Health Care in Tibet /Yushu

Dear Friends of Surmang,

It’s very meaningful to enter this year-end report, since it gives us the opportunity to reflect on 2014 and the years before.

2014 was a year that brought several things to fruition that had been cooking on the stove for the past 20 years. I often say that Surmang Foundation is like a rock and roll band that played small clubs in central California for 15 years and then one day became an overnight success.

Connecting to Tibetans

Maybe there’s a kind of inner Steve Jobs in me. When we were asked in the mid-90’s how we knew that the Tibetans would want a clinic, I responded in effect, “they don’t know they want it yet.”

Tibet is one of the most remote places in the world and Surmang sits at the center of that.

One of the marks of that success is risk taking connected with openness and communication with the Tibetan people of Surmang. Unlike the fans of the mythical rock and roll band, the Tibetans are not Californians. They lead traditional herding and farming lives are not into experimentation. So they are slow. There are few if any people wearing watches in Kham. In 1996 Tai Situ Rinpoche told me that going there would be like going back 500 years in time. He said, “For every 10 discursive thoughts an American has, a Tibetan has 1.”

So these are not people who are experimenting in lifestyle. The ideas that we had as a group came out of our admiration for these people as survivors, as people who are very warm, as people who are very genuine. I think that when you connect to people on that level, you can connect with your own warmth and genuineness.

When we opened full time in 2000, there was a question about how to charge for services, since these people make about US 12¢/day. It was clear that we couldn’t judge people based on their appearance since nomads who have 500 horses dress exactly like those who have 5. Also they didn’t seem to know they were poor. Was I going to be the guy who told them that?

 So we provided the services for free. And that’s the way it’s always been. It was only 10 years later that we found out –thanks to the Peking University assessment—that our cost of providing services per patient visit was about 1/7 that of the public health hospitals. In doing this, we stumbled across what is perhaps their #1 cultural value: jinpa, which in Tibetan means “generosity.” In about 2008 one of the high Tibetan lamas wrote a memorial, which declared our clinic a Medicine Buddha center.

 Another element of connecting directly to our beneficiaries is the lack of orthodoxy: neither medical, public health nor development. This means we, in essence, learned to cook from scratch, meaning we weren’t taking anyone’s word for it. In some ways this open view put our direct experience with Surmang on the front burner and as a result it became actually easier to take on appropriate public health, medical or development advice. It wasn’t always so natural or easy for me, like back in 2006 when Mauritz Van pelt told me that our foundation is about “empowering women.” I’ll never forget that. It was a defining moment; that advice would become our victory banner 9 years later, reducing maternal mortality in a place where it is the #1 killer and in writing a proposal about empowering women and girls in Tibet.

 It made it possible to hear the sage advice of Dr. Ray Yip, regarding Chinese PH policy during his many trips to Surmang. It made it possible to see that clinical delivery was the most advanced form of the assisted delivery our Community Health Workers were giving. But whatever we learned was based on the foundation of our own openness and experience.

2014

We had 4 very great medical volunteers: Board member Dr. Julie Carpenter, back for her third rotation. Drs. Laura Kimbro, Trudy Singzon and Sisi Zhao. Dr. Kimbro is an OBGYN who has done many such international rotations as is Dr. Singzon. Dr. S is also a teacher of an international OBGYN protocol, A.L.S.O.

 2014 was the year we became –with the help of the Chinese Government, Yushu Public Health Bureau—a registered charity in China. It was the year we began the journey with supporters and donors from inside China. Why not? We are a Chinese organization. It was the year of our engagement with the Danish Chamber of Commerce China, resulting in the construction of a birthing center on our Surmang campus and the installation of birthing centers at 4 partner township hospitals.

 So it seemed natural, after our 4^th Annual Fundraiser in Beijing, that we figure out how to use that birthing center to maximum advantage. The answer was articulated in a proposal written by Suzanne Smith and myself over a two-month period. The guts of the proposal lie in empowering women and girls in Tibet. And the means to achieving that goal is to reduce maternal and infant mortality. Dying in the process of creating life is the greatest challenge Tibetan women face. We proposed doing this through incentivizing mothers, community health workers and our doctors in pre-natal exams, birthing, post-natal and well-baby exams.

