Family Planning

In 1980 the One Child Policy (originally the One-Is-Enough campaign) was enforced and embraced. While the Chinese Government claims that it has slowed the population growth, its success in terms of of broader impacts has been hotly debated outside the country. Issues of infanticide, female orphans and gender imbalance are common knowledge, as are negative attitudes towards daughters. What is arising now, however, are a whole range of more subtle social changes.

Chinese children are often referred to as 'Little Emperors' (China Today, August 2005: 56) and with good reason. As a rule, their grandparents take care of them while their parents are out at work and there are usually 6 adults to one child, per household. In such circumstances it is easy for them to become spoilt. An infant is constantly with his or her parents. It sleeps and eats with them and when not asleep, is tied to its mother's or grandmother's back in a sling. A mother feeds her infant every time it cries (day or night) and chronically fatigued parents have said to us on occasion,"well you know, we can only have one child...".

According to China Today 32% of Chinese school children experience some kind of psychological problems as far more importance is placed on scholastic performance than a happy state of mind or good health. (There is also pressure on schools to rate hihgly in the 'league tables' (so teachers aren't punished) which means that children attend school from 7am to 10 pm.) Medical specialists say that the psychological problems stem from pressure exerted by parents, school, peers and society as a whole.

The Chinese Government announced early in 2006 that the One-Child Policy would be maintained in China. The exemptions to this include the self-employed (such as farmers), members of 'official' minority groups and certain other people living in rural areas (can't be more specific about that at the moment). Interestingly, during a recent homework exercise I asked students to write about what they would do if they were president of China. Many stated that they would ban childbirth altogether.

If a couple do have a second child the consequences are a fine and loss of job, if one works within a Dan Wei (Work Unit). This means loss of income, accommodation, status and further employment prospects. For the wealthy and/or self-employed the consequences are less significant.

So, how do Chinese couples manage to comply? Abstinence, sterilisation or other means of contraception? I have yet to find out although this may not be the easiest topic to broach. I'll let you know when I have more information!

Sexual Health, HIV & AIDS

Gonorrhoea and syphilis are the most common sexually transmitted diseases found in Yunnan. The number of these cases are increasing rapidly in Yunnan.

The greatest concern to the Government at the moment, however, is HIV and AIDS. 27% (28, 391 people) of China's reported HIV cases are in Yunnan Province. The high rates of transmission in Yunnan are thought to be a result of the geographical location and the transient population. Yunnan shares a total of 4060 kilometres of border with Myanmar (Burma), India, Laos and Vietnam. It's proximity to South East Asia and location within the 'Golden Triangle' have led to high rates of prostitution and drug use. In 51 % of reported HIV cases the source of transmission is said to be drug use (sharing needles). In 27.2 % of cases the source of transmission was said to be sexual intercourse and over 20 % are for unknown reasons (the above reasons not discounted). In 2004 0.4 % of pregnant women tested were found to be HIV+ (4 in every 1,000)

Many organisations and charities (some supported by the International Red Cross) are tackling HIV and AIDS education, counselling and family support through community based projects. The main challenges involve:

 Reducing the stigma associated with HIV and AIDS

 Breaking the taboos around sex

 Educating people about condom use

 Accessing marginalised groups (drug users, sex workers)

As well as supporting community-based projects the Government has changed certain policies to allow progress in tackling the above problems. For instance, it is no longer illegal to carry a condom. Hotels can now provide them in rooms and sex workers will not be charged if they are found in possession of a condom. Community-based are also allowed to supply clean needles and there are more hospitals open to provide confidential HIV tests and follow-on care.

Simao Teachers' College is establishing itself as a center of information, guidance and support on sexual health matters, particularly HIV and AIDS. So far this has involved comprehensive lectures and peer led workshops regarding sex, contraception and sexually transmitted diseases.

Malaria

'When did you start your tricks, Monsieur?.... I know your game now, streaky Sorceror.'   

From 'The Mosquito' by D.H.Lawrence

When we were back in Scotland, trying to decide between a VSO placement in either Ningxia or Yunnan, the main question we had to ask was: 'What are the risks of catching malaria in south Yunnan'. It was a question that wasn't fully answered until we got here, but in the run-up to leaving it caused the expenditure of a lot of nervous energy! 'There hasn't been any malaria in Simao for 30 years' we were told...and now we're here we don't take any form of malaria prophylaxis (we did when we visited Laos), but we do take great care to avoid being bitten by mosquitoes as much as possible: insect sprays, long-sleeves and trousers after dusk, and mosquito nets over our beds.

