Cengong is even more isolated than Majiang (see HERE and HERE).  Cengong is situated in eastern Guizhou province in an area dominated by the Miao and Dong ethnic minority groups.  As the altitude decreases in Guizhou as one moves from the north-west to the south-east, Cengong’s relatively low altitude within the surrounding mountains means the area has a sub-tropical climate with monsoons, high temperatures and high humidity.  In many ways, it is typical of China’s poor mountainous agricultural areas.

Cengong County has an area of 1486 square kilometres, and in China’s very hierarchical system of governance, comprises 4 townships, 7 residential committees and 1681 administrative villages.  Farmers comprise 91% of the population, which according to government statistics totals 227,330 people.  Of this number, about 20,000 live in the county seat town of Cengong.

About half the population consists of people from various ethnic minorities.  There are 18 ethnic minorities in Cengong country, the most numerous being the Tujia, Miao, Dong and Gelao.  At the end of 2007, the county’s average annual income per capita was RMB¥2097, or US$307.

Cengong currently has 129 village medical clinics.  Many of these are in the health worker’s own home or in small rented premises, where the typical monthly rent is about RMB¥100.  Most of these clinics are inadequate in terms of hygiene, size (they are typically less than 40 square metres) or facilities (they seldom have running water).  In most of the clinics, diagnosis, treatment and storage of medicines are not being done in separate rooms, as government regulations require.  In many of the clinics, the health workers have no choice but to use the same space for their own everyday activities such as cooking, eating and sleeping, while providing treatment on the same bed that they or their family use for sleep at night.

Furthermore, the clinics in Cengong lack many basic medical facilities.  According to the official requirements of Guizhou province, every village clinic should have 20 standard items of equipment, including beds for diagnosis, apparatus for transfusions, a stethoscope, a sphygmomanometer, equipment for measuring weight and height, inoculation packages, a diagnosis box, and so on.  In most of the clinics on Cengong county, only simple equipment such as thermometers, tongs, scissors and stethoscopes are found.

Although called ‘doctors’, most of the health care workers have only basic training.  They work on a self-employed basis, charging nothing for patient consultations or home visits, and making their living by selling basic medicines (for which they are permitted to make a 15% to 20% profit).  There are currently 179 rural health care workers in Cengong county, of whom only 48 have received institutionalised health care training and high school education.  Nonetheless, they are usually the most educated and literate people in their respective villages.

Unfortunately, the working conditions of the health care workers are so poor that many of them have left their villages to work in towns or cities where they can earn much higher incomes.  As a result, the current supply of village health care workers, and thus health care, fail to meet the needs of local people.

Building on the established partnership between GCAT and the Amity Foundation, which has committed itself to providing 100 village medical clinics in poor rural areas of Guizhou, I accompanied 12 students from Li Po Chun United World College to Guizhou in late October 2009.

On our first day in Guizhou, we visited several village clinics to gain an understanding of the needs of the area.  The first village was Bai Shui, part of the area governed by Shui Wei township.  Located on a steep slope overlooking the nearby river, Bai Shui was as beautiful as it was isolated – the drive from Cengong took about two and a half hours along narrow, twisting, often unsealed roads.  The clinic was located in a rented room on the ground floor of a multi-storey building, and despite the initial impression on modernity, the clinic was very small, even though it did have a separate room for the beds.

Our second village visit (after lunch) was eagerly anticipated, as this was the village where Amity had been proposed GCAT could sponsor a new clinic building.  Miao Luo village was located in the district of Tian Ma township, which was situated 5 kilometres away.  The village had 642 households with a population of 3562 people, scattered among several small hamlets.  Of this number, 524 were women of child-bearing age, and 219 were children under the age of 7 years.

The existing clinic at Miao Luo was located in an old grey brick building near the centre of the village.  The clinic comprised two small rooms with a total area of 20 square metres.  Although there were three health care workers, only one had been trained by the Amity Village Doctor Training program.

Because of the small size of the clinic, on a busy day patients would have to line up under the eaves of the building, and transfusions were usually performed on a wooden bench.  After an initial briefing, our students were divided into two groups, each accompanying one of the health care workers as they performed home visits.  I accompanied the group with Dr Dai (an unfortunate name for a doctor when expressed in English!), walking several kilometres to visit some elderly patients.

We (and the Amity staff) were somewhat surprised to find that the government had recently built a new two-storey clinic in Miao Luo, just a few hundred metres away from the old clinic.  Funds had been obtained from government sources, and clinic building was rapidly constructed, sharing space with the Village Committee offices.  Although it was gratifying to see that the health care needs of the Miao Luo villagers would be met much more quickly than anticipated, it did mean that there was no point in GCAT sponsoring a clinic in that village as planned.

The next morning, we therefore travelled to another village that certainly did have a need for a new clinic.  Zhu Ba village was in the district administered by Yang Qiao township, and comprised about 2400 people in dispersed hamlets, mainly of the Tujia nationality.  Families in this area are permitted to have two children, and last year the village 12 births and 6 deaths.  The resident health care worker, Dr Wang, was of Dong nationality, and she had been working in Zhu Ba since 1994.  Although the demand for services is declining (as the township hospital is just 6 kilometres away, with improving transport connections), the need remains for basic care of the elderly, the children and pregnant women.  Like other clinics we visited, Dr Wang rents the small room at a monthly cost of RMB¥100, which coincidentally is the same amount as she receives each month as a subsidy from the government.

