On remote Tibetan plateau, a health-care program that could be a model for China

When Puder, a Tibetan woman from a yak-herding family in this remote village on top of the world, had her two children, she spurned the local habit of giving birth on a bed of dried yak dung. Instead, she chose to lie on some old clothes to soak up the blood.

“I didn’t like the way I had seen other women’s babies come out all covered in dung,” says Ms. Puder, who like many Tibetans uses one name. “It seemed dirty.”

Her instinct for basic hygiene – rare among the nomadic Tibetans who graze their yak herds on these grassy slopes 12,000 feet above sea level – made Puder a natural candidate to join an innovative plan by a nearby American-funded clinic to train birthing assistants. And it is saving lives in one of China’s most isolated regions.

The Surmang Foundation’s clinic, set in a Buddhist monastery, is also pioneering a system of rural health care for the ultrapoor that some experts say could be a model for the rest of the country.

“What makes the clinic unusual is that it actually is what it should be” offering possible lessons for the government as it tries to reform its patchy and expensive health care system, says Ray Yip, a public health expert with the Gates Foundation who is advising Surmang.

Lee Weingrad, the American who set up the foundation, first came to this region in 1987 because his Buddhism teacher had once been an Abbott here.

Mr. Weingrad says he saw past the romance of saffron-robed monks spinning prayer wheels and the wild scenery to the consequences of the dire poverty that afflicts most nomadic Tibetans, many of whom live on a few cents a day.

He found that maternal and infant mortality rates in Surmang County were among the highest in the world, according to an assessment carried out by the international health experts he consulted. Twenty percent of babies were not surviving until their first birthdays, the survey reported. And 3 percent of mothers were dying in childbirth, 300 times the rate in the United States.

In response, he created the Surmang Foundation, which in 2005 began to train 40 local women like Puder as community health workers with simple, birth-related skills.

“There are so many problems in these ultrapoor areas,” says Weingrad. “We just picked out one niche where we think we can make a difference.”

Life and death

It does not take much to make a difference between life and death here.

Sometimes it might just be the slim package that the clinic’s two doctors give to expectant mothers who visit for an ultrasound exam. It contains a disposable sheet onto which the baby can be delivered cleanly and a sterile razor blade – safer than the rusty knives often used to cut umbilical cords. Sometimes it can be the presence of a woman like Puder at a difficult birth. The clinic cannot perform emergency cesareans, but she says she did once stop a woman’s bleeding with massage and Tibetan medicine. “She would have been lucky to survive had she been on her own,” Puder believes.

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