Providing medical care in Guizhou
Sunday, 9 November 2008
I have just spent a week in Majiang county, an area in China’s Guizhou province that has been designated by China’s government as a ‘poverty county’ of national significance. Accompanying me were 12 stunningly outstanding students from the Global Concerns Action Team (GCAT) of Li Po Chun United World College, and our aim was to advance the work on a project we have undertaken in partnership with the Amity Foundation to help build and equip medical clinics in this very needy county.
Majiang is situated near the centre of Guizhou province, about one and a half hour’s drive from the provincial capital of Guiyang. Situated beside the Qingshui (Clearwater) River, Majiang is a rural county with an area of 1200 km2 and a mild, wet, sub-tropical climate. The area is populated by many minority ethnic groups, with the Miao group being the most populous. Most of the county’s 220,000 people live in small 
farming villages, although there are also nine designated townships in the county. The main farming products are garlic and a special type of rice. The town of Xiasi in the east of Majiang county is famous for its dogs; its guard dogs are specially trained to maximise their aggression, which is easy to understand given the fact that they also are part of the local diet.
Majiang is an area with significant medical needs – although this is not to say there have not been major advances in recent years. The county already fulfils 95% of the government’s health vaccination targets, which helps to explain why the county has experienced no serious epidemics in the past five years. As a result of a vigorous public health education campaign, the percentage of pregnant woman delivering their babies in hospitals rose from just 2% to over 80% in the five year period 2002 to 2007.
However, of the county’s 129 villages, only six had clinics of an acceptable standard as at 2007. This led to the initiation of a program by the Amity Foundation’s Hong Kong bureau that aimed to build 100 medical clinics in Majiang county as soon as the money could be raised. In response to this need, GCAT at LPCUWC raised the funds in early 2008 to build two of these clinics, the first of which was completed just before our visit. At the time of our visit, 44 clinics had been built, 21 by the Amity Foundation and 23 by the Chinese government.
We arrived in Majiang on Sunday afternoon, 2nd November. Our first visit was to the Majiang County Health Bureau, where we were briefed by the Director, Miss Wu Lumei. Miss Wu explained that in addition to building clinics, Amity was also involved in training village health workers, and having witnessed this 
example of NGO work, the government had also become involved in the activity. She also described Amity’s work to improve hygiene by an innovative program of installing biogas plants in people’s kitchens.
She explained to us that the village medical clinics only treat common problems such as colds and stomach problems, as well as doing pregnancy checks and promoting health education. The village health workers are really paramedics who are in many ways the modern equivalent of the Barefoot Doctor’s of China’s Cultural Revolution period. More serious diseases are referred to doctors at higher level hospitals.
In answer to a question from one of our students, Miss Wu noted that like other parts of the world, HIV/AIDS is a growing concern. Within China, Guizhou appears in the middle of provincial rankings of AIDS, but within Guizhou, Majiang has the lowest incidence of HIV/AIDS among all counties. This was explained by Majiang’s high proportion of ethnic minorities, who tend to have more conservative attitudes towards sex than other groups.
We were told about one example of a health worker who is operating in Jianke county, a remote mountainous area of Guizhou. When asked last year how AIDS is spread, the health worker immediately blushed heavily, and in a hesitating and embarrassed manner said “it depends on where you are sitting”, noting that if you sit downwind of an AIDS-infected person who are more likely to become infected. Such is the need for training of medical workers in this region.
The task of building the medical clinics is obviously a huge one. The priorities in deciding where to build the first clinics are determined by factors such as (1) whether the existing building is actually collapsing, (2) how far the village is from the county hospital, and (3) the density of the local population.
Armed with this excellent background information, on the following morning (i.e. Monday 3rd November), we travelled about 40 minutes by bus to Gonghe village, the centre of an area populated largely by Yao 
nationality people which was the location of the first GCAT-sponsored clinic Our purpose in visiting was certainly an exciting one – we went in order to join a ceremony marking the completion and opening of the clinic GCAT had sponsored. Under overcast skies in the village’s only street, there were speeches from county government officials, a township representative, the local doctor in Gonghe village, myself as principal of Li Po Chun UWC, and Anil Kumar Verma Rodriguez, the LPCUWC student (from Mexico) who is the leader of GCAT’s ‘Medical Clinics in Guizhou’ Project Team. This was followed by presentations of brass plaques and HK$12,500 worth of medical equipment, the result of GCAT fundraising in recent months. After a deafening cacophony of fireworks, our students then performed a song and a dance to the delight of the villagers who had gathered 
to witness the important occasion. The sight of mud-clad peasants restraining their water buffaloes standing in front of a roadside butcher’s stall with various roughly cut parts of pigs displayed in the open on old wooden boards watching our students performing a Latin American dance to the music of an iPod amplified through a hand-held megaphone is one that will stay with me for many years to come!
