Health Care in Tibet /Yushu

By Janis Whang Tseyong-jee, with Drs.Phuntsok Dongdrup, Sonam Drogha

Introduction

Our partnership calls for exporting our Surmang Prototype to the rural public health system. One part of this is provider training in the township clinics. Another is the exporting of our Community Health Worker (CHW) project. Within the rural public health system there is an incipient system called Village Health Workers. Training VHWs was the main work we accomplished this summer.

The 2012 VHW training started early in July, three training sessions were conducted. One in Xiewu Township, one in Rongbo Township, and one in an ecological migration village of Rongbo, where people from three former villages have been moved to. The village is about 30 km from the township.

13 new VHWs were recruited in total. One was added to the Xiewu VHW team and 12 from Rongbo, basically we have 2 VHWs from each village of Rongbo. Now there are 19 VHWs outside Surmang area. Making our total corps of CHW/VHWs 59.

Thanks to the support of Yushu Prefecture Public Health Bureau, Yushu County Health Bureau, and Rongbo Township government, the whole VHW training project this summer was very successful. The help we got from the township clinics was extremely important, for without it the trainings wouldn't have been so successful. 

Xiewu VHW Training

The first training was done in Xiewu, one of the eight townships of Chengduo County, which is about 46 km to the northeast of Jyekudo. The training took place on the fifth of July; the original plan was to start in June. However, it was postponed till July due to the fact that it was the season for digging caterpillar fungus (cordyceps sinesis) the main income local families rely on for living. The training was done in a conference room at the Xiewu Township Clinic building, which was a kind offer from the director of the clinic.

Who were trained

Out of the 7 VHWs from last year, 6 attended the training. For the seventh, the clinic director tried to contact the other one to inform her about the training, but unfortunately couldn't reach her. It seemed no any other VHW knows anything about her; we didn't even get her name. However, instead of her we had a new VHW this year. Songcho, a 63-year-old village doctor who has been practicing medicine in the community for more than 4 decades. She has shown great interest in learning, and her rich experiences were shared with the other village doctors throughout the training. We had her to demonstrate many times in the training how to help delivering a baby, how to do CPR, and etc.

The training design

The training in Xiewu was designed a bit differently from our previous training. for all the other VHWs are literate and 6 of them were trained in Jyekundo (Yushu, Chn.)for 6 months by the Jinpa Project, a local NGO in that is also dedicated to health related issues in Yushu. It was different in a way in that the training was more detailed and included more medical terms and professional skills. After the training by Jinpa, they returned to Xiewu and interned at the township clinic for 1-3 years respectively. Some of them didn't return to their own community after their internship due to the fact that there weren’t yet village clinics. However, they are still paid by the government annually, and each of them received 3,000 Yuan since last year. According to the clinic director, 3 new clinics are being built in the villages where there had never been clinics. They are Bamba, Adroronba, and Xiasayba, hopefully the new village clinics will be in use this fall.

Problem with Meds supply from the Township Clinics

At the village level clinics, they will be providing a few kinds of vaccinations for newborns, including TB, Measles, DTP, and Hepatitis B, if power isn’t a problem. Another interesting thing we heard was that the village doctor got the medicine to use at their clinics from the township clinic, and then they decide the price of the medicine when they prescribe the medicine to the patients. However, Zuncho told us that they don't make profit out of it, because the price of the medicine they get from the township clinic is higher than the retail pharmacies.

Record Keeping

The record forms they were given last year to keep track of their work was collected, however the main four columns, including place where the births took place, the mother’s condition, the baby’s condition and the number of visits, were left blank probably due to miscommunication last year. They kept the record of newborns that got vaccination, not necessarily the deliveries they attended. We explained how to record and the beneficiary of keeping not only a record of the newborns and mothers, but also for all the patient they see, hopefully it will build up their interest and confidence in keeping patient records which might contribute to the electronic records keeping in the future.

Donation of Equipment

At the end of the training, each one of the VHWs received birthing kits, soups, eye ointments, and Surmang caps. They were all very satisfied with the training, and they request that we offer more training in the future and they wish to learn more about gynecological problems. They were also suggesting that providing gynecological books might also be very beneficial since they are all literate and will able to use the book as reference.

Rongbo VHW Training

Rongbo is about 70 km from Jyekudo, and it was the second most seriously damaged town during the April 14, 2010 earthquake. It was estimated that the earthquake killed around 100 people and most of the houses here were destroyed. Therefore, the whole town Rongbo was reconstructed, and many houses are still under construction.

The training began on the 13^th of July. The training in Rongbo couldn't be organized right after Xiewu, because of the damage the township clinic suffered from the earthquake in 2010. The new building was completed early this year, but it was not yet ready. It was decided to give the first training be given in the township, because three villages of Rongbo are located near by and it was within walking distance for most of the VHWs. The second training was given in an ecological migration village that is about 30 km from the township. There lives 617 families from three former villages of Rongbo Township, that’s why the community is called ‘617.’

All the VHWs from Rongbo were illiterate except for one, which is similar to our CHW in Surmang area. Both of the training sessions started in an awkward atmosphere, all the VHWs were shy to speak and became embarrassed easily when talking about pregnancy. However, the whole situation changed on the second day, probably because they started to realize that there’s nothing to be embarrassed about when comes to life and death. Addition to the regular neonatal care we often do in Surmang, we included information about HIV/AIDs and basic CPR in the training at Rongbo this year. In fact, one of the reasons for that is that there is confirmed case of HIV in Rongbo, however no further information was known.

Gayjee Zongkou Village

According to the VHWs, Gayjee Zongkou had the highest maternal and child mortality among all the six villages of Rongbo, and the accessibility of the village still remains a problem for the year around.  Unfortunately, we were not able to get anyone from that village. New VHWs from this village should definitely be recruited in the near future.

Despite the fact that almost none of the VHWs has been to school, they are mostly quick learners and they were all very active in the role play during the training and asked lots of questions regarding assistance in deliveries. Besides, they required to be trained in blood pressure measuring and the use of pregnancy testing sticks. And the VHWs from an ecological migration village, where using thermometer wasn’t included in the training, asked to add it in the training next year.

Having our Surmang CHW, Dadren, from Surmang, at the training this year was helpful, because people tend to listen more carefully when it’s based on first-person accounts, their own true stories. She shared her own experience about the deliveries that attended before and after she became a community health worker. Some of the stories were very sad, one of them was about her daughter lost her baby when she was seven months pregnant. 

She also shared a story of how she saved one of her grandchildren, who was not breathing, when he was born by using what she had learned from the training.

She emphasized many times how much she appreciate that she was trained as a CHW, and told how very important it is for a woman to be able to assist deliveries. She said that almost every woman has sisters, and will probably have daughters and granddaughters. Being able to help them in risky moments like giving birth makes you not only a better sister, mother or grandmother, but also a life saver.