Status Quo of the Health Work

　　With the advent of the 1990s, three strategies were worked out to improve medicare services in the rural and pastoral areas. And achievements have been scored in these regard.

　　Healthcare Network. By the end of 1996, there were 1,300 medical institutions in the Tibet Autonomous Region. They had a total of 6,1 36 beds and were staffed with 10,936 professional medical workers, including 8,628 technical personnel. In addition, there were 4,402 medical workers working in various villages. Recent years saw an investment amounting to 130 million yuan made by the State departments concerned and various provinces in China around the 30th anniversary of the founding of the Tibet Autonomous Region. The investment was used to build the Tibetan Medicine Factory of the Tibet Autonomous Region, the Contagious Disease Hospital of the Tibet Autonomous Region, the Birth and Health Training Center of the Tibet Autonomous Region, and the InPatient Hospital of the Lhasa People's Hospital. These have strengthened the hand of the healthcare institutions in serving the locals. What deserves special mentioning is the progress made in treating diseases plaguing the plateau, such as plateau pneumochysis, plateau coma, plateau glycopenia and plateau high blood pressure. Clinical treatment of these plateau diseases has reached the internationally advanced level. Great efforts have also been made to study the preventive medicine, and important success has been achieved in this regard.

　　Medicare Work in Farming and Pastoral Areas. Before the Sichuan-Tihet and the Qinghai-Tibet highways were built, Tibet relied heavily on medicine and even injection needles, absorbent cotton and ethyl alcohol imported from its foreign neighbors or transported from Chengdu and Lanzhou some 2,000 km away. In the latter case, medical supplies were first transported with trucks to Garze and Golmud, where they were carried to Tibet on human and animal backs. Only three hospitals were equipped with 30 milliampere X-ray devices, and only one medical laboratory was armed with two telescopes.

　　In the 1960s, medical institutions at and above county level were generally equipped with needed medical devices, and some of them were equipped with ECG devices, refrigerators, ultrasonic and 200-milliampere X-ray devices. By 1965, hospitals at the municipal and prefectural levels were equipped with ambulances. By 1989, hospitals at the municipal and prefecture levels could basically meet local needs for clinical treatment, scientific research and teaching.

　　Hospital equipment in Tibet saw fresh improvement in the 1980s. From 1981 to 1983, the Health Commission of the Tibet Autonomous Region and county hospitals were added with 1,281 pieces of medical instruments in 73 kinds, valued at 5 million yuan. By 1989, most of the county hospitals were equipped with 50 milliampere X-ray devices, ECG devices, Model A ultrasonic diagnosis meters, refrigerators, surgical operation beds, shadowless lamps, scalpel kits and ambulances. Some even were equipped with 200 milliampere X-ray devicesand fiber gastroscopies. Township clinics were also added with needed medical devices.

　　In the 1990s, the people's government of the Tibet Autonomous Region held three health work conferences focusing on farming and pastoral areas. Various health institutions implemented the Notice of the People's Government of the Tibet Autonomous Region for Strengthening Health Work in the Farming and Pastoral Areas. They have built 330 township clinics, and expanded 13 central township clinics, 14 county epidemic diseases prevention stations and 12 county medical stations for women and children. Involving a total investment of 22.33 million yuan, these cover a combined construction area of 57,600 square meters. In the meantime, efforts were made to arm 22 border counties with X-ray and ultrasonic B devices, hospital beds and transport means, plus needed medical equipment for some 60 townships in these border areas.

　　To perfect the medicare system, Tibetan department concerned worked out a reform program. In 1993, the people's government of the Tibet Autonomous Region promulgated the Provisional Methods for Management Over Free Medicare. According to this Methods, special allocations were earmarked to fund the free medicare system, amounting to 10 million yuan in 1993 and 20 yuan after 1994.