After inspecting the new medical clinic, our students were divided into two groups to accompany the local clinic doctors as they embarked on their daily rounds of house visits. This was a great opportunity both to 
see the area’s living conditions close up and at first hand as well as to gain a deeper understanding of the health needs of the population and work of the doctors. We were privileged to be invited into people’s extremely simple homes with a minimum of furniture and concrete walls decorated with old ‘model worker’ certificates and, in one case, huge fading posters of Marx, Engels, Lenin and Stalin. We were able to watch as the doctors performed their health checks, as well as being able to ask the doctors, their patients and their families a vast range of questions.
After lunch, we visited two village clinics, one recently built and the other desperately in need of replacement. The first, the new clinic, was in Machang village. A quick tour of the clinic confirmed the propensity to use intravenous drips to treat a wide variety of conditions in rural China. Three patients were all receiving drips, one for a cold, one for a skin condition, and one for menstrual difficulties.
After a valuable exchange of information with the village doctor, our students were taught how to use the machines that measure blood pressure – learning the valuable lesson that it is not as easy as it looks! I also had an unexpected and pleasant surprise when the village doctor from Gubing village arrived to say ‘hello’. This doctor was the one who had fallen into the river with me in March as together we slipped off a wet water pipe that was being used as a bridge at the time.
Our final stop for the day was Xian E, a village populated by people of the She tribe. The village was situated in a spectacular location on the edge of a mountainside, overlooking an expansive valley of terraced rice fields at various stages of cultivation under the intensive care of several farmers with their water buffaloes, interspersed by the steep peaks of limestone hills.
At night, the doctor sleeps on the bed in a tiny back room that is also used for giving intravenous drips; it must be at least a little disconcerting to sleep under a wire coat hanger on the ceiling holding a few empty drip bottles with plastic tubes protruding from them. The doctor had several heart-rending stories to tell of her experiences, including one very tragic case in Gubing village of a 14 year old girl who died after her tuberculosis had been misdiagnosed as a much lesser ailment.
The entire following day (Tuesday 4th November) was spent in Chengzhong village, a place that I had visited during my visit in March which was populated with Miao people. One aim of this day was to establish trust between ourselves and local communities. Majiang 
county is quite unfamiliar with visits by foreigners, and we had learned the previous day over lunch that our visit at this time had at first been disallowed by local officials who were worried about the influx of foreign ideas and the workload that our visit might bring. It was only due to the intervention of Miss Wu from the Health Bureau that our visit had finally been permitted, and then only with a limit of 12 students rather than the 18 I had hoped to bring.
The visit was a great success in every way. As we arrived in the village, we were greeted by many of the local people, the women clothed in their finest Miao dresses and offering welcome drinks from saucers. We were then treated to a Miao dance beside the busy roadway in front of the medical clinic. Chengzhong’s medical clinic is a woefully inadequate old leaning timber 
structure with the inside walls covered in recycled disassembled corrugated cardboard boxes to keep out the wind. A long question-and-answer session with the village doctor revealed the difficult conditions and sacrificial nature of her work, together with the extraordinary commitment of the doctor to her 24-hour calling. The clinic was so small that we could see the entire operation by looking in through the open frontage from the street – although the elderly gentleman receiving an intravenous drip must have been a little surprised at the keen interest being shown in his treatment.
After spending time at the medical clinic, we crossed the street to an open concreted area usually used for threshing rice. Here we both experienced and performed a concert, with alternating items performed by local villagers and our students. Over a hundred primary school children encircled the paved area, together with many of their parents, and the delight of everyone present was readily apparent by the widespread smiles and applause, and the constantly growing crowd. Our students’ performances were especially appreciated, and included a specially written musical on hygiene and keeping healthy, a Chinese song, a 
western song (Mama Mia, complete with Abba-style actions), a song with guitar accompaniment, a Latin American dance, and finally the Macarena to which we invited the village children to join in. The event finished with a traditional Miao dance, with visitors and locals dancing in a huge circle to the accompaniment of bamboo flutes.
After a Miao-style lunch with many of the local villagers in a building beside the Qingshui River, it was time for our students to perform some serious service work. Construction of the much-needed new clinic recently commenced in Chengzhong, and the afternoon was spent assisting the local builders with the work. All our students took turns at three tasks: mixing cement, carrying bricks and laying bricks to build the walls. Some of our students took immediately to the tasks 
assigned, while others took a quarter of an hour or so to build up confidence, speed and proficiency. By sunset when we finished work, the heights of the walls had almost tripled in height from 0.6 metres to 1.5 metres, and although the individual builders may have been able to complete the work a little faster, the help of 12 extra energetic and willing helpers certainly made their jobs easier for the afternoon. It also gave our students a true appreciation of the demanding nature of building construction work – everyone could feel which muscles they had been using by the time they got to bed that evening!
