Surmang Foundation

We work in a place that is 97% ethnic Khampa Tibetan. Our mission is to promote health among the ultra-poor, those who earn less that US 14/day, in remote Qinghai Province, China. With few roads, cars or electricity, creating access to services is a high priority.Our goal is to create greater access to health care and earlier intervention, applied to mother and child health. He hope to overcome world-record high maternal and infant mortality/morbidity. We have accomplished this with a regional medical center, a model for rural health care delivery among the ultra-poor that is being prototyped in the Yushu Public Health System.
Feb 21, 2014

Winter '13 and Early Spring '14

winter in East Tibet 1
winter in East Tibet 1

The winter months are quiet ones for our programs but not for our clinic projects nor the Khampa Tibetan patients. In October, the snows come down to about 3500m, the nomads fold up their sturdy yak hair tents, and with their herds of yak, horses and goats go to the lower elevations, to their villages and permanent homes. By December the passes close. The Surmang Clinic, the Community Health Workers and the 4 township hospitals are snowed in. For a time when the passes are closed, with days short, the families stay warm around the yak dung stoves eating tsampa and yak jerky, drinking salty butter tea.

For patients who are not facing life or death crises, wintertime brings farmers and nomads closer proximity to medical help than in the summer when the nomads are disbursed among the remote alpine encampments. This is good news for any kind of sub-acute problem. But for problems that require evacuation it is difficult. But for women and children who need early intervention the clinics are closer than in the summer.

Higher skill levels for providers and early intervention. That is the key.

Increasing the skills of these providers in ways they can use, and linking up these folks –village health workers to village doctors, village doctors to township hospitals—that’s the way you create a system with synergy. That is why we are building birthing centers this summer with the help of the Danish Chamber of Commerce, China. But the hardware, the bricks and mortar only take us so far. We need support from you through globalgiving.org to pay for the training of these rural doctors, to enable them to use these facilities.

And that is the reason we’ll have a much bigger training of village docs and village health workers this summer than ever before. It sounds simple, but actually the directness and lack of jargon-driven agendas makes us outside the box of conventional development and public health approaches.

In the winter we too, at Surmang Foundation sit around our virtual fire, a period of regrouping, planning and strategizing. We can’t travel to East Tibet to oversee projects so we design for the coming year, we recruit the volunteers who will work on these projects, and we raise the funds we need for the whole year. So we must plan carefully to use our resources carefully. That’s where you, the donor come in.

In the November Beijing Fundraiser we auctioned off a “Tibetan Family” in the guise of dolls donated to our cause. The winning bid on the families represented the cost of providing medical care to a family. We were very successful, raising over $4,000 for each “family.” I encourage anyone who wants to participate at this level to make such a donation.

2014 promises to be a big year for us –we so far have 4 volunteer doctors including the return of our own esteemed Dr. Julie Carpenter. We’re going to visit once again the Shechen Orphanage and offer medical services there.

Suzanne Smith, a veteran of over 10 years in community organizing in Africa will join us as a project manager. Janis Tse yong-jee will return. The Chinese community is rising to the challenge – there will be a fundraiser in March. We are now registered in Qinghai Province. We are hoping for national registration by the end of the year.

It feels like our resources are gathering. Our calling is the stuff of life –and death—mothers and babies who carry the future of Tibetan families and Tibetan culture. So in the words of the poet, we have promises to keep and miles to go before we sleep. Please help.

Winter in East Tibet 2
Winter in East Tibet 2
Winter in East Tibet 3
Winter in East Tibet 3
Tibetan Family
Tibetan Family

Links:

Nov 19, 2013

End of Year Report

Core Project and Government Partnership.

This year our clinic at Surmang saw over 12,000 patient visits for free, including meds. This year the clinic played a central role in the roll-out of our partnership with the Yushu Prefecture Public Health Bureau. The purpose of this partnership is to bring the Surmang model into the public health system as a sustainable prototype. Our clinic became user-friendly jumping off point for volunteer doctors, doing training at the 4 partner hospitals.

The awesome challenges of this project

It’s hard enough to create and run a private one-off project in remote Yushu Prefecture.  But to leverage the qualities of that project and our good relationship with official China, to put it in the public health system, is something else again. No one else is doing that.

The challenges boil down to the fact that at our own clinic we control all the elements of HR, management and central supply, and zero of those in the 4 partner hospitals in the public health system. How we present our model depends on how we engage docs in the PH system. We have been selective in the sense of only training those who are focused on personal and medical excellence. Our job is to convince them that our foundation is the ticket to help them achieve just that.

Doctor Volunteers in 2013

This year we were lucky to have three volunteer doctors apply for our program. For reasons beyond us, one was denied a Chinese visa. Our two remaining volunteer doctors were Elizabeth Van Dyne and Rebekah Sands. Dr. Van Dyne had the excellent translation services of Mathilde Paturaux, and worked for us for about a month in June. Dr. Van Dyne came to us from the US and Mlle Paturaux from Brittany, France. They were able to travel to Surmang and all 4 of our partner township hospitals:  Mauzhuang, Xialaxu, Xiewu and Longbao.

Here is an excerpt from her report:

On the last night I drew a smashed, congealed Snickers bar out of my bag, and broke it into 4 lopsided, jagged pieces. We laughed as we chewed, seeing each other’s faces through the light of a battery-operated lamp. “This is very, very good,” one of the Tibetan physicians said. It was one of her few lines of English she said to me, and she said it to emphasize how really good the chocolate bar was. From the medical education, patient interactions, majestic scenery, to the Snickers bar, as I boarded the plane to take me back to Beijing and S. California, I had to agree, yes this was all very, very good indeed.