　　The people's government of the Tibet Autonomous Region stresses the importance of medicare for women and children, who make up two-thirds of the total population. In the whole region, there are 42 hospitals for women and children. Some 17,000 women and over 250,000 children have received organized physical examinations. Use rate of modern child delivering methods reaches 91.75 percent in cities and towns, and 57.58 percent in farming and pastoral areas. From 1990 to 1995, the Tibet Autonomous Region and the UN Children's Fund conducted health projects for women and children in 16 counties. The former put in 11.87 million yuan and the latter US$880,000.Thanks to these projects, the death rate for pregnant and lying-in women and babies dropped from 715.8 per 100,000 and 91.8 per 1,000 in 1989 to 486.39 per 100,000 and 55.21 per 1,000 in 1996. From 1996 to 2999, similar projects will be conducted in 23 countries, with the people's government of the Tibet Autonomous Region putting in 13.63 million yuan and the UN Children's Fund US$690,000. Such projects are expected to boost healthcare of women and children in the Tibet Autonomous Region.

　　The Health Commission of the people's government of the Tibet Autonomous Region sponsored unified health work in farming and pastoral areas. For example. Rinbung County was granted 694,200 yuan worth of medicine and equipment. Efforts were also made to train 12 medical workers for the county. In addition, some 100 medical workers were sent to 18 poverty-stricken counties for family planning services. All these help with elimination of poverty there.

　　Infectious and Endemic Diseases. Efforts began to improve the immunity of the Tibetans in the 1980s, with BCG vaccine inoculated in a planned way. Medical institutions at the and above the county level provide with X-ray services and chemical examinations. All these help with treatment of tuberculosis.

　　Given historical reason, syphilis and gonorrhea were serious in Lhasa and areas where people were comparatively crowded. With the peaceful liberation of Tibet in 1951, PLA medical workers entered these areas. Before long, such diseases were brought under control. Following the Democratic Reform in 1959, efforts were made to publicize the PRC Marriage Law. In the early 1960s, VD which had been running rampant in Tibet for a long period was rarely seen.

　　Endemic diseases plaguing Tibet then included Brucella, goiter, Keshan disease, Kaschin-Beck disease and fluorine poison. In 1976, the CPC Tibet Autonomous Regional Committee set an office to fight these endemic diseases. City and township governments in the region followed suit after 1977. A 1980 investigation showed that there were still some 500,000 people suffering from these endemic diseases in the whole region.

　　Brucella is an acute infectious diseases for both man and animals. It was a major scourge for pastoral area. At the end of 1964, a group was sent to two counties and one pasture in the pastoral area in northern Tibet for a nine-month investigation. Laboratory tests showed that this disease ran rampant there. In 1979, the people's government of the Tibet Autonomous Region began to allocate 3 million yuan a year for the prevention and treatment of the disease. From 1980 to April 1983, a total of 196,098 people in the region were investigated, and 14,217 of them were found to have contracted the diseases. Thanks to measures taken thereafter, the disease was controlled. Hospital treatment cured 88.24 percent of them.

　　Endemic goiter is the result of lack of iodine in soil, water, animals and plants. Investigations conducted after 1976 showed that some 100,000 people, making up over 66 percent of the total population, in 72 counties suffered from goiters. Governments at various levels made herculean efforts to solve the problem by organizing medical workers specialized in the treatment of endemic goiter there. Labs were formed in Lhasa and Shannan for the purpose. Adding iodine to salt and encouraging the people to take iodine capsules prove to be a good method. Over the years, more than 2.4 million people in the goiter suffering area had taken the iodine capsules and were encouraged to consume salt and tea which are added with iodine. In October 1996, a publicity campaign was launched in Tibet to alert the public to the seriousness of goiter. In October 1997, a work conference was held to find out a solution and plan future work. A general survey of six counties in 1997 showed that the goiter suffering rate dropped by below 8 percent, a level up to or close to the State goal.

　　In the 1990s, the health departments in the Tibet Autonomous Region earnestly carried out the PRC Law on the Prevention and Treatment of Infectious Diseases. Efforts were made to prevent and treat major diseases. In 1995, the incidence of the infectious diseases was 461.08 per 100,000, a fall of 49.18 percent when compared with the 1990 rate of 907.28 per I 00,000, and the death rate dropped by 54.34 percent.

　　Plague hit the Tibet Autonomous Region in recent years. Health departments at various levels made great efforts in the last two years to cope with the situation, thus effectively checking the spread of the plague.

