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May 26
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Celebrating Twenty Years

Dharma Sagara Clinic’s 20th Anniversary slogan: “Build it and they will come.”

by Lee Weingrad

dutsi til 3 copyYou wake up one day, both your children are in college, your black hair has turned silver, and your fledgling Tibetan health project is twenty years old. This year we celebrate the 20th anniversary of the Surmang Dharma Sagara clinic.

It was 1992 and I thought, “Who would ever give us money for a clinic if we didn’t have permission from the Chinese government to build in Tibet?” What started out as a dream became a very real contract with the Qinghai government, with the help of Governor Huang Jing Bo. Not so long after we signed the contract, it morphed into a grant from Caritas. We broke ground in 1993, and completed construction in the summer of 1996. Since then, there have been twenty brutal Khampa Tibetan winters, as well as a devastating earthquake that took down the 400 year old monastery assembly hall but didn’t scratch the clinic.

Back in 1995 when I spoke to the head of Mother and Child Health at UNICEF Beijing, she asked me, “How do you know that anyone will ever come to the clinic?” I asked her, “Did you see the movie ‘Field of Dreams’? Kevin Kostner’s character is told by a ghost to build a baseball diamond in his Iowa cornfield. “What makes you think they will come to play?” he asks the ghost. “Build the field and they will come.” That is what I told her.

Screen Shot 2016-05-20 at 5.03.57 PMAnd come they did. In the past ten years alone over 120,000 patients have come. I have to admit that some of the success was just driven by plain old stupidity. I was told by several experts in international development that we would end up like Rodney Dangerfield (and get no respect!) if we didn’t charge for our services. For the life of me I couldn’t figure out how much to charge, or to whom. By looks alone, I couldn’t tell the difference between a wealthy nomad who had 200 horses and a poor one that had only 20. They dressed the same, and looked the same. The only thing that made sense was to charge everyone the same low fee, and for me and the foundation to work on getting the funds to make a universally low fee structure possible. Years later Damchu Rinpoche, brother of the late exiled Abbot of Surman, Chogyam Trungpa, wrote a very touching memorial about our generosity, emphasizing that generosity is a key value for Tibetans.

The clinic is an odd building for China: high passive solar gain, which means it is a heat sink. It has walls that are two layers of brick on one side and on the other, with about a foot of volcanic ash in between. It has double-paned windows. It was designed in Boulder, Colorado by Adrian Sopher and Paul Cloppenburg. It was a tough project to do because the blueprints had to be translated into Chinese. Then we had to find a contractor who could read a blueprint. That eliminated traditional Tibetan rammed-earth builders, even if we could find one. We had to find one who could not only read a blueprint, but could read it in Chinese!

construction 2We ended up with a contractor from Chengdu. He was the scion of a Chinese feng shui lineage. Before we chose a site, I asked him, “What’s the best place around here to build?” He looked around and said, “Anywhere. The place has a lot of power. It’s a counter-clockwise conch. But be careful of the tiger in the mountain. It can eat the cow.” We had the monks do a consecration of the site, and we were ready to go.

In the four years before the building was completed, before we had our own permanent structure, we would hold clinic in tents, and in monks’ quarters that we could rent. It was OK, but finally at the end of 1996, the building was done. We had had over 150 volunteers participating in the construction process. We went through two phases, one from 1996 to 2002, and another phase after that.

In 2001, volunteer doctor Julie Carpenter asked, “Where are the women and children in this clinic?” That question was a game changer for us, because until then we had no idea why all the patients were men, all with arthritis or stomach pain.

It had become a joke among our doctors:

Doctor: “What’s the problem?”

Patient: “I have a stomach ache.”

Doctor: “How long have you had this problem?”

Patient: “Ten years.”

It was no coincidence that in 2003 we hired a second doctor, Sonar Drogha, who would specialize in mother and child health.

In 2003 we signed an agreement to do a survey of four hundred nomadic women in the Surmang area. In 2004, eleven volunteer doctors, along with their interpreters, horses, trucks, motorbikes, sleeping bags, and tents, set off to find out what was keeping these women from seeking medical care. We found out that the problem was immobility. The women were dying in great numbers along with their babies, at rtes perhaps as high as anywhere on earth. There were 3,000 maternal mortalities for every 100,000 live births; one in five babies would not live past the second birthday.

Through the World Health Organization, we soon found out that more than 6,000 women per year suffer a similar fate. Tibetan society seems to be at risk from a totally invisible killer, one that every Tibetan woman knows quite well: death in the process of making life. As Laurie Garrett noted, there are no celebrity endorsements available for pregnant Tibetan women who bleed to death. We found ourselves at the locus of a public health nightmare.

Slide #1-2In 2005, we began to train forty community health workers. They were training to be village first responders, particularly for mother and child health. In 2009, we contracted with Peking University to conduct a survey comparing our clinic with township hospitals. We found that patient satisfaction at our clinic was higher, that patient visits were much more frequent, and that our operating costs were significantly lower, even though we were including free medications. With two doctors and 732 monthly visits, and a budget of $150,000 per year, we had a per-visit cost of only $17.07, including births and well-baby visits.

