Dear Friends,
[The back story]
We depend on your support, the support of individual donors big and small. This project, in its 30th year, proves that it is possible to realize a dream --of healthcare and empowering women-- with an inspired but uncomplicated narrative.
When I first arrived in 1987, there was no clinic and there were only ruins of this 500 year-old monastery.
in 1992, when we signed the partnership agreement with the Chinese Government, Qinghai Province to build the clinic, we soon received the $150,000 for the clinic construction. This was to be the only substantial donation we received.
The building took 3 years to complete. Since I come from a background of teaching and also wholesale and retail sales you might wonder how we could succeed. I was asked that very question many times by NGO and PH professionals.
[Enter Kevin Costner]
In perfect 202-20 hindsight, knowing nothing about public health -- outputs and indicators, Gannt Charts and logframes-- I remember being asked by an official at WHO, “how do you know you will succeed if you build a clinic?” I answered her, “Did you see the movie “Field of Dreams” when Kevin Costner’s character asks the same question and the ghost answers him, “build the field and they will come”?
Kevin Costner: "build it and they will come."
But where my creds were non-existent, my instincts were good. And our connection to the community was even better. The clinic we built was the only new construction at Surmang since the disastrous years of 1959-1966. When I first got there, most of the monastery buildings were flattened, in ruins. Our work was the first exposure of this remote place to the outside world and the first vote of confidence in its future.
Now 32 years later, the monastery is in a robust growth cycle. The clinic has gone from “the free clinic,” to one of the more successful experiments in remote primary care. Don’t forget, a big medical school or school of public health doesn’t have our back.
[Empowering women and girls]
Not only that, but the focus of our work on women and girls has begun to bear fruit in our asymmetric war against the low status of women and girls. We also discovered that a very inexpensive model of providing health care, inexpensive despite the fact that all the services and meds are free. With no co-pays or insurance, our model at Surmang is truly “single payer,” and explains why our costs, according to a study by Peking University is $7/patient visit, vs $35 in the public sector.
[This year]
Last year through your kind support we added a water system.
This year, we will add upstairs
--an oak floor to the second floor --replace the kitchen floor
--replace the kitchen cabinets --remove the wall between the dining area and the small bedroom, opening up the space
--re-finish the small br in the NE corner, adding a new window. downstairs
--build bathroom and shower --create storage space for meds in the current tromb entrance whole building
--replace all broken all broken double-pane windows --install Hunter-Douglas style thermal window treatments.
Please support us this year. $500 or $5, it matters not.
Lee
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They make 50¢ a day.They live in one of the most exotic, beautiful remote places in the world: East Tibet, SE Qinghai Province, China.
They have no transportation, public or private and the nearest hospital is over a broken road, a 6000 m pass, and when women bleed to death it’s in the fields in unassisted births. If you are a child, 1 in 5 die from dehydration caused by diarrhea. Women and girls have low status.
On the other hand, in this beautiful place, it’s not hard to make a difference, giving free care to whoever walks in the door, tracking pregnant women with one of 40 Community Health Workers, giving gynecological exams on the the only ultrasound within 75 miles.
We give asking nothing in return, a service, a free service. Years ago it seemed like the only option not it’s clear we plugged into their primary religious value: generosity, or jinpa in Tibetan. There was no other way; we could not distringuish the nomad who had 30 horses from the one who had 3, based on how they dressed.
The accident of not knowing how to collect for services and meds led us to not only give them away, but also to tap into their primary cultural value. The result has been 130,000 patient visits in the last 10 years.
Our doctors are both MDs in the Chinese allopathic system. We have had high level doctors train them every year: Chinese, Canadian, Norwegian, American, Dutch, German. For nearly every one, the experience was a watershed moment in their life.
Now approaching our 31st year, we look forward to further government partnerships, distance consultation, and futrther improvements to our clinic. 2018 was the year we installed running water. 2019 is the year we hope to partner with the government to fill the gap in epidemiology, and remote consultation. Our work is a brilliant model of cooperation and service. Please join us.
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The Surmang Clinic is the oldest philanthropic clinic in a Tibetan region. For the 26 years of its clinic history, the idea of a water system was never far from our minds. There were several engineers who drew designs, but we always seemed to lack the ability to actually execute, until US Board member, Architect Ralph Allen and Canada Board member Lyle Weinstein came along.
In 2011, Surmang Foundation received a donation of two pumps by the Danish pump manufacturer, Grundfos, via the support of the Danish Chamber of Commerce, China. By late 2017, we’d received the last design, the one we intended to use, from Ralph and Lyle. Both had been to Surmang and understood the difficulty of capital construction there.