 And why not? Already our salaries to community health workers are 1/3 of their family income. Since the government has stopped the collection of cordyceps sinesis (“worm grass”) due to possible extinction, it makes sense that increasing income would make clinical delivery more attractive.

Through the help of Director Chris Devonshire Ellis, 2014 was the year that we partnered with Dezan Shira to get the benefit of their expertise in financial reporting. Not only that, they did 3 articles for us in their 40,000 member "Asia Briefing." 2014 was the year that our website, www.surmang.org, was redone largely with the help of the marketing firm, Shanghai Jungle. In our last reported week our requests for pages went from an average of 3500/week, pre-re-do, to 15,000 a week, post.

In addition  Did I mention that 2014 is the year when our Surmang Clinic achieved status as a government clinic? That means that we are the beneficiaries of meds, supplies and can register births (and deaths).

 Part 2 of the proposal is the creation of an income stream –a weaving co-op so we can re-introduce traditional yak cashmere blankets and shawls, a skill lost during the cultural revolution. Usually in the NGO business success is monitored according to measurable outputs and indicators. But for this project –as well as mothers and babies not dying in birth—the non-measurable outputs are really the strongest. These are: how a woman feels about having a baby. Joyful or life threatening? And how a traditional sacred craft like weaving reassures Tibetans of their place in this world. In a book on Balinese weaving, someone said, “the patterns in this cloth are the lens which brings the power invisible world into the visible.” I hope that the cloth of our foundation could as a whole could have a similar wholesome impact, as we enter 2015.

I welcome you to join us.

Lee Weingrad

Director

Links:

• Search for us on Google

East Tibet 2010.

Our team was doing an emergency assessment of Yushu Prefecture township hospitals following the disastrous 2010 earthquake. The way was muddy and rutted. We had to get out of the Landcruiser often to push.  On the way to the Mauzhuang hospital, I saw a bunch of our Community Health Workers (CHWs) by the side of the road.  It was very unexpected. They were having an informal meeting, right there in the open.

I got out of our 4x4, in the thin air near Rijie village. About 10 Surmang Foundation Community Health Workers (CHWs) were waiting. No training program, no money, no pregnant women. Just us. Khampa Tibetans are very straightforward so I asked them: “Look there's no one here except us. Just speak to me directly. If you could change anything about our work, what would it be?”
 
One, Palmo, stepped forward and spoke, shouting, almost crying. “You should have started 10 years earlier! So many mothers and babies who died would be walking the earth with their loved ones now!”
 
I was speechless.

I think until that point I was pretty proud of our achievements -- after all, we'd not just lowered maternal mortality and infant mortality rates (mm to zero 2010 to 2013), but there  was a sense that we'd been able to change the way medical care works for women and overcome a great deal of the cultural inhibitions among Khampa Tibetans, such as no one ever getting undressed in front of another person, ever, or women giving birth with the animals.

But in this case I realized how profoundly these women pay the price and bear the burden of maternal and infant mortality and pay the price mainly alone, by themselves. And also I saw that no matter how stoic we think these nomads and farmers are, it was clear to me right then, how deeply these women carry their history and their struggles with them every day into the present. And Palmo's remark made it clear to me that they now had some other reference point, that it's possible to have children without rolling the dice to determine if you live or die.

It made me see how deeply the work that we are doing affects not just each woman we help, but the entire cultural landscape. It also made me see how totally vulnerable these woman are, not just physically, but emotionally and spiritually as well.

So yes. It's a failure that we didn't start earlier. But in a sense her remark was a kind of Zen koan. It is impossible to return to the past. But in a sense I saw that we have to be open to the wounds that these women carry and not just expect that our optimism and our accomplishments combined with Tibetan grit are some kind of balm that wipes the slate clean. When you bring that much hope and change to people, you have to also own the despair and solidity that arises from the past.

Links:

• Shining Through, Surmang's new video
• Surmang website