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
Health Care in Tibet /Yushu
Health Care in Tibet /Yushu
Clinic Patient Waiting Area
Clinic Patient Waiting Area

To Tibet in my red Porsche.

In the past two years we’ve continued our work at Surmang providing free health care to some of the most impoverished in China. Unfortunately, Covid had other ideas. Now we are well into our second year of Covid. But this is the only time when the clinic was closed by the command of the Chinese Government.

Where I live, Beijing, all the businesses have been closed: banks, restaurants, car repair businesses, shopping malls. The Chinese Government has taken very stern measures and the proof is in the pudding: only 5500 Chinese Covid-related deaths …for a country with 1.4 billion people! Entering China is impossible and even then requires a 21-day isolation. It is hard to bear, I haven’t seen my adult children in 2 years. But I’m confident that we will come back from this plague in a few months.

This is not a complaint -- it''s the reality of what it takes --to try to do some good in China. It's the reality of working in an ethnic Khampa Tibetan region as well  one whose highest spiritual achievements are secret to outsiders, and whose independence and ancient secrets do not assume any lower status to the much larger Chinese presence. My own status is and was as an outlier on one hand and a kind of official koshering on the other. I was just fresh from "the kitchen"  having being a student of the monastery's recently deceased 11th incarnate Abbot  and having recently arrived after his cremation in 1987. I've been to this remote place about 35 times. So it's become part of my culture as well. 

Please continue your generous support of our work.

***

“Trivially true is true nonetheless,“ a fellow University of Iowa grad student in philosophy analyzing language.

My own return to China in 1990 was naïve, and if full of profound/trivial truths, was also full of inspiration. I had sold my 1968 red Porsche before leaving Boulder, Colorado. That’s how confident I was. Upon entering Beijing, a young grad student asked me if I was married. I showed her the picture of the Porsche. “No children however.”

I was going to do something for the Tibetans of Surmang, E. Tibet. I’d made the hijiera there in 1987 and was the first foreigner to do so. The place looked like it was like a pancake, flattened by a bomb. A year before, I’d met the Chinese Ambassador Han in Colorado —someone straight out of Central Casting— at the Boulder home of my Buddhist teacher, Chogyam Trungpa. Ambassador Han in turn offered to help and he referred me to an old friend, a Chinese Cabinet minister. The greatest need I saw was to rebuild their health; I couldn’t rebuild their monastery. I knew my own inspiration well, but I knew its limitations better. I was one person. Now this year the young graduate student and I are celebrating our 30th wedding anniversary in our new home in Beijing.

Following the advice of my Buddhist teacher, Chogyam Trungpa Rinpoche, I vowed to myself not to enter the shark-filled waters of Chinese –Tibetan politics. But I could do something that crossed the lines of politics and religion. Even that was dangerous — since at the time foreigners were watched carefully, and sometimes followed. The question of “who are you?” was a redeeming quality since my own personal history had no dangerous liaisons, no politics, no religouis involvement, little intrigue. But even porpoises sometimes get caught in shark nets.

My friend was working as the chief attaché to the head of the State Nationalities Affairs Commission, a cabinet-level position. She had just gotten her masters in Tibetan. After the Gang of Four, China was knee-deep in Deng Xiaoping his successor, and creator of the era of opening and reform. Permission was no longer required for foreigners to travel to Tibet. The communes were broken up. Openness rued the day and took a second place to wealth. “It is glorious to be rich is,” was the motto du jour.

Even my friends in the US were skeptical not only of my motives, but of anything Tibetan. In Beijing I was getting a better reception. The Commissioner was curious about Naropa Institute (now University) started by Chogyam Trungpa and was enthusiastic about leading a government delegation to Boulder. Being pro-active he arranged a meeting with the Governor of Qinghai Province, Hon. Huang Jingbo, who put me in touch with his Vice Governor. Surmang is in Qinghai Province. The latter traveled to Beijing and we began a month-long meeting. The result was the government as a partner in the construction and creation of a clinic at Surmang Dutsi Til monastery.

