The Surmang Clinic is the oldest philanthropic clinic in a Tibetan region. For the 26 years of its clinic history, the idea of a water system was never far from our minds. There were several engineers who drew designs, but we always seemed to lack the ability to actually execute, until US Board member, Architect Ralph Allen and Canada Board member Lyle Weinstein came along.
In 2011, Surmang Foundation received a donation of two pumps by the Danish pump manufacturer, Grundfos, via the support of the Danish Chamber of Commerce, China. By late 2017, we’d received the last design, the one we intended to use, from Ralph and Lyle. Both had been to Surmang and understood the difficulty of capital construction there.
By late 2017 we assembled a team consisting of myself, daughter iana Weingrad, son Joseph Weingrad and Russell Iser, a Master Plumber from the US. All three –iana, Joseph and myself—have nearly perfect Chinese language skills.
The source of the water was to be the stream that runs by the monastery, a stream that feeds the upper reaches of the Dzachu, the “wild yak river,” what we call the Mekong River. At Surmang this stream is referred to by as “the heart’s blood of Demchog, or Chakrasamvara,” one of the two names of Buddha in the lineage of Surmang Tibetans.
As good as our plans were, we found that recent construction blocked direct access to the stream, so we met with Trungpa Rinpoche XII, Chokyi Sengay, the Abbot of Surmang Dutsi-til Monastery.
The founding director of Surmang Foundation, Lee Weingrad, was the first non-Tibetan to meet Rinpoche back in 1992. Rinpoche agreed to let us connect to the year-old water main that had recently been installed by the Chinese government. The foundation offered to continue its help of the monastery with a helicobacter infectious disease project in 2019.
To do that, we needed a revised drawing to connect the water main to the clinic. Fortunately Joseph Weingrad had the skills to create such a graphic:
Within a few days a backhoe was summoned, the trench was dug and the pipes were laid. Connecting the pipe was the next task. Since we had purchased all the necessary equipment and supplies in Yushu, we had all the PVC pipe needed to join and lay the pipe.
As the last pipes were joined, and the backhoe returned to fill the trench, the next morning with perfect timing, a local Lama blessed the project.
After 26 years of planning, the clinic water system was finally completed. We told everyone that we would be back next summer to install a modern shower and composting toilet.
The day before we left, Joseph Weingrad filmed an interview with Laizhong, with one of the oldest members of the Surmang Community. She broke our hearts when she said, “the clinic is like a mother and father to me.” That interview will be available soon.
The next day, August 2nd, we returned to Yushu. Everyone was happy since we’d completed a project that we’d talked about 26 years before. Its completion firmly brought the clinic and health care into the 21stC.
It would be impossible without your steadfast support, the donors of GlobalGiving.org
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Our Clinic building was started in 1993. I'd never built anything before in my life.
Dharma Sagara Clinic is an odd building for China, and an even odder building for Tibet. It’s like no other. It’s high passive solar gain, techno-geek for grabbing the sun’s heat and keeping it and releasing it at night when it’s cold. And it does get cold at night at 14,000', 4000m. The windows all face south. The walls are two courses of brick with volcanic ash in between. The floors don’t touch the earth. It withstood the 2010 Yushu earthquake that brought down two very large 400 year-old monastery buildings.
My original instinct was “how are we going to raise the money to build it when it’s in a closed-to-foreign-travel region of China?” (a prohibition since lifted, ed.) I decided that I had to get an agreement with the Chinese Government to build the clinic. That process took almost a year '92 -'93.But by the end of '92, we had an agreement. You'd think there would be some difficulty in getting their cooperation. In fact they were happy to sign. The donated construction funds came about 3 months after the ink dried.
It took 3 years for the building to be completed.
When it was done – summer of 1996— we had neither doctors nor a plan for its use in any grownup sense of the word. I knew nothing about outputs and indicators, logframes or GANNT charts, sustainability or the “n’s” of infant and maternal mortality.
In the winter of ’96 I visited the Beijing office of UNICEF, looking for funding. The China Director of Mother and Child Health, Susie Jollie, asked me a perfectly reasonable question, “how do you know that whatever funding you get will result in health benefits for mothers and children?” I asked her if she’d seen the movie, “Field of Dreams.” It’s about a farmer in Iowa, played by Kevin Costner. He’s approached by the ghost of the 1912 Chicago “Black Sox” who threw the world series. They wanted to return to earth once more to do it the right way.
"How do I know they will play if I build the field?" Kevin Costner asked. “Build the field and they will come” was the answer.
And this is what I said to Suzie Jollie, "build the field and they will come." And come they did. We’d started a Community Health Worker corps in 2006. We got an Siemens Ultrasound in 2008. In 2011 we had maybe the first ever Rural Health Festival. The assembled CHWs reported that in the previous year there had been no infant or maternal mortalities. Down from world-record-high infant and maternal mortality.
