Successful mission brings medical aid to rural clinics by Linda Griffin August 1

Program director Linda Griffin (left) transfers badly needed supplies to
the clinic of Keluotong Township, Dege County.

Successful mission brings medical aid to rural clinics

by Linda Griffin
August 1, 2002

Contents of this report

Last year, a team led by Dr. Bruce Beattie of International SOS surveyed
clinics and hospitals along the north Sichuan-Tibet highway, in the course
of a marathon bike ride. Dr. Beattie made recommendations about what the
clinics need, and this year Kham Aid donated US$11,000 worth of equipment
to five of the most needy rural clinics: Tagong, Zhuwo, Rongbatsa,
Manigango and Keluotong.

We (Linda Griffin and Wu Bangfu) ordered the equipment from a medical
storehouse in Chengdu and accompanied the delivery truck on a five-day
journey, distributing equipment and reassessing needs at each clinic. We
found that the situation had changed little since last year, with the
exception of Keluotong where construction on a much-needed new clinic
building is under way and due for completion in November.

These are all government-run clinics and some are covered by the National
Aid for Tibetan Areas Program. However, the form of aid provided is not
always appropriate. Earlier this year, a Kham Aid team visiting one clinic
in the remote county of Xinlong found a startling range of equipment USG,
gastric lavage machine, oxygen concentrators and abortion machine sitting
untouched in a store-room, still in their original packaging. Most local
people could not afford or did not understand the need for such services,
and the doctors did not have the skills to operate the machines, we were told.


Reuseable hypodermic - often used when the disposable syringes run out. We gave our clinics 10,000 disposable syringes each, and donated autoclaves so that reuseable equipment can be properly sterilized.	"Electric abortion suction unit" - found in the storeroom, untouched and still in its original packaging.

At every clinic we heard that patients could not afford more than the most
basic treatment. According to one doctor at Manigango, the clinics are
supposed give all patients the necessary treatment anyway and in cases of
genuine poverty (this is left to the clinics' discretion) the government is
supposed to provide subsidies to cover the costs. In practice this
obviously doesn't happen, except sometimes in the case of minor treatment.
It's difficult to establish whether the funds simply are not available in
the first place, or whether they get siphoned off at some level of
administration.

The goal of this project is therefore to improve the quality of basic rural
health care, within the scope of what these clinics are actually able to do
at present.

Equipment provided:

The foremost daily task at a rural clinic is the treatment of common
illnesses. Therefore, top of our list was a range of modern diagnostic
equipment: stethoscopes, otoscopes (device for looking into ears and
throat), thermometers, blood pressure machines and haemocue (device for
measuring haemoglobulin). The clinics do already have some of this stuff,
but it is generally old and worn, and a dozen doctors may share one set of
equipment.

Medicines are frequently administered by injection, as are vaccines, but
the clinics lack adequate supplies of disposable needles and methods of
sterilization do not meet recognized safety standards. We bought 10,000
disposable needles and syringes for each clinic hopefully enough to last
for several years as well as modern electric autoclaves (sterilizers) for
four clinics. The doctors often travel over wide areas to carry out
immunization programs in remote villages and nomad communities, and last
year's survey found that none of the clinics were able to keep the vaccines
cold and therefore effective. A refrigerator for storage and cold boxes for
transportation were provided to all five clinics.

These clinics do have to deal with emergencies, but under the present
circumstances lack of training and inadequate hygiene it is not
appropriate to spend money on operating theaters. Rather the clinics need
to provide first aid and stabilization until the patients can be
transported to the nearest urban hospital. We brought stretchers, suture
kits, bowls for dressings and a range of scissors. Midwifery is another key
function of rural doctors: we provided delivery bundles with all the
necessary equipment. Baby scales and growth charts were added to monitor
the growth of infants in their critical early months.

The examining rooms, wards and doctors' living quarters at most of these
clinics are dingy and run-down. This has a serious effect on both medical
hygiene and staff morale.. During our visit, Manigango clinic requested
bedding for their wards their current facilities were so decrepit that one
nomad in-patient and his family were actually camped out in the clinic
yard! On the way back from Keluotong, I stayed behind an extra day at
Manigango to arrange the delivery of a dozen mattresses, quilts, covers and
sheets. These should also be provided to the other clinics on a future
trip. Kham Aid's 'Better Homes' project, which kicks off this September, is
an attempt to improve the living quarters of rural doctors and teachers.

Rongbatsa clinic has an X-ray machine which doesn't work, apparently due to
wiring problems. The survey team was told last year that it could be
repaired for around 2000 yuan (US$250). We asked the director to find out
exactly what is required and promised to fund the repair job if the cost is
reasonable.

