| Mar 7, 2013
2012 - 2013 next steps for the Surmang Model
Mother and Child
When the heads of foreign foundations that support orphanages talk with me here in Beijing, I ask them: “Why are there so many orphanages in Tibetan regions?” It’s because the mothers are dying in pregnancy or childbirth in record numbers. “Why not work further upstream?”
When we think of the challenges to Tibetan culture, conventional wisdom lists economic, political or environmental challenges as the major obstacles. Yet, the biggest challenges are actually found further upstream. They are the death of mothers during pregnancy or delivery, the death of children in the first 5 years of life. When a nomadic or farming mother dies, the family often craters.
As in the rest of the developing world, today’s top killers in ultra-poor regions of China are maternal death around childbirth and pediatric respiratory and intestinal infections, evidenced by Yushu Prefecture’s high maternal and infant mortality. Yet, as Laurie Garrett correctly points out, there are no marches down 5th Ave. for dying women, or celebrity endorsements for children dying of diarrhea.
Yushu Prefecture has off-the-charts high maternal mortality (according to our own stats, 3000/100,000 live births vs. the national Chinese average of 31.9 per 100,000 live births) and high infant mortality (200 versus the China’s national average of 13.8 per 1,000 live births).
Yet, compared to seemingly opaque, economic, political or environmental challenges, it is possible to eliminate maternal mortality. Surmang Foundation has proven just this. In 2011, the last year of record, Surmang Community Health Workers reported zero maternal mortalities.
In 2010, a 7.1 magnitude earthquake leveled Yushu, leaving over 5,000 people dead and all schools and hospitals in rubble. Although the first response was swift in China, the disaster opened the door to leapfrogging the quality of the public health system.
The Yushu Public Health Bureau turned to Surmang Foundation for such a solution.
Cost-effective, user-friendly, the experience at Surmang was that “financial determinism” is not the path to greater public health. It’s not a question of throwing more money at the problem. It’s a question of working strategically.
Surmang’s two dedicated doctors, Surmang’s corps of 59 Community Health Workers (CHWs), created a user-friendly system that is in some ways closer to “Moneyball” than conventional public health wisdom. The solution is not throwing more money at the problem. The solution is working smart. In the previous 10 years, 150,000 patients have visited the Surmang Clinic. This is a rate 10x higher than the township clinics. Treated for free, with free meds, the cost per patient visit was $7 net compared with $35 in the public health system. Maternal mortality in the Surmang region was reduced to zero. This is the model we will to export to the public health system. This is our contribution to Tibetan, Uigyur and Mongolian culture.
Yushu Prefecture is 97.5% ethnic Tibetan. It is one of the most Tibetan places on earth. The Surmang-Government partnership is in four townships in Yushu Prefecture: Xiewu, Xialaxu, Longbao and Mouzhang. The problems there are similar to the rest of the 40 million strong ultra-poor catchment:
- No access to health care because of no roads, no cars, no phones
- No access to health care means that the system is not user-friendly – written forms for illiterate patients and cash-in-front procedures for cash-poor farmers and nomad
- Lifetime-tenured doctors who are poorly trained and have no incentive. or exposure to, or access to quality medical training.
2012 was a bridge year for giving this project legs. This year, we will train over 40 new Community Workers and over 20 Township hospital doctors, with volunteer doctors from Tibet, China, the US and Canada. We will begin the long climb to establishing the Surmang model of rural health care as a sustainable prototype in China’s rural health care system. We will be doing something strong and something sustainable not only for the mothers and children of Yushu Prefecture, but for their culture and their economy: ensuring life for mothers and children.
best regards, and appreciation for your continued support,