TJC Sept. 2011, 63). The TJC indicates that most Tibetans do not attend college due to a lack of funds (ibid., 64).#According to the CTA's website, the CTA's Department of Education oversees 73 Tibetan schools in India and Nepal, providing education to approximately 24,000 Tibetan students (CTA n.d.c). There are different administrative bodies under the umbrella of the CTA's Department of Education (ibid.). One administrative body, the Central Tibetan School Administration (CTSA), operates 28 schools in India for Tibetans, 6 of which are residential schools and 22 of which are day schools (CTA n.d.b). Approximately 10,000 students are enrolled at Tibetan schools operated by the CTSA (ibid.). In addition, there are also 17 Tibetan schools for orphaned and destitute Tibetan children administered by the Tibetan's Children Village and 12 schools in remote locations from the mainstream Tibetan community that are administered by the Sambhota Tibetan Schools Society (ibid. n.d.d).#4. Political RightsThe TJC states that Indian authorities sometimes restrict the right of Tibetans "to demonstrate, associate, and express themselves politically" (TJC Sept. 2011, 59). According to the New Indian Express, the government policy of India is to prohibit Tibetans from political activity (6 Jan. 2013). Open states that Tibetans "must keep their political voices muffled" (15 Mar. 2014).#CNN reports that 200-300 Tibetans were arrested in March 2012 after 1,000 Tibetans staged a protest in New Delhi against the Chinese President's visit during a BRICS [Brazil, Russia, India, China and South Africa] summit in March 2012 (CNN 28 Mar. 2012).#The Professor indicated that there have been recent court cases to prohibit public displays of Tibetan prayer flags and stones (Professor 3 Dec. 2014).#However, sources indicate that Tibetans who were born in India were allowed to register to vote in India's 2014 elections for the first time (IANS 22 Oct. 2014; The Times of India 2 Mar. 2014). According to the Times of India, India's Election Commission ordered all states to include Tibetans born in India between 1950 and 1987 in its electoral lists (ibid.).#5. Land RightsSources report that Tibetans are not allowed to own land in India (Open 15 Mar. 2014; ANI 21 June 2014; Professor 3 Dec. 2014). The Professor noted that because non-citizens are not allowed to own land, the standard procedure is for a Tibetan who wants to purchase land to find an Indian to put the land in his or her name, a practice known as "benami" (ibid.). The Professor reported that there is a land case in Dharamsala to evict Tibetan holders of benami land (ibid.). Further and corroborating information could not be found within the time constraints of this Response.#The Professor reported that there have been several land eviction cases involving Tibetans (ibid.). She provided one example in which 114 Tibetan families in Shimla were being evicted from land that they have been living on for 30-40 years (ibid.). In another example, 218 Tibetan families in Dharamsala were being evicted purportedly because the land was designated as "'forest land'" after they settled there in the 1960s (ibid.). In both cases, the Professor indicated that the states issued the eviction notices and that settlement talks did not occur until the CTA intervened and got the federal government involved (ibid.). Further and corroborating information could not be found within the time constraints of this Response.#6. Tibetan Rehabilitation Policy 2014Sources report that on 20 October 2014, the government of India issued the "Tibetan Rehabilitation Policy 2014," which allows Tibetans access to social benefit programs run by the government of India (CTA 8 Dec. 2014; IANS 22 Oct. 2014). According to the Hindustan Times, an Indian English-language daily newspaper, the new policy allows Tibetans to access benefits under the National Rural Employment Guarantee Scheme and the Public Distribution System (The Hindustan Times 12 Nov. 2014). The same source indicates that the policy also requires state governments to sign lease agreements with the Central Tibetan Relief Committee for the land occupied by Tibetan refugees (ibid.). The Indo-Asian News Service (IANS) reports that the policy allows Tibetans to access jobs in which they are professionally qualified, such as in the fields of nursing, teaching, chartered accountancy, medicine and engineering and allows Tibetans to get a trade license and permit [to start their own enterprises] (IANS 22 Oct. 2014).