Team from Hong Kong helps spread awareness in remote rural areas
Volunteers visit Liuzhou city, Guangxi Zhuang autonomous region, to train members of the Dong ethnic group in public health and disaster preparedness. (PHOTO PROVIDED TO CHINA DAILY BY CCOUC)
In a remote village in Southwest China that had been hit by an earthquake six months earlier, Emily Chan Ying-yang saw signs of trouble brewing.
People were profoundly depressed. Their days were spent without electricity or fresh water, while chickens roamed freely through their ramshackle homes.
Chan's efforts in leading a team of volunteers in Ma'anqiao village laid the foundation for what has become an ongoing effort to help prepare people in remote villages for when disaster strikes.
The public health scholar from Hong Kong made her first visit to Ma'anqiao, 120 kilometers from Panzhihua, Sichuan province, in March 2009.
"Unhealthy conditions, with humans and livestock living together, and animal or human waste scattered throughout living areas, heightened health risks in a place that had earlier been struck by disaster," Chan said.
Now assistant dean and professor in the Faculty of Medicine at the Chinese University of Hong Kong, she believes that damage caused in impoverished, disaster-stricken areas can be greatly mitigated through public education.
There is government help, but such assistance mostly comes after disaster strikes. Chan's goal is to carry out risk assessment and preparedness training.
Since she first visited Ma'anqiao, she has led more than 700 volunteer students from Hong Kong universities into risk-prone areas. Their journeys have taken them to outlying villages in nine provinces and to the suburbs of Chongqing.
Each team consisted of 10 to 20 students, with Chan or other instructors taking the lead.
They lived with villagers for a week or two, talked to them, and even played games with them, but the sole objective was to prepare them for disaster. In each case, the teams focused on local health risks, including water contamination.
Chan identifies a common thread running through the disaster-hit areas to which she leads her students. Poverty is inevitably widespread and people live far from medical centers that can provide assistance.
"The sites we select to visit must have been hit by disasters within the previous five years and be located at least five hours from the nearest medical center," she said.
The teams work to help vulnerable communities in rural and remote areas to cope with disaster before outside assistance arrives, she said.
Chan added that 70 percent of the villagers interviewed felt helpless when faced with disaster. Fewer than 5 percent had emergency kits that would help them to prepare for earthquakes, landslides or other disasters. Even simple first aid was the responsibility of village doctors. Locals had no idea how to treat even simple injuries.
"Their awareness of how to rescue themselves needed to be awakened and their proficiency in self-rescue had to be improved," Chan said.
She pointed out that first responses are crucial after a natural disaster. When an earthquake occurs, people need to be educated to stay far from slopes that might collapse, or rivers that could burst their banks. Downed power lines can deliver a fatal shock after a disaster, and people are warned not to try to swim through floodwaters unless there is no other choice.
These basics are communicated through simply illustrated posters, improvised dramas or games.
Chan and her teams also help design simple, inexpensive disaster kits, using materials easily acquired locally.
"We taught villagers to use old T-shirts as bandages to bind a wound," Chan said. Villagers are also shown how to prepare a simple rehydration solution made from salt, sugar and water. This is an effective means of treating dehydration caused by diarrhea. "While we were in Qinghai province, where sugar is not readily available, we taught villagers to use rice water instead," Chan added.
The health promotion program initiated by Chan selected villages where ethnic groups live for field trips. Most were located in remote underdeveloped areas and there was limited information in their native languages.
"There are not many official public health documents specifically formulated for ethnic groups," Chan said.
Over the past decade, the program has helped 12 ethnic groups. They include: the Dai, Dong, Jingpo, Lisu, Miao, Yi and Zhuang in the southwest of the country; Mongolian, Korean and Manchu in the northeast; and Hui and Tibetan in the west.
"The living habits and hygiene conditions differ among ethnic groups, so do health risks," Chan said.
"Among the Yi and Dai groups in the southwest, farm animals are free to enter households, leading to health problems associated with water contamination, such as diarrhea. In the northeast, many ethnic Manchu villagers experience respiratory diseases due to indoor air pollution from cooking fumes."
Chan believes that identifying specific health needs and developing targeted measures to address them are the most effective ways of promoting public awareness of how pre-existing public health risks are exacerbated when disaster strikes remote ethnic villages.
Hong Kong students working on the project arrived with questionnaires for villagers and local doctors, to help assess local needs. The most important questions, beyond living conditions, related to community awareness of infectious and noncommunicable diseases, and which of these are most prevalent in the local area.
