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 15/day, in remote Qinghai Province, China. With few roads, cars or electricity, creating access to services is a high priority. Creating access to quality care is our aim. Our goal is to create greater access to free quality health care and earlier intervention, focused on mother and child health.The main problem is to empower women and girls. Our primary goal is to overcome world-record high maternal and infant mortality/morbidity. The downstream effects of healthy moms and babies impact Tibetan culture, more strongly than re-introducing wolves has resto...
Nov 18, 2016

2016 End of year Report and 25 year Retrospective

Drs. Kireet Tauh and Tonia Berg
Drs. Kireet Tauh and Tonia Berg

Looking back on 25 years in Tibet

Steve and me

In the mid 90’s Steve Jobs went to New York to meet with some New York venture capitalists to fund the iPod. They asked him, “What kind of focus groups did you run?” Jobs replied, “What kind of focus groups did Gandhi run?” They asked again, “how do you know they’ll like it?” He replied, “They don’t know they want it yet.”

While I’m no Steve Jobs, I faced exactly the same kind of questions in establishing healthcare in E. Tibet. What kind of capacity do you have? What are the established needs? I was not a public health professional and while I knew none of the answers, I was confident we would succeed. And succeed we did.

The 4000 m alpine summers of Surmang are short and glorious, aromatic deep green fields abundant with wildflowers and wildlife. Snowcapped mountains glistening with sunlight rising on their horizon frame the scene.

In 1991 we made out first trip with volunteer doctors to Surmang. It was 4-wheel drive country, with no roads and rivers and with no bridges. But the local response was breathtaking. No one had ever gone to so much trouble before to take care of them. Hundreds of people would come to our tent to be treated. Every day. While their personal response was very warm, none of them had ever seen more than one foreigner before. Me.

One of our doctors, David Dubin, said, gesturing to a Khampa warrior with long braided hair and a sword, “I feel like I landed on another planet.” I responded, “Imagine how they feel when they see us!”

We continued. In 1992 we signed a partnership agreement with the Qinghai Prefecture government to build a clinic. Within 6 months we had the funding from Caritas. Three years later 1996, the clinic was finished. By 2000 we had a local Tibetan who completed 3-year-post-HS training as a doctor. By 2001 we had a second, a female. That summer our overseas volunteer doctors began a journey that continues today: training our two doctors.

Throughout those first years of the 2000’s volunteer doctors like Julie Carpenter of Boulder, CO, would ask, “Why are there no women and children in this clinic?” That question was a game-changer. As a result we shifted our focus to mother and child health.

In ’94 we penned an agreement with the Yushu Prefecture Government to do a mass-data survey of 400 nomadic mothers. This is China and foreigners don’t run around surveying the locals. It had never done before, hasn’t been done since.

We found out that the region has one of the highest maternal mortality records on earth, on the level of Uganda or Somalia. I found out later that WHO estimates 6000 women die each year from childbirth or pregnancy. And they didn’t count Qinghai or Sichuan. The biggest threat to Tibetan health was facing death in the process of making life. The next year, 2005, with the cooperation of the government, we began to train 40 Community Health Workers, women embedded in their villages and nomadic camps to pro-actively remove the sword of Damocles hanging over the neck of every Tibetan mother and girl.

By 2011 maternal mortality in our area went to zero. And stayed close to there.

 

This year, 2016.

This year’s report will come at the end of November. Anecdotally I can report that among our clinic’s 9000+ patients treated for free and the region’s 95+ births, there were only 2 maternal mortalities and 1 infant mortality.

In the early 90’s Suzie Jolly, then with UNICEF asked me when we were building our clinic, “how do you know you will get any patients?” I asked her if she saw the movie, “Field of Dreams.” In that movie Kevin Costner’s character is asked to build a baseball field in his Iowa corn field so that the ghosts of the corrupt Chicago Whitesox (the “Blacksox”) could play an honest game and redeem their souls. He said, “How do I know they will play if I build the field?” The ghost said, “build the field and they will come.” I repeated this story to Ms. Jolly.

Two years ago I was re-connected to her through the late Maurice Strong. He said, “Call her up.” And so I did. When she answered the phone and I identified myself, she said, “build the field and they will come.”