I vowed to myself to abandon any ambitions for myself. In 1992, within a month of signing the MOU, we received a grant of $150,000 from the Catholic Church’s main charity, Caritas. Within 6 months we began construction.

To be successful in China you have to avail yourself of the resources that the government blesses.We quickly found a good partner at the Yushu Prefecture Bureau of Health. They were all Khampa Tibetans. That wasn’t a problem. The problem was who are our patients? In 2001 at our clinic, Dr. Julie Carpenter asked me, “where are the women?” And more importantly, “why were they not at the clinic?”

By 2004, the connection with the local Prefecture Bureau of Health provided a warm harbor for Surmang Foundation. We signed a partnership agreement with them that allowed us do a public health survey —going tent to tent, knocking on flaps, to determine the levels of maternal mortality and infant morbidity and mortality.

You might think, “of course,” but his kind of “mass data” survey as political scientists call it, was until then unheard of in the People’s Republic. With a model based on a study from Nepali social scientist, we surveyed 800 nomadic and farming women, using young Tibetan teachers on summer break from Yushu as our interlocutors. They traveled by yak, horse, motorcycle, pickup truck, foot. At the expense of unwarranted redundancy, this kind of survey was not only unheard of before but after as well.

The raw data told a chilling story: the region around Surmang had among the highest if not the highest rates of infant and maternal mortality and morbidity (illness) …in the world. On the same levels as Somalia, Zimbabwe. Initial results were 3000 maternal mortalities per 100.000 live births. I asked one of our consultants, Maurits Van Pelt, formerly of Medecins Sans Frontiers, “can a figure like that be conceivably higher?” He answered, “yes, if a woman gives birth over an open fire.”

We received no help among the foreign foundations operating in China: Gates, Swiss Red Cross, The Bridge Fund, UNDP, Soros as well as a big Nepal monastery operating clinics in Kham and a Tibetan Lama from Scotland. Maybe we just didn’t play the game well enough to sit at the table with these big boys and girls. Maybe it was luck, because our major focus was including the Chinese Government in our project design. I don’t know.

But I do know that by 2011, all the "biggies" were shown the door and we, Surmang Foundatio, were the only remaining international foundation still having a place at the table in a Tibetan area of China. I'm very proud of that.

But more importantly, by 2011, at our Public Health Festival, the Community Health Workers announced there were neither Maternal Mortalities nor Infant mortalities reported in our clinic nor in the 15 villages in our catchment. Please join us!

Lai Zang
Lai Zang
Tashi, first person I met in my first visit, 1987
Tashi, first person I met in my first visit, 1987
9 Days in Labor, (in the Chicago Tribune)
9 Days in Labor, (in the Chicago Tribune)
Mother and Child health
Mother and Child health

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Who we work for
Who we work for

2021 in East Tibet.

“When can we visit Surmang?” again and again I was asked by our patrons in Beijing.

2021 was hardly the year in which I could give an optimistic answer. Everything in 2021 was shut down.

When 2021 dawned in China, it was a time of city-wide shut downs, of draconian prohibition of foreign travel in or out of China, of mandatory masks, and the required use of cell phone software that verified one’s location and the health status of all Chinese and all visitors to China. There were no exceptions.

As project managers, we were passing the disaster going the other way. Our goal was to drive the car of clinic project design forward in three directions:

  • one, the main one was to keep it open to the people we serve.
  • Another one one was  to raise the clinic itself to international standards of health care.
  • the tbird being to begin converting part of the clinic to a lodge.

After 30 years at Surmang I could read the handwriting on the wall: Yushu was becoming China’s Bhutan. So 2021 was dedicated to two goals: —meeting international standards of clinical care: not only keeping the clinic open in the face of Covid shut downs, but moving ahead with the renovation of the clinic: a modern toilet, washing machine, shelves and scrubs, new meds storage, kitchen, tiled bathroom with hot water shower. — and guest quarters, the development of a lodge for visitors to Surmang.