The focus of our service work shifted on the following day (Wednesday 5th November). Our task on that day was helping to teach advanced English to senior high school students at the Majiang Middle School. We walked up the steep hill to the school, arriving just after 9:00 am to find a very impressive set of buildings, beautifully if surprisingly landscaped with fountain and pavilions, and with hundreds of eager young faces watching our arrival from the classroom windows above the driveway. The school was established 70 years ago in 1938, but the buildings are all new (and still expanding), and the school currently houses just over 3500 students. It is the only school in Majiang country to accept students up to Senior High 3 (i.e. pre-university).
Our visit began with an assembly in the school auditorium at which the school was introduced to us by the Principal, after which I introduced the United World Colleges and the purpose of this visit, after which I presented an LPCUWC flag to the host Principal. Following this, Anil spoke about GCAT’s work in general and with the medical clinics in particular, after which each of our students introduced themselves in their own language, in English and in Chinese. The assembly closed as one of the local students read a beautiful poem she had composed in honour of our visit.
Then the real work began. Our students were divided into three teams of four each, with each team teaching English to a class of about 70 students in Senior High 1 (i.e. only a year or two younger than our students). Our students had prepared thoroughly and the lessons went extremely well, providing the local students and teachers alike with an approach to effective English teaching that was much more interactive 
and quite different from the standard textbook approach that was usually used. Following the first one hour lesson, our student teams then moved to new classrooms to undertake a second one hour lesson, this time focussing on English language dialogues (which were presented through several innovative games and group work). Some measures of the success of the visit were the huge number of photographs taken on mobile phones by local students of each other with their new foreign ‘teachers’, the large number of e-mail addresses exchanged and the request from the Vice-Principal of the school for an ongoing exchange relationship with LPCUWC (which we will continue to explore).
At midday, all the students set off for home (or to their boarding house) for lunch. About 85% of the students at the school come from small, outlying villages (such as the ones where we are helping to build medical clinics), and so they board at the school during the week, going home only on weekends. In fact, many of the poorer students do not even go home on weekends because the cost of doing so (about 10 yuan each way by bus) is prohibitive for them.
There were three components to the afternoon session at the school, to which we returned at 2:00 pm. First, we had some sports matches – serious ones, with referees and very clear rules – in badminton, table tennis and volleyball. Second, we enjoyed a demonstration of Chinese painting and calligraphy, at which we were presented with some beautiful examples to take back to Hong Kong. Third, we finished off the day with a “party”, which was actually a set of excellent performances by both schools on a well equipped open stage on the edge of the school’s sports field. We enjoyed a real feast of local ethnic dances performed by 
the local students (mainly Dai and Miao minorities) as well as a brilliant but very surprising interpretation of Brittany Spears. In return, the LPCUWC students performed their repertoire as presented the day before at Chengzhong village (but without the health education item). To say the reaction of the students present was ecstatic would be a gross understatement – we certainly finished a brilliant day on a truly high note, with our students being treated like celebrities who were surrounded by groupies as they reluctantly left the campus.
Our visit to the school was the first time that any student or teacher had ever met a native speaker of English. For the students, it brought learning English out of being just a textbook subject into being seen as a true means of communication that had the potential to open many new opportunities. For the teachers, it was a rare opportunity to communicate in English with a native speaker – which a large group of them did with me at length during the afternoon sports matches.
Our next day (Thursday 6th November) brought some of the heavy rain for which Guizhou is famous, and this hampered our program to some extent. We began the day by travelling to Mengjiang, a small village near Gonghe (the site of the first clinic sponsored by GCAT). Mengjiang was the temporary location of the second GCAT-sponsored clinic. Actually, our second clinic was earmarked for a different village, Gaijiang, which was located just on the other side of Gonghe (the three villages are located close to each other in a 
line). The clinic we visited had been in Gajiang’s area when the location of the clinic had been decided, but after construction began the administrative boundary shifted and the clinic found itself in Mengjiang instead. As a result, construction has just begun of another new clinic beside the road in Gajiang, and when it is finished, the equipment donated by GCAT and the commemorative plaque will be relocated to the new clinic. Actually, the three village clinics in Gonghe, Gaijiang and Mengjiang work closely together in any case, partly because one of the doctors is male and therefore the local women do not allow him to examine them – this is why most of the new village doctors being trained are female.
Construction of the clinic in Majiang had only been finished a couple of weeks before our visit, and the electricity would have been connected on the day of our visit if it had not been for the heavy rain. The clinic is very well situated on an elevated piece of land beside the river, accessible by a narrow concrete walking bridge across the stream. We spoke to the village doctor (who had been present at the opening ceremony for the clinic in Gonghe) who said she was hoping the new clinic could commence operations in a week or two.
