On remote Tibetan plateau, a health-care program that could be a model for China
The Surmang Foundation is training community health workers on the remote Tibetan plateau, where small advances can mean the difference between life and death.
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Sometimes it is simply a matter of knowledge. “Before, pregnant women around here paid no attention if they were vomiting or suffered swellings or bleeding,” says Drogha, the clinic’s female doctor. “They would just go on working. Now community health workers explain to them that this is abnormal and
get them to come to see me.”
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At the heart of the community health worker network is the foundation’s clinic in the nearby village of Jherekhe, where Dr. Drogha and her male colleague Phuntsok offer free consultations in a simply furnished surgery room. They are trained and equipped to set broken bones and to pull teeth, (Dr. Phuntsok also cares for villagers’ Tibetan mastiffs), but most patients come with lesser ailments.
And they come in droves. Between them Drogha and Phuntsok deal with 13,000 patient visits a year, six times the load of the much better staffed government clinic 10 miles up the valley, they say.
“I used to go to a government clinic near my home but I think the treatment is better here,” says Jiucha, a yak herder, as Phuntsok takes his blood pressure. “Everyone likes this clinic,” adds his son-in-law, Gaya, waiting in the clinic’s grassy yard while his wife has an ultrasound. “The doctors are skilled and they are good people. The fact that it is free counts, too.”
Run on a shoestring budget
The clinic runs on a shoestring budget of $140,000 a year – spending one-sixth what the government clinic spends per patient, according to a 2009 study by Peking University’s Institute of Population Studies.
That is largely because the two doctors prescribe far less medicine than government-employed doctors who are paid so poorly that they make their living mainly from the markups they earn on medicines they prescribe and sell.
“When the doctors don’t profit from selling meds, that creates a tremendous amount of trust among the patients,” says Weingrad.
The profits most Chinese doctors make from such sales in government clinics and hospitals distort prescriptions nationwide, but they are a particular problem in areas such as this. “People are poor, so it is not so easy to squeeze money out of them,” says Dr. Yip, making most doctors reluctant to treat them. “Phuntsok and Drogha can treat 20 patients a day or 100 patients a day. But that doesn’t have any bearing on their salaries and nor does the amount of medicine they prescribe,” Yip adds.
“They are properly compensated and properly supported and properly supervised so they can do the work they want to and respond to local needs,” he says. “That is not happening with most rural health services across China, which are not well managed or supervised or paid.”
Surmang plans this year to introduce its health-care model, complete with networks of community health workers, to four government-run clinics in Tibetan areas.
Success, cautions Yip, will depend not only on whether the foundation can supplement the government doctors’ salaries sufficiently to compensate them for the money they will no longer earn by selling medicine, but whether the doctors can let go of their old habits of overprescribing, and whether they will accept close supervision.
“This will be difficult, but not impossible,” Yip predicts. “Creating one clinic where you control everything is one thing,” says Weingrad. “To be able to do it in the public health sphere and avail the biggest public possible of our model – that would really be something.”
IN PICTURES: Helping hands for Tibetans in China