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MSF in China, 2001
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Grim Prospects for Health Care in Rural China
The "socialist market economy" that has taken root in China has had strong repercussions on health in rural communities. The cost of medical care has skyrocketed, insurance coverage has plummeted, and many skilled medical workers have fled rural areas for more lucrative work in the cities. Few rural families can afford even basic medical care. MSF focuses its attention on largely rural areas in western China, fighting infectious diseases such as AIDS and tuberculosis, offering medical attention to those families that cannot afford it, and providing cleaner drinking water in some areas.
Difficulties in the health sector are compounded by fear and denial of some sectors of society and certain diseases, such as HIV/AIDS. Estimates of the number of HIV/AIDS cases vary; poor surveillance means that official estimates of 600,000 cases or other estimates of around a million may be too low. Sometimes local officials take pains to conceal the problem, or fail to look into it. However, encouraging signs at the national level include a revised national policy, and some committed officials and activists who are trying to tackle the problem.
In Liangshan prefecture in Sichuan province, MSF reaches out to high-risk groups such as migrants, drug users, and prostitutes in detention centers, detoxification centers, and karaoke bars. Workshops educate health care workers and the general public about the epidemic. MSF has renovated several clinics and laboratories, trained health staff, and provided drugs for treating sexually transmitted diseases (STDs). A smaller, similar project runs in the Kunming area of Yunnan province.
In Nujiang prefecture in Yunnan, MSF has set up a tuberculosis (TB) control program. MSF trains local health staff in the Directly Observed Treatment Short Course (DOTS) protocol for TB treatment. In addition, MSF provides TB medicines and treats people living in remote mountain villages. In Guangxi province, MSF also treats TB and trains health workers. In the same area, general medical aid is given to indigent people. In Xichou county in Yunnan, a hygiene and water and sanitation program targets infectious diseases.
In Shaanxi province, over 200 street children were given food, shelter, medical attention, and education until this program was shut down in late 2000 because of difficulties with Chinese partners. MSF later relaunched the project in cooperation with regional authorities.
MSF has worked since 1993 to combat Kashin Beck Disease (KBD), or Big Bone Disease, in Tibet autonomous region. The disease, whose cause is not well understood, progressively attacks the joints, reducing mobility and causing pain. After several years working to alleviate pain through physiotherapy, MSF began research and preventive activities in 1997, reaching 22 villages. Seventeen other villages also benefit from prevention work, while 50 community clinics still provide physiotherapy. In early 2001, a general water supply program was extended within Tibet, and another water program was set up in Kashgar prefecture in the Xinjiang Uighur autonomous region, where bacteria and chemicals have long contaminated the water supply.
Aid to Refugees From North Korea
Since its departure from North Korea in late 1998 because of lack of access to the population and lack of independence to carry out its programs, MSF has tried to assist North Korean refugees coming into China. In August 2001, MSF expressed its alarm when refugees inside China near the frontier were forcibly repatriated to North Korea. MSF asked the Chinese authorities if it could assist the refugees. By early September 2001, it was still not clear whether the request would be granted. Although work in North Korea itself has been impossible since late 1998, MSF continues to monitor the nutritional crisis in that country.
During the course of the last year, MSF also responded to numerous emergencies in China in and around its ongoing program sites, including floods, village fires, and measles epidemics.
MSF has been working in China since 1988.