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Basic medical care is rudimentary and overloaded
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FOUR Tibetan children between the ages of 3 and 6 years old were brought to Shanghai earlier this month to undergo surgeries for congenital hip dislocations.
They were the third group of children to benefit from care at Shanghai Children’s Hospital under the auspices of the city’s Aid Tibet project.
One of the guiding lights behind the medical care is Dr Yang Xiaodong, a cardiovascular specialist and office director at the hospital. He learned first-hand about the health care problems of people living in the remote Shigatse Prefecture of Tibet in June 2013, when he joined 67 other Aid Tibet workers on a three-year stint there.
After two days of rest to adjust to the high altitude, Yang began work at the Shigatse People’s Hospital.
He had fully expected to find an underdeveloped medical system, but the backwardness of what greeted him was surprising. Most of the hospital’s buildings dated back to the 1980s and were in dire need of rehabilitation.
“There was no separate ward for newborn babies, much less any intensive care unit for those needing special treatment,” Yang said.
His first task was to sterilize several wards and set up special wards, an intensive care unit and a pediatric care unit.
“Our purpose was to not only transfuse blood to them but also to enable them to generate blood by themselves,” he said, metaphorically speaking. “We set up a standard continuum of care that can be continued long after we leave.”
Shanghai Children’s Hospital signed a technical cooperation agreement with the Shigatse hospital to train local medics in Shanghai and to send Shanghai experts to Shigatse for short-term programs every year.
The Shigatse hospital is woefully overloaded, Yang said. It has 300 beds serving about 400 in-patients daily.
“Many Tibetans are poor and lack modern medical knowledge,” he said. “They don’t go to hospital unless they are suffering serious conditions, so those who do come usually require hospitalization. You can imagine how overworked doctors and nurses here are!”
One of Yang’s appointed assignments was to help Tibetan children with heart diseases and send those in critical condition to Shanghai for medical treatment.
Children living in oxygen-deficient Tibet, where the average altitude is 4,500 meters, suffer much higher incidence of heart disease than those living in lower elevations, he said.
A survey done in local schools between 2008 and 2009 found that 1.2 percent to 1.4 percent of Tibetan children suffered heart problems, compared with 0.6 percent to 0.8 percent in lower elevations. The survey didn’t include children too sick to go to school or those who died before school age.
Since 2012, more than 50 children with congenital heart disease have received free treatment in three Shanghai hospitals, 20 of them at Shanghai Children’s Hospital.
While examining local children, Yang said he came across a high rate of congenital dislocation of the hip joints. Eleven children have already undergone surgery in Shanghai, and a third group arrived at the beginning of August.
Hip dislocations can be caused by congenital factors or by improperly swaddling of babies, Yang said.
Many Tibetan parents have no idea of the condition and don’t recognize that their children have a medical problem, he said. Routine health exams of children are not very common.
“If found in infancy, hip dislocations can be corrected with professional devices and exercise,” he said. “But the condition worsens as the children grow up, often requiring painful and expensive surgical procedures.”
The usual cost of upwards of 50,000 yuan for an operation is beyond the reach of Tibetans.
“That is equivalent to two or three years’ income for most Tibetan families,” Yang said.
He tells the story of one patient that lingers in his mind.
When pediatricians from Shanghai were providing free clinic services in a Tibetan village in May, a 22-year-old young man showed up hobbling on crutches. He was suffering from untreated congenital hip dislocation. The surface of his joints have been so badly worn that he couldn’t walk on his own, Yang said. Not wanting to live with the disability, the man’s wife divorced him.
Doctors told him the only hope of recovery was to get artificial joints in his hip. He certainly couldn’t afford that.
“Even that wouldn’t be a final solution because the artificial joints would need to be replaced in 10 years or so,” Yang said. “The disease has changed his life forever. He can’t work and earn money. He has no one to look after him. If the condition had been treated in his childhood, it would be totally different,”
Yang sighed with regret. “That’s why I have been trying my best to advance this program. I don’t want to see such unfortunate people like this anymore.”
Yang said 15 of 200 Tibetan children diagnosed with congenital hip dislocation in the past year have been treated in Shanghai.
Having lived in Shigatse for more than a year now, Yang said he himself is suffering the effects of high altitude, such as lapses of memory, sleeplessness, plethora and gout. He still has two years left in his tour of duty.
“Though I feel uncomfortable sometimes and I miss my family so terribly that I video chat with them almost every day, I still have a keen sense of mission here,” he said. “My own child is living a healthy and happy life in Shanghai. I want the children here to have the same opportunities in life.”
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