#However, the representative of the CTA Department of Home explained that the implementation of the "Tibetan Rehabilitation Policy 2014" depends on a decision by state governments to do so (CTA 8 Dec. 2014). Similarly, the Professor said that portions of the policy "are merely suggestions to the state governments" (Professor 3 Dec. 2014). She noted that the implementation of the policy will need to be monitored to determine "what changes are actually made" and "whether it is having any effect on the lives of Tibetans in India" (ibid.).7. Situation of Tibetans without RCsThe TJC report notes that Tibetans without an RC have difficulty securing housing, since most landlords require proof of legal status, and also have difficulty finding employment because "most businesses, including those run by the CTA, condition employment on possession of an RC" (TJC Sept. 2011, 47).According to the Secretary of the BDL, Tibetans without valid RCs face arrest and fines, but he said that he was not aware of cases of deportation for not having an RC (BDL 5 Dec. 2014). The Professor indicated that Tibetans without RCs face detention and deportation in addition to arrest and fines (Professor 3 Dec. 2014). The Times of India reported cases in which Tibetans were arrested for not having valid documents (The Times of India 20 Nov. 2012).The Professor stated that "[w]ithout a valid RC, Tibetans' presence in India is illegal which renders them vulnerable and subject to harassment by the police, detention, fines and deportation" (Professor 3 Dec. 2014). She conducted eighteen in-depth interviews with government officials and others in Delhi, Shimla and Dharamsala in June 2014, to determine whether Tibetans without valid RCs were being arrested and/or deported (ibid.). She provided the Research Directorate with details of four case files from 2012 and 2013 in which Tibetans were subject to arrest, fines and deportation under Section 14 of the Foreigners Act, 1946 [4] (ibid.). Prison sentences, which occurred in three of the four cases, ranged from 35 days to seven months (ibid.). In one case from 2012, a Tibetan monk was arrested and prosecuted for not having a valid RC and was sentenced to 35 days imprisonment, followed by deportation (ibid.). The Professor said that, to the best of her knowledge, the deportation was carried out (ibid.). She explained that the defendant had entered India in 1999, at a time when the government of India was not issuing RCs (ibid. 16 Dec. 2014). In two cases from 2013, deportations were ordered, but were not carried out because the defendant renewed his RC in one case and was granted a stay by the High Court in order to renew his RC in the other (ibid. 3 Dec. 2014). However, even though the High Court granted a stay in the one 2013 case, the court found that the deportation order was still "'appropriate and in accordance with the law'" (ibid.). In the fourth case, from 2013, a Tibetan who could not produce an RC after police stopped him and asked for his ID during a routine patrol, was fined 1,000 rupees [approximately C $18], sentenced to seven months in prison, and ordered deported (ibid.). The case was appealed, but the court upheld the punishment and deportation upon completion of the defendant's prison sentence (ibid.). According to the Professor, the defendant was deported and is "reportedly in a Chinese jail" (ibid. 16 Dec. 2014). Further and corroborating information about these cases could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.The US Department of State's Country Reports on Human Rights Practices for 2013 states that under the Foreigner's Act, 1946, refugees are treated as any other foreigners, and that their presence in India without valid travel documents or residential documents is treated as a "criminal offense, rendering refugees without appropriate documentation vulnerable to refoulement and other abuses" (US 27 Feb. 2014, 30). However, Country Reports 2013 stated that there "were no reports that the government refouled refugees during the year" (ibid.).The CTA's Department of Home representative said that Tibetans without RCs are "legally subject to deportation" (CTA 31 Dec. 2014). Regarding the situation of Tibetans who have an expired RC, he cited a case from Himachal Pradesh in which a Tibetans who failed to renew his RC on time was imprisoned for a few months, although the Indian government intervened to stop his deportation (ibid.).1] The Central Tibetan Administration was established by His Holiness the Dalai Lama in 1959 as a continuation of the government of an independent Tibet (also referred to as the Tibetan Administration in Exile) (CTA n.d.e). His Holiness the Dalai Lama the 14th retired in 2011 as the political leader of Tibetans in exile, but continues to act as their spiritual leader (Dalai Lama 19 Mar. 2011). He established a democratic system of governance for Tibetans in exile and ended the system of rule by which the Dalai Lama is both the political and spiritual authority for Tibetans (ibid.). According to the CTA's Office of Tibet in Washington, DC, the CTA "functions as a veritable government and has all the departments and attributes of a free democratic government" (CTA n.d.e). However, media sources note that the CTA is not officially recognized by any country (IANS 22 Oct. 2014; Open 15 Mar. 2014).