Health
 China
Project #5500

Health Care in Tibet /Yushu

by Surmang Foundation
Assisted birth
Assisted birth

2016 Surmang Foundation Clinic Report

 1) Case data

In 2016 Surmang clinic registered patients totaled 10790 people, or about 900 patients per month. Of those were 17 were women who gave birth, 1527 patients received ultrasound, including 288 ultrasound for pregnant women. 61 patients had to be transferred to other hospitals due to dystocia and various serious illnesses. We did 193 house calls or a little less than 4 per week. One patient died at the clinic (cerebral hemorrhage due to a traffic accident).

 2) Treatment

According to the basic symptoms of the patient this year to analyze the majority of patients Surmang offering from

o   influenza,

o   hypertension,

o   cerebral hemorrhage,

o   arthritis,

o   fracture hyperplasia,

o   fractures,

o   appendicitis, cholecystitis (gall bladder inflammation),

o   gastric ulcer,

o   gynecological diseases,

o   trauma,

o   dystocia (slow, or difficult childbirth),

o   dysentery,

o   Tuberculosis and

o   hepatitis B and other symptoms of different diseases. in the past two years, tuberculosis and hepatitis, diabetes, have especially become more prevalent.

In addition to tuberculosis and hepatitis, acute appendicitis and cerebral hemorrhage and other difficult diseases, the vast majority are patients are those who are treated for rehabilitation, that is to say, those have been previously treated for chronic problems and who return for treatment.

In a change from previous years, are males or female from the age of 30 present a suffering high blood pressure. We attribute high blood pressure to dietary causes. Our experience is that the illnesses arising from diet most are: high blood pressure, tuberculosis, and hepatitis. A similar situation has been recorded as well in city, prefecture and state hospitals.

 3) Hours of operation

In accordance with the regulations; our normal working hours: 9:00 am to 12:00 pm, 2:00 pm to 6:00 pm. But in many cases, we have to use off-hours as well to diagnose and treat patients. Sometimes patients were treated late at night traversing tens of miles of dangerous dirt mountain road to go to the patient's home for medical treatment. Most of our patients have no means of transportation beside horse or yak and so we do what we can while they are in the clinic and otherwise make house calls.

When we encounter a poor family suffering from serious illness in need of being transferred to a hospital for treatment, we ourselves will drive the patient free of charge about 150 kilometers to the prefecture hospital.

Starting in 2016, the policy of the Government requires all newly born children to have birth certificates. The result is that most of the mothers now go to the city hospital to give birth, since the government hospitals are the places where birth certificates are provided.

There are other reasons, such as reimbursement via insurance requires city or prefecture hospital delivery. In addition, due to the limited conditions of our clinic, some maternal diseases, (pregnancy-induced hypertension, nephritis, premature birth, dystocia, bleeding) and other reasons they need to go to the prefecture to get treatment. In addition, this year, many mothers presented high blood pressure and nephritis and other comprehensive diseases, diseases mainly produced by eating habits and lifestyle and life pressure. This is a great change from the past.

 

3) Community based training

As in years past, highly qualified foreign doctors worked volunteer rotations. Volunteer Doctors carried out a full range of medical training.

These Include:

o   the use of antibiotics,

o   hypertension,

o   heart disease,

o   tuberculosis,

o   hepatitis,

o   arthritis,

o   digestive diseases,

o   community health etc.

What we have learned is to train the 40 CHWs, the Community Health Workers, to deepen and expand their knowledge and to trust them as people who have deep roots in their villages. That is the way we increase our survival --building a culture of strong healthy mothers and girls.

CHWs are actively involved and very grateful for their role as teachers among their communities, spreading knowledge of disease and disease prevention. On one level, basic knowledge of the causes of disease and related work and the importance of community health is one part of their role. Another is to identify what kinds of social and cultural changes –such as washing of hands and surfaces connected with the preparation of food— are a necessary component of a healthy community. After many years in this very traditional society, the small changes in behavior have had a sea change impact on the largest threat everyone can see: virtual elimination of maternal mortality and morbidity and vast reductions infant mortality and morbidity. This gives the clinic and the Surmang Foundation increased credibility working alongside their friends and neighbors for the protection of health and life and ensuring strength for women and girls, resulting in the sustainability of Tibetan culture.