In September we hosted volunteer Dr. Rebekah Sands from New Zealand. Rebekah is a product of the international school of Tianjin and speaks flawless Mandarin. Her self-sufficiency was a first for our foundation –it’s not every day that we come across a person who has native-level Mandarin, to have a medical volunteer who does not need an interpreter.  She spent more time on her own, a quality that bespeaks her true Kiwi grit and self-sufficiency. Drs. Sands and Van Dyne were great addition to our previous vintage of great volunteers.

Training Village Health Workers

As we know, Tibetan culture is under enormous pressures – cultural, political, and economic. Among those, probably the most unsung are those created by maternal and infant mortality.  The death of a mother in rural Tibet often means financial ruin or the cratering of the family unit. This accounts for the high number of orphanages in ethnic Tibetan areas.  That’s why we say, “if you want to save a culture, save a mother.”

Remoteness and geographic challenges are as serious as any other cultural challenges – keeping women and children far away from services and in the cross-hairs of maternal and infant mortality. There is no doubt that to cure maternal mortality, hospital delivery is the key.  However with poor dirt roads, no village cell phone service, no public transportation and no private ownership of cars, infrastructure is the primary obstacle to realizing that goal.

Since it’s beyond our capacity to build roads or an ambulance service connecting the villages to the township hospitals, we must provide assisted delivery in the remote villages as we’ve done at Surmang through the Community Health Worker project. 

This year we trained over 50 Village and Community Health Workers, under the direction of Janis Tseyong-jee, MPH. What made this year’s training unique was that the trainers were all Khampa Tibetan women:  Janis, Dr. So Drogha, and Pema tso, one of our Community Health Workers. We have moved a step into training other trainers –TOT.

While there are government paid Village Health Workers, they are an under-utilizied, and largely untrained resource.

But, as we’ve shown over 20 years, these health challenges are amenable to change. In fact, compared with other challenges, especially political and economic, we can make a real difference. We are on the cutting edge of what people can do in such challenging conditions, and have instilled confidence among rural women that there is something they can do about their own situation. Our unique contribution is that we are not extra-system.

Model Transplant

We want to transplant this model inside the public health system. In late July, we met with the government – they support our work, just as we support putting our model in the public health system. At our summer meeting with the Director of the Yushu Public Health Bureau we received a standing ovation when I said, “if you want to save a culture, save a mother.” Please join this cause.

Legal registration

Surmang Foundation has become legally registered in Qinghai Province as the, The Qinghai  Nomadic Health Promotion Assn. Registration was done with the active help of the Qinghai Government, and our two most pro-active supporters, Mr. Deng Haiping and Dr. Xiao Jiugha. Dr. Xiao is a Khampa Tibetan and retired head, Yushu Prefecture Public Health Bureau.

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Attachments:
Sep 3, 2013

Putting Mothers and Children in First Place

We stand for healthy families. But how can you have a healthy family and a healthy culture when the mothers and children are dying in record numbers? Yes, it’s true that Tibetans and other minorities in China live in very low population density. But there are over 40 million of them in China –including Uighurs, Kazaks and Mongols-- who have lack of access to quality health care.  That's more people than live in Spain.

There’s a direct correlation between the dramatic health levels –especially the world-record-high infant and maternal mortality stats-- and access to quality health care in places like Qinghai. A nomadic or farming mother in Yushu Prefecture stands a 1-in-15 chance of dying during pregnancy or delivery. There are a lot of orphanages in Tibetan areas, makes sense, because the mothers die and orphanages are downstream results of maternal mortality. Our goal is to up-end that through creating greater access to health services and increasing the quality of the services that are already there. This is the heart of the Surmang model.

We have changed the odds for mothers and babies, by eradicating maternal mortality in our own catchment and significantly lowering infant mortality. What is the cost? Our estimate is about $225/birth.  I think you could say ‘this is the cost of not having children and mothers die. But what is the cost when then do die?’ It can’t be photographed; it can’t be quantified. This is where the international community of supporters comes in.

As a health care strategy, building local capacity is the answer. This spring, Janis Tseyong-jee, with help from Surmang Foundation, graduated from Tulane University with an MPH. Janis is now one of the very few Tibetans with an MPH.  Janis has volunteered for our foundation every year for the past 6 years. This year she made the transition from one of the principal assistants in the CHW (Community Health Worker) program to a vital role as a designer and implementer.

The CHW program is one of the two pillars of our Surmang Prototype – creating assisted births through home-based health care. This July and August, Janis trained over 30 Surmang CHWs, and paid their incentives for training, assisting in birth, well-baby checks and referrals to our clinic. In addition for the second year, we were able to extend CHW training in the townships and villages in our government partnership catchment.  Our goal is to have over 400 CHWs. It’s hard to put into words the real-world challenges that Janis, Dr. Drogha and Dr. Phuntsok face when a program like this is implemented. Just getting all these CHWs in one place for training is one such challenge. Getting to the place where we do the training is another –roads are not paved, and in the summer monsoon season, frequently washed out. But the support and determination on the part of our staff and the CHW trainees more than compensates for these obstacles.

As we know, Tibetan culture is under enormous pressures – cultural, political, and economic. Most we cannot do much about. Remoteness and geographic challenges are as serious as any – keeping women and children far away from services. But, as we’ve shown over 20 years, these health challenges are amenable to change. We are on the cutting edge of what people can do in such challenging conditions, but we are not extra-system. We want to transplant this model inside the public health system. In late July, we met with the government – they support our work, just as we support putting our model in the public health system. At our summer meeting with the Director of the Yushu Public Health Bureau we just about received a standing ovation when I said, “if you want to save a culture, save a mother.” Please join this cause.

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