The first 6 months of the year was a time when travel in Beijing was somewhat relaxed —meaning we could actually enter a huge Home Depot-type store, where we went ahead and bought: -a complete kitchen with oven and sink and copious counter space and shelves and -a large Panasonic refrigerator -a Japanese tea house, complete with tatami mats and shoji screens.

These were stores were places we were familiar with. In the pre-Covid days they were somewhat bustling, like American big-box stores. This year they were largely empty. With the kitchen interior measurements in hand, I was able to place the order and have the design department come up with the kitchen drawings. The store manager knew well our charity clinic and told me they would support our purchase. The ¥150,000 (US $24,000) kitchen could be ours for ¥100,000 (US $16,000). It was a severe price reduction that included all the design modifications and transportation.

While not an IKEA-style assembly, the parts had to be all coded to be able to fit together. Now I started to wonder about putting in a wall, shoji screens and tatami mats for the bedroom whose walls we’d removed to expand the upstairs.

When I went to visit the company that made such a room, such a tea house, it became clear to me that we should not just put up walls and screens, but tatami mats and shelves. The full monte.

The tea house company, like the big-box retailer, also promised a deep discount. And they made good on their promise. The whole tea house was sold to us for a little over $3500.

Installed. Delivered.

We would install a traditional Japanese tea house in a 100% ethnic Khampa Tibetan region! What made the idea even more ironic was the fact that my own late Buddhist teacher was not just an aficionado of Japanese culture, but a lineage holder in the Sogetsu School of Japanese flower arranging!

 

II. Surmang in September.

I was worried for a good deal of early 2021. First there were no flights out of Beijing. Then no flights to Xining, Qinghai. Then Yushu Prefecture wherein lies Surmang, was on lockdown. Then just Surmang. By the end of July I began to get indications that we could indeed go in September.

I went with Mikko Lan, a Director of Ogilvy, and with Boon from a UN Women’s foundation. We went for about 10 days. While we were there we assembled the beds, the shower, and the kitchen.

It was a transformation worthy of the most beautiful butterfly. 2022's plan is the addition of 3 bedrooms upstairs is to create a lodge so that when this scourge does end we can accommodate eco- and anthro- tourists (and our Beijing patrons!) to help make the Surmang Clinic sustainable! The icing on the cake will be meeting and clinical rooms downstairs

Now it is 2022. Let’s all plan on meeting at Surmang! Do you drink tea?

Lee

Teahouse with shoji and tatami
Teahouse with shoji and tatami
New kitchen
New kitchen
New kitchen 2
New kitchen 2
Building the kitchen
Building the kitchen
The Crew!
The Crew!
Tibet (in case you thought we were elsewhere!)
Tibet (in case you thought we were elsewhere!)
Clinic and prayer flags
Clinic and prayer flags

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Beautiful Surmang
Beautiful Surmang

My daughter iana, was born about 3 months premature, 26 years ago. My wife, Wenjing, had placenta previa and fibroid mayomas , uterine tumors that, as if the prematurity weren’t enough, were threatening my wife’s and baby’s  life with fatal hemorrhaging. Thus began my journey with mother and child health.

It was something that neither of us could prepare for. Because of a very great Headmaster at Western Academy of Beijing, Ian Rysdale, Wenjing was air evacuated to the Queen Mary Hospital in Hong Kong, which with its 18 stories, had a one entire floor a pediatric neo-natal care unit. 1 ½ months later, a very tiny Iana Cybele Weingrad was born. And Wenjing was alive to talk about it. iana was named after Ian Rysdale.

Thus my journey with mother and child health began right then and there, with my own lifetime membership in the circle of life. 

I began to see these struggles in every small child and every mom, dad, grandpa and grandma in rural China. With our clinic in 4400 m-high rural Tibet, I became sensitized to not only how vulnerable women are there, but how dangerous it is, especially when you don’t live near an urban 18 storey Hospital. 

