International staff: 57
National staff: 125
The liberalization of China's economy has given the country one of the fastest-growing economies in the world. But public health has deteriorated since the introduction of the "socialist market economy."
Many families, especially those in poor rural areas, can no longer afford even the most basic medical care. The result is a large-scale migration of health care providers to urban areas, where people can afford their services. The consequence for rural communities is clear: a rapid deterioration of the quality and availability of medical care.
Economic crisis hits medicine
The commercialization of the health system means that many people, and especially the poorest, are left without basic medical care. Because their income often comes directly from the services they provide, health workers in China increasingly prescribe drugs and treatments that are inappropriate or expensive in order to boost their income. As a result, because preventive medicine is not very lucrative, it is often neglected. The expanding economy, combined with this laissez-faire style of health care, has had an enormous impact on the care being provided throughout the country.
MSF is active primarily in Yunnan, Sichuan, and Shaanxi provinces and in the Guangxi and Tibet autonomous regions. The organization has long-term projects for improving basic health care, fighting tuberculosis (TB), venereal diseases and Kashin Beck Disease (KBD), improving water and sanitation and providing information on HIV/AIDS. MSF also advises local governments on disaster response.
In Danian and Gongdong, in Guangxi Autonomous Region, MSF supports official health structures medically and financially. Teams also exchange ideas with their Chinese colleagues on treatment choices and the functioning of the health system. In Shaanxi, MSF welcomes about 50 street children at a small center in Baoji, offering them shelter, food, medical care and schooling.
Basic care is also given in mountainous Qighai province, in the town of Jiqu. MSF is working on a complete renovation of the town's clinic and also offers basic medical care.
In Yunnan, MSF has been improving the water supply in several areas, with a focus on improving water quality rather than quantity. Hygiene education is an important part of the project, as is consultation with villagers.
Infectious diseases are epidemic
Infectious diseases such as TB, hepatitis and HIV/AIDS are on the rise throughout China. It is estimated that one million Chinese will have HIV by the end of 2000. However, because the AIDS epidemic is underplayed by the government, accurate figures are not available.
At the end of 1999, MSF started an HIV/AIDS awareness program in several counties in Yunnan province, which has one of the highest numbers of HIV-infected people. In the southern Sichuan province, a similar project has been underway since September 1999. In both programs, MSF works closely with the authorities to reach health care workers and people at risk of infection. Public information campaigns, often the only legal way to talk about condom use in the country, are an important part of MSF's work. In Sichuan, MSF is working to set up clinics to treat sexually transmitted diseases (STDs). This has included renovating laboratories training lab staff in diagnostic techniques.
TB is also a growing problem in China. In Yunnan province, MSF trains health staff in DOTS (Directly Observed Treatment Short Course) TB treatment, which calls for patients to be directly supervised while taking their medication. MSF set up laboratories for testing and monitoring TB. The organization provides all the drugs and monitors every step of the DOTS treatment. MSF also monitors the factories producing the TB medicine.
In addition, a public information campaign targets the Lisu, Dulong, Tibetan, Nu and Bai ethnic minorities, who live in a remote mountain valley with a high rate of TB, a poor infrastructure and a low level of health services.
In 2000, TB programs were set up in both Danian and Gongdong. Village doctors have been trained to follow up with TB patients once they have left the hospital.
Over three million people in Asia suffer from Kashin Beck Disease (KBD), also known as Big Bone Disease. MSF research and medical activities in Tibet are focused on this illness, which progressively affects the joints, decreasing mobility and causing pain. The disease has no clear cause but is related to four factors: a toxin from a fungus on crops; a deficiency in iodine; a deficiency in selenium and certain vitamins; and a lack of hygiene and good drinking water. As part of its attempt to learn more about the disease, MSF is trying out various prevention measures on a sample of 1,055 children in 24 villages.
Prevention of the disease involves supplying iodine, selenium and vitamins C and E, as well as improving the quality and storage of basic food supplies such as grain.
MSF tries to ensure both access to clean drinking water and community education in hygiene. In Lhasa, Shigatze and Lokhas prefectures, 164 clean rural drinking sources were developed between 1993 and 1999. MSF is now evaluating how the systems are actually being used. Part of this assessment looks at local knowledge, attitudes and practices related to water and hygiene. The results of the study will guide future water projects in Tibet.
In Kashgar prefecture, 80 hand pumps will be installed in two of the poorest counties, in small, remote communities of less than 200 inhabitants. The project promotes community participation and is linked to health and hygiene education.
Physical therapy programs, in place since 1997, reach those suffering from KBD and help alleviate pain. MSF has also equipped Confucius Hospital in Lhasa and trained lab workers in KBD-related techniques. Physical therapy courses have been introduced to the curriculum of local medical schools, and health workers have been trained in KBD control.
MSF is looking at expanding the current KBD program to Chamdo prefecture in eastern Tibet.
MSF has been working in China since 1988.