What can be further from my world in sea level S. California, than to go to the Tibetan Plateau to work with Surmang Foundation? I was there in June to help advance the rollout, the prototyping of their rural health model, a model that seeks to bring sustainable quality care to 4 impoverished townships in Yushu Prefecture, East Tibet. It was a startling journey, a great adventure.
According to the WHO, health is “the complete physical, mental and social well-being and not merely the absence of disease or infirmity.” When you work with a view like that you can’t help but meet kindred spirits on your journey. And that is exactly what happened to me.
Despite the snow-capped 18,000’ peaks, the lush green valleys with grazing yaks and horses, my whole experience came down to people. Connecting to people I would otherwise never know. And that connection is what I saw and what I took home to the US with me.
You might think knowledge is the crucial element, but care cannot be delivered without a sound human relationship. People caring for people. Teaching in medicine relies on the same principles – it all comes down to people. As doctors we all share in both the suffering of patients’ debilitation and the joy of patients getting better.
My travels confirmed what I already suspected: from America to East Tibet, our shared journey of health transcends culture. As far away as East Tibet, the doctors I recently trained went into medicine to care for the patient. That is also why I, an American physician, also went into medicine. Helping to close the gap between the health levels in both places is why I volunteered for Surmang Foundation.
What I found was that despite cultural, language and physical differences, the common ground of caring was our common language.
Traveling with ace interpreter Mathilde Patureaux, we went to four Townships: Mozhang, Xialaxu, Xiewu and Longbao. At an average elevation of about 4000m (about 13,000’) we made our way through ice, snow, sleet and snow to deliver our model. We did this through Surmang Foundation Physician Professional Development Training Modules (PTDM), developed by 2012 Surmang intern Christal Chow. The PDTM was founded upon the principle that no matter where we practice, we are all physicians who went into medicine with the aim of helping people.
The course is made up of 8 modules of clinical content, based on the diseases most common in East Tibet. For example, as essential hypertension is a common problem in East Tibet, it is part of the first module. We discuss the topic, go through how to identify hypertension, take a blood pressure reading well, what medications are available at their clinic, and based on those medications available, how to treat.
At the beginning a qualitative asset assessment composed of 21 questions was completed to get to know the physicians and their communities. It is the buy-in from getting to know the physicians that allowed for trust and changes to in-patient care.
But the program wasn’t open to everyone. Only those with high motivation and desire to improve their community were selected for the program. The training is one-on-one, opening lines of communication, establishing a strong physician-to-physician relationships, and ultimately leading to changes of practice that improve patient care.
Worms in her Ear.
“Doctor, there are worms in her ear,” the mother said.
“How do you know?” I asked through our translator --originally from France-- who translated from English to Mandarin. A Tibetan doctor who translated from Mandarin to Tibetan, to a concerned parent who responded in Tibetan that the child was irritable, but did not have a fever and was eating well.
The parents had never seen the worms in the ear, but they expected that was the reason she was irritable. I took out an otoscope (instrument to look in ears), that I had borrowed from a friend in the United States and peered in the child’s ears. I only found some earwax and eardrums that were normal. The baby had a little bit of a runny nose, appeared well, and had normal vital signs. It was most likely a cold. The Tibetan doctors and I discussed the case as well as how to use an otoscope. They told me that they do not have any medication for worms in their clinic and that they also do not have an otoscope. Although worms are a common pediatric problem in East Tibet, I was thankful to have not seen any worms in the ear, as our medications were limited. We let the family know that we did not see any worms in the ears, and they went home happy. The otoscope and I were far from Los Angeles. Being a blonde-haired, blue-eyed doctor, I was quite an enigma. I would probably have stopped traffic, if there were any traffic to stop. In the village restaurant, the children would watch me as my chopsticks teetered to drop noodles on the table. We all would smile at each other across the room. To arrive at the remote clinic and village, we drove through streams, mud, and rocky roads. We were about 3 hours from the hospital, above the tree line, in a mystical snowy (even through it was the end of May), mountainous land.
Although the city had no electricity and no running water, we had a generator at the clinic that ran in the evenings. The physicians were all extremely hospitable, and we sat in the kitchen tent to eat lunches and dinners together. The clinic was still under construction, built after the Yushu earthquake of 2010. Something I found unexpected and amazing was the level of hope of these physicians, who felt that the effects of the earthquake was stimulus for construction of new buildings and also brought the hope of electricity and running water someday soon. I was, needless to say, excited to be there and to learn from and train the physicians there. These physicians are truly on the frontier, taking care of anyone sick at a moment’s notice. I found we shared much as physicians, as we talked about gastrointestinal complaints, dermatology, and the physical exam. We also shared much as people. We ate with our trainees and slept in places provided by the clinics. 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.
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