Once the findings are evaluated, the team returns for a second visit to hold workshops aimed at eliminating the conditions that contribute to poor health. These range from personal hygiene, care for the environment, waste management, animal care, the handling of poultry, occupational safety and indoor air quality. Special attention is paid to conditions contributing to hypertension and diabetes.
In villages where no Mandarin is spoken, the teams use posters and translators to communicate the dangers of pesticides and their handling, especially the need to keep toxic substances out of children's reach.
In some cases, dramas are performed to remind local audiences to avoid health risks associated with livestock contamination of water sources, and to highlight correct preventive measures.
"All these healthy practices target the local natural environment and the health risks or needs," Chan said. The program, based on what is familiar to villagers, makes them more engaged, and they understand more easily.
In Ma'anqiao, which lies on the Jinsha River, an earthquake and flood-prone area, villagers were taught to assemble disaster preparedness kits. The items they contain are easily made or obtained locally, such as soap, towels, water bottles, flashlights, even whistles that can save victims from yelling for help as they wait to be rescued.
An open ending
Typically, it takes three to four trips to complete a village study over one to three years, including a final visit to evaluate the impact of previous efforts. However, that does not mean all local health issues have been completely resolved.
In January last year, Chan led a team of 15 volunteers to revisit Ma'anqiao, nine years after her first trip.
The village was better off. There was electricity, fresh water and even internet access. Some villagers had become skilled at social media. Most, however, still do not know where to access information related to new, emerging public health concerns, Chan said.
One ongoing concern is for mental health. Traditional family-based rural lives have been broken. Most young and middle-aged villagers work far from home, where wages are higher. Elderly people and children are left behind, feeling lonely and insecure. There is also stress for migrants working in cities.
Chan believes every project is openended. As long as there are healthcare issues, she will keep returning.
She is not alone, having been joined by healthcare workers from the Chinese mainland and even overseas in recent years. These trips have led to a series of training manuals being published on health and disaster preparedness in rural areas.
Kevin Hung Kei-ching, assistant professor of emergency medicine at CUHK and a team leader and veteran of more than 30 field trips, said:" We introduce the basics. It is like sowing seeds and letting them germinate by themselves.
"You can't expect the standards of public health in these remote ethnic villages to improve significantly just on the basis of one or two field trips," said Hung, who is also an accident and emergency doctor for the Hospital Authority in Hong Kong.
"It takes the whole community to work together to improve public health levels," Hung added.
The work has its own rewards when all the efforts pay off. Last year, during Chan's latest visit to Ma'anqiao, team members cheered when locals displayed their disaster-preparedness kits, showing that they had been maintained for all these years.
The Ethnic Minority Health Project initiated by Chan led to the founding of the Collaborating Centre of Oxford University and CUHK for Disaster and Medical Humanitarian Response, or CCOUC.
Chan has served as CCOUC director since its founding in 2011. Her disaster relief initiative has become a flagship program and paved the way for her efforts to build the emerging discipline of humanitarian medicine in the Greater China area.
The project offers field experience for Hong Kong university students. These efforts have paid off in another way, with the program being awarded second prize in the 2018 National Teaching Achievement Awards (Higher Education). The Ministry of Education cited the creative ways for teaching and learning that have evolved through the program.
"Some 700 students, most of them from Hong Kong, have participated in the project since it was inaugurated," Chan said.
Before going on field trips, students have to map out logistics for the project, including special attention to the physical, cultural and ethnical issues in the areas they are visiting.
On site, they learn crowd control, venue management and event scheduling. Workshops are usually attended by more than 100 villagers.
Evan Shang Su-wei, an undergraduate in medicine at CUHK, said, "I improved my clinical communication skills."
He said the experience taught him to be tactful and ask questions about local health habits in a sensitive manner. He added that recording villagers' medical histories also helped during his internships. Shang has been on field trips to Jilin, Sichuan and Yunnan provinces.
Carol Wong Ka-po found that the fieldwork made her more determined than ever to pursue a career in public health.
"There are a lot of transitional problems in rural China. I learned to understand people's behavior and reasoning before evaluating their needs and how to address them," said Wong, now a program manager at CCOUC.
Among the so-called empty-nest elderly people she met on the field trips, some said they were willing to go to senior care homes to avoid being a burden on their children.
As time passes, new concerns arise. Suicides have been reported among the elderly population, and Wong believes that aging is a new public health concern that the program must address.
HONG KONG NEWS