By late 2017 we assembled a team consisting of myself, daughter iana Weingrad, son Joseph Weingrad and Russell Iser, a Master Plumber from the US. All three –iana, Joseph and myself—have nearly perfect Chinese language skills.
The source of the water was to be the stream that runs by the monastery, a stream that feeds the upper reaches of the Dzachu, the “wild yak river,” what we call the Mekong River. At Surmang this stream is referred to by as “the heart’s blood of Demchog, or Chakrasamvara,” one of the two names of Buddha in the lineage of Surmang Tibetans.
As good as our plans were, we found that recent construction blocked direct access to the stream, so we met with Trungpa Rinpoche XII, Chokyi Sengay, the Abbot of Surmang Dutsi-til Monastery.
The founding director of Surmang Foundation, Lee Weingrad, was the first non-Tibetan to meet Rinpoche back in 1992. Rinpoche agreed to let us connect to the year-old water main that had recently been installed by the Chinese government. The foundation offered to continue its help of the monastery with a helicobacter infectious disease project in 2019.
To do that, we needed a revised drawing to connect the water main to the clinic. Fortunately Joseph Weingrad had the skills to create such a graphic:
Within a few days a backhoe was summoned, the trench was dug and the pipes were laid. Connecting the pipe was the next task. Since we had purchased all the necessary equipment and supplies in Yushu, we had all the PVC pipe needed to join and lay the pipe.
As the last pipes were joined, and the backhoe returned to fill the trench, the next morning with perfect timing, a local Lama blessed the project.
After 26 years of planning, the clinic water system was finally completed. We told everyone that we would be back next summer to install a modern shower and composting toilet.
The day before we left, Joseph Weingrad filmed an interview with Laizhong, with one of the oldest members of the Surmang Community. She broke our hearts when she said, “the clinic is like a mother and father to me.” That interview will be available soon.
The next day, August 2nd, we returned to Yushu. Everyone was happy since we’d completed a project that we’d talked about 26 years before. Its completion firmly brought the clinic and health care into the 21stC.
It would be impossible without your steadfast support, the donors of GlobalGiving.org
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Our Clinic building was started in 1993. I'd never built anything before in my life.
Dharma Sagara Clinic is an odd building for China, and an even odder building for Tibet. It’s like no other. It’s high passive solar gain, techno-geek for grabbing the sun’s heat and keeping it and releasing it at night when it’s cold. And it does get cold at night at 14,000', 4000m. The windows all face south. The walls are two courses of brick with volcanic ash in between. The floors don’t touch the earth. It withstood the 2010 Yushu earthquake that brought down two very large 400 year-old monastery buildings.
My original instinct was “how are we going to raise the money to build it when it’s in a closed-to-foreign-travel region of China?” (a prohibition since lifted, ed.) I decided that I had to get an agreement with the Chinese Government to build the clinic. That process took almost a year '92 -'93.But by the end of '92, we had an agreement. You'd think there would be some difficulty in getting their cooperation. In fact they were happy to sign. The donated construction funds came about 3 months after the ink dried.
It took 3 years for the building to be completed.
When it was done – summer of 1996— we had neither doctors nor a plan for its use in any grownup sense of the word. I knew nothing about outputs and indicators, logframes or GANNT charts, sustainability or the “n’s” of infant and maternal mortality.
In the winter of ’96 I visited the Beijing office of UNICEF, looking for funding. The China Director of Mother and Child Health, Susie Jollie, asked me a perfectly reasonable question, “how do you know that whatever funding you get will result in health benefits for mothers and children?” I asked her if she’d seen the movie, “Field of Dreams.” It’s about a farmer in Iowa, played by Kevin Costner. He’s approached by the ghost of the 1912 Chicago “Black Sox” who threw the world series. They wanted to return to earth once more to do it the right way.
"How do I know they will play if I build the field?" Kevin Costner asked. “Build the field and they will come” was the answer.
And this is what I said to Suzie Jollie, "build the field and they will come." And come they did. We’d started a Community Health Worker corps in 2006. We got an Siemens Ultrasound in 2008. In 2011 we had maybe the first ever Rural Health Festival. The assembled CHWs reported that in the previous year there had been no infant or maternal mortalities. Down from world-record-high infant and maternal mortality.
In the year ending 2017, we’d treated about 1200 patients per month for free including meds. That’s 120,000 patient visits since 2008. Contrary to what one might think about a growing clinic, our cost basis remains the same – for one obvious reason that we have one administrator, myself. One meds and equipment procurement officer, myself. And one primary representative to the support community, myself.
Within China and outside China our base of support has grown, because of the simplicity of our project design and because we're not connected to any Church, corporation, government or big nonprofit.
