Health
 China
Project #5500

Health Care in Tibet /Yushu

by Surmang Foundation

 

 

 

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 Patients with Dr. Phuntsok
Surmang Patients with Dr. Phuntsok

Surmang Clinic:  Semi-annual Report 1/1/15 to 5/30/15

Bi-lingual Report

By Dr. Phuntsok Dongdrup, Clinic Director

1

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.

2

 

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.

3

9001200200600150

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.

4

 

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.

1

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.

 

3)

 

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.

4)

38

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

Prayer Flags
Prayer Flags
Our partners
Our partners
Patient exam
Patient exam
Dr. Berg & patient
Dr. Berg & patient
Drogha making a house call
Drogha making a house call
Waiting Room, Surmang Clinic
Waiting Room, Surmang Clinic

Links:

Waiting Room, Surmang Clinic
Waiting Room, Surmang Clinic

This year we begin our 23rd year in Tibet.

We start the year with a new birthing center and with the challenge of installing birthing centers in 3 partner township hospitals in Yushu Prefecture, Qinghai Province. Sometimes people ask me what is the greatest difficulty of working in Tibet. The answer is always “everything.”

There are severe challenges in what a health promotion organization can do, since in this most-Tibetan, ultra-rural region, there is hepatitis, STDs, TB, infant stunting (no iodine in the salt) chronic cardiovascular disease (ever try walking around at 13,500’ for a few years?), and of course infant and maternal mortality and morbidity.

The question is not “what can we do to help?” but “what can we do that will achieve the greatest sustainable results?” In answer to this question, we chose mother and child health. Why? Because regardless of political, environmental, spiritual challenges, without healthy mothers and health babies, there is no Tibetan culture of any kind. Period.

If you want to save a culture, save a mother.

When we look even deeper, we have found that the lack or care for women and girls, women and babies, is a reflection of the low status that women and girls have in Tibet and for that matter nearly everywhere else in the world. Because we are a small foundation, we’ve had to focus and we found that focusing on safe deliveries, healthy babies, and strong girls, is an important contribution we can make to Tibet.

Why? For one thing, no one else is doing it. At least no one else is doing it quite the same way we are. We started out by basically getting the trust of our communities by offering free medical care and free medicine, with medical services given by people who are from their area, who speak their language. Doctors and patients who look at this help And it is.

Next we examined the reality of health care in the region through one of the only mass-data public health surveys (2005) and through an apples-to-apples comparison between our services and those of the Public Health Bureau. By the time the devastating 2010 Yushu earthquake came along, we had something to offer them, a model that we hoped to roll out as a sustainable prototype.

We moved out of our safe niche at Surmang into the bigger world of rural public health in partnership with the government.

That was the beginning of our partnership with the Yushu Public Health Bureau. I know many people will think  that “the government is not the solution to the problem, it is the problem.”  But in this case our government partners were and are all ethnic Khampa Tibetans who have an eye for innovation and an appreciation for grit.

We came up with training programs for not just our two docs, Phuntsok and Drogha, but for the docs we train in Maozhuang, Xialaxu, Xiewu and Longbao township hospitals. Our volunteer doctors were and are superstars –strong open people who are happy to make a palpable difference.

The reception our docs received was equally strong. Tibetans are naturally warm, genuine people and they are quick to recognize warmth and genuineness in others who come to help. The result of this synergy was the government offering to create an umbrella organization to guarantee the continuity of our work. After all, since 2008, there has been a steady attrition of international foundations in Tibet. Trace Foundation, Bridge Fund, One HEART Tibet, Doctors Without Borders, Tibet Poverty Alleviation Foundation. All gone. There are very few international foundations left in Tibet, as we are reminded by our government partners.

An officially chartered organization was started by the government in 2014, The Yushu Farmers and Nomadic Health Promotion Association. Through this organization our programs have the basis for continuing far into the future.

But there is a catch. The departure of all these big foundations is because of their funding from either the US Government or very big international foundations. We receive funds from neither. So we are dependent on you donors through Globalgiving.org. Please help!

Please continue your support and generosity.