Although the Amity Foundation has not yet built any medical clinics in Cengong county (GCAT’s clinic in Zhu Ba will almost certainly be the first), the government has built several.  We visited one of these in Yang Qiao village.  Unlike some of the two storey government clinics, the clinic in Yang Qiao was smaller than the clinics provided by Amity, and featured an internal dispensary rather than one with an open sales area facing the street.

The afternoon of our second day was spent in a small village that was closer to Cengong township.  La Qia Fan was a rural village that had received government funding for infrastructure (such as roads, houses, and biogas tanks), and had thus developed into a ‘model village’ for villagers from other areas to come and observe, and hopefully learn from La Qia Fan.  In this way, La Qia Fan had developed into a centre for the diffusion of new technology and new ideas for Cengong county.  The village even had a laboratory that was developing HYVs (high yielding varieties) of rice suited to Guizhou’s climate.

Our visit began with a typical farmers’ lunch in one of the village households.  After lunch, our original intention was to help the farmers with their work in the fields, but recent rains had made the fields inaccessible.  Therefore, following a short tour of the village, the students helped a 91 year old women by removing the kernels of dried corn from their cobs so that the kernels could be crushed and made into powder for feeding to the pigs.  We then proceeded past the village brickworks to the sweet potato gardens, where some harvesting took place, before returning to the village compound where the students performed a cultural show (including a skit on hygiene that the students wrote and prepared themselves) for the villagers.

On the next day, the students’ ‘service learning’ took a new form, teaching classes in to of Cengong’s primary schools.  The morning was spent at Xin Xing No.2 Primary School, where our students split into four groups, each teaching a class of 50 children on a different theme – ‘Art and Craft’ for one class, ‘Music and dance’ for another class, ‘Basic English Language’ for another and ‘Sports and Games’ for the other class.  The same pattern was repeated in the afternoon at a different school, the Xin Xing No.3 Primary School.  At both schools, our students were rapturously received, being swarmed by the students and, for almost half an hour at the end of the second school visit, being hounded for autographs.

Our fourth full day was devoted to exploring the culture of the minority nationality groups that dominate the life of south-east Guizhou.  Our main destination as Xijiang, a large Miao village set in spectacular mountain scenery along the course of a swiftly flowing river, the Xi Jiang.  Although our initial impressions of the village were that it was somewhat commercialised and oriented towards tourism (as it featured a museum of Miao culture and has stands where visitors could dress in Miao clothing for photographs), further exploration confirmed that the commercialisation was largely restricted to the main street and an amphitheatre where cultural performances could be seen.  Most of Xijiang was a naturally functioning Miao village, built in traditional Miao wooden architecture and surrounded by terraced padi fields.  Indeed, Xijiang was a good example of how tourism can be used to preserve the cultural identity of a group of people while at the same time earning income in a ‘clean, green’ manner that enables the standards of living of the residents to rise markedly – as seen by all the new construction occurring in the village.

On the fifth and final day of the trip, the group visited Majiang, the county where last year’s China Week group had helped build a new medical clinic, and where two GCAT-sponsored clinics had been opened.  The first stop was the clinic at Chengzhong, a Miao village where the LPCUWC students had built much of the wall structure during the visit in November 2008.  Having last seen the clinic as a construction site, it was wonderful to see the finished clinic, and even better to speak with the health care worker who we had seen the previous year working in a decrepit old wooden shelter, the interior walls of which were lined with corrugated cardboard to keep the winds out of the clinic.  The doctor was delighted to see our students, and expressed her deep gratitude for the part our students had played in making the new clinic possible.

We then drove to Gonghe village where the previous year our students had attended the opening ceremony for the GCAT-sponsored clinic.  Unfortunately, the clinic was closed on the day of this visit because it was market day in the nearby town, and traditionally the clinic receives very few patients on market days.  Nonetheless, it gave our current students a feeling of immense pride to see the name of their College on the plaque at the front of this clinic in remote Guizhou province – a fitting location for the final group photo of the trip.

I am very grateful for the tremendous support provided during the trip by the two staff members from the Amity Foundation office in Hong Kong who accompanied our group, Ms Tong Su and Ms Han Tsoi.  They were great sources of information for our students and help develop insights and understandings that would not otherwise have been possible.  I was also grateful that Mr Su Pong from the Amity Foundation’s Head Office in Nanjing was able to accompany us on our trip.

The 12 students on the trip were excellent ambassadors for the College and their countries.  They were enthusiastic contributors at every stage of the trip, and endured even the most gruelling conditions (such as meals over-dosed with copious chillies) without ever complaining.  Hopefully they have gained new understandings and insights into the medical needs of rural China, as well as developing a commitment to ongoing service to improve the health standards of people in areas of deprivation.

If you haven’t already done so, you can access galleries of images of all the places mentioned on this page by clicking HERE.