There's a local (and fairly ancient) proverb in this part of China which warns: 'If you plan on going to Simao, you'd better marry off your wife first'. What exactly this means I'm not sure, but I didn't mention it to Lesley before we left for this 'Land of Lethal Vapours', as Simao used to be known! However, since the formation of the PRC in 1949 China has considerably reduced the incidence of malaria epidemics to the point where, in Yunnan, the only risk is in sparsely populated border areas in Mengla and Menglian Counties and in the low lying river valley of the Yuan Jiang (Red River).

During 1991-1995 the incidence rates of malaria in Yunnan were 5 to 10 times higher than the figure for China as a whole and malaria was the second or third cause of morbidity of communicable disease in the province. The problems of dealing with malaria are numerous - multi-drug resistance is common and the disease is often found in the mobile populations of migrant workers who inhabit the border regions (Myanmar, Laos). Health education of these ethnic minority groups is one area where resources are being focused.

Two million people die from malaria every year, mostly children in Sub-Saharan Africa. But did you know that 10,000 people bring it back to Europe from their foreign travels every year? Malaria is a disease of the blood caused by single-celled organism called plasmodium, a parasite found in the saliva of one species of mosquito. There are 4 types of Plasmodium, but only one (P.falciparum) is dangerous (malignant). The parasite is transferred from mosquito to human in the saliva of the biting insect.

Altitude Sickness

Acute Mountain Sickness and Treatment

An altitude over 3,000 meters (9,843 feet) is usually defined as high altitude. Since most places in Tibet are higher than this level, Acute Mountain Sickness (AMS), also called Altitude Sickness is the biggest health risk to tourists in Tibet. AMS is common at high altitudes due to the decreasing availability of oxygen. Most people will experience differing degrees of symptoms at high elevation. The occurrence of AMS is dependent on the altitude, the ascent rate and individual physical condition. Symptoms of AMS include headache, nausea, dizziness, fatigue, shortness of breath, loss of appetite and disturbed sleep. Most people will experience one or more AMS symptoms upon their arrival in Tibet. The symptoms will usually gradually decrease in severity during acclimatization. Mild AMS usually will not interfere with mild activity.

However AMS can be very serious, with the most serious symptoms being High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE), which can be fatal. Symptoms of HAPE include weakness, shortness of breath, even at rest, impending suffocation at night, and a persistent productive cough with white, watery, or frothy fluid. Symptoms of HPCE may include headache, ataxia, weakness, hallucinations, psychotic behavior, coma and loss of memory. Both approach and strike at night and can be fatal! Immediate descent is the surest treatment.

Before visiting Tibet, get as fit and healthy as possible, both physically and psychologically. Visitors having record of heart, lung, other organ problems or anemia should consult their doctor before making the decision to visit Tibet.

AMS can be lessened or avoided with proper acclimatization, which will also ease and reduce AMS symptoms. A gradual ascent will allow your body to acclimatize to higher altitudes and the decreased oxygen supply. Go no higher 300 - 400 hundred meters (984 - 1,312 feet) daily and have a rest after each 1,000 meter (3280 feet) ascent. Medication also helps to prevent AMS. Mild AMS symptoms can be treated with proper medication. If medication does not relieve the symptoms, go to hospital or evacuate immediately to safe altitude!

The following precautions may help to prevent or lessen the effects of AMS:

1.       Since fluid loss usually accompanies the acclimatization process, drink plenty of fluids (3 - 4 litres daily at least) and eat carbohydrate food to keep the body properly hydrated;

2.       Do not over exert and only partake in light activity immediate after your arrival;

3.       Don't smoke, drink alcohol or take other depressants such as tranquilizers and sleeping pills. These will depress the respiratory drive and limit oxygen intake. Always keep in mind the following rules which will ensure a smooth and enjoyable trip to Tibet:

4.       Any sickness at high altitude is AMS until proven otherwise; · Never go higher with symptoms of AMS;

5.       It is significant that you report any symptoms of AMS immediately to other group members in the trip.