Our work is to save Tibetan culture. If you want to save a culture, save a mother. We get no funds from foreign governments or churches or big foundations. We are driven by individual donations. There is one big takeaway for our many small donors: the feeling stays with you. Help us. See what happens.

a patient
a patient
Community Health Worker Training
Community Health Worker Training
Young Khampa Girl examination
Young Khampa Girl examination
"I will fight 6000 maternal mortalities"
"I will fight 6000 maternal mortalities"

Links:

Aug 17, 2016

Summer on the Plateau

A young patient
A young patient

Winter exits the stage late at 4000 m., and summer comes even later. This year we once more had the expert services of two volunteers -- Drs. Tonia  and Kireet  of Vancouver, Canada. They work side-by-side with resident docs Phuntsok  and Drogha. Dr. Kireet, a 4th year resident in cardio surgery, was particularly interested in the ultra-high salt intake among Khampa Tibetans. On a healthy side, salt helps keep fluids inside the body and this is particularly useful on the high plateau. This is because, without much atmosphere to speak of, there is little atmospheric pressure and when there is less atmospheric pressure, the liquid in one's body basically flies into space. This is why volunteers often experience chapped lips during an all-day rain fall.

The downside for many Tibetans is very high blood pressure and also the resulting chronic arteriosclerosis and heart disease. The problem when we treat this sympomatically, by giving BP meds, is that it doesn't go after the heart, so to speak, of the problem, which is salt intake that is 5 to 7 times that recommended.

Dr. Tonia, a 4th year Radiology Resident, was interested in cario-applications of our ultra-sound to Dr. Drogha. As usual Dr. Drogha is a great student and picked up moved year's lessons to a new high. 

In August, Dr. Ron arrived -- his 3rd volunteer rotation. Everyone was happy to see him back again. All three volunteer docs were received with typical low-definition Khampa warmth and smiles.

This year, we've had the services of manager/interpreter Lobsang. Lolo, as he is known, adds a kind of off-handed tri-lingual fluency and humor to the project. 

  • Meds inventory. Although it's boring to say this in a GG report, the 10 days I was there were spent setting up a meds inventory system. We had to do this since we were the recipients of a $12000 donation from a Chinese pharma company. 
  • Water. We are moving ahead in setting up a water system for the clinic. At this point we visualize that it will cost about $20,000 to deliver the water from upstream to a tank in the Clinic building. 
  • Relations with the monastery. This year the Abbot of the Surmang Monastery gave his unqualified support for the clinic.  We welcome the increased marriage of our two worlds. 
Patients.
Patients.
Donated meds.
Donated meds.
Phuntsok and Lolo in Jiegu
Phuntsok and Lolo in Jiegu
Preparing the inventory software
Preparing the inventory software

Links:

May 20, 2016

The 20th Anniversary of Surmang's Dharma Sagara Clinic: build the field and they will come.

putting up the building
putting up the building

You wake one day, both your children are in college, your black hair is silver and your fledgline Tibetan health care project is 20 years old

This summer we celebrate the 20th anniversary of the Surmang Dharma Sagara Clinic.

It was 1992 and I though, "who would ever give us money if we don't have permission from the Chinese Government to build in Tibet?  What started out as a dream became a contract with the Qinghai Government, with the help of Gov. Huang Jing Bo. Not so long after we signed the contract we got the construction funds -- our only big grant. We broke ground in '93, and completed the work in the summer of '96. There have been 20 brutal East Tibetan winters in between, and and devastating earthquake in 2010 that took down the 400 year-old monastery on whose land we sit. But it didn't scratch the clinic. 

And come they did. In the past 10 years alone, over 140,000 patients. Over 150 volunteers. I have to admit that some of the success was driven by naive luck. I was told by several experts in international development and public health that, like Rodney Dangerfield, we'd get no respect if we didn't charge for services. But for the life of me I couldn't figure out how to do that. By looks alone, I couldn't tell the difference betwen a nomad who had 200 horses and one who had 20. The dressed the same and looked the same. The only thing that made sesnse was to charge everyone the same and for me and the foundation to do the work to get the funding elsewhere. So since then we've never charged for services or meds.

We took a place with among the highest maternal mortality rates in the world --3.000/100,00 live births-- down to zero in 2010 and kept there near there ever since. 

In '95 when I spoke to the ehad of Mother and Child Health at UNICEF in Beijing, she asked me, "how do you know that anyone will ever come to the clinic?" I asked her, "did you see the movie, "Field of Dreams?" Kevin Kostner's character is told to build a baseball diamond in his Iowa cornfield. "What makes you think they will come to play?" he asks the ghost. "Build the field and they will come," was the answer. That's what I told her. Now she's at Ford Foundation and when I contacted her 20 years later, her first words, on hearing my voice, were, "build the field and they will come."

years after completion, patients line up
years after completion, patients line up
patients waiting to see one of our docs
patients waiting to see one of our docs

Links:


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