Health Care in Tibet /Yushu

by Surmang Foundation
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Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
$10,000 of donated meds, all given patients gratis
$10,000 of donated meds, all given patients gratis

We have, since 1988 tried to answer the question: if all life on earth were under threat, and we could through mass interstellar transport, save a significant number of earthlings, who would we save?

It occurred to me that we have attempted to answer that question in the past 30 years. At the head of a line, most people would include Wall St. bankers, politicians, Iowa corn farmers, entertainers, doctors, scientists, and professional athletes. I would put first the common people of East Tibet: the farmers and the nomads and then the monks, nuns and yogis first in line on that rocket ship. Why?

These humble and mainly illiterate people are survivors. And as Covid 19 has taught us, that is no small accomplishment. But beyond mere survival there are other praises we can sing.  As few of them would admit in their humility, they carry the culture of vastness, cheerfulness, and most importantly, compassion. In our 30 years of work at Surmang,  it is our honor to help revitalize them.

This year we will reach out to other international foundations so that our success can become not just a model of rural health work, but one of an international standards clinic. Our clinic building was the first new construction at Surmang after the disastrous years of 1955 – 1980.

But it wasn’t on barren ground. As Karma Sengay Rinpoche told me in 1991, there are many larger Surmang monasteries than Surmang Dutsi til, but none holier.

Outreach to the Chinese Government.
I’ve tried to follow the example of their late Abbot, Chogyam Trungpa, by not collecting projects but by giving projects away. and embracing anyone willing to help. There were some bad harvests along the way but most, starting with Chinese Ambassador Han in 1986 to the head of the Minority Affairs Council in 1990, to the Qinghai Governors to the head of the Yushu Public Health Bureau, we sought out the partnership with the government in order to see what we could do to help. Our over 5 partnerships with the Chinese government were a bridge not just with China and the Chinese Government, but with foreign leaders seeking to connect with the wisdom of the of the region’s wounded but undying spiritual vitality.

Much of the help was done out of respect for Chogyam Trungpa so much so that we were told in a private audience with the Qinghai Governor, that our philanthropic work was the upaya, the compassion, of the Vidyadhara, Chogyam Trungpa. After all these years, it is very very likely that our clinic is the only international clinic in an ethnic Tibetan region.

Iana Weingrad and Clinic Assistant Mgr. Achi
Iana Weingrad and Clinic Assistant Mgr. Achi
Dr. Phuntsok Dongdrup, Clinic Director
Dr. Phuntsok Dongdrup, Clinic Director
Donated print from Derge, Kham's iconic library
Donated print from Derge, Kham's iconic library
Beibei Huang -the vitality of  mothers & babies
Beibei Huang -the vitality of mothers & babies

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Achi, Clinic Mgr (r). iana Weingrad volunteer, (l)
Achi, Clinic Mgr (r). iana Weingrad volunteer, (l)

I’m not a young man — so I’ve seen a lot of years. I don’t know what 2021 will bring, but 2020 was as close to a Ray Bradbury novel as I care to get. At the end of January 2020 I went to Hawaii to see my daughter starring in a dance performance at the University of Hawaii, “The Last King of Bali.” Then, I almost couldn’t get back into China, where I live. 

Time and again since then I couldn’t get out of our compound where we live —the requirements just to go to the shopping center are draconian. With the various forms of ID, entering the local supermarket itself is like entering a foreign country. Everyone has cell phone software that tracks their movements. It is inconvenient, but then again so is death by Covid-19. Social distancing and pro-active public health management has kept the situation from going from bad to worse in China. With low car use, the skies are as blue as I remember them in my 30 years here. 

Fortunately for our clinic in far away Qinghai, on the vast Tibetan plateau, social distancing is a normal part of Tibetan culture and we didn’t have to create any special procedures. But women still get pregnant, babies are born. And that is our foundation’s sweet spot. 

2020 was a good time for taking a long look planning our future. 

