User:Surmang

Surmang Foundation

Overview Surmang Foundation is a US nonprofit charity (Friends of Surmang, Inc.) active in Yushu Prefecture, Qinghai Province, China. It has worked in the 97% ethnic Tibetan Yushu region establishing a private clinic in 1992 based on free, efficient, high-quality health care services, treating over 150,000 patients for free in the past 10 years. Its focus is on primary health care and in particular mother and child health due to very high rates of maternal and child mortality and morbidity. Yushu Prefecture is part of a larger catchment of the ultra-poor in China, where 40 million people earn less than ¥1 RMB (US15¢)/day. In the past two years the foundation has worked to export that successful model of rural health care delivery to the public health care system, first in Yushu Prefecture, then to the broader catchment of ultra-poor China, moving it from a one-off project to a sustainable model.

The Region Yushu Prefecture is in Qinghai Province in SW China. It is 188,794 sq.km. (72,894 sq.mi), roughly the size of the US State of Washington, or about half again the size of England. It is a vast area with 500 mountains higher than 5000 m (16,404 ft.). Surmang itself has tributaries of the Dzachu (Tib.) (Lancang Jiang, Chn., Mekong River). It abuts the Tibet Autonomous Region to the south and west, Sichuan Province to the east and Amdo Prefecture to the north. It is the borderland between the high plains/grassland nomadic regions and the lower elevation farming regions. It is a place of few roads and other infrastructure.

It was part of the Tibetan Kingdom until the dissolution of the last central Tibetan dynasty following the assassination of the cruel King Langdarma in the 10th C. Following Langdarma’s demise, regions such as Nanchen and Dege became separate kingdoms. Surmang itself was part of the Kingdom of Nangchen part of the Nyishu Dza Nga (Khampa Tibetan) or the 25 regions under Nangchen and not under the authority of the Central Government of Tibet.

The People It is a very Tibetan place. It is home to 297,000 people 97% of whom are ethnic Khampa Tibetan. It has a low population density region of 1.57/sq.km compared with Beijing’s 1,167.3/sq.km. They are agricultural – mainly nomadic yak herders and farmers, monk, nuns, truck drivers and a few businessmen. Nomads account for more than 50% of the population. Permanent winter quarters are in the villages in the valleys of Surmang (about 4000 m) and in the warmer months they move their tents, livestock and families to traditional high alpine meadow encampments where they raise yak, dri, goats, sheep and horses. It is largely a barter economy. The people there live traditional lives based on their Buddhist faith and their support and connection to regional monasteries. Prior to 1958 the monasteries were major landlords and were supported by sharecropper farmers and nomads. Surmang Dutsi-til is one such monastery. With a history of over 500 years, the Surmang Dutsi-til Monastery has been the seat of its abbots, the lineage of the incarnate Trungpa lineage. Although like the preponderance of Yushu, a Kagyu Monastery, Surmang also included Nyingma and Chöd lineages streams. The Surmang Clinic is located on the land given by monastery of Surmang Dutsi-til. The cooperation between the monastery and the Foundation accounts a part of the success of the clinic, meaning derived from its acceptance among the patients and other stakeholders. In the 20 years since the Surmang Foundation has worked in Qinghai, it has provided free medical care, including medicines, to anyone who uses its services. The pro-active quality of these services, the fact that the doctors are on salary and that medicines are free, has attracted in the past 10 years alone, the Surmang Clinic has had over 150,000 patient visits. Patient catchment is as far away as Chamdo and Nangchen.

The Foundation has developed a rural health care model that is currently (2012) being prototyped for use in the Yushu Prefecture public health system according to an agreement signed with the Yushu Prefecture Public Health Bureau in late 2010. This prototype is significant due to the fact that it represents breaking out of a one-off private clinic to sustainably impact rural public health care delivery.