Babies are our business.
Babies are our business.
examination
examination
patients
patients

Links:

Dear Friends of Surmang,

It’s very meaningful to enter this year-end report, since it gives us the opportunity to reflect on 2014 and the years before.

2014 was a year that brought several things to fruition that had been cooking on the stove for the past 20 years. I often say that Surmang Foundation is like a rock and roll band that played small clubs in central California for 15 years and then one day became an overnight success.

Connecting to Tibetans

Maybe there’s a kind of inner Steve Jobs in me. When we were asked in the mid-90’s how we knew that the Tibetans would want a clinic, I responded in effect, “they don’t know they want it yet.”

Tibet is one of the most remote places in the world and Surmang sits at the center of that.

One of the marks of that success is risk taking connected with openness and communication with the Tibetan people of Surmang. Unlike the fans of the mythical rock and roll band, the Tibetans are not Californians. They lead traditional herding and farming lives are not into experimentation. So they are slow. There are few if any people wearing watches in Kham. In 1996 Tai Situ Rinpoche told me that going there would be like going back 500 years in time. He said, “For every 10 discursive thoughts an American has, a Tibetan has 1.”

So these are not people who are experimenting in lifestyle. The ideas that we had as a group came out of our admiration for these people as survivors, as people who are very warm, as people who are very genuine. I think that when you connect to people on that level, you can connect with your own warmth and genuineness.

When we opened full time in 2000, there was a question about how to charge for services, since these people make about US 12¢/day. It was clear that we couldn’t judge people based on their appearance since nomads who have 500 horses dress exactly like those who have 5. Also they didn’t seem to know they were poor. Was I going to be the guy who told them that?

 So we provided the services for free. And that’s the way it’s always been. It was only 10 years later that we found out –thanks to the Peking University assessment—that our cost of providing services per patient visit was about 1/7 that of the public health hospitals. In doing this, we stumbled across what is perhaps their #1 cultural value: jinpa, which in Tibetan means “generosity.” In about 2008 one of the high Tibetan lamas wrote a memorial, which declared our clinic a Medicine Buddha center.

 Another element of connecting directly to our beneficiaries is the lack of orthodoxy: neither medical, public health nor development. This means we, in essence, learned to cook from scratch, meaning we weren’t taking anyone’s word for it. In some ways this open view put our direct experience with Surmang on the front burner and as a result it became actually easier to take on appropriate public health, medical or development advice. It wasn’t always so natural or easy for me, like back in 2006 when Mauritz Van pelt told me that our foundation is about “empowering women.” I’ll never forget that. It was a defining moment; that advice would become our victory banner 9 years later, reducing maternal mortality in a place where it is the #1 killer and in writing a proposal about empowering women and girls in Tibet.

 It made it possible to hear the sage advice of Dr. Ray Yip, regarding Chinese PH policy during his many trips to Surmang. It made it possible to see that clinical delivery was the most advanced form of the assisted delivery our Community Health Workers were giving. But whatever we learned was based on the foundation of our own openness and experience.

 

2014

We had 4 very great medical volunteers: Board member Dr. Julie Carpenter, back for her third rotation. Drs. Laura Kimbro, Trudy Singzon and Sisi Zhao. Dr. Kimbro is an OBGYN who has done many such international rotations as is Dr. Singzon. Dr. S is also a teacher of an international OBGYN protocol, A.L.S.O.

 2014 was the year we became –with the help of the Chinese Government, Yushu Public Health Bureau—a registered charity in China. It was the year we began the journey with supporters and donors from inside China. Why not? We are a Chinese organization. It was the year of our engagement with the Danish Chamber of Commerce China, resulting in the construction of a birthing center on our Surmang campus and the installation of birthing centers at 4 partner township hospitals.

 So it seemed natural, after our 4th Annual Fundraiser in Beijing, that we figure out how to use that birthing center to maximum advantage. The answer was articulated in a proposal written by Suzanne Smith and myself over a two-month period. The guts of the proposal lie in empowering women and girls in Tibet. And the means to achieving that goal is to reduce maternal and infant mortality. Dying in the process of creating life is the greatest challenge Tibetan women face. We proposed doing this through incentivizing mothers, community health workers and our doctors in pre-natal exams, birthing, post-natal and well-baby exams.

