By KaWing Cho – Columbia University – 2012 APAMSA Global Health Fellow
Over the last year, I’ve had the opportunity to work in China conducting research targeting the growing chronic diseases situation in China. Although China is still a developing country, albeit behind the reins of a galloping economy, the disease composition that the country currently faces is remarkably similar to that of a developed one with a majority of morbidity and mortality due to chronic diseases like heart disease, lung disease, and cancer. Working at the George Institute for Global Health in Beijing, China, I have been able to take part in a project aiming to reduce cardiovascular disease risk in resource-poor areas where such diseases are becoming increasingly prevalent, like Tibet, China. The project hopes to evaluate whether adapting a simplified cardiovascular management plan for use among Tibetan village doctors, who normally have a low level of medical education and access to limited medical resources, is feasible and can lead to risk reduction in cardiovascular high risk patients in these areas.
As a member of this project team, I worked to develop health education materials for use by the village doctors, specifically targeting modifiable lifestyle risks, and monitored how the village doctors followed up with their high-risk patients according to the simplified management plan. Although most of my work occurred