We bought a lot of furniture from IKEA and a big Panasonic washing machine, new beds, convertible sofas, meds cabinets. At the end of the summer a ceiling was installed in the entire first floor. Next time you need to call an electrician just say a prayer of thanksgiving that your home is not in East Tibet!  In addition to GlobalGiving.org., our patrons here in China want to visit and I want all of you to also see what good your donations have created. We plan on using the second floor of the clinic as a lodge just for that purpose when we don’t have programs there, such as community health worker training, or visiting doctors providing training. But that will have to wait to later this summer. 

You are all invited. 

Our 2020 donations were the best since our foundation’s creation in 1988. Please continue your support. Until then, please add your name to our growing mailing list to keep track of our continuing strange and wonderful story, increasing the status of women, saving their lives and those of their babies.

Dr. Phuntsok Dongdrup, Clin. Dir. leaving Beijing
Dr. Phuntsok Dongdrup, Clin. Dir. leaving Beijing
Print of Callig.of Chogyam Trungpa sold at Gala
Print of Callig.of Chogyam Trungpa sold at Gala
Donated antique E. Tibetan carpet at Gala
Donated antique E. Tibetan carpet at Gala
Community Health Worker Training @ Surmang Clinic
Community Health Worker Training @ Surmang Clinic
Remote, 5000m, Chang Thang, near Surmang.
Remote, 5000m, Chang Thang, near Surmang.

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Surmang Clinic
Surmang Clinic

This year, Surmang Foundation’s Dharma Sagara Clinic is isolated because of Covid-19.

So even the difficult travel to Qinghai Province and then 1500 km south at> 4000 meters, was made impossible due to the shutdown of air travel, not to mention the draconian measures such a social distancing and quarantine. Our Mother and Child programs which started in 2005, have been working well. This year the downstream effects of Covid effectively postponed the start of a second phase, a new health promotion program our foundation wanted to provide in 2020.

Despite our hubris as foreigners, since antiquity the region was also isolated. For Khampa Tibetans, social distancing is a traditional way of life. These peaceful nomadic yak herders, barley farmers and monks and nuns practicing meditation had never seen a foreigner until 1987, the year I arrived. This reason alone —the absence of primary care and mother and child health— ensured the sad reality that only returning visitors were death and disease.

That is, until the Dharma Sagara Clinic. Our clinic’s work was not just a plug-and-play health center, but a gradual elevation of the culture of health, to chip away at the very patterns of life that made having a baby and being a baby a kind of Russian roulette.

This year’s isolation has not impacted regular clinical operations — social distancing is a traditional way of life in this ethnic Khampa Tibetan region. Nor have there been outbreaks of Covid at Surmang. We are still treating about 1000 patients/month. In fact you could say that the last several months we’ve continued our work to the usual: full waiting rooms, pregnant moms, newborn babies, treating diseases like placenta previa, Hepatitis, high blood pressure, emergency medicine and trauma. Soon the snows, in this the Land of Snows, will return and Mother Nature’s winter will once again have the last move in social distancing.

[The Nuns Project]

Back in 2019, 2020 was the year we were to start a public health program among the nuns to eliminate the scourge of h-pylori, hepatitis, and TB. The idea is to eliminate these diseases and then make the nuns agents of change in public health in the Surmang region, since the nuns and monks enjoy very high status among the Khampa Tibetans. To the best of my knowledge, this way of leveraging our status at the Monastery to make the monastics agents of change in the community has never been done before. But this year’s Covid quarantine of foreigners and non Surmang Tibetans made these plans something we’ll have to do next year.

[What can be done?]

So what could we do? We decided to complete the interior, the clinic’s physical improvements. These have been furnishings and improvements such as the installation of a ceiling in every room on the 1st floor. The IKEA furnishings include 7 modern beds, sheets, quilts, pillows, nightstands, lights, cabinets for meds, a play area for children, a convertible sofa, a wingback chair, and finally Hunter-Douglas style window treatments to further insulate the building from the cruel East Tibetan winter. We also put the finishing touches on our new tiled toilet/shower. Last but not least is a washing machine —since water was installed two years ago.