With no private automobile ownership, living on a funky dirt road, on the south side of a 16,000’ mountain pass,  5 or 8 hours away from any hospital,  I learned that this is not some freakish rural outlier. It is the norm, precisely the  challenge, what  every rural Tibetan woman faces, day in , day out, traditionally without midwives, or nearby hospitals. I even came up with a slogan: "if you want to save a culture, save a mother."

It is a very very bad case study of how threatened, un-empowered women, women who until our clinic came along, and how they lived with since time immemorial. It is one where they had to give birth by themselves in the fields with the animals or in the yak bier, and cut their umbilical cord by themselves, with the oldest, rustiest knife available. Unassisted.

It was a ritual that perfectly mirrored the very low status of Tibetan women.

After the birth of our baby,  iana, I vowed to do something about them. Now 25 years later, I can boast that we trained our two doctors with over 150 very great volunteers, doctors  from Beijing, San Francisco, Vancouver, Colorado, New York. With the help of the American Chamber of Commerce of China, Ogilvy, Siemens and Beijing United Family Hospital we received modern equipment like an autoclave, ultrasound and microscope. 

In an area that held among the highest maternal mortality in the world, at 1200 mortalities/100,000 live births, we were able to reduce the MM to zero by 2011.

But we still have a ways to go — our building was aging and not aging well. In the last 6 years we turned all that around fixing

            —our leaky roof,  

            —our clinic floor

            —a new ceiling

            —a hardwood oak floor

            —a modern sanitary shower and toilet

            —computers and a printer for the doctors’ offices.

Somehow all of this seemed like problem solving,  problem by problem. Then it occurred to me when our patrons in Beijing would ask over and over again, that Surmang was not just some cast-off funky part of Qinghai. No.  It is China’s own Bhutan and with the right environment our patrons could come to an exotically beautiful —and holy— part of China but support our work at the same time. 

That’s how the idea of a lodge at the clinic was formulated. So this year we installed a new kitchen and with the generosity of a big company here in Beijing, and coverted one of the bedrooms into a Japanese shoji and tatami room, a tea room. Oddly enough we found that the suppliers of these rooms were willing to discount their materials 40%, 50% because they were, like me, inspired to give back to the neediest people in China. Take a look at what donations have done to our clinic. Make mother and child health a sustainable project!

And join our cause! 

Mani Stones
Mani Stones
New Kitchen
New Kitchen
East wall with stove
East wall with stove
New Shower
New Shower
Volunteers assembling furniture
Volunteers assembling furniture
Patient
Patient
Design for tea house
Design for tea house

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$10,000 of donated meds, all given patients gratis
$10,000 of donated meds, all given patients gratis

We have, since 1988 tried to answer the question: if all life on earth were under threat, and we could through mass interstellar transport, save a significant number of earthlings, who would we save?

It occurred to me that we have attempted to answer that question in the past 30 years. At the head of a line, most people would include Wall St. bankers, politicians, Iowa corn farmers, entertainers, doctors, scientists, and professional athletes. I would put first the common people of East Tibet: the farmers and the nomads and then the monks, nuns and yogis first in line on that rocket ship. Why?

These humble and mainly illiterate people are survivors. And as Covid 19 has taught us, that is no small accomplishment. But beyond mere survival there are other praises we can sing.  As few of them would admit in their humility, they carry the culture of vastness, cheerfulness, and most importantly, compassion. In our 30 years of work at Surmang,  it is our honor to help revitalize them.

This year we will reach out to other international foundations so that our success can become not just a model of rural health work, but one of an international standards clinic. Our clinic building was the first new construction at Surmang after the disastrous years of 1955 – 1980.

But it wasn’t on barren ground. As Karma Sengay Rinpoche told me in 1991, there are many larger Surmang monasteries than Surmang Dutsi til, but none holier.