 And why not? Already our salaries to community health workers are 1/3 of their family income. Since the government has stopped the collection of cordyceps sinesis (“worm grass”) due to possible extinction, it makes sense that increasing income would make clinical delivery more attractive.

Through the help of Director Chris Devonshire Ellis, 2014 was the year that we partnered with Dezan Shira to get the benefit of their expertise in financial reporting. Not only that, they did 3 articles for us in their 40,000 member "Asia Briefing." 2014 was the year that our website, www.surmang.org, was redone largely with the help of the marketing firm, Shanghai Jungle. In our last reported week our requests for pages went from an average of 3500/week, pre-re-do, to 15,000 a week, post.

In addition  Did I mention that 2014 is the year when our Surmang Clinic achieved status as a government clinic? That means that we are the beneficiaries of meds, supplies and can register births (and deaths).

 Part 2 of the proposal is the creation of an income stream –a weaving co-op so we can re-introduce traditional yak cashmere blankets and shawls, a skill lost during the cultural revolution. Usually in the NGO business success is monitored according to measurable outputs and indicators. But for this project –as well as mothers and babies not dying in birth—the non-measurable outputs are really the strongest. These are: how a woman feels about having a baby. Joyful or life threatening? And how a traditional sacred craft like weaving reassures Tibetans of their place in this world. In a book on Balinese weaving, someone said, “the patterns in this cloth are the lens which brings the power invisible world into the visible.” I hope that the cloth of our foundation could as a whole could have a similar wholesome impact, as we enter 2015.

I welcome you to join us.

Lee Weingrad

Director

Links:

one of our many mothers we help
one of our many mothers we help

 

East Tibet 2010.
Our team was doing an emergency assessment of Yushu Prefecture township hospitals following the disastrous 2010 earthquake. The way was muddy and rutted. We had to get out of the Landcruiser often to push.  On the way to the Mauzhuang hospital, I saw a bunch of our Community Health Workers (CHWs) by the side of the road.  It was very unexpected. They were having an informal meeting, right there in the open.
I got out of our 4x4, in the thin air near Rijie village. About 10 Surmang Foundation Community Health Workers (CHWs) were waiting. No training program, no money, no pregnant women. Just us. Khampa Tibetans are very straightforward so I asked them: “Look there's no one here except us. Just speak to me directly. If you could change anything about our work, what would it be?”
 
One, Palmo, stepped forward and spoke, shouting, almost crying. “You should have started 10 years earlier! So many mothers and babies who died would be walking the earth with their loved ones now!”
 
I was speechless.
I think until that point I was pretty proud of our achievements -- after all, we'd not just lowered maternal mortality and infant mortality rates (mm to zero 2010 to 2013), but there  was a sense that we'd been able to change the way medical care works for women and overcome a great deal of the cultural inhibitions among Khampa Tibetans, such as no one ever getting undressed in front of another person, ever, or women giving birth with the animals.
But in this case I realized how profoundly these women pay the price and bear the burden of maternal and infant mortality and pay the price mainly alone, by themselves. And also I saw that no matter how stoic we think these nomads and farmers are, it was clear to me right then, how deeply these women carry their history and their struggles with them every day into the present. And Palmo's remark made it clear to me that they now had some other reference point, that it's possible to have children without rolling the dice to determine if you live or die.
It made me see how deeply the work that we are doing affects not just each woman we help, but the entire cultural landscape. It also made me see how totally vulnerable these woman are, not just physically, but emotionally and spiritually as well.
So yes. It's a failure that we didn't start earlier. But in a sense her remark was a kind of Zen koan. It is impossible to return to the past. But in a sense I saw that we have to be open to the wounds that these women carry and not just expect that our optimism and our accomplishments combined with Tibetan grit are some kind of balm that wipes the slate clean. When you bring that much hope and change to people, you have to also own the despair and solidity that arises from the past.

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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