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Health Care in Tibet /Yushu

by Surmang Foundation
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Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Patient at our clinic
Patient at our clinic

In 2019 the Dharma Sagara Clinic at Surmang Dutsi til has treated over 12,000 patients, for free. Including meds.

In particular, we have elevated the status of women by focusing on maternal and infant mortality and morbidity. We have worked in an area that had sub-Saharan-level maternal and infant mortality rates. We lowered the former to zero by 2011. 

 2019: What we did with your help  

With your generosity

  • We have added a shower and a toilet; 
  • We have added a storage area for meds and supplies; 
  • We have replaced all double pane broken windows. 
  • Expanded the upstairs dining area to include a small bedroom.
  • Added a quality solid oak floor to the dining/meeting area
  • Added a vinyl floor to the kitchen
  • Refurbished a small bedroom by adding the hardwood floor, and a new window.

In 2019 we achieved Revenue Canada nonprofit status for Surmang Foundation Canada. (cf our website for details)

2020

We want to bring health to the 90 nuns of the Surmang Dutsi til Monastery. As monastics, they are community leaders. They are are celibate and they have high status. But as women that status is threatened by infectious disease, issues of personal hygiene and environmental issues, such as unsanitary food preparation, the presence of helicobacter and tuberculosis and most importantly, lack or access to proper gynecological care. They share the plight of women in rural ethnic Tibet.

We will change that in 2020.  

In connection with our goal of international hygienic standards for the clinic and for the community, the 90 Nuns of Surmang play a leading role. We will provide not just primary care, but also have the nuns serve as a model of what the community can achieve with clean clothing, bedding and food preparation. 

1. The Nuns Project.

Extending health services to these leaders of the community —the 90 nuns of Surmang— we will be extending health to the community as well and  improving  the status of these women and girls.

The nuns have very high status in the lay community. We will eliminate helicobacter, TB and Hep A and C with a pro-active program that will not only create sanitary conditions for the nuns, but also use their example as a means of influencing the lay community. 

2. Incentivized visits

We have successfully extended medical resources to women who are in their child-bearing years through a network of 40 Community Health Workers, In 2020 we will be even more pro-active. We will incentivize pregnant women and community health workers to come to the clinic for pre-and post-natal examinations. We will pay them to come to examinations.

Providing  robust pro-active health services to a very poor area will show ourselves, China and the world what we are capable of accomplishing. We will be one of the high capacity health care clinics that will operate on international standards.

Cervical Cancer

In cooperation with United Family Foundation, we are planning on doing cervical cancer screening at our clinic in the summer of 2010.

All with your help. Please continue this important journey with us. 

Mom and baby born at our clinic
Mom and baby born at our clinic
Little boy born in December at our clinic
Little boy born in December at our clinic
Redone dining rm: hardwood floors and new windows
Redone dining rm: hardwood floors and new windows
Putting in the new main entrance
Putting in the new main entrance
Achi, Asst. Director (l), & iana Weingrad (r)
Achi, Asst. Director (l), & iana Weingrad (r)

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A mother and baby
A mother and baby

Before our clinic started its work, the maternal mortality rate at Surmang was higher than that of Sierra Leone, Africa, the place with the world’s highest maternal mortality rate. The heart of our work is the 1300 patients we have treated for free --including meds-- every month for the past 23 years, focusing on mother and child health and keeping the maternal mortality rate at zero or very close to zero.

This is how we work for the empowerment of women.

Since 2007, the last three years at Surmang have been dedicated to expanding the clinic’s capacity to serve its immediate community as well as the larger catchment. Strictly speaking this region is within a 20 km radius of the clinic. But we frequently have patients that come from as far away as Chamdo, in the Tibet Autonomous Region to the south and Sichuan Province to the East. Both these regions are strictly Khampa Tibetan regions, despite their being in different political entities. For the most part all these people more or less speak the Khampa dialect of Tibetan, a dialect that is impregnable to a Tibetan speaker from Lhasa.

 

[2007 Roof]

The infrastructure changes started in 2007, when we put a metal roof over the clinic. Tibet is known as “the land of snows,” and the accumulation of snow over the winters of the past 25 years had challenged its existence. Back then, in 2007 an engineer told us we had three choices: put up a roof, rebuild the current roof every three years or do nothing, in which case the building would collapse in 5 years. We chose “A,” put up a roof. My wife immediately contacted Chinese patrons and within two hours we raised $9000.

 

[2018 Plumbing]

Do you think it’s hard to get a plumber in Denver or San Francisco? Try getting one in Surmang!

Last year we installed a water system, connected to the monastery’s line, a system installed by the government after the locally constructed lines failed 3 times. The work was mainly designed and executed by staff member Joseph Weingrad, with assistance from a Master US plumber, Russel Iser.* That took over a month, but it worked.

The next step was to replace the tile with flat black marble and install waiting room chairs and burn the wooden benches that had served us well since 1997. The Clinic is a high-gain passive solar building, which means that it can absorb the sun’s heat during the day and disburse it to the building at night. There is no connection between the floor and earth below.