Dharma Sagara Surmang Clinic

December 30, 2016

Mother and baby
Mother and baby
Dr. Phuntsok and patient
Dr. Phuntsok and patient
Dr. Drogha Making a House Call
Dr. Drogha Making a House Call
Drogha being trained on ultrasound
Drogha being trained on ultrasound
Patient outside the clinic
Patient outside the clinic

Links:

Drs. Kireet Tauh and Tonia Berg
Drs. Kireet Tauh and Tonia Berg

Looking back on 25 years in Tibet

Steve and me

In the mid 90’s Steve Jobs went to New York to meet with some New York venture capitalists to fund the iPod. They asked him, “What kind of focus groups did you run?” Jobs replied, “What kind of focus groups did Gandhi run?” They asked again, “how do you know they’ll like it?” He replied, “They don’t know they want it yet.”

While I’m no Steve Jobs, I faced exactly the same kind of questions in establishing healthcare in E. Tibet. What kind of capacity do you have? What are the established needs? I was not a public health professional and while I knew none of the answers, I was confident we would succeed. And succeed we did.

The 4000 m alpine summers of Surmang are short and glorious, aromatic deep green fields abundant with wildflowers and wildlife. Snowcapped mountains glistening with sunlight rising on their horizon frame the scene.

In 1991 we made out first trip with volunteer doctors to Surmang. It was 4-wheel drive country, with no roads and rivers and with no bridges. But the local response was breathtaking. No one had ever gone to so much trouble before to take care of them. Hundreds of people would come to our tent to be treated. Every day. While their personal response was very warm, none of them had ever seen more than one foreigner before. Me.

One of our doctors, David Dubin, said, gesturing to a Khampa warrior with long braided hair and a sword, “I feel like I landed on another planet.” I responded, “Imagine how they feel when they see us!”

We continued. In 1992 we signed a partnership agreement with the Qinghai Prefecture government to build a clinic. Within 6 months we had the funding from Caritas. Three years later 1996, the clinic was finished. By 2000 we had a local Tibetan who completed 3-year-post-HS training as a doctor. By 2001 we had a second, a female. That summer our overseas volunteer doctors began a journey that continues today: training our two doctors.

Throughout those first years of the 2000’s volunteer doctors like Julie Carpenter of Boulder, CO, would ask, “Why are there no women and children in this clinic?” That question was a game-changer. As a result we shifted our focus to mother and child health.

In ’94 we penned an agreement with the Yushu Prefecture Government to do a mass-data survey of 400 nomadic mothers. This is China and foreigners don’t run around surveying the locals. It had never done before, hasn’t been done since.

We found out that the region has one of the highest maternal mortality records on earth, on the level of Uganda or Somalia. I found out later that WHO estimates 6000 women die each year from childbirth or pregnancy. And they didn’t count Qinghai or Sichuan. The biggest threat to Tibetan health was facing death in the process of making life. The next year, 2005, with the cooperation of the government, we began to train 40 Community Health Workers, women embedded in their villages and nomadic camps to pro-actively remove the sword of Damocles hanging over the neck of every Tibetan mother and girl.

By 2011 maternal mortality in our area went to zero. And stayed close to there.

 

This year, 2016.

This year’s report will come at the end of November. Anecdotally I can report that among our clinic’s 9000+ patients treated for free and the region’s 95+ births, there were only 2 maternal mortalities and 1 infant mortality.

In the early 90’s Suzie Jolly, then with UNICEF asked me when we were building our clinic, “how do you know you will get any patients?” I asked her if she saw the movie, “Field of Dreams.” In that movie Kevin Costner’s character is asked to build a baseball field in his Iowa corn field so that the ghosts of the corrupt Chicago Whitesox (the “Blacksox”) could play an honest game and redeem their souls. He said, “How do I know they will play if I build the field?” The ghost said, “build the field and they will come.” I repeated this story to Ms. Jolly.