After returning across the narrow concrete bridge, we drove through Gonghe to Gaijiang to see the site of the new clinic under construction. Only the foundations have been set in place, but local officials were hoping that construction would be completed by the end of November. Due to the heavy rain, no work was underway when we saw the site.
Having completed our visits to all the GCAT-sponsored health clinics, the Health Bureau officials were keen to show us two of the sites of Xiasi, the nearest township to our clinics. Our first stop was the kayaking course on the Qingshui River that was used for the training of China’s Olympic team. Claimed to be the best such course in Asia, it was an impressive sight, especially given its spectacular setting beside the limestone cliffs and rushing waters of the river. It would probably have looked even better on a fine day when kayakers were using the course to practise. Our second sight was a ‘farm’ where local dogs are bred as watchdogs and guard dogs. The dogs were of a distinctive local breed, known as Xiasi dogs, all white in 
colour and known (and bred) for their aggression. We were told that “Xiasi dogs are the number 3 most famous breed of dog in the world” which I must confess made me feel that my knowledge of dog breeds had been woefully inadequate prior to that visit. Nonetheless, there seems to be big money in selling Xiasi dogs, each of which fetches between RMB¥7,000 to RMB¥20,000.
We followed these visits with a superb Miao-style lunch, which was a great ‘spice-fix’ for those of us who enjoy spicy food. For most of us present, including myself, it was also our first taste of dog meat (but not Xiasi dogs of course – something that was even tougher!).
We then spent the entire afternoon at Tonggu, a small village about half an hour’s drive south-east from Xiasi. Tonggu is known for its naïve-style peasants’ paintings, and we spent the afternoon in a workshop learning the techniques of this form of art. This was a sensational experience of ‘learning from the 
peasants’, in spite of the language barriers (the local women who taught us spoke no Putonghua, only Miao language). The encounter helped all of our students appreciate the intricacy and vibrancy of the Miao paintings, and we were able to come away with beautiful (though usually half finished) paintings before the paint finally ran out in the late afternoon.
Our final day in Guizhou came all too quickly. After an early 7:15 am check-out from our hotel and an early breakfast, we drove 75 kilometres east of Majiang to Xijiang, a beautiful mountainous area inhabited mainly by Miao people at the head of a steeply sided gorge with a fast flowing river – the Xi Jiang (or West River). Xijiang is China’s largest Miao village, with over 1000 households and a population of 5120 people. Like most Miao villages, the buildings were impressive two or three-storeyed wooden dwellings rising from the 
river in the bottom of the valley up the steep slopes of the surrounding hills. As our aim was to gain a deeper understanding of the Miao culture that dominates Majiang county, we spent some time in the excellent museum that has been built in Xijiang before exploring the town more fully. Large numbers of the villagers were practising for the upcoming dances and pageant to celebrate the Miao New Year, which was scheduled just a few days after our visit.
After a somewhat inadequate hour and a half in the village, we enjoyed an early lunch of spicy Miao food before leaving for the long drive to Guiyang Airport. Fortunately, we road was good and the weather the best we had experienced in Guizhou – the first blue skies appeared on our drive to the airport – and so we arrived in adequate time for our flight to Shenzhen.
We presented farewell ‘thank you’ gifts to Miss Wu and Tong Su who had done so much to help make our visit proceed smoothly, and then quickly checked in and boarded our flight. If we discount the fact that my bag didn’t arrive at Shenzhen, and that the food served comprised just a tiny lonely packet of dried preserved beef, then it was difficult to fault the flight.
And yet I sensed that there was something missing from the wonderful China Week experience that made it lack authenticity. On every one of my previous 60 visits to China (except one which was a one-day trip spent inside the grounds of a school in Guangzhou), I have seen a car (or truck or bus) accident. This trip had been free of such accidents, but the drive from Shenzhen Airport to the border crossing at Lo Wu re-established the tradition, with an accident between a bus and a car just 10 minutes before reaching Lo Wu.
To see the 333 images of this trip, please click the links below:
Majiang Health Bureau meeting (6 images)
Gonghe village, the opening of the new health clinic and medical house calls (33 images)
Machang village (with its new health clinic) (6 images)
Xian E village (with its old health clinic for comparison) (21 images)
Chengzhong village, with its old health clinic and a reciprocal performance (75 images)
Our students helping to build a new clinic in Chengzhong (45 images)
Our students teaching English in Majiang School, playing sports and performing (63 images)
Mengjiang and Gaijiang villages, with the new GCAT-sponsored health clinic (12 images)
Xiasi town - the kayaking course, breeding dogs and having lunch (18 images)
Tonggu village, experiencing peasant art (21 images)
Xijiang village, a large Miao village near Kaili (24 images)
Majiang County - some general views (9 images)