[2] The Tibet Justice Center is a volunteer committee of lawyers and other experts that works on four key areas to promote the self-determination of Tibetans: human rights, environmental governance, refugee protection and self-governance for the people of Tibet (TJC n.d.a). The organization was founded over 20 years ago (ibid.). Its board of directors includes practicing attorneys, an attorney-advisor at the US Department of Justice, professors at Boston University, Oxford University, and Touro College, and other professionals (ibid., n.d.b). Several people contributed to the research, writing and editing of Tibet's Stateless Nationals II: Tibetan Refugees in India, including an attorney, a professor of law at Boston University (who is also the president of TJC's board of directors), and a professor of law at Touro College [who was also contacted as a source for this RIR] (TJC Sept. 2011, 73).[3] The Professor indicated that many Tibetans who had entered India with the pilgrimage category of the SEP remained after the expiration of their authorized stay, rendering them ineligible for RCs and living illegally in India (Professor 16 Dec. 2014). In recognition of the problem, RCs were offered to the Tibetans who had overstayed their duration under the pilgrimage category, and approximately 300 people came forwardTibetan Rehabilitation Policy." (Fac The original version of this document may be found on the offical website of the IRB at http://www.irb-cisr.gc.ca/en/.

Here is a detailed list of what you can expect in Bhutan. I hope this helps:1. Passport and VisaNo visa is required to visit Bhutan. An identity document, be it either passport or an election commission ID card is, however required for presentation at the immigration during entry, to obtain an entry permit along with two passport size photographs.If you plan to reach Bhutan by road, then you are required to obtain an 'Entry Permit' on the basis of valid Travel Document from the Immigration Office of Royal Government of Bhutan at Phuentsholing, located on the Indo-Bhutan border opposite Jaigaon, West Bengal. In case, you are not carrying a valid travel document, you should approach the Indian Consulate Office in Phuentsholing and apply for the "Identification Slip" with proper proof of Indian nationality. The 'entry permit' allows one to visit Thimphu and Paro only. However, any tourist going beyond Thimphu and Paro need to acquire a 'special area permit' from the RGoB Immigration Office at Thimphu on any working days (Monday to Friday).2. Arriving in BhutanEntry procedures are generally simple. Bhutan’s customs regulations provide stiff penalties for those found guilty of carrying any dutiable or prohibited goods.The following articles are exempt from duty:·Personal effects for daily use·One litre of alcohol (spirits or wine)·Instruments or appliances for professional use·Photographic equipment, video cameras and other electronic equipment for personal use.Remember, Commercial filming requires a permit, which can be processed though the tour agent. Further fees and surcharges may be levied.·One carton of 200 cigarettes is permitted for personal use but subject to tax of 200%.If importing any items to Bhutan which are for sale or gift, they may be liable for customs duty. On departure, visitors are required to fill out a departure form, which will be asked for by Customs authorities.Dzongkha is Bhutan’s official language. Dzongkha literally means ‘the language spoken in the dzongs and administrative centers in all the districts of Bhutan’. Besides Dzongkha, there are two major languages spoken by the people of Bhutan: Sharchokpa (spoken in Eastern Bhutan) and Nepali (spoken in Southern Bhutan).Because of the ethnic diversity of the Bhutanese people, there are also 19 dialects and languages spoken throughout the country. You will be able to communicate with many in English though; it’s the instruction