In the year ending 2017, we’d treated about 1200 patients per month for free including meds. That’s 120,000 patient visits since 2008. Contrary to what one might think about a growing clinic, our cost basis remains the same – for one obvious reason that we have one administrator, myself. One meds and equipment procurement officer, myself. And one primary representative to the support community, myself.
Within China and outside China our base of support has grown, because of the simplicity of our project design and because we're not connected to any Church, corporation, government or big nonprofit.
Our constant overhead and growth allows us to do the things we put off for years, such as:
--new flooring upstairs
--new double-pane windows
--new waiting room furniture
--a water system.
--last year we put a metal roof on the clinic
But we need help. I’m writing this to assure you that we have built the field and they have come. The only complaint I’ve ever heard from the Tibetan women is “Why didn’t you come 10 years earlier? There’d be many women and children who died, who would be walking the earth now!” Unfortunately of all my powers, having a DeLorean and going back in time is not one of them.
We are looking for about $10,000 this summer to complete the above projects. Please join us. Help us complete the field of dreams for Tibetan women and children.
Lee
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2017 Surmang Foundation Clinic Report
Phuntsok Dongdrup, MD, Clinic Director & Sonam Drogha, MD Associate Director
[Dr. Phuntsok Dongdrup has worked for the Surmang Clinic for 17 years. Dr. Sonam Drogha, 16 years. ed.]
Introduction
Our work is patient-centered medicine, which means that we strive to see the patients on an eye-to-eye level, as fellow Khampa Tibetans and work from the point of view of our culture and religion, both of which are based on generosity. Generosity is our primary cultural value.
And so we are united in spirit with the patients, many of whom we have known our entire adult lives.
Familiarity, warmth and openness are the basis for our work. From a Chinese or Western perspective, we might see these people as poor, since their income levels are about US 25¢/person/day. Who are they? They are nomads, farmers and monks and nuns. They are people who herd, farm or pray here -- all descendants of people who have been doing this for a thousand years and in the case of the monastery, 400 years.
To open the doors of our work without concern about the ability to pay, we have three standards:
Patient Load
This year we treated 12,587 patients, averaging about 34 patients/day, if we were open 365 days of the year. But the truth is that we are closed for about a month every year, due to monthly religious holy days and also the lengthy national day, and Chinese national New Year’s (week), and Tibetan Lunar New Year (another 2 weeks).
That would mean we actually see 1,144 patients/month or about 38 patients/month. Some times of year, such as in July when Khampa Tibetans gather “worm grass,” or cordyceps sinesis, there are very few patients. And in the winter, there are days when we see 100 or more patients/day and often keep the clinic open until late at night, 7 days a week.
Clinic hours are 9:00 to 12:00 am, 2:00 to 6:00 pm. But often we have to take the time to take a break to diagnose and treat the patient. Sometimes, even at late night, we have to go to the heavily afflicted patient's home for medical treatment before climbing tens of miles of hard-and-dangerous mountain road.
Mother and Child Health
1703 women were OBGYN patients, treated both neo- and post-natal using ultrasound. Our clinic is one of the few outside the large Prefecture Hospital, that not only has a functioning ultrasound, but that has international doctors who come to aid in our professional development on this and other devices.
27 babies were delivered.
Diseases
Remarks
The vast majority of patients are treated and rehabilitated at the Surmang Foundation Clinic. Male or female patients from the age of 30 suffering from high blood pressure are a problem due to environmental problems such as altitude (clinic is at 14000’+, 4200m) and diet (Khampa Tibetans eat a very salty diet, and few vegetables). Increase in high bp, I personally believe is caused by diet. In the last two years most seriously ill patients suffer from high blood pressure, tuberculosis and hepatitis.
The profile of patients in Yushu Prefecture and Yushu City hospitals is similar to that of the Surmang Clinic.
There are two problems with severely ill patients or those needing emergency care. One it the long distance (150km) over poorly maintained mountain roads. Another is the dearth of private transportation and the complete absence of public transportation. To provide these patients with emergency or surgical care, we will drive them free of charge to the Yushu Prefecture Hospital.
This number includes women giving birth. Most of this year's maternal patients were sent to the Prefecture, because of a recent government policy, requiring a birth certificate. For high risk pregnancies (pregnancy-induced hypertension, nephritis, premature birth, dystocia, bleeding) mothers need to be evacuated for birth or treatment of disease.
For Khampa Tibetan mothers and mothers-to-be, this has challenged cultural mores that don’t see a hospital is a place where you might go when you are sick on one hand, but don’t consider pregnancy or childbirth an illness, on the other.