　　Beginning in 1986, the Tibet Autonomous Region worked hard to strengthen the immunity of children. As a result, the incidence of measles, tuberculosis, diphtheria and whooping cough dropped to an impressive margin. Thanks to efforts made over the years to prevent and treat leprosy, only 80 people are suffering from leprosy, and efforts are made to eliminate incidence of leprosy in the autonomous region.

　　Tibetan Medicine Prevention and Treatment Network With Lhasa as Its Center. Tibetan medicine has a history of more than 2,000 years. It is the crystal of the struggle waged by the Tibetans against the nature and diseases. It is also a part of the traditional Chinese medicine. It boasts not only a long history but also rich clinical experience and theory unique to itself.

　　Following the peaceful liberation of Tibet in 1951, the Central Government formulated policies to encourage the development of Tibetan medicine. Famous Tibetan medicine works were compiled, translated and published. They include Tibetan Medicine Code, Four-Volume Medical Code, Traditional Tibetan Herbal Medicine, and Tibetan Medical Science. Not long ago, the Collected Series Charts on the Four-Volume Medical Code (Tibetan-Chinese) was published. The color Charts explain systematically and scientifically the basic theory of Tibetan medicine contained in the Four-Volume Medical Code. As the first and only one in China and the world at large, the Charts constitute a treasure in the Tibetan culture and also in the Chinese medical world.

　　By the end of 1995, the autonomous region boasted 14 Tibetan medicine research institute and Tibetan medicine offices in over 60 county hospitals; 506 hospital beds (an increase of 110 beds from 1990); 1,071 Tibetan medicine workers, plus 429 folk doctors working in farming and livestock breeding areas; and 4,000 rural Tibetan medicine doctors, 40 percent of them being capable of providing with medical treatment.

　　In accordance with the Regulations on Tibetan Medicine Hospitals in China and the Standards on Divided Management Over Tibetan Medicine Institutions, rules and regulations were worked out to strengthen the behavior of existing Tibetan medical organs in medical treatment. Statistics show Tibetan medicine hospitals were visited by 530,000 people in 1997, making up 20 percent of the total number of visits to hospitals in the Tibet Autonomous Region. Also in 1997, the Tibet Autonomous Regional Tibetan Medicine Hospital was visited by 198,000 people.

　　The Tibetan Medicine Pharmaceuticals of the Tibet Autonomous Region produces more than 100,000 kg of Tibetan medicine in 350 varieties a year. Upon completion of an expansion project undertaken with investment amounting to 76 million yuan made by Jiangsu Province, the plant will become the largest Tibetan medicine production center in the region.

　　A total of 32 Tibetan medicine works have been compiled and published; 13 out of 26 scientific research projects won technological progress awards at the regional or ministerial level. Ranmasnagpei, a traditional Tibetan medicinal drug, won international awards two times; and another Tibetan medicine drug named Zotai won the State patent. At the 26th Geneva International Invention and New Technology Exhibition in April 1998, the Chizhen Pain Relieving Plaster produced by the Nyingchi Chizhen Pharmaceuticals won the gold invention award, the first time in the Tibetan history.

　　In 1993, the PRC Ministry of Public Health (Now the Ministry of Health) held a symposium on Tibetan medicine was held in Lhasa. Up till now, the Tibet Autonomous Region has 14 drugs listed into the State Medical Code; 41 kinds of Tibetan medicinal herbs and 97 Tibetan medicine drugs listed into the standard Tibetan medicine drugs of the Ministry of the Public Health; 35 kinds of Tibetan medicine drugs and preparations listed into the standard Tibetan medicine drugs. All these pave way for Tibetan medicine to expand Chinese and foreign market shares. The Tibet Autonomous Regional Tibetan Medicine Hospital and the Shannan Prefectural Tibetan Medicine Hospital have all set up their respective traditional Chinese medicine hospitals in accordance with the decision of the State Administration for Traditional Chinese Medicine.

　　In October 1997, the people's government of the Tibet Autonomous Region held its second congress on Tibetan medicine. The conference made the Decision on Strengthening Tibetan Medicine Work, and adopted the Ninth Five-Years Plan on Tibetan Medicine Cause (for 1996-2000) and the Plan for Further Development in the 2000-2010 Period. The participants agreed that the production of Tibetan medicine should adapt to the market economic structural reform. While maintaining the characteristics of Tibetan medicine, efforts should be made to combine clinical treatment with scientific research, and combine Tibetan medicine with traditional Chinese medicine and Western medicine. Only in this way can Tibetan medicine develop further.