 

[2019. The beat goes on]

This year’s work was far more ambitious. It was to

  • Move the front entrance to the south and make the entrance hallway into a meds storage area.
  • Replace the flooring in the east wing with the same flat black tile as in the waiting room.
  • Create a downstairs bathroom complete with flush toilet, shower and hot running water.
  • Remove the wall separating the 2nd floor meeting dining room from the small bedroom next door, resulting in
  • Install 60 sq. m of solid oak flooring in this conjoined, expanded room.
  • Remove and replace all kitchen cabinets, sinks, gas stoves and flooring and make it a modern Formica-kitchen counter-top area. Move the stove from the kitchen to be near to the meeting/eating area as a place to gather around in cold mornings to drink tea or coffee over a warm stove. 

 

[Why the big fuss?]

We definitely have the trust and love of the people we serve, our catchment. That took a long time to accomplish in this very traditional region. I can feel it when I go there.

Now that that trust is established, we should be able to raise the clinic service level according to international hygiene and medical standards. While it’s not that difficult to do, neither is it easy. As I’ve said before, Surmang is not in the middle of nowhere, it’s on the edge of nowhere.

To that end, we’ve engaged and partnered with United Family Hospitals and Clinics in Beijing, the largest international-standards hospital group in China. They will assist us to create a further miracle in this remote, beautiful, sacred, under-served region of China.

Lee Weingrad

*name used by permission 

A mother, a baby
A mother, a baby
laying the marble tile
laying the marble tile
waiting room with new tile, new furniture
waiting room with new tile, new furniture
moving the door to the south side of the clinic
moving the door to the south side of the clinic
new bathroom
new bathroom
a visit to United Family Hospital Beijing
a visit to United Family Hospital Beijing
new roof
new roof

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There is a history, a unique history in the very beautiful, sacred, far away place, Surmang, East Tibet.

History has often been unkind to Surmang. After I arrived in 1987, there was a spate of construction at this 400 year-old monastery. The bad news was that the 2010 Yushu earthquake destroyed most of these newly reconstructed buildings. The good news was that our clinic survived intact. In the last few years there’s been a second spate of monastery construction making our clinic the “gray lady,” compared to the newer buildings.

Our work.

Our work has introduced medicine to remote SE Qinghai, China, aka East Tibet, Kham. We remain of of the few foreign foundations in any Tibetan region, thanks largely to the acceptance of the people we serve and the cooperation of the government (and us proactively seeking their partnership). Our aim is neither political nor religious. It is empowering women and girls by reducing maternal and infant mortality and morbidity. The arc of our work has been to first get these traditional people used to our clinic, Then based on that trust, raise the gaze of these Khampa Tibetan men, women and children. 

It’s worked out well — we —out two local Khampa Tibetan MDs, Phuntsok Dongdrup and ?Sonam Drogha, and a staff of 5, treat about 1100 patients a month for free, and in the process lowered maternal mortality to zero in 2011 and it stayed there ever since.

This summer.

This summer we will complete a 3 year cycle of construction at the clinic. We will:

  • put in a new kitchen
  • new upstairs oak floor
  • tear down a wall to make a bigger meeting space.
  • replace broken thermal windows.
  • install modern insulating window treatments (thermal curtains)
  • install is modern shower and composting toilet.
  • create a meds storage by moving the front door from the east side to the south side.

it’s been a very interesting journey. We’ve grown. I’ve grown.

  • we have a strong following in China.
  • we are now registered as a separate foundation in Canada (Surmang Foundation Canada)
  • we are crossing our fingers anticipating the registration this year of an independent, yet affiliated Chinese foundation.

I will go there in a couple of weeks and hope to return with new photos to share. 

Please continue your generous support of our effort in this year’s re-do, creating further proof, of “build the field and they will come.”

Lee Weingrad

Director, Surmang Foundation

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The Clinic
The Clinic

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

Clinic waiting room
Clinic waiting room
Surmang From Above, by Ian Allen
Surmang From Above, by Ian Allen
2nd Floor Changes this June
2nd Floor Changes this June
Architect Ralph Allen's plans for this summer
Architect Ralph Allen's plans for this summer
We'll add a downstairs bath and shower
We'll add a downstairs bath and shower

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Laizhang
Laizhang

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.

Dr. So Drogha with her new baby
Dr. So Drogha with her new baby
New patient waiting area floor and furniture!
New patient waiting area floor and furniture!
Some of our 40 community health workers
Some of our 40 community health workers
Lee Weingrad unexpectedly meeting monastery Abbot
Lee Weingrad unexpectedly meeting monastery Abbot
The Dharma Sagara Clinic at Dutsi til Monastery
The Dharma Sagara Clinic at Dutsi til Monastery

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Organization Information

Surmang Foundation

Location: Boulder, CO - USA
Website:
Facebook: Facebook Page
Twitter: @surmang_found
Project Leader:
Lee Weingrad
Founder
Beijing, Beijing China

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