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Changes transform childbirth in Tibet
(China Daily)
Updated: 2005-01-19 03:03 During her first six years of working as the only
obstetrician in the Pozhang Township Hospital in the Tibet Autonomous Region,
Mima only delivered 20 babies among a childbearing population numbering 1,700.
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Tibetan woman gets a dental check as many other locals line up for a
physical once-over at a mobile medical unit in Yushu Tibet Autonomous
Prefecture, Qinghai Province. On the sparsely populated Qinghai-Tibet
Plateau getting to a doctor or hospital is often beyond the means or reach
of locals, particularly pregnant women. Mobile medical services staffed by
doctors and nurses from city hospitals provides a medical lifeline for
locals. [newsphoto] | But in 2004 alone, says
Mima, who began working in 1997 after four years at Nanjing Medical School,
"I've delivered eight births, all safe."
The turning point came last May when Mima attended a course sponsored by the
United Nations Children's Fund (UNICEF) in the capital Lhasa. There she not only
learnt from the lectures given by experienced county doctors, but was also given
the opportunity to put into practice some of teaching.
"I performed my first Caesarean operation during the training. I was both
excited and nervous. It was an emergency when the woman in labour was rushed to
hospital, but eventually both the mother and baby were safe after a one-hour
operation. I am so proud of myself. I finally have the feeling of being an
obstetrician," said Mima.
Her dream of specializing in obstetrics began soon after graduation, but in
the six years before the course, she had "only performed some basic prenatal
examinations."
Pozhang Township Hospital, the only one for the local population of 7,000 in
Shannan Prefecture, possesses just one bed, bought in the 1980s, two pairs of
scissors and one set of obstetric forceps for midwifery.
"It is far below the required sanitation and safety standards. No one dares
to deliver babies in such conditions," she said.
"Some of the pregnant women go to the county hospital to deliver, which takes
them at least an hour by car. Most others would rather have their baby at home
with the help of relatives to save both time and expense. This is very
dangerous."
But it was not only knowledge Mima, 29, took away from the course, she was
given an obstetrics kit, courtesy of UNICEF, and, in terms of her work and
equipment, an invaluable asset.
"It even includes a sucker to drain amniotic fluid from the newborn's mouth,
nose and ears. With that you can save the infant from suffocation. In the past I
have had to solve the problem using my hand, which is very unprofessional and
dangerous to the baby," explained Mima.
Suolang Zizheng, 29, has no doubts about the benefits of recent changes at
the township hospital. Her first baby suffocated soon after a home delivery in
2001. In July 2004, Suolang successfully delivered her second child at the
township hospital with Mima's help.
"Starting from the sixth month of my pregnancy, Mima gave me regular prenatal
examinations every month,'' said Suolong. Sterile measures were in place for the
actual delivery and
80 per cent of the 1,000 yuan (US$120) medical fees were exempted, a major
consideration for a family with an annual per capita income of 3,000 yuan
(US$360).
Infant mortality in Tibet, used to be as high as 430 per thousand births, a
direct result of poor midwifery services. Improved health facilities had
drastically cut the figure to 399 in 100,000 by 2003, although that is still
much higher than the national average of 10 in 100,000 in Shanghai and 15 in
100,000 in Beijing.
But many hospitals in Tibet still cannot provide
appropriate labour facilities., Only 42 per cent of the 119 medical institutions
in the prefecture are equipped to handle childbirth, said Ciren Dundan, head of
the Medical Bureau of Shannan Prefecture.
As for Caesarean sections, "only hospitals in Lhasa and a few other major
cities are able to perform the operation. At county level, five out of the 73
hospitals can do Caesarean sections," says Luosang, director of the Department
of Basic Medical Protection for Women under the Medical Bureau of the Tibetan
Autonomous Region in Lhasa.
"Caesarean sections require an anesthetist and obstetric table, which most of
the Tibetan hospitals cannot afford."
The vast area that comprises the region and its small, but scattered
population also hinder development of obstetric and neonatal services.
"Highway transportation and communications are not so convenient partly due
to its high elevation ," says Luosang. "It takes at least one hour to get to the
nearest hospital by car in most Tibetan counties. Although the local medical
institutions waive 80 to 100 per cent of delivery fees, transportation expenses
alone can be a problem."
Then there are traditional taboos.. "Tibetans used to regard giving birth as
something secret and private," says Luosang.
"A newborn is kept from visitors until it is one month old. So many Tibetan
women feel it strange to have their baby delivered in hospital in front of
strangers."
For this reason many would rather resort to unprofessional relatives to act
as midwives, he says.
"Newborns, often delivered unprofessionally in cold and dirty houses, are
also very likely to die from measles and other contagious diseases," he added.
Since 1999, UNICEF has funded projects in 15 counties and all seven
prefectures, including Lhasa, in a bid to cut maternal mortality and neonatal
tetanus by increasing the number of hospital deliveries, says UNICEF National
Health Nutrition Project officer, Liu Bing.
"The strategy of the project is to increase the quality and decrease the cost
of hospital deliveries by equipping them with sophisticated facilities, trained
staff and encouraging women to give birth in hospital," he says.
To this end, the projects give 20 yuan (US$2.4) to every woman who has her
baby in hospital and 10 yuan to the person who accompanies her, be it a relative
or a medical worker.
The relative can also sleep at the hospital and cook meals in the
patient-friendly kitchen close to the hospital.
In the past five years, a total of 420,000 yuan (US$50,000) has been spent in
this regard.
In addition, since 1998 central government has allocated 200 million yuan
(US$24 million) to improving medical services in Tibet. Of the 672 counties and
townships, each has benefited by 100,000 yuan (US$12,000) to update their
obstetric facilities and build new hospitals.
Medical training in Lhasa for grassroots medical workers like Mima have also
helped improve the rate and conditions for hospital deliveries. Besides the
basic theory of hospital delivery, medics from poor counties and townships have
been given the opportunity to intern in large hospitals in Lhasa. About 1,000
nurses and medics have been trained in the past four years, at a cost of 300,000
yuan (US$36,000) annually.
And the efforts are beginning to bear fruit.Hospital deliveries were up from
13 per cent in 1998 to 40 per cent in 2003 in the 15 UNICEF targeted counties,
said Liu Bing. And the figure for Shannan prefecture reached 57 per cent.
"There has been much progress for women and children in Tibet, although there
is still much work to do to catch up with the rest of China," remarked Bellamy,
UNICEF executive director during her visit to Tibet last September. "We need to
strengthen preventative health and expand the project to more counties."
Mima hopes Pozhang Township Hospital can get more obstetric tables and that
more experienced doctors will join her, thus sparing pregnant women a long
journey to reach a proper childbirth unit . "I enjoy midwifery, simply because
it is such a huge pleasure to see the faces of new mothers when shown the clean
and healthy new childbirth facilities."
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