Health Care in Tibet /Yushu

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

Links:

• Surmang Foundation website

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:

• Patients are treated for free
• Medicines are prescribed and given for free
• Mother and child health are our primary concern.

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

• Influenza
• Hypertensive myocardial infarction
• Cerebral hemorrhage
• Arthritis
• Osteoproliferation
• Fractures
• Appendicitis
• Hypertension
• Gastric ulcer
• Gynecological diseases
• Trauma
• Cholecystitis
• Difficult birth/labor
• Hepatitis
• Tuberculosis

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. 

Links:

• Surmang Foundation's website
• Surmang Foundation's Facebook page