This prototype is part of a partnership agreement to restore township clinics in Yushu Prefecture that were severely earthquake-damaged in 2010. The hallmark of this model has been local doctors and staff, high access to services, high quality residential training of doctors, close management, and a high degree of buy-in and participation among stakeholders, including monks, farmers, nomads. Its efficacy has been documented by various sources, including a study by Peking University Institute of Population Studies, Dr. Mary Wellhoner in an analysis of the 2005 KAP public health study  and various articles such as the Chicago Tribune  and the Christian Science Monitor. The roll-out of mother and child health care has been through the work of 40 Community Health Workers, local women who are embedded in their farming and nomadic communities. Their participation has helped to make public health a part of this traditional culture and accounts for drawing down maternal mortality to zero in the past two years.

History Surmang Foundation’s founder, Lee Weingrad met exiled Tibetan Lama Chogyam Trungpa in 1970, during Trungpa’s first visit to the US. Until 1959, 11 Trungpas were the abbots of the 13-monastery Surmang group. Although Trungpa often referred to his seat in E. Tibet, he did little to encourage rekindling any connection to those monasteries, or Tibetan politics or culture, and instead urged his students to develop further openness and connection to Western culture.

By 1976 Mao Zidong and Zhou Enlai were both dead. By 1980, Deng Xiaoping became head of the Chinese Government and the period of rule by ideology gave way to a more pragmatic approach of “opening and reform.” In 1981 the monks were allowed to return and restore monasteries destroyed by the Cultural Revolution. In 1983, Lee began to explore the possibility of traveling to Surmang, wondering what remained of this once sacred place. In 1986, he attempted that journey but, despite going overland from Kathmandu to Lhasa, he was unable to make last leg of the trip from Lhasa to Surmang. The route from Central (“U-Tsang”) to E. Tibet (“Kham”) is long and at that time all of the roads were unpaved and subject wash-outs and landslides. In addition to natural obstacles, there were legal one. Truck drivers found with foreigners in their cabs would have their driver’s licenses confiscated. Although 1986 was a kind of legal limbo for individual travelers in Tibet, it was not unusual to hear stories of foreigners traveling without official permits to be stopped, have their passports taken away and put on the next bus to Lhasa. In 1987, he planned a second attempt, this time from Beijing. The trip was delayed, however, by the passing of Trungpa. After the lama’s funeral, Lee went to Beijing to attempt to go to Surmang from the east, via Chengdu, the capital of Sichuan Province. During a month-long stay at the Jinjiang Hotel in Chengdu, he met with Penor Rinpoche, who had recently completed his first post-exile visit to his monastery, Palyul, in far western Sichuan. Rinpoche arranged transportation for Lee from Chengdu to Surmang, and then across the Tibetan Plateau to Lhasa. The trip took 2 ½ weeks, with many surprises including arriving at Surmang Dutsi-til Monastery. In early September 1987, Lee arrived at Surmang. With photos and relics of Trungpa’s cremation, he was met by a throng of smiling and crying faces, who were aware of their abbot’s recent passing. In leaving the monastery a week later, he vowed to return and do something to help these people. On returning to the US, in 1988, Surmang Foundation (Friends of Surmang, Inc.) was incorporated in the US State of Colorado.

In 1990 the Chinese Government Bureau of Minority Affairs invited Lee to come to Beijing to confer regarding philanthropic projects in Yushu. Starting in 1991, foreign volunteer doctors would travel overland to Surmang (5 days!) to hold a free clinic. Those early clinics were held either in a rented house or a tent. In 1992 an agreement was penned and in 1993 construction began of a clinic at Surmang. It was completed in 1996. In 2000 two local Tibetans –Phuntsok Dongdrup and So Drogha-- were hired to be full-time doctors. In 2003 the foundation authorized a participatory rural assessment (PRA), creating a way for local stakeholders to voice their concerns about future plans. In 2004, Surmang Foundation organized a Knowledge, Attitudes and Practices public health survey of over 400 nomadic women. The results were astounding. 3,000/100,000 live birth maternal mortality and 1 in 5 infant mortality. The next year, 2005, began the Community Health Worker project, to roll out mother and child health to the most rural regions. “Friends of Surmang, Inc.,” dba Surmang Foundation, a 501(c)3 EIN 74 2549293