Two years ago I was re-connected to her through the late Maurice Strong. He said, “Call her up.” And so I did. When she answered the phone and I identified myself, she said, “build the field and they will come.”

Our work is to save Tibetan culture. If you want to save a culture, save a mother. We get no funds from foreign governments or churches or big foundations. We are driven by individual donations. There is one big takeaway for our many small donors: the feeling stays with you. Help us. See what happens.

a patient
a patient
Community Health Worker Training
Community Health Worker Training
Young Khampa Girl examination
Young Khampa Girl examination
"I will fight 6000 maternal mortalities"
"I will fight 6000 maternal mortalities"

Links:

A young patient
A young patient

Winter exits the stage late at 4000 m., and summer comes even later. This year we once more had the expert services of two volunteers -- Drs. Tonia  and Kireet  of Vancouver, Canada. They work side-by-side with resident docs Phuntsok  and Drogha. Dr. Kireet, a 4th year resident in cardio surgery, was particularly interested in the ultra-high salt intake among Khampa Tibetans. On a healthy side, salt helps keep fluids inside the body and this is particularly useful on the high plateau. This is because, without much atmosphere to speak of, there is little atmospheric pressure and when there is less atmospheric pressure, the liquid in one's body basically flies into space. This is why volunteers often experience chapped lips during an all-day rain fall.

The downside for many Tibetans is very high blood pressure and also the resulting chronic arteriosclerosis and heart disease. The problem when we treat this sympomatically, by giving BP meds, is that it doesn't go after the heart, so to speak, of the problem, which is salt intake that is 5 to 7 times that recommended.

Dr. Tonia, a 4th year Radiology Resident, was interested in cario-applications of our ultra-sound to Dr. Drogha. As usual Dr. Drogha is a great student and picked up moved year's lessons to a new high. 

In August, Dr. Ron arrived -- his 3rd volunteer rotation. Everyone was happy to see him back again. All three volunteer docs were received with typical low-definition Khampa warmth and smiles.

This year, we've had the services of manager/interpreter Lobsang. Lolo, as he is known, adds a kind of off-handed tri-lingual fluency and humor to the project. 

  • Meds inventory. Although it's boring to say this in a GG report, the 10 days I was there were spent setting up a meds inventory system. We had to do this since we were the recipients of a $12000 donation from a Chinese pharma company. 
  • Water. We are moving ahead in setting up a water system for the clinic. At this point we visualize that it will cost about $20,000 to deliver the water from upstream to a tank in the Clinic building. 
  • Relations with the monastery. This year the Abbot of the Surmang Monastery gave his unqualified support for the clinic.  We welcome the increased marriage of our two worlds. 
Patients.
Patients.
Donated meds.
Donated meds.
Phuntsok and Lolo in Jiegu
Phuntsok and Lolo in Jiegu
Preparing the inventory software
Preparing the inventory software

Links:

putting up the building
putting up the building

You wake one day, both your children are in college, your black hair is silver and your fledgline Tibetan health care project is 20 years old

This summer we celebrate the 20th anniversary of the Surmang Dharma Sagara Clinic.

It was 1992 and I though, "who would ever give us money if we don't have permission from the Chinese Government to build in Tibet?  What started out as a dream became a contract with the Qinghai Government, with the help of Gov. Huang Jing Bo. Not so long after we signed the contract we got the construction funds -- our only big grant. We broke ground in '93, and completed the work in the summer of '96. There have been 20 brutal East Tibetan winters in between, and and devastating earthquake in 2010 that took down the 400 year-old monastery on whose land we sit. But it didn't scratch the clinic. 

And come they did. In the past 10 years alone, over 140,000 patients. Over 150 volunteers. I have to admit that some of the success was driven by naive luck. I was told by several experts in international development and public health that, like Rodney Dangerfield, we'd get no respect if we didn't charge for services. But for the life of me I couldn't figure out how to do that. By looks alone, I couldn't tell the difference betwen a nomad who had 200 horses and one who had 20. The dressed the same and looked the same. The only thing that made sesnse was to charge everyone the same and for me and the foundation to do the work to get the funding elsewhere. So since then we've never charged for services or meds.

