Health Care in Tibet /Yushu

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