　　New Achievement in Family Planning. Further achievements have been made to the family planning pro-gram in the Tibet Autonomous Region and the growth rate of the population in the region has been reduced.

　　The expanding population and the relatively low standard of education in Tibet hindered its economic development. It was imperative to control growth of the population and enforce a regional family planning program.

　　In May 1991, the CPC Central Committee and the State Council issued The Decision on Enforcing Family Planning Program and Controlling the Population Growth, which stated that the family planning program should also be implemented in China's ethnic groups for the further development of their economy, culture, and reduction in the size of their population. The government at all levels in Tibet realized the importance of the coordinated development between population, socioeconomic, natural resources, and environment and they included family planning in the overall plan for socioeconomic development. Many Tibetan farmers and herdsmen have also recognized the need for family planning since more children in the family create increased financial burdens. Many Tibetan women of childbearing age support the family planning program by using a form of contraception.

　　The Tibet Autonomous Region offers expert family planning advice in hospitals and sent 100 family planning teams to villages, pastureland, and poor counties to distribute medicines and offer expert advice. In addition , the teams provided necessary medical equipment for the local units. In recent years, the general health of Tibetan women has been considerably improved and the population growth rate has also been reduced, which resulted in an improved ratio between the population and socioeconomic.

　　At the end of 1997, the total population of Tibet was 2.4 million, the birth rate was 21.48 per thousand, the death rate was 6.69 per thousand and the natural growth rate was 14.69 per thousand representing a decrease of 6.12 per thousand, 2.51 per thousand, and 3.61 per thousand respectively from the 1990 figures. The population of Tibet has benefited from this modern approach as the birth and death rates have been significantly reduced and the average life span of Tibetan people is expected to reach sixty five.

　　New Moves in the Legal System in the Health Development. Following the promulgation of The Law of Medicine Management, Prevention and Cure of Infectious Disease, and The Management Rules of Medical Organization the Tibet Autonomous Region issued The Methods of Enforcement and, according to the various conditions in the region, they laid down The Prevention and Cure of the Plague, Prevention and Cure of Tuberculosis, The Management of Public Health Services, The Transient Management Methods of Free Medical Services and Regulations of the Implementation of Management Rules of Medical Organizations. Various health units strictly enforce these policies by supervising the sale of medicine and ensuring hygienic preparation of food thereby striking a heavy blow to the criminals who make and sell inferior or fake medicine and food products. These measures safeguard the people's health.

　　In the light of the state-issued Management Rules of Medical Organizations and the Tibet-issued Regulations of the Implementation of management Rules of Medical Organizations, the medical organizations in Lhasa City have been consolidated since 1995. The individual medical units have been reorganized and after about one year since the enforcement of these regulations, 62 medical units in Tibet have been issued with operating licenses, including 18 individual units, 10 collective units, and 34 clinics. One hundred and thirty seven medical units which did not meet the required standard have been forced to close.

　　Expanded Cooperation With Foreign Countries. In September 1994, the National Conference on Medical Assistance to Tibet was convened in Lhasa. The Ministry of Public Health issued The Decision to Further Improve the Program of Assistance to Tibet, increased the provinces from 12 to 14 and designated ten units directly under the ministry as support units to their counterparts under the Public Health Department of the autonomous region. Thanks to the cooperation between Tibet and the support units a number of medical projects have been undertaken. In just over three years 195 technical personnel and administrative cadres from Tibet have enjoyed advanced studies in the support provinces. The support provinces have also dispatched II 2 cadres and technical personnel into Tibet. Hunan Province invested 2.5 million yuan for the construction of hospital complexes in the Shannan area of Tibet and other provinces contributed capital and other essential medical equipment, including vehicles, totaling 4.2 million yuan.

　　Tibet has also received international assistance and exchanged expertise internationally in such medical fields as maternity care, child hygiene, water quality and toilet improvement, immunization, prevention and cure of tuberculosis and leprosy, disaster control, medical education and accident and emergency treatment. Tibet has received a total of 0.15 billion yuan in financial assistance, which greatly improved the medical development of Tibet.

