Where There Are No Doctors
Amity trains paramedics in Southern Ningxia
More than a third of the population of the Autonomous Region of Ningxia are Hui (Muslims), descendants of Arab and Iranian (Persian) traders who traveled to China during the Tang Dynasty. The Hui minority tends to be concentrated in southern Ningxia where poverty is widespread. Theresa Carino visited Amity's medical projects in the province in April 2000 and reports below on her impressions.
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A village in Haiyuan County, Ningxia Province |
Located in southern Ningxia, one of China's poorest provinces, Haiyuan County combines in its name the Chinese characters for "sea" and "grasslands" none of which is visible in its stark, uniformly brown, arid landscape. Frequently hit by sandstorms originating from the Tengger Desert in neighboring Inner Mongolia, the area, like much of Ningxia, receives low rainfall for half of the year. During years of drought, which are nine out of ten, there may be no rainfall for a whole year. Historically, Yin Chuan, the capital of Ningxia was the seat of the Western Hsia Dynasty (c. 1000 AD) which attained cultural heights. In the last few centuries, however, frequent drought and desertification have reduced much of the province to extreme poverty. While the average annual income of villagers is 800 RMB (around US$ 100), most receive about 500 RMB a year.
According to Dr. Ma, Provincial Health Bureau Director, some families used to be so poor, they owned only one pair of trousers. There were those too poor to have chopsticks and bowls. Dr. Ma personally experienced the hardships of life in the area having spent 13 years during the Cultural Revolution in Haiyuan County. Many villagers suffer from lung problems such as tuberculosis and pneumonia because of the aridity and the presence of sand particles in the air. Intestinal diseases are also common since water is scarce. For the 380,000 people living in Haiyuan, the main source of water is the Yellow River, which could be between 15 to 30 kilometers away from a village. In 1999, there was no rain for the entire year, bringing drought to the area. Ma described how, during the Cultural Revolution, water cisterns had to be padlocked so their contents could be carefully rationed to "properly registered" residents. In times of severe drought, each villager was restricted to one glass of water per day! Today, the situation has improved a little but for some villagers, fetching water on foot from a distant source can still take an entire day.
Access to basic medical care is equally inadequate. There are 24 "hospitals" in Haiyuan County but only four of these can undertake simple surgery such as appendectomies. Only 20% of babies are delivered in hospitals even if there are nine hospitals where this can be done. Infant mortality rate is high, with three deaths out of every 100 births. Many babies die from lung infections and other complications arising from poor hygiene.
To help remedy the situation, Amity's Medical Division started a training program for "village doctors" (or paramedics) in Ningxia in 1997. By the end of 2000, 400 village doctors have been trained, all of them coming from villages that have never seen a doctor or a clinic. Amity employs some basic criteria in selecting candidates for training. They must come from villages which have no clinic or doctor. Candidates, who must be recommended by their village, need to have at least middle school education and be able to pass "preliminary exams." Simple criteria but rather difficult to implement considering the fact that adult illiteracy in the rural areas is 50% and reaches 70% among women. Trainees should also have some means to sustain operating a small village clinic. To set up a tiny, spartan "consulting room", usually attached to his/her home with a small stock of medicine, a village doctor needs 2,000 to 3,000 RMB (US$ 250 - 375), a fortune by local standards. Very often, the local health bureau provides a monthly subsidy of 20 RMB to the village doctor who then helps in community health education and immunization. Monthly incomes of village doctors range from 50 RMB to 500 RMB depending on the local situation and the skills and reputation of the doctor.
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Yang Zhixiu checking on patients resting on a "Kang" in her home |
Thirty-three year old Yang Zhi Xiu, an Amity-trained village doctor in Bei Liang, a predominantly Muslim village in Haiyuan County, has chalked up an impressive reputation in her village and beyond since she opened her clinic a year ago. For the 400 villagers, having Yang as village doctor has spelt the difference between life and death. Two days before my visit, she had literally saved the lives of 2 children who had accidentally ingested rat poison. Without Amity's training, she would not have known what to do in such an emergency. Yang also delivers babies and treats three to four patients a day, many of whom come from miles around. Most have throat and lung infections. Difficult cases requiring surgery or psychiatric care are referred to township or county hospitals.
Yang's professionalism is reflected in her ability to maintain an impeccably clean home and clinic despite the scarcity of water. To ensure better care for her patients, she has even had to share the comforts of her own home. During my visit, she had two patients sleeping on her large "kang" (traditional bed heated from below) -- one a young woman who had just suffered a miscarriage and the other a three-month old baby suffering from diarrhea and dehydration. She explained, "The clinic, which is at the other end of the house, is too cold in winter, so I decided to have them stay here, in my room and on my bed, where it is much warmer."
Yang's success as a village doctor has been achieved at great emotional cost and personal sacrifice. To join Amity's training program she had to leave home and her youngest and fourth child, who was then only 10 months old, over the strong objections of her husband. Her junior high education in the village had not prepared her adequately for the courses which she initially found extremely difficult. But she was determined to succeed. She had seen her own sister die at the age of 11 and witnessed the death of a woman from childbirth--all because there was no doctor in her village. After weeks of homesickness, frustration and tears, Yang decided to focus and buried herself in her studies. During weekends, when others would go home to their families, she would stay on in Gu Yuan district and volunteer her services at the district hospital. She had to scrub floors and perform menial duties but she could also learn from observing what went on in the hospital.
During her 18-month training, Yang returned home only three times. Yang recalled, "After the first six months, my baby could not recognize me! Now that he is three years old, he still calls my sister who took care of him 'Mommy' and refers to me as the 'Mom from Gu Yuan'!"