[Wrapping it up]

When the furnishings are installed, we will have a clinic that is unparalleled in terms of function and taste. Although we have much further to go — a kitchen next year— I am very proud of this result so far. It will arouse the confidence and comfort of all guests who stay at the Dharma Sagara Clinic. I’m also hoping that in the future as eco-tourism grows for Surmang, that it will be a place of unparalleled dignity and comfort for those seeking to visit this extraordinary place. Please come!

Patient Waiting
Patient Waiting
Patient Waiting Area -- old floor, old walls
Patient Waiting Area -- old floor, old walls
125 year old drawing of Surmang Monastery
125 year old drawing of Surmang Monastery
Training Comm Health Wrkrs -- Mother Child Health
Training Comm Health Wrkrs -- Mother Child Health
One of 7 new beds from Ikea, Beijing
One of 7 new beds from Ikea, Beijing

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Newborn and mom at Clinic
Newborn and mom at Clinic

Look --I’ll tell you something I discovered. By myself.

I’m not a doctor, not hospital administrator/designer and before Surmang, I had no background in Public Health. I’ve never been in clinic design/hospital administration before I woke up one morning and decided that we should have a clinic at Surmang. A very remote part of Tibet.  And I never raised money for a cause before. The people at Surmang are very poor people.

That was 30 years ago.

I went to see the people I thought could help me. Actually I was dumbstruck.

I remember in 1992 or so seeing the head of UNICEF in Beijing. She was very friendly. She said “how do you know you can build a clinic at Surmang and it will succeed?” I asked her if she saw the movie “Field of Dreams.” Kevin Costner, the Iowa farmer, asked the ghost the same question and the ghost replied, “Build the field and they will come.”That’s what I told the UNICEF head. 

A second event occurred a few years later when I met a woman who ran a rural clinic in Ladakh,India,  a Tibetan region. Her advice was, “no matter what the cost, the patients must pay.”  

[Should I bow to greater wisdom?]  I thought I should bow to greater wisdom. But something in my gut told me that the advice I was given was a poor fit.                                                     

The Surmang Tibetans were/are so poor I couldn’t never figure out how to charge them for meds and for services. Based on their appearance, I could not tell the difference between the man who has 500 horses and the man who has 5. 

The only thing I could do is administer a means test, and given 95% illiteracy in Tibetan, they could not fill out a form and also, I was not about to have them admit to a fellow Tibetan how rich or poor they were. In fact, their culture doesn’t work that way --they have no idea of “being rich or poor,” which is to say they never ever think about money. So why should I be the one to make that change in their culture? They don’t think of themselves as poor. So what I ended up doing was to not charge them. I raised the money for their services and their meds. We paid for their health. It was one of the greatest decisions I made in my life. Ever.

[The structure of a hospital. The structure of our clinic.]     It took me a while, but I realized that when you go to a hospital, a good deal of the charge is for the largish administrative function of the hospital:  the building maintenance, the computers, the payment scheme, the purchasing of equipment and meds. So many hands to pass through and somehow we think of that as the norm. Hospitals have become health cash cows in America: at each door was someone with their palm extended in order to be paid.     

With Surmang, the administrative wing was and is me, 2000 km away in Beijing. I raise the money to pay for the meds; I raise the money to pay for the equipment. I pay the docs' and assistants’ monthly salary. Originally, I thought this was a funky home-grown mistake. Now 30 years later,  I have seen that ghost baseball team come to our field to play on Kevin Costner’s farm.

I soon figured out that our model was very very cheap to run compared with even the rural clinics of the Chinese government. Peking University computed it on an all-in perpatient visit cost. For a Township Chinese Municipal Hospital it’s $38 per patient clinic. For Surmang Foundation it’s $7. 