Power supply

Last year's team found that power supply was unreliable at many clinics, so
we brought emergency rechargeable battery lights and reassessed the need
for generators. The situation seemed to have improved this year Tagong,
Zhuwo and Rongbatsa reported that outages occurred only occasionally in the
winter months, and at Keluotong a brand new power transfer plant is under
construction right next door to the clinic and due to come on line in
September.

Bringing medical equipment and supplies to Maniganggo Township,
Dege County.

Manigango was the one exception: the whole town has been blacked out for
well over one year now and 'next year' was the most specific estimate
anyone had of when power would resume. The clinic has a one-kilowatt
generator which is sufficient only for lighting and minor appliances, while
the X-ray and ultrasound machines sit gathering dust in a locked room. The
clinic receives no subsidy for fuel from the Dege health authorities, and
the doctors pay out of their own pockets to run the generator for a few
hours every evening. The director, a young and very intelligent guy, was
actually discouraging when we enquired about getting a bigger generator to
power all the equipment, because they can't afford the fuel. Solar power
could cost as much as one million renminbi (US$125,000) to power the whole
clinic. The director himself suggested we wait until next year to see if
the promised power supply arrives and is reliable, before considering
back-up options. Manigango is a bleak place at the best of times and I'm
sorry to leave the clinic in the dark for another winter.

Doctors' hopes & frustrations

One encouraging observation is that the medical reference books we
brought one comprehensive doctor's manual and one rural health care guide
for each clinic were very well received. In most of the clinics, doctors
immediately grabbed these and started reading them. In Zhuwo one doctor sat
engrossed in the manual for a full hour while we had lunch, and in
Manigango, where we stayed the night, one doctor was reading it when I got
up at 7am!

Likewise, at most of the clinics the doctors asked for further training.
ISOS have lined up places for two doctors and one medical college teacher
from Kham on a two-month training program in emergency medicine. This will
happen in 2003. Meanwhile, Kham Aid's midwife training program is now into
its second year and we hope to organize other training programs in
cooperation with the local health authorities. Obstetrics and child
nutrition are among the proposals currently on the drawing board.

At this stage, we also have to make sure that training remains within the
limitations of rural doctors' actual work. The director at Manigango had
taken a year-long course in surgery but was frustrated at not being able to
use his skills, since the local nomad population could not afford the fees
and the clinic's 'operating theater' was not sterile enough to safely
perform operations anyway.

We stayed overnight at several clinics and I stayed two nights at
Manigango, so we had the opportunity to get to know some of the doctors and
their problems. I have to say, I didn't talk to a single doctor who was
content with his/her posting. All had been assigned to their clinics on
graduation from college (usually the Medical Vocational School at Guza,
near Kangding), and most hoped for a transfer to a bigger urban facility.
The reasons for their dissatisfaction are manifold.

Besides the primitive living and working conditions, isolation is a major
factor. The doctors at Manigango, a remote high-altitude outpost, seemed
entirely dependent on each others' company for social life. Although nearly
all ethnic Tibetans, they have difficulty communicating with the local
population of herders whose dialect they don't understand and who have a
very different outlook on life. The young unmarried doctors were
particularly miserable, as they saw little chance of meeting a suitable
partner there. Without connections in the right places, they have little
hope of a transfer, so the best Kham Aid can do is try to boost morale by
improving the clinics' facilities.

Future action

Besides the training proposals and 'Better Homes' project mentioned above,
Kham Aid hopes to expand its medical equipment program to include more
rural clinics throughout Ganzi prefecture. There are several hundred such
facilities and many are in even worse condition than those selected for the
pilot project. Follow-up visits to the five clinics will ascertain the
usefulness of the equipment already donated, for future reference.
Appropriate higher level equipment will be provided to the pilot project
clinics if funds can be raised. For instance, Tagong reiterated a request
for an X-ray machine and a replacement for their old USG machine which is
virtually un-useable.

This program is modest in scope, but its benefits can go a long way. As one
young doctor told me: "You're helping a lot of people, even though they
don't know anything about you. Even one disposable needle can save a life.
A refrigerator full of vaccines can save many lives. And it's a great
encouragement to us doctors when you bring support from such a far-away place."

For more information, write to doka(at)khamaid.org.

This program was funded by supporters of the 2001 bike trip, and by an
anonymous donor - THANK YOU VERY MUCH!

If you want to get involved, please join our 2003 "Tour de Kham" bike ride
next summer; write to pam@khamaid.org.