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.
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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."
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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.
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2015 is 23rd year of our providing medical services in Tibet. It’s been an interesting year. But then again we are working in Tibet and at 4000m, (13,000’ +) it’s bound to be interesting.
In terms of patient visits it was another over-the-top year for our clinic. About 1400 patient visits per month. This means that each patient returns about once. To give a reality check about our work and compare it with the much larger PHS county hospitals:
Number of doctors
Monthly patient visits
Surmang Clinic
2
1400
Township Hospitals
12
100
This means for an all-in budget of $150,000/year, our per-patient visit cost is about $9. This includes births and well-baby visits. I think that’s something.
The statistics above show what kind of model, what quantifiable outputs we want to contribute to the rural government hospitals. Actually the phrase “rural Tibetans” is a kind of joke, since most Tibetans live in far-flung farming or nomadic regions. Tibet is 1/5 of the Chinese landmass with .5 of her people. Before 1959 there were no roads, since the Tibetans didn’t use the wheel and thus no carriage or car (wheel is a sacred object), and there were no cities, except for Lhasa.
We continued our training of our two Surmang Clinic docs, Phuntsok and Drogha, as well as the training of docs in Yushu PHS hospitals in accordance with our government partnership. We had a very great collection of 4 volunteer doctors, each doing a one-month rotation. 3 from Canada, 1 from Australia. Great people. Unbelievable what luck we had to get them and also for the people we serve great luck. One of my enduring observations is that from nomads to farmers, monks to businessmen, all Tibetans know quality and all Tibetans know when someone is there to help them out, without expecting anything in return.
The challenges we face are management, financial and legal. By management, I mean that the project design is not from a school of public health, nor from a medical school, nor from a big foundation or foreign government. Our expertise is on-the-job training, which ensures that, if we pay close enough attention, it will be possible to learn lessons from our patients, doctors, and other stakeholders. I think that sense of pure vision is not lost to our Chinese government counterparts, because we have the blessing of being virtually the only international foundation in Tibet.
Financially we have always operated on a shoestring and always lived hand-to-mouth. I believe that there is strength in this approach, even though it is difficult. Our weakness is our strength and our strength is realizing that you don’t have to be big to get big results. This is the story of David and Goliath, and according to Malcolm Gladwell, about 40% of all military victories are where the winning side was smaller or less well equipped than their adversaries. When you win that way, the victory is sweeter because it’s come out of your playbook, your experience, not out of a tradition or a textbook. This is definitely our story and what contributes to what Dr. Ray Yip, recently retired Director of Gates Fnd China described as our pre-eminence as experts in the field of Tibetan health care.
Now we enter the cold weather in Tibet and the season when our patient visits and births will spike. I ask you to continue supporting our work as you’ve done in the past.
We still have a ways to go
· Our priorities are home delivery with Community Health Worker assistance. But we need to maximize the clinical visits by pregnant women. For the ones that seem more difficult, we need to have clinical delivery or in the worst case, be taken to the prefecture hospital for delivery. We can do this.
· We need to install a water system. We have the pumps. We need to raise the funds to do this. A water system will bring our clinic to the next level
· We need to re-boot our sat dish so that we can effectively do remote consultation and diagnosis using blood diagnosis and ultrasound
· We need to build a training center so that the PH service doctors we train will have a proper venue.
Surmang Clinic: Semi-annual Report 1/1/15 to 5/30/15
Bi-lingual Report
By Dr. Phuntsok Dongdrup, Clinic Director
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201420151318053168B420.193
1) Case Record Data: During the period there were 13,180 patients come to the clinic, which including 53 baby deliveries, visit 168 patients at home, 420 B-Ultrasounds. Transferred 19 car accident patients to other hospitals. 3 patients dead from hypertension and dystocia.
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2) Treatment: Per the doctor’s record,most of the patients came to the clinic because of flu, hypertension, cerebral hemorrhage, arthritis, bone hyperplasia, appendicitis, cholecystitis, gastric ulcer, gynaecopathia, traumata, dystocia, dysentery, phthisis and hepatitis. After got treated in the clinic, most of them got well, only few patients were transferred to other hospitals since heavily cerebral hemorrhage or/and acute appendicitis.
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3) Working time: Our regular daily working time is from 9am to 12pm and then 2pm to 6pm. But if have patients other than the working time, we will also have them treated, sometimes we even go visit patient who leaving dozens of miles away from our clinic at mid-night. And if any poor patient with serious sick and need to be transferred, we’ll drive and take them to the township hospital which 150km away from our clinic without any cost.
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4) Special cases in countryside: different from the patients in big cities, most of countryside patients are come to the clinic with fire burned, dystocia, acute appendicitis, cerebral hemorrhage and bromatoxism.
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20142015
5) Community health training: from year 2014 to year 2015, we took foreigner volunteers doctors Chao and Berg to Yushu Surmang clinic, Maozhuang clinic, Xiewu town and Longbao town for community health work training. Our first stop is the Modi village in Surmang Township, where the Surmang clinic located. The main contents for are mother-child health problem, sanitary conditions and doctor training. After the training we found: the high maternal and infant mortality are because the rare healthcare and poor sanitary conditions, as well as the poor knowledge on how to deliver babies. Training for the women who leave in the area is very hard because nomadic leaves scattered and the traffic condition is bad, but every single people in the group did their best to ensure the training completed successfully.
2)CHW
38
2014 502525
6) Community Health Worker: 38 nomadic women from different villages are part of our community health network. During the training period, we taught the women how to help pregnant woman to deliver baby with better and healthier way, they learned very fast even more than our expectation. We believe they can definitely help other pregnant women on dystocia and other birthing related issues when they back to their own village.
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7) When community health workers returned to their own village, they helped a lot for their own neighborhood, and the response from different regions are all positively. People expect more and more charity would come to their place with taking advanced knowledge to help local people live better and healthier.
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8) Surmang Foundation covered all the meal related expenses during the Community Health Worker training, including all the doctors (local and foreign), interpreter and 38 women who got trained. And for getting heathier and better environment for pregnant women, a birthing center is under built.
Dr. Phuntsok Dongdrup
Medical Director,
Dharma Sagara Clinic
Surmang Foundation
2015611
11th June 2015
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