Barbara Bale: reaching sick children in remote rural areas in China

Barbara Bale We are here in a remote mountainous village in Yunnan to understand more about what happens when a baby or young child gets sick. We already know too many die from illnesses that could be prevented or easily treated.

China’s famous “barefoot doctor” system was abolished in 1981 with the end of the commune system of agricultural cooperatives. As often happens, it is now recognised that a primary health care approach is the most efficient and cost-effective way to organise a health system, producing better outcomes, at lower costs, and with higher user satisfaction.

This is a tea growing area among the Wa people whose communities straddle the border of China and Myanmar. Their settlements are on the tops or sides of craggy limestone mountains up deeply rutted muddy roads that challenge even the x4 wheel-drive cars of our partners from the township hospital.

Each main village has a doctor – the legacy of the barefoot doctors of the past – but many outlying villages are a 5-6 hour walk from any source of care if a child is sick. We are visiting these poor and remote communities with Save the Children’s global leaders in community case management – “a strategy to deliver lifesaving curative interventions for common childhood illnesses, in particular where there is little access to facility-based services.”

The main cause of death among young children here is pneumonia, a disease that requires early recognition and treatment. All the mothers we talked to had at some time brought a sick child to the village doctor. Many village doctors have not received any recent training and provide a part-time service while subsistence farming. We listened to them explain what they do if a 6 -month-old baby has a cough and difficulty breathing, revealing they have little idea on how to identify and manage childhood pneumonia correctly.

As we make the slow journey back from each village, we become more and more convinced that in partnership with the local health staff and the communities they serve, we can do something to save young children’s lives in such places, where the impressive overall achievements of China’s health system do not penetrate.

I return to Beijing not only with a few grams of the tea much appreciated by English consumers, but also with a renewed determination to work harder so fewer parents have to endure the heartbreak of losing a child from a preventable or treatable illness.

Barbara Bale is the newborn and child survival director for Save the Children.

Save the Children is the BMJ’s 2010 Christmas charity. In this year’s joint Christmas appeal we’d like to raise at least £30 000, and we are asking you all to help us achieve this target. To make a donation now, follow this link.

This blog also appears on the Save the Children website