language in schools and therefore widely spoken.3. Airport SecurityWith a little preparation you can do to make sure your journey through airport security is as quick and hassle-free as possible. All you need is to make sure that you don’t carry prohibited goods with you.4. When to visitThe climate in Bhutan is extremely varied. Southern Bhutan has a hot, humid sub-tropical climate that is fairly unchanging throughout the year. Temperatures can vary between 15-30 degrees Celsius. In the Central parts of the country the climate cools a bit, changing to temperate and deciduous forests with warm summers and cool, dry winters. In the far Northern reaches of the kingdom the weather is cold during winter. Mountain peaks are perpetually covered in snow and lower parts are still cool in summer owing to the high altitude terrain.There is no special time to visit this gorgeous, unexplored, enigmatic country. The never-ending festivals and abundant heritage sites provide visitors with a wide array of experiences throughout the year.Spring (March, April & May) is considered the most beautiful time of the year, resplendent and ablaze with a spectacular array of bright colours. Bhutan's landscapes are at their best at this time of year before the monsoon arrives, with colourful rhododendrons carpeting the hillsides. Autumn (September, October & November) provides spectacular view of some of the tallest unclimbed mountains in the world. It is also the best time for trekking and travelling. Much of the east-west highway remains snowbound during winter (December, January & February). Travel during June, July & August months are avoidable.5. Internal flightsDruk Air (Royal Bhutan Airlines) is the main air carrier in and out of Bhutan. Daily air services between Paro and Bangkok and Paro and Kolkata and weekly services between Paro and Kathmandu are also operated by Tashi Air (Bhutan Airlines), an independent Bhutanese airline. An internal flight operated by Druk Air flies between Paro and Bumthang. Flights can be subject to disruption due to weather conditions.Phuntsholing, Gelephu and Samdrup Jongkhar in eastern Bhutan are the only land border areas open for tourists. You can get more information on the Tourism Council of Bhutan website.6. VaccinationsIt is recommended that you consult with your General Practitioner or Practice Nurse 6-8 weeks in advance of travel. A letter of your health condition is recommended. Carry a medical kit if you plan to stay long.Medical facilities are not so common in rural parts of the country. Whilst Bhutan is a relatively safe country to visit, and there are currently no mandatory health requirements, public health facilities are basic in some regions. Over-the-counter drugs are readily available, but prescriptions must be obtained from doctors. Measles, diarrhoea, a respiratory infection are common in Bhutan, like in any other developing countries.The World Health Organization has recommended vaccinations for diphtheria, tetanus, Hepatitis A, and Hepatitis B. Outbreaks of dengue fever and malaria can occur in Bhutan. First-aid items such as scissors, bandages, gauze, thermometer, sterile needles and syringes, safety pins and tweezers can be carried.This country has either areas with high altitude (2400m or more) or/and areas with very high altitude (3658m or more). Travellers who may go into areas of high altitude should take care to avoid ill effects of being at altitude including Acute Mountain Sickness, a potentially life-threatening condition.7. Travel insuranceMedical travel insurance is strongly recommended. It is mandatory for all visitors to Bhutan to hold a valid comprehensive travel insurance policy that includes cancellation & emergency evacuation cover.Many travel insurance companies no longer offer cover for trekking, rafting or other adventure activities. Please ensure your policy covers exactly the activities you will undertake on your journey. The travel insurance can be considered especially if you are planning adventure sports, such as surfing, diving or hiking.Travellers must ensure that they are covered with their medical insurance while on their trip. However, it is extremely important to disclose your medical history with your travel insurance company; as if a claim arises due to an undisclosed medical condition you may not be covered.Protect yourself with a travel insurance that will cover all the activities you are planning to do, pre-existing medical conditions, emergency evacuation, injury, or lost luggage.8. Things to Pack·ID documents: Passport, driver’s licence, visa·Money, credit