Our constant overhead and growth allows us to do the things we put off for years, such as:
--new flooring upstairs
--new double-pane windows
--new waiting room furniture
--a water system.
--last year we put a metal roof on the clinic
But we need help. I’m writing this to assure you that we have built the field and they have come. The only complaint I’ve ever heard from the Tibetan women is “Why didn’t you come 10 years earlier? There’d be many women and children who died, who would be walking the earth now!” Unfortunately of all my powers, having a DeLorean and going back in time is not one of them.
We are looking for about $10,000 this summer to complete the above projects. Please join us. Help us complete the field of dreams for Tibetan women and children.
Lee
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2017 Surmang Foundation Clinic Report
Phuntsok Dongdrup, MD, Clinic Director & Sonam Drogha, MD Associate Director
[Dr. Phuntsok Dongdrup has worked for the Surmang Clinic for 17 years. Dr. Sonam Drogha, 16 years. ed.]
Introduction
Our work is patient-centered medicine, which means that we strive to see the patients on an eye-to-eye level, as fellow Khampa Tibetans and work from the point of view of our culture and religion, both of which are based on generosity. Generosity is our primary cultural value.
And so we are united in spirit with the patients, many of whom we have known our entire adult lives.
Familiarity, warmth and openness are the basis for our work. From a Chinese or Western perspective, we might see these people as poor, since their income levels are about US 25¢/person/day. Who are they? They are nomads, farmers and monks and nuns. They are people who herd, farm or pray here -- all descendants of people who have been doing this for a thousand years and in the case of the monastery, 400 years.
To open the doors of our work without concern about the ability to pay, we have three standards:
Patient Load
This year we treated 12,587 patients, averaging about 34 patients/day, if we were open 365 days of the year. But the truth is that we are closed for about a month every year, due to monthly religious holy days and also the lengthy national day, and Chinese national New Year’s (week), and Tibetan Lunar New Year (another 2 weeks).
That would mean we actually see 1,144 patients/month or about 38 patients/month. Some times of year, such as in July when Khampa Tibetans gather “worm grass,” or cordyceps sinesis, there are very few patients. And in the winter, there are days when we see 100 or more patients/day and often keep the clinic open until late at night, 7 days a week.
Clinic hours are 9:00 to 12:00 am, 2:00 to 6:00 pm. But often we have to take the time to take a break to diagnose and treat the patient. Sometimes, even at late night, we have to go to the heavily afflicted patient's home for medical treatment before climbing tens of miles of hard-and-dangerous mountain road.
Mother and Child Health
1703 women were OBGYN patients, treated both neo- and post-natal using ultrasound. Our clinic is one of the few outside the large Prefecture Hospital, that not only has a functioning ultrasound, but that has international doctors who come to aid in our professional development on this and other devices.
27 babies were delivered.
Diseases
Remarks
The vast majority of patients are treated and rehabilitated at the Surmang Foundation Clinic. Male or female patients from the age of 30 suffering from high blood pressure are a problem due to environmental problems such as altitude (clinic is at 14000’+, 4200m) and diet (Khampa Tibetans eat a very salty diet, and few vegetables). Increase in high bp, I personally believe is caused by diet. In the last two years most seriously ill patients suffer from high blood pressure, tuberculosis and hepatitis.
The profile of patients in Yushu Prefecture and Yushu City hospitals is similar to that of the Surmang Clinic.
There are two problems with severely ill patients or those needing emergency care. One it the long distance (150km) over poorly maintained mountain roads. Another is the dearth of private transportation and the complete absence of public transportation. To provide these patients with emergency or surgical care, we will drive them free of charge to the Yushu Prefecture Hospital.
This number includes women giving birth. Most of this year's maternal patients were sent to the Prefecture, because of a recent government policy, requiring a birth certificate. For high risk pregnancies (pregnancy-induced hypertension, nephritis, premature birth, dystocia, bleeding) mothers need to be evacuated for birth or treatment of disease.
For Khampa Tibetan mothers and mothers-to-be, this has challenged cultural mores that don’t see a hospital is a place where you might go when you are sick on one hand, but don’t consider pregnancy or childbirth an illness, on the other.
Conclusion
In short, we achieved gratifying results in 2017. However, we should realize more clearly that the more outstanding our achievements are, the greater the responsibility we assume and the heavier our burden on our shoulders. As Buddhists we don’t separate our spiritual practice from our working life. We always think that our work is very spiritual, very important. To this end our staff works together in that same spirit, setting an example of wakeful, spiritual cooperation. We hope to make a contribution to our entire society beyond our society, our country, in the same way as well. We will continue in this spirit and so contribute to a healthy, sane world from our remote corner, hopefully for a long long time.
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