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.
Baby and caregiver, Lhoka prefecture, Tibet
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.
Yarlung Tsangpo River in Lhoka Prefecture
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.
Tags: babies, breastfeeding, child health, China, every one, hygiene, immunisation, Shanghai, Tibet
December 7th, 2010 at 9:37 AM
Thanks Barbara. This is fascinating. We have to keep remembering that national averages hide deep inequities between communities and between the poor and rich. It always surprises me that, when exclusive breastfeeding has such clear advantages, why even simple evolution has failed to ensure that it is practiced universally? We know that pernicious advertising of breastmilk substitutes is driving down breastfeeding rates but in your example that does not seem to be the case – it seems a tradition that families have passed on. Haven’t these communities seen for centuries the link between exclusive breastfeeding and healthly children and adults? It would be great to hear why this situation has arisen.
December 10th, 2010 at 3:04 AM
Beautiful imagery, Barbara. Thank you for writing this. Though we strive to have all deliveries in a hospital or birthing facility, this demonstrates that not all policies can be “one size fits all”. Skilled health workers within the community saves the lives of mothers and newborns. They also address harmful behaviors such as giving babies any food or fluid other than breastmilk before 6 months. Keep up the good work!
December 10th, 2010 at 10:11 AM
Some health practices like introduction of food immediately after birth and home deliveries are age old traditions that we need to overcome if we have to make an impact in our humanitarian work. In a typical rural community, from conception to delivery and care of child a young mother will have a traditional birth attendant as the nearest ‘health worker” in her village.Therefore she has all the reasons to belive its right to give food, water, honey and sugar within one hour after delivery. Worth noting is that traditional birth attendants have high acceptance and respect among community members more than health professionals.
I think putting emphasis on training(one year) the birth attendants on skilled delivery and health education will be a more sustainable solution.
April 28th, 2011 at 8:04 AM
Very much enjoyed your article. Thank you!
The challenges you described are similar to those facing ethnic minorities in some of the poorest, most difficult to reach communes and villages along the northern and central border areas of Vietnam. They are problems of equity and quality, they are principally poverty linked. Recalling GOBI FFF… Just curious to know: What is the literacy level of Tibetan women of reproductive age? How is the state of maternal health and nutrition? What’s the fertility rate? Access to clean water and sanitation? What are some of the sociocultural and economic barriers to accessing health services at the prefecture centre. Are there user fees?