So you might say it’s socialized medicine we practice. But there’s more. About 10 years ago one of the high lamas from the monastery told me that because we give everything away, because we treat people kindly, that our Clinic embodies the highest ideals of Buddhism: “jinpa,” or generosity, the hallmark of the health element of Buddhist wakefulness, personified in Medicine Buddha. So by some stroke of luck we’ve tapped into the heart, the core of Surmang Tibetans’ culture. 

Is it any wonder they support our clinic as their own? Please help us go further with this work. Support the clinic as your own. Every pfennig, Loony, nickel, yuan RMB, shekel, helps. 

Thanks,

Lee Weingrad
Director

 
little boy born at clinic
little boy born at clinic
4 year retreatants we serve
4 year retreatants we serve
Doctor volunteers on a hike
Doctor volunteers on a hike
nuns we serve & will recruit as community leaders
nuns we serve & will recruit as community leaders
our pledge
our pledge

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Patient at our clinic
Patient at our clinic

In 2019 the Dharma Sagara Clinic at Surmang Dutsi til has treated over 12,000 patients, for free. Including meds.

In particular, we have elevated the status of women by focusing on maternal and infant mortality and morbidity. We have worked in an area that had sub-Saharan-level maternal and infant mortality rates. We lowered the former to zero by 2011. 

 2019: What we did with your help  

With your generosity

  • We have added a shower and a toilet; 
  • We have added a storage area for meds and supplies; 
  • We have replaced all double pane broken windows. 
  • Expanded the upstairs dining area to include a small bedroom.
  • Added a quality solid oak floor to the dining/meeting area
  • Added a vinyl floor to the kitchen
  • Refurbished a small bedroom by adding the hardwood floor, and a new window.

In 2019 we achieved Revenue Canada nonprofit status for Surmang Foundation Canada. (cf our website for details)

2020

We want to bring health to the 90 nuns of the Surmang Dutsi til Monastery. As monastics, they are community leaders. They are are celibate and they have high status. But as women that status is threatened by infectious disease, issues of personal hygiene and environmental issues, such as unsanitary food preparation, the presence of helicobacter and tuberculosis and most importantly, lack or access to proper gynecological care. They share the plight of women in rural ethnic Tibet.

We will change that in 2020.  

In connection with our goal of international hygienic standards for the clinic and for the community, the 90 Nuns of Surmang play a leading role. We will provide not just primary care, but also have the nuns serve as a model of what the community can achieve with clean clothing, bedding and food preparation. 

1. The Nuns Project.

Extending health services to these leaders of the community —the 90 nuns of Surmang— we will be extending health to the community as well and  improving  the status of these women and girls.

The nuns have very high status in the lay community. We will eliminate helicobacter, TB and Hep A and C with a pro-active program that will not only create sanitary conditions for the nuns, but also use their example as a means of influencing the lay community. 

2. Incentivized visits

We have successfully extended medical resources to women who are in their child-bearing years through a network of 40 Community Health Workers, In 2020 we will be even more pro-active. We will incentivize pregnant women and community health workers to come to the clinic for pre-and post-natal examinations. We will pay them to come to examinations.

Providing  robust pro-active health services to a very poor area will show ourselves, China and the world what we are capable of accomplishing. We will be one of the high capacity health care clinics that will operate on international standards.

Cervical Cancer

In cooperation with United Family Foundation, we are planning on doing cervical cancer screening at our clinic in the summer of 2010.

All with your help. Please continue this important journey with us. 

Mom and baby born at our clinic
Mom and baby born at our clinic
Little boy born in December at our clinic
Little boy born in December at our clinic
Redone dining rm: hardwood floors and new windows
Redone dining rm: hardwood floors and new windows
Putting in the new main entrance
Putting in the new main entrance
Achi, Asst. Director (l), & iana Weingrad (r)
Achi, Asst. Director (l), & iana Weingrad (r)

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Organization Information

Surmang Foundation

Location: Boulder, CO - USA
Website:
Facebook: Facebook Page
Twitter: @surmang_found
Project Leader:
Lee Weingrad
Founder
Beijing, Beijing China
$140,717 raised of $200,000 goal
 
2,783 donations
$59,283 to go
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