cards·Appropriate seasonal clothing and undergarments·Bathing suit, sunscreen·Sunglasses, hat·Basic medical kit and toiletries·Cameras, batteries·Laptop, cell phone, chargers·Power outlet adaptor·Insect repellent9. MoneyBhutanese currency is Ngultrum (Nu.) and is officially pegged to the Indian Rupee (Rs.). Indian Rupee is acceptable all over Bhutan, except Rs 500 and Rs 1000 notes.Credit cards are accepted, but in a very limited number in Thimphu. It is mainly accepted by Deluxe hotels, restaurants and few selected Handicrafts establishments, located in relatively larger towns. ATMs facilities are available only in selected towns. MasterCard and Visa international credit and debit cards can be used on these ATM’s to withdraw cash. Traveller’s Cheque can be easily withdrawn and exchange in local Bhutanese currency. Rupees can be changed by travellers from banks, or at hotels. It is recommended to carry money throughout the trip.10. TippingTipping in Bhutan is not compulsory. Hotels and restaurant bills include service charges of 20%; there is no need to add anything further onto these bills. It is not compulsory to give out tips as you are the one to decide whether they are tippable or not. The drivers don’t necessarily expect tips from you. Remember, all taxis are not metered here in Bhutan. But all drivers here are well mannered and don’t necessarily charge excess charge for the travel. Trekking, helpers and cooks here work for meagre sums. It will be a good gesture if you can tip them, but it is not compulsory. There might be instances of you getting help of a horseman to take you uphill on a horse back. You can tip him Nu 200-300.11. Personal securityBhutan, the land of happiness is one of the safest places on earth for solo and female travellers. Crimes are almost zero here. But it is good to stay vigilant to theft activities and ensure that your personal belongings remain close to you at all times. Trekking alone in Bhutan is not permitted. Trekking can be dangerous. If you decide to trek in Bhutan, plan carefully and use reputable trekking companies with professional guides. Exercise normal safety precautions in Bhutan. The risk of landslides increases significantly during monsoon season (June – September), including around major roads and in all trekking areas. Monitor the media and other sources for information on local travel conditions.12. Your health and safetyTravellers, who ascend to altitudes greater than 2,500m, particularly if the ascent is rapid, are at risk of developing altitude sickness. Altitude sickness can be life threatening and can affect anyone. If you plan to travel to high altitude areas, see your doctor beforehand for advice specific to you and your situation.Flooding and landslides can occur with little warning throughout the country, particularly during the monsoon season (June to September). Services and transport are often affected; contact your tour operator to check whether tourist services at your planned destination have been affected if travelling during monsoon season.Stay alert to changing weather conditions and adjust your plans if necessary. Prepare for activities by wearing the right clothes and packing protective items, such as bug spray, sunscreen, and a basic first aid kit. Very cold temperatures can be dangerous. Dress in layers and cover heads, hands, and feet properly if you are visiting a cold location.Even though earth quake is a worst case scenario, you should be familiarise yourself with your accommodation's emergency procedures for such situations. If you are travelling on roads close to the mountains, be alert to any hazards that appear.13. Telephone and EmailInternet facility is available all around Bhutan including Wi-Fi service in major hotels; although the speed may not be comparable as you are use to. Thimphu, Paro, Trongsa, Bumthang have good mobile and internet connectivity. If you are travelling on the road between valleys, network might deteriorate. Internet cafes are limited in Bhutan. You can think of getting a Bhutanese SIM card from the telecom in Thimphu. The only Indian service provider that works in Bhutan is Airtel. It is best to buy a B-Mobile or Tashi SIM card from any telecom shop in Thimpu. You can't get sim card providing photocopy of your passport. The sim will be activated as soon as you make a call from it and select the preferred language. Purchasing a local SIM card for your smart phone or iPad will give you WiFi most of the way through the Kingdom for those who need more connectivity.14. Food in BhutanBhutanese cuisine is influenced by