Outreach to the Chinese Government.
I’ve tried to follow the example of their late Abbot, Chogyam Trungpa, by not collecting projects but by giving projects away. and embracing anyone willing to help. There were some bad harvests along the way but most, starting with Chinese Ambassador Han in 1986 to the head of the Minority Affairs Council in 1990, to the Qinghai Governors to the head of the Yushu Public Health Bureau, we sought out the partnership with the government in order to see what we could do to help. Our over 5 partnerships with the Chinese government were a bridge not just with China and the Chinese Government, but with foreign leaders seeking to connect with the wisdom of the of the region’s wounded but undying spiritual vitality.

Much of the help was done out of respect for Chogyam Trungpa so much so that we were told in a private audience with the Qinghai Governor, that our philanthropic work was the upaya, the compassion, of the Vidyadhara, Chogyam Trungpa. After all these years, it is very very likely that our clinic is the only international clinic in an ethnic Tibetan region.

Iana Weingrad and Clinic Assistant Mgr. Achi
Iana Weingrad and Clinic Assistant Mgr. Achi
Dr. Phuntsok Dongdrup, Clinic Director
Dr. Phuntsok Dongdrup, Clinic Director
Donated print from Derge, Kham's iconic library
Donated print from Derge, Kham's iconic library
Beibei Huang -the vitality of  mothers & babies
Beibei Huang -the vitality of mothers & babies

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Achi, Clinic Mgr (r). iana Weingrad volunteer, (l)
Achi, Clinic Mgr (r). iana Weingrad volunteer, (l)

I’m not a young man — so I’ve seen a lot of years. I don’t know what 2021 will bring, but 2020 was as close to a Ray Bradbury novel as I care to get. At the end of January 2020 I went to Hawaii to see my daughter starring in a dance performance at the University of Hawaii, “The Last King of Bali.” Then, I almost couldn’t get back into China, where I live. 

Time and again since then I couldn’t get out of our compound where we live —the requirements just to go to the shopping center are draconian. With the various forms of ID, entering the local supermarket itself is like entering a foreign country. Everyone has cell phone software that tracks their movements. It is inconvenient, but then again so is death by Covid-19. Social distancing and pro-active public health management has kept the situation from going from bad to worse in China. With low car use, the skies are as blue as I remember them in my 30 years here. 

Fortunately for our clinic in far away Qinghai, on the vast Tibetan plateau, social distancing is a normal part of Tibetan culture and we didn’t have to create any special procedures. But women still get pregnant, babies are born. And that is our foundation’s sweet spot. 

2020 was a good time for taking a long look planning our future. 

We bought a lot of furniture from IKEA and a big Panasonic washing machine, new beds, convertible sofas, meds cabinets. At the end of the summer a ceiling was installed in the entire first floor. Next time you need to call an electrician just say a prayer of thanksgiving that your home is not in East Tibet!  In addition to GlobalGiving.org., our patrons here in China want to visit and I want all of you to also see what good your donations have created. We plan on using the second floor of the clinic as a lodge just for that purpose when we don’t have programs there, such as community health worker training, or visiting doctors providing training. But that will have to wait to later this summer. 

You are all invited. 

Our 2020 donations were the best since our foundation’s creation in 1988. Please continue your support. Until then, please add your name to our growing mailing list to keep track of our continuing strange and wonderful story, increasing the status of women, saving their lives and those of their babies.

Dr. Phuntsok Dongdrup, Clin. Dir. leaving Beijing
Dr. Phuntsok Dongdrup, Clin. Dir. leaving Beijing
Print of Callig.of Chogyam Trungpa sold at Gala
Print of Callig.of Chogyam Trungpa sold at Gala
Donated antique E. Tibetan carpet at Gala
Donated antique E. Tibetan carpet at Gala
Community Health Worker Training @ Surmang Clinic
Community Health Worker Training @ Surmang Clinic
Remote, 5000m, Chang Thang, near Surmang.
Remote, 5000m, Chang Thang, near Surmang.

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Organization Information

Surmang Foundation

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

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