　　In the early 1950s, Tibet began its medical and health undertakings and its medical personnel training program, including opening short-term training courses and establishing medical schools and institutes. Western medicine methods have been introduced and developed in Tibet. The Tibetan and Chinese Han doctors in Tibet have gained practical experience and conducted medical scientific research relative to their own regional characteristics. After 40 years, their hard work has born fruit. Moreover, they have made medical academic exchanges with other provinces and municipalities in China as well as abroad.

　　During the initial stage of Tibet's peaceful liberation, the training of medical personnel was treated as a priority. The Central Government of China held two training sessions for Tibet with the Changdu Health Team in 1953 and 1954. The two sessions trained 69 students who studied the textbooks written by their teachers. After six months the 69 students took up their posts and learned to appreciate the benefits of a hygienic approach while in working with their teachers. Training courses were also introduced in Lhasa and Xigaze and thus the first medical contingent had been established in Tibet. In 1957 the Beijing Hygiene School trained 50 Tibetan students. The Tibetan youth had been sent to study medicine in Sichuan Ya'an Hygiene School and Lanzhou Northwest Institutes for Nationalities. These students graduated between 1960 and 1963 and later became the backbone of Tibet's medical services. Cering Zholga, vice-chairman of the people's government of the Tibet Autonomous Region, is one of these graduates. Since the 1970s many universities and schools in China have opened courses for Tibetan students including the Harbin Medical Sciences University, the Chinese Medical Science University, the Sichuan Hygiene Cadre Institute, the Hebei Medical College, hygiene schools in Shenyang, Tai'an, Kaifeng and Hengyang and the Chongqing Pharmacy School. Thereby a medical and health contingent, with the Tibetans as the main force, has been established in Tibet.

　　In 1995, the people's government of Tibet readjusted the structures of medical education, shifting its focus to the training of senior medical personnel. A medical school under the auspices of Tibet University was established and the management of the medical school for Tibetans was improved. During the period of the Eighth Five-Year Plan (1991 - 1995), 2,000 medical staff had been trained to work in Tibet. Medical scientific research in Tibet attaches importance to clinical practice and they have made 47 medical achievements. They have successfully conducted high altitude intracardiac surgery in the open air. Now, Tibet leads other places in China in the study of Tibetan medicine including the treatment of mountain sickness.
Sanitary Improvement in Tibet. The Sanitation and Hygiene Committee, the earliest non-government hygienic organization in Tibet, was established in Lhasa in 1953 and later its branches were set up in other places in Tibet. The committee launched a thorough cleanup program by the masses. In its first two years Lhasa residents and PLA soldiers jointly disposed of garbage, dredged sewers, filled up puddles, repaired roads, built public toilets and made garbage cans. After the reform of democracy in Tibet in 1959, Tibet established sanitation and hygiene committees in its cities and counties, which helped Tibetan people develop a habit of washing and bathing, encouraged haircuts, eliminated louses and ensured human beings lived apart from domestic animals. In the past 40 years, Tibetan people have greatly improved the standard of living and made significant progress with regard to standards of hygiene.

　　Since the 1960s, the epidemic prevention stations in Tibet conduct regular examinations of food manufacturers including food processing plants, breweries, and cold storage facilities. Food which does not meet the required standards of hygiene is not allowed to be sold and rotten food is destroyed. Meanwhile, the epidemic prevention stations help the food plants establish and improve their management of hygiene.

　　Since 1979, Tibet has strengthened both the overall plans for hygienic development and encouraged public awareness. The dirty and messy places in cities and counties have taken on a new look and Lhasa built a sewer .The subdistrict offices and other units pay particular attention to beautifying the environment and they often hold hygienic contests.

　　Over the years, the hygienic work in Tibet has seen rapid development and the health condition of its people has also improved. These all attribute to the people's government of the autonomous region that stresses the importance of hygienic work, issued 11 hygienic documents, and adopted a series of hygiene measures. Since the Tibet an people benefit greatly from the hygiene reform in Tibet, they will involve themselves more than ever in the hygienic work.