Chinese, Tibetan and Indian culture. The main dish generally includes white or red rice, seasonal vegetables, and meat (pork and chicken), are often cooked with chili or cheese. Red rice, which is extremely nutritious and similar to brown rice, forms the main chunk of most meals in Bhutan. Ema Datshi is the National Dish of Bhutan, a spicy mix of chillis and the delicious local cheese known as Datshi. This dish is a staple of nearly every meal and can be found throughout the country. Phaksha Paa and Jasha Maru taste spicy but delicious. Don’t miss the butter tea or Po Cha, prepared using Yak butter.Most restaurants in Bhutan offer customers a range from Continental to Chinese, and from Bhutanese to Tibetan and Indian cuisine.The Losar Festival, celebrated between February and March, is the best time to be in Bhutan to enjoy exquisite Bhutanese cuisines. The celebrations include traditional morning meal eaten at sunrise, midday meal and afternoon snacks. Foods like Tshos (fried biscuits), Changkoi (stew made of fermented rice), mandarins, diced sugar cane, cheese and porridges are offered during this time.15. AlcoholLiquor is surprisingly cheap and good quality here. Incidentally, one of the things you should shop for while in Bhutan is local brands of alcohol. If you are travelling to Bhutan, it's recommended to forget your branded liquor preferences and sample the lovely local selections of wine, whiskey, rum and vodka on offer.The beer quality in Bhutan can really surprise you. There are 5 local beers that are brewed inside the country. Thunder 15000, a 8% strong beer, Thunder 1100 8%, Druk Supreme 6%, Druk Lager 5% and Red Panda 5%, a wheat beer. A few varieties of beer are available in most hotels and restaurants. The Bhutanese prefer local homebrewed alcoholic drinks mainly made from wheat, millet, corn and rice. Soft beverages are also available for the non-alcoholic taste.Most restaurants serve varied brands of alcohol and almost every grocery shop sells local brands. Named after the King of Bhutan, K5, is Bhutan’s most popular and the best whiskey. Grain Whiskey and Royal XXX Rum are other local favourites.16. ShoppingBhutan is renowned for its arts and crafts, which can be either Buddhist or secular in their inspiration. You can buy handicrafts such as carpets, colourful masks, jewellery, silver, bronzes, hand-woven bamboo items and Bhutanese wooden products at Thimphu. In Paro, Thimphu and Phuntsoling. There are number of stores selling ready-to-wear Bhutanese garments in traditional patterns.Textiles of Bhutan are amazing…and they have a spiritual story behind them which makes their study a fascinating process. Helped by a local, you can visit independent weavers or shops and can buy weaves at a lower price. If you do not have a local helping hand, it's best to visit a Govt operated outlet. National Handicrafts Emporium (in Norzim Lam) is a good choice for buying textiles.Check out any of the craft stalls in Norzim Lam near Taj Tashi. You will surely hunt up a great bargain and there is an amazing range of fabrics and other crafts on offerIf you are deeply interested in art, you would be able to appreciate Thangkas or scroll paintings.Crafts like table runners, wall hangings, bed spreads have exquisite embroidery and are a good buy provided you can bargain well. Inexpensive buys include wooden bowls, spoons and handicraft items. Paro, Thimphu and Phuntsheoling are all good places to buy crafts, masks and decorative items.One of the best things you could buy in Bhutan are freshly packed and dried produce from the local market as there are several kinds of things on sale here which you have never probably eaten/ used before. Noodles, Rice, Chilly Powder, special tea can be found in the local markets.17. When you leaveAll rules applicable to duty free imports are applicable to exports. The prohibitions list is also same for import-exports. Arms, ammunition, narcotics, wildlife products, especially from endangered species cannot be taken back without clearance. The Customs department is especially strict about the export of antiques and in case you are carrying a souvenir that looks particularly old, you need to obtain a certificate from Tourism Council of Bhutan proving that it is a non antique. Departure formalities are straightforward but require production of the form that was completed on arrival and may need to show all the items listed on it. A lost form means complications and delays. Customs authorities pay special attention to religious statues. It would be prudent to have any such statue cleared, old or new.