Conclusion
In short, we achieved gratifying results in 2017. However, we should realize more clearly that the more outstanding our achievements are, the greater the responsibility we assume and the heavier our burden on our shoulders. As Buddhists we don’t separate our spiritual practice from our working life. We always think that our work is very spiritual, very important. To this end our staff works together in that same spirit, setting an example of wakeful, spiritual cooperation. We hope to make a contribution to our entire society beyond our society, our country, in the same way as well. We will continue in this spirit and so contribute to a healthy, sane world from our remote corner, hopefully for a long long time.
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Dinesh’s Song
By Dinesh Mistry, MD
Surmang, September 18, 2017
Dark, cold, rainy, muddy Tibetan September afternoons at 4000 meters (14000+ ft.) can carry a sense of foreboding. The spring and summer monsoonal rains from the Himalayas have ended a month ago. Winter’s coming.
A nomadic couple came to Surmang clinic with their 2-month daughter. One of Surmang’s few well-to-do families, they are benefactors to the monastery, and they were treated with deference. But that was then. Now, due to do alcoholism, they had lost most everything. And now, their baby girl was facing her own winter.
She was having difficulty feeding, difficulty breathing. The little girl had a fever and cough. She was pasty white, gasping for air. Her cries were often, but very weak and a temperature of 39.5C (103,5º F.) Her breathing had a whistling sound suggesting widespread pneumonia. Her pulse was greater than 200 bpm. This baby was at death’s door.
My initial reacting was to resuscitate and send the baby to the prefecture hospital at Yushu. Unfortunately, because of the family's financial constraints, it was out of the question.
We went ahead and started care for this very sick infant. I thought she might not survive. Dr. Phuntsok started the intravenous, but we had nothing to stabilize this vital access. So we got the father holding the foot and ankle to make sure that the fluids kept running, while the mother cuddled the baby. We started fluids to resuscitate the infant, and gave intravenous antibiotics. Over a period of two to three hours, the infants breathing became less labored, but was still indrawing, the temperature came down to 38ºC, the heart rate dropped below 200bpm.
We gently gave a sigh of relief. She survived the first two hours. We kept our fingers crossed for the next crucial 24.
We did not have the facility to keep the infant and the parents had chores to do at home. So
They went home with strict instructions to come back if the infant becomes worse, or to come the following day for intravenous treatment.
The following morning, it was my time to leave. We called Dr. Drogha, several times regarding the infant, but she did not answer, and we expected the worst. We tried calling again when we reached Yushu at about 1pm(it had taken us 4+ hours on some really treacherous and impassable roads because of some heavy rains, the night before).
Dr. Drogha answered and gave us feedback. She had gone to the patient's home to see the infant, where she gave the intravenous antibiotics again. The parents did not bring the child to the clinic because she was better than yesterday and they had chores to do.
postscript I.
Before Dr. Mistry got on the Beijing-Vancouver flight, we called the clinic. Phuntsok told us that the little girl had completely recovered –no fever, normal pulse.
Lee Weingrad
postscript II.
This is one very dramatic story and yet is it is but one of the more than 10,000 that occur at Surmang every year. It is a credit to the foundation that the clinic is there at all, and further that these two angels, bodhisattvas, Phuntsok and Drogha are there with their unbelievable skill and devotion to give the same care and compassion to all. Amazing. They are local heroes.
Dinesh Mistry, MD
Dinesh Mistry, MD has recently completed his second rotation at the Surmang Dharma Sagara Clinic in E. Tibet. He is a doctor from Calgary, Alberta. He is a member of Surmang Foundation Canada’s Board of Directors.
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There is a land that time forgot, hidden behind the highest mountains in the world. It's a place of yak-herding nomads, farmers, monks, nuns, moms and dads. It’s a place where there are no days of the week, no family names, no watches, no weeks, no months, no years and few cars. It’s a place where no one speaks Mandarin Chinese, and almost no one can read or write their own language, Khampa Tibetan. It sits apart from the rest of us cut off by 2 /16,000' passes, with very long snowy winters and short glorious summers.
It is Surmang.
But it is not a place that disease forgot. It is a place with no doctors, with world record-high infant and maternal mortality and also communicable diseases. It is a place whose culture grew in antiquity in isolation. For 25 years Surmang Foundation has operated quality public health, at clinic in this remote part of East Tibet.
With your help and that of GG.org, we've treated over 130,000 patients for free and reduced maternal mortality to zero in 2011 and kept it near there since. Now it's time to go further. Here is where we need your help:
Public Health. We are expanding our public health calling to include three infectious diseases:
They are all treatable. They are all nearly 100% prevalent in each and every Surmang Khampa Tibetan.
Capital Construction. In addition we’ve gone from being the only new building on the block to being one of the oldest buildings. So we are in the beginning stages of renewing our footprint:
In the shadow of the vast number of international foundations that have left China, we remain. Getting support from people like you who read this appeal, not being connected with a big School of Public Health, Medical School, foreign government or international foundation, we've gone about our work for 25 years.
We depend on your help. As we say "when you help them, the feeling stays with you."
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