Tibet has one of the highest rates of maternal and child mortality and morbidity in the world; therefore improving women and children’s health is critical to improve the health situation in Tibetan society overall. The Tibetan Healing Fund carries on its mission to respond with comprehensive health projects to improve the health conditions in rural Tibetan communities. The Tibetan Natural Birth and Health Training Center (“Birth Center”) is the major component of such interventions.
The Tibetan Natural Birth and Health Training Center (birth center) will provide women and children in rural Tibetan villages a place for safe, affordable, linguistically and culturally appropriate health services and health education. The center will serve as a training facility for community midwives and health educators and a resource center for women to learn about personal and family health and nutrition.
Establishing the first birthing center in Rebkong County (Malho Tibetan Autonomous Prefecture, Qinghai Province) will improve and strengthen the public health infrastructure at the county level as well as provide an opportunity for advancing the health care delivery system, particularly health care for reproductive women and their children.
This project is a comprehensive, multilevel health program, which deals with the county level to outreach and educate the rural village communities and individuals at the family level. The Rebkong Tibetan Natural Birth and Health Training Center is designed based on the concepts of US public health and community oriented primary care.
During the spring of 2008, we restarted construction after a long winter. The plan and preparation of the Birth Center took three years, and the building construction started in the fall of 2006. This center will be completely built by local people using regional resources. THF projected having the construction completed by December 2007, but we need to move this date to 2008. Once the building construction is completed, the inside walls are painted, and the center is equipped with the medical equipment, supplies and furniture, the Birth Center will be opened.
It is the first comprehensive birthing center in rural Tibet. The work process is managed by Tibetan Healing Fund’s local health project advisors and the Birth Center’s Management Committee. The center is managed by local Tibetans and it will be intergraded into the Rebkong County Health System in order to sustain its long-term service for the region.
The approximate total budget for construction and medical supplies and equipment is $70,000 (US dollars), which is raised by Tibetan Healing Fund in the USA. The Birth Center could not have been conceived or begun without the donations of time, resources, and medical equipment from local Tibetan and Chinese friends as well as the financial support of our donors.
The Tibetan Natural Birth and Health Training Center (“Birth Center”) is established to be the cornerstone of health care for women and children in the Rebkong health care system. The following sections provide more details.
Goals and Objectives:
The main goal of the Birth Center is to provide access to quality, safe, affordable, and linguistically and culturally appropriate health services. This includes general maternal and child health care, natural delivery, and health education to local Tibetans. The center will also serve as a training facility for community midwives and health educators, and as a resource center for women and their families to learn about health related issues in order to reduce mortality and morbidity.
The goal will be accomplished by:
• Increasing access to culturally and linguistically appropriate health care services for rural Tibetan women and newborns;
• Increasing the number of safe deliveries;
• Increasing the number of rural women receiving pre-natal, post-natal, and neonatal care;
• Decreasing risk of death and disability from hemorrhage, eclampsia, obstructed labor and infection;
• Providing family planning services;
• Providing delivery kits for safe home births;
• Increasing access to essential drugs of Tibetan and western medicine;
• Providing management for complications and safe transport for emergencies related to pregnancy and childbirth.
• Increasing rural women’s and their husband’s knowledge of physiology, women's health, family heath, hygiene, nutrition, infectious disease such as HIV/AIDS and TB, and disease prevention.
C. Training Services
• Increasing the number of trained village Community Midwives to assist safe delivery and arrange for emergency transport if complications arise;
• Increasing the numbers of village Health Educators.
The location of the Birth Center is in the town of Rongwo, which is the prefecture seat and the center of Rebkong County in terms of location and transportation. The 75 villages and 12 townships are located in the surrounding areas with various distances to the town of Rongwo. Moreover, Rongwo is the capital town of Rebkong (Malho) Tibetan Autonomous Prefecture, which is the center of education, health, transportation, economic development, and commercial market for the prefecture. Thus, the Birth Center was strategically located in the town of Rongwo in order to reach the Rebkong population with the capacity to serve people from the other three counties within the prefecture as well.
Scope of Building:
The Birth Center will be a large contemporary Tibetan style building. It is built around a center courtyard with rooms for health service activities and administration. Facilities include three home-style birth suites, pre and post natal exam rooms, pharmacy, offices, spiritual room, and a substantial educational classroom for training both Community Midwives and health workers. The total size of the buildings is 504.86 square meters with three components of one building:
1)Two story building with 12 rooms which is 296 square meters. This is the main building and it has major activities rooms including exam rooms, pharmacy, office room, spiritual room, and conference room.
2)Three home-style birth suites with 3 large rooms which is 105.75 square meters.
3)Utility and facility rooms including laundry room, stokehold room, kitchen, restrooms, and gate keeper room with 103.08 meters.
Permits require an outer wall and gate, as well as the infrastructure for water system, electricity, sewer system.
Medical Equipment and Supplies:
Since this is a natural birth center, it will not rely on high levels of modern technology and supplies. However, the Birth Center is going to be one of the only health facilities for women and children who expect to receive comprehensive care. Unlike US birth centers, it is one of the only health facilities for Tibetan women and children. For this reason, we must include capable technology and skills, and be prepared to diagnose, provide health problem management, and emergency life saving services. In addition, the Birth Center will need to have essential drugs and supplements such as vitamins and iron. Also, the Birth Center will need to be stocked with Tibetan herbal medicine for assisting in deliveries, health problem management, and disease prevention.
The building will be Tibetan traditional style with necessary furniture, such as tables, chairs, cabinets in exam room, pharmacy, and waiting room. The health education conference room will have a dry-erase white board, tables, and chairs. The spiritual room will be organized with Medicine Buddha’s statue and Thangkas as well as the space to arrange a sitting area for conducting birth ceremony prayers and rituals. The three birth suites will be designed as a Tibetan home style which includes a Tibetan style warm bed and sitting places as well as a clean shower and restroom in each of the suites. The suites have the capacity to let a pregnant woman rest and stay comfortably with her husband and family members. The suites will create privacy for the family. The laundry room will have a washer and dryer machine.
The kitchen will be equipped with the necessary cooking equipment, supplies, and a stove. Stokehold is a settled stove for heating entire rooms during the winter and each room has this heating system as part of the furniture.
Finance and Sustainability:
The Birth Center qualifies as a Chinese non-profit organization. Criteria of a non-profit health organization includes being supported by the government, local communities or NGOs, but also for the organization become self-sufficient via minimum service fees without a surplus fee. Thus, the government is obligated to not charge an annual tax. The Birth Center will charge a minimum fee for health care services and training programs in order to be self-reliant; however, if anyone cannot afford the fees, the services will be free of charge.
We aim to make the Birth Center a model facility and one that can be replicated in other areas of need. This will be a force to improve maternal and child health care in remote and rural areas of Tibet and we strive for it to be a major component of the health care system. We are hoping to have a positive impact in terms of increasing utilization of high quality health care services, which will reduce mortality and morbidity among women and children. As a result, this will create a model for Tibetan maternal and child health care.