We took a place with among the highest maternal mortality rates in the world --3.000/100,00 live births-- down to zero in 2010 and kept there near there ever since. 

In '95 when I spoke to the ehad of Mother and Child Health at UNICEF in Beijing, she asked me, "how do you know that anyone will ever come to the clinic?" I asked her, "did you see the movie, "Field of Dreams?" Kevin Kostner's character is told to build a baseball diamond in his Iowa cornfield. "What makes you think they will come to play?" he asks the ghost. "Build the field and they will come," was the answer. That's what I told her. Now she's at Ford Foundation and when I contacted her 20 years later, her first words, on hearing my voice, were, "build the field and they will come."

years after completion, patients line up
years after completion, patients line up
patients waiting to see one of our docs
patients waiting to see one of our docs

Links:


Attachments:
waiting room
waiting room

Wintertime is when the nomadic yak herders return to their winter homes with their families and livestock: yak, horses, goats. The winter quarters are permanent structures in villages with names like Modi, Jerikhe, Rijie. There is a reason why Tibet is called “the land of snows.” As precious as the fragrant wildflower displays are in the short alpine summer, that is how brutal the weather is at 4300 meters (13000’). It will snow heavily and continuously for months with no snowplows. If they are anything, the Tibetans are survivors and there are few among us outsiders who could take winter’s full measure at Surmang.

With the villages full, is the busiest time of the year at the clinic. Phuntsok has told me that some days they will see 300, 400, 500 patients and work from early morning to late into the night. It is difficult to describe the grit of our two doctors, Phuntsok Dongdrup and So Drogha. So I’d like to take the opportunity to salute their efforts. They are local heroes.

They operate one of the few private clinics in Tibet that are focused on mother and child health. Phuntsok has been with Surmang Foundation since 2000. Drogha since 2001. 2016 is his 16th year, Drogha’s 15th. What makes the Surmang Dharma Sagara Clinic unique is the dedication and professionalism of these two Khampa Tibetans. For each and every one of those 15 and 16 years, they have received hands-on training by foreign volunteer doctors who have high renown in their fields. 2016 will be the first year that all 5 volunteer doctors will be returned volunteers.

For our patients, the result has been quality health care and free meds with no questions asked, no bureaucratic hoops for the patients to jump through, with an emphasis on early intervention and local access in a place with few roads, fewer cars and little electricity or phone connectivity. It’s user-friendly health care.

Because our patients can recognize kindness and quality care, 2015 saw over 18,000 patient-visits to our clinic.

In 2015, Surmang Foundation faced challenges from a tightening official environment. We are one of the few international foundations in Tibet. Yet, in the face of these challenges, we were able to be gifted $15,000 in medicines, and another $51,000 in our Annual Appeal. So, like climbing Everest or Meru, the question isn’t so much a question of the environmental dangers, such as weather, crevasses and vertical ascents so much as it is our own preparation, fitness and grit to fulfill our promise. And our own openness. We took a region that had among the highest maternal mortality rates in the world and by 2011 reduced it to zero. And it’s stayed close to there ever since. Infant mortality has declined significantly too. We have that commitment. We have that grit.

The challenges for 2016 are: construction of a water system and a training center. For the first we need $25,000. For the latter $60,000. This is our clinic’s 20th year of operation. Let’s join in the celebration and ensure continued success!

Please join us. Tibetans say “repay kindness with kindness” and this is certainly true with those who contribute to this project. The feeling stays with you.

Dr. So Drogha
Dr. So Drogha's resolve
3 patients
3 patients
Feeling Stays with you
Feeling Stays with you

Links:

 

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Organization Information

Surmang Foundation

Location: Boulder, CO - USA
Website: http:/​/​www.surmang.org
Project Leader:
Lee Weingrad
Founder
Beijing, Beijing China

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