Tibet: Child health on the roof of the world
Monday 6 December 2010
The smell of yak butter and incense, the rosy red cheeks of the babies’ wind-blown faces and the snow-capped mountains framing the tawny landscape, are all forever etched in my mind.
I have just been to Tibet where the under-5 child mortality rate is at least six times higher than in Shanghai. The poorer Western regions and provinces of China still have a large burden of child deaths primarily due to pneumonia and birth asphyxia.
Even with substantial investment by the Chinese government in infrastructure (hospitals, schools, roads), not surprisingly, ensuring access to health services for scattered communities and nomadic people living in tough geographical areas is a real challenge for any health system.
We have an experienced Tibetan health team who over the last decade have established Save the Children’s credentials through solid partnerships and strong community development activities to improve health outcomes.
We are now preparing to move into another phase as part of our global campaign for child survival, EVERY ONE, which will seek to demonstrate ways essential health services can reach the women, babies and young children who need them.
I am sitting outside a small and unsanitary home in a village in the Lhoka valley enjoying the bright sunshine while talking with carers of young children under five. The women’s faces are tanned and weather beaten, each child clinging to its relative.
One six-month-old infant takes an interest in me and lets me play with him. I surreptitiously give him a quick check – his anterior fontanelle is closing, his head control is good and he makes a well co-ordinated grab for my glasses!
He seems a reasonable weight but he has been fed tsampa (barley flour moistened into a ball) since three days after birth along with breast milk.
We promote the WHO and UNICEF recommendation to feed the baby only breast milk from birth to six months of age, an action that helps to protect a baby’s health and reduces infant deaths from infections.
We ask where all the babies were born (China has a 100% hospital delivery policy), explore infant feeding practices, and ask how families access health services if their child is sick.
This community is not far from the prefecture centre but still some women deliver at home with no skilled birth attendant and clearly young child nutrition and basic household hygiene leave a lot to be desired.
Our time is limited and the double translation is slow (Tibetan-Mandarin-English) but this visit will help us to design a full assessment to be carried out later by our Tibetan team.
Understanding as much as possible about the daily lives and challenges faced in raising healthy children in this context is the key to targeting the issues with appropriate actions.
Proven, cost-effective child survival interventions address the most common and often preventable causes of child deaths like diarrhoea, pneumonia, and neonatal conditions.
Interventions are deceptively simple – a skilled attendant across the continuum of care (antenatal, delivery, postpartum including essential newborn care), immediate and exclusive breastfeeding, full immunisation, and community-based treatment of sick children.
But how to integrate such potentially life saving actions into the local health services, making them more accessible for mothers and babies when they need them, as well as encouraging better child rearing practices in the home will now occupy our thoughts.
It won’t be easy – although the landscape is stunning, I can only imagine what hardships the climate, the terrain, cultural practices, and poverty bring to a child’s ability to survive and thrive here.
As I leave the austere snowy-topped mountains, the turquoise blue rivers with their broad sandy banks, the spinning prayer wheels, and the wonderful smiling faces of the Tibetans, I hope very much that we will find a way to add value to the efforts of the government in our shared goal to sustainably improve the health of Tibetan mums and babies.