A foreign organization creating an institution in a Tibetan region has to walk on eggshells. In addition to the obvious political downsides, there are cultural obstacles as well. By 2005, we had an ultrasound machine, thanks to Siemens and United Family Hospital. But doing gynecological exams was another matter. Like many traditional people, Tibetans seldom undress; they never undress in front of others. Conflicting with this prudishness was their practicality, understanding what was at stake for their survival, and witnessing the results of our clinic. After about three years, Tibetan women were no longer resisting gynecological exams.

In April 2011, a major calamity befell Yushu Prefecture: an earthquake that nearly wiped Yushu/Jiegu off the map. Our own traditionally-constructed second building was destroyed, but our clinic survived. The Surmang monastery assembly hall, four hundred years old, was ruined beyond repair.

At that time, we signed an agreement with the government to export the success of our Surmang model to four additional townships: Mouzhang, Xialaxu, Xiewu, and Longbao — the epicenter of the earthquake. The prefecture was in a world of hurt, and we were there to help. We would train their doctors just as we trained doctors Phuntsok and Drogha at the original clinic.

In the five years since the earthquake, we’ve done as we promised. The ability of our small foundation to impact the operating procedures of the rural public health system is limited by very different operational styles and processes. To some extent, I’d say the graft didn’t take, and what we’ve done at Surmang hasn’t been completely replicated. But for the doctors we’ve trained, their exposure to the very talented providers who came all the way from the West to help has had a big impact. Our volunteer doctors can add their expertise directly. This has been appreciated, especially in Xiewu, which is fifty kilometers north of Yushu.

In 2011, we held what was perhaps the world’s first rural health festival, a peer-led conference. All forty of our children and women’s health workers were there, and government representatives were there too — sixty people in all. There were eight experts in home-based health care, coming to assess the results. It was at this conference that future plans were devised for our work, and it was there that the children and women’s health workers announced a major success: in 2010-2011, there had been no maternal mortalities — not one.

IMG_0668 copy 2-2Although we’ve been able to operate at the same level since 2011, the future is hard to predict. Political pressures in Tibetan areas are a factor, excluding almost all foreign non-governmental organizations (NGOs). On the other hand, longevity of a program like ours is always a plus in China. Supporting that longevity, we have not had the backing of any foreign government, university,or  international NGO, and no religious support or religious agenda. To be honest, sometimes I wish we did.

I ascribe this lack of institutional support to our plain meat-and-potatoes approach to rural health care. What we do has no sophisticated theory of public health behind it. It amazes me how sophisticated other projects and their theories can be, when all you really have to do is help the women survive — by giving them rapid intervention and access to quality care.

While this simple approach can keep us separated from the big institutional funders, it has also kept our work out of the political limelight. I’m proud of the fact that our foundation is still there, still flourishing after twenty years. I think that as long as we continue in this clear, compassionate way, we will continue to help. This continued work is possible only through the generosity of many individual private donors.

More than a year ago now, I received a phone call from my friend Maurice Strong. His own efforts are almost exclusively on the environmental side of things, so his support has mainly taken the form of encouragement. He told me he’d been to the Ford Foundation in Beijing, and had spoken to them about our work. He told me to call Susie Jollie, the former mother and child health director at UNICEF that I mentioned right at the start of this story. So, I called her up. When she picked up the phone, what was the first thing she said? “Build the field, and they will come.”

Editor’s Note: to support the continued work of this foundation, visit their web page: http://www.surmang.org

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7 responses to “ Celebrating Twenty Years ”
  1. Nicki Dayley
    May 29, 2016

    So impressive! A true blessing…and offering. “Generosity is the virtue that produces peace. ” You found your true calling.

  2. Ellen Fasano
    May 28, 2016

    Congratulations Lee on your amazing perseverance and bodhisattva activity. You bring caring and true help to those in need.

  3. Kristi Anderson
    May 28, 2016

    You done good Cookie Monster!!
    Simple is the best and I have a feeling that the good feng shui didn’t hurt either. Very moved to hear of the success of your project. Please continue to keep us posted.

  4. Of course the most amazing thing of all is that you managed all this without me.

  5. Calabdra Smith
    May 27, 2016

    Thank you for all you have been doing on the ground, Lee; and for the inspiration this provides when most news stories in the West are either distressing or trivial; finally, thank you for the opportunity and invitation to share this most auspicious story, which I am happy to do.

  6. Arthur Ramsay
    May 27, 2016

    More moved than I can express. You are a true heart son of your teachers. Your own teaching manifesting in this activity is beyond every paramita. All who have helped you are also profoundly kind through to profoundly all victorious. Your activity is its own reward of course. Nevertheless you should be recognised by all in positions of standing with every possible honour. You are all great examples to us lesser beings.

  7. Timaree Bierle-Dodds
    May 26, 2016

    congratulations on offering such a beneficial service!

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