China 1998

International staff: 42 National staff: 85 REDUCED FUNDING FOR HEALTH While a Western lifestyle is catching on in the big cities, economic reforms have resulted in drastic reductions in funding for health, welfare and education that have particularly affected the rural areas. Here, the public health system has collapsed and, in a country in which natural disasters are both frequent and severe, an estimated 500 million people have no access to safe drinking water. In China, as elsewhere, MSF targets marginalised minorities. They can be divided into four groups: many of the 56 ethnic groups, some seriously affected by HIV, STDs, TB and malnutrition; drug users and prostitutes (both are illegal activities); the poor who do not have access to health care services and education. Yunnan province: (home to 36 ethnic groups) Here, MSF is working to improve the health services provided to the rural counties of Xichou and Xundian (pop. 120,000) through training and supervising village doctors. A water and sanitation programme is underway in three villages in Xichou aimed at improving and protecting existing water systems, constructing biogas plants and increasing health and hygiene awareness. HIV/AIDS and STDs are targeted in the floating population of an estimated 300,000 in Kunming with the focus on education, medical care and advocacy. Sichuan province An HIV/AIDS/STD programme began in spring 1998 in Liangshan prefecture in the mountainous area of Sichuan bordering Yunnan, aimed at the Yi minority, drug addicts and prostitutes and the floating population. Many Yi come into contact with drugs and are infected with HIV when they seek work in the city. Their village communities are quite unprepared for dealing with this problem, as are the local health authorities. The intention is to increase knowledge about these diseases through training health workers and educating the population, as well as providing medical care for STDs and an advocacy effort aimed at changing official and general attitudes towards those affected. Another focus is on physiotherapy treatment and training for local doctors dealing with sufferers from Kashin-Beck ("big bone") disease among ethnic Tibetans living here. Guangxi Autonomous Region MSF is collaborating with the provincial health authority to renovate existing hospitals in rural areas and construct new ones, provide medical equipment for hospitals and for clinics staffed by village doctors, and train health care personnel. The team is also setting up and implementing a collective insurance system aimed at meeting the national requirement to make health structures semi-autonomous. At the beginning of 1998, a celebration was held in Guosui township, Xincheng county, to inaugurate the completion of a new water pipeline. Neighbouring villages are being connected up to this network, which will supply clean drinking water for 12,000. Water and sanitation activities are also planned to accompany a medical programme in Liuzhou, Rongshui county, which includes construction of a referral hospital in Gongdong. Completed mid-1998, the hospital includes a small surgery unit and medical equipment supplied by MSF. MSF plans to continue drinking water supply projects in Xincheng and Shanling counties for another two years. Qinghai province A primary health care programme is underway in Nangqian county, Yushu prefecture, one of the poorest in Qinghai with a large dispersed Tibetan ethnic population. Training is being given to village and clinic doctors focusing on the main endemic diseases and renovation work has been completed in the county hospital and township clinics. Emergency relief targeting a total of 80,000 people affected by severe snow storms was also organised in Yushu county. Food aid was distributed and medical kits provided to village and township doctors. Treatment was required for snowblindness, frostbite and diarrhoea. An emergency programme was carried out in Hebei province following an earthquake in January 1998. The MSF team handled the procurement and transportation of essential antibiotics and monitored their distribution among the most needy 412,000 homeless survivors suffering from acute respiratory infections. MSF also provided emergency relief early in 1998 to Tibetans living in Yushu prefecture of Qinghai province suffering as the result of heavy snowstorms. Hong Kong The assistance programme for interned Vietnamese refugees ended in March 1998. MSF successfully advocated for a number of severely ill refugees to remain in Hong Kong and others were allowed entry to some Western countries after the June 1997 hand-over to China. The Autonomous Region of Tibet The MSF team continues to train doctors and physiotherapists in the treatment of Kashin-Beck ("big bone") disease in Lhasa, Lhoca and Shigatse. Research is an important part of the programme for this presently incurable disease. Training sessions are held for doctors and medical supervisors on subjects such as the introduction and use of essential drugs, respiratory tract infections and diarrhoea, as well as sterilisation and hygiene in clinics. The drugs "revolving fund" cost recovery system has been successfully implemented in two counties of Lhasa prefecture in order to guarantee the maintenance of sufficient drug supplies. The water and sanitation programme, now in its third year, is progressing successfully in collaboration with the village communities who are receiving clean water, and basic hygiene and health education. There have been 50,000 beneficiaries so far. A MSF team made emergency distributions of antibiotics, snow-blindness and frost-bite medicines in Nagqu prefecture of Tibet, following exceptionally bad snowfalls last winter.