Primary Health Care in the communities of the Kham

The infrastructures of basic health care are rare and poorlyequipped in the region of Sershul (Dzachukha).

For now, only a rudimentary hospital exists, equipped with only ten beds, not fit for any surgical procedures, and seriously lacking in proper medication.

The clinic of Sershul Gompa put in place a training program 3 years ago, for it’s physicians in order to enhance the quality of medical care.

Concerned with the gravity in the decline of the medical situation in Serchul over the past three years, Norlha now joins forces with «Sershul Dropen Ling», the association of the Clinic of Sershul Gompa,in order to support this initiative, indispensable to the 68'000 inhabitants of the district.

 

Regional situation

There are three major issues in the region

• Access to health care

A very rough climate combined with very basic transportation infrastructure makes access to even basic health care very difficult in the region.

 

• Affordability of health care

Nomads have little to no income, their basic needs being covered by the keep of livestock. Furthermore, they receive no form of social aide from the government.

This makes it impossible for them to cover the costs of medical consultations let alone the cost of medication.

 

• Quality of health care

The overall quality of care provided, of the medication available, as well as the nursing staff qualifications must be reviewed and improved.

 

Partners

The projects are implemented by our local partners.

Norlah has worked since 2009 with the Sorig Dropen Ling association, who created the first clinic of Sershul Gompa back in 1992. Their experience, their local foundation and the confidence of the population makes them ideal partners to enhance primary health care in the region.

The cultural role of monks and lamas makes that they are well often the most efficient social partners to go to the population and to increase awareness. Their selfless and unbiased approach, as well as their education is an important vector of the success of implementation of projects.

 

Technical partners

Norlha works in collaboration with various specialised ONGs such as :

the Swiss Red Cross, Save the Children, Kham Aid, the Bridge Fund

 

Alongside this, Norlha has resorted to surveys and expert advice of Swiss physicians and nurses on medical questions and community health care facilities.

 

Needs

The inhabitants of the region suffer the most often from illnesses of the kidneys, liver, lungs, eyes and the articulations. Added to this, apparently benign illnesses (flu, etc.), malnutrition,are often fatal since not treated in time. There is also a strong need regarding health care support for pregnancies/motherhood and all the issues linked to malnutrition.

The demand of the population is to enhance the care, the qualification of the physicians and the nursing staff of the clinic of Sershul Gompa, as well as to inform the population on the questions of hygiene, of nutrition, of reproductive health, etc. who have a direct incidence on their general health.

 

Goals

The goals of this project are:

 

• A place adapted for the inquiry about/purchase of medicines, including rooms for middle and long term care

• To enhance and to complete the available care: dental care, minor surgery, basic ophthalmology, obstetrics, paediatrics, nutrition advice, etc.

• To enhance the benefits of the qualified, motivated and recognised medical staff

• To increase awareness amongst the population on the importance of their state of health; concerning hygiene and nutrition for example.

• To provide sufficient, adapted , medication and medical material

• To provide basic or advanced training to the nursing staff, this includes knowledge sharing between Tibetan and western medicine (with European physicians)

 

Means of intervention

• Detailed study on the current situation; detailed inventory of infrastructures by conducting on site visits to observe practices and allow exchange of knowledge.

• Increasing awareness on health education (priority in care to mother’s and children) through workshops on community health using teaching material recognised and understood locally.

 

Nutrition

Quality and the variety of food is fundamental for health. However, the altitude, remoteness and poor transportation infrastructures make that vegetables, necessary to a balanced diet, are the most often out-of-date before arriving on the platters of Sershul.

Thus, in order to fight against malnutrition, Norlha supports the construction of altitude greenhouses. Some vegetables grow there since the fall 2008 and feed the schoolchildren, the old people and the families in financial difficulties.

 

Training

Continuing education of the local nursing staff in the domains of care to the mother and the child, Nutrition, Hygiene, hospitable Management, preventive Medicine, etc.

 

Decentralised structures

Construction of a clinic with examination rooms and rooms for hospitalisation.

Local production of quality medication;to find a reliable channel of supply for basic medication, affordable to the nomads.

 

Distribution of sunglasses

The nomads of the Kham live at such high altitude that they suffer from eyesight problems caused by burns due to the strong solar radiation (see picture below).

 

Norlha called on the Dutch EyeClarify association, in order to provide the inhabitants of the region of Sershul with sunglasses, allowing them to protect their eyes appropriately.

 

Project manager: Frédérique Espuña

Documents and publications

Health Issues in Sershul District - a short report, Norlha Publications, 2007

Bref compte-rendu de la Santé communautaire dans le District de Sershul, Publications Norlha, 2009

Community Health Improvement Program, project description, 2009

 

Organisations internationales

+ Health Care in China
+ World Bank: China at a Glance
+ HEALTH POLICY AND SYSTEMS RESEARCH IN CHINA, UNICEF/UNDP/World Bank/WHO

Governments and ministries

Health policy challenges in the Tibet autonomous region. A December 2000 report, US Embassy Beijing, China

Health Policy Challenges In The Tibet Autonomous Region, U.S. Embassy Beijing

2005 Annual Report, Congressional-Executive Commission On China (US Congress)

Further Australian Support for Tibet's Health Sector, Minister For Foreign Affairs, Alexander Downer

Academic research

Nutritional and health status of Tibetan children living at high altitudes, Harris NS et al., N Engl J Med 2001; 344: 341–47.

Poor nutritional status of younger Tibetan children living at high altitudes, Dang S. et al., Eur J Clin Nutr 2004 Jun; 58: 938–46.

Alarming facts about the health and nutrition of children in Tibet, Maberly, Sullivan, New England Journal of Medicine, 2001 Feb

1;344(5):373-4.

Nutritional and health status of Tibetan children living at high altitudes, Harris NS, New England Journal of Medicine, 2001 Feb

1;344(5):341-7.

Study Links Malnutrition to Stunted Growth of Tibet’s Children, Erik Eckholm, Published: February 1, 2001

Assessment of the health status and risk factors of Kham Tibetan pastoralists in the alpine grasslands

of the Tibetan plateau, Peter M. Foggin et al., Département de Géographie, Université de Montréal, Canada H2V 2B8, Plateau

Perspectives et Upper Yangtze Organization, PRC.

NGOs

Socioeconomic Status and Maternal and Child Health in Rural Tibetan Villages, Tibetan Healing Fund, 2007

Tibet Child Nutrition and Collaborative Health Project: Saving Tibet’s Children, Sienna Craig

Delivery and Deficiency: Health and Health Care in Tibet, Tibet Information Network, London, November 2002.

Encyclopedia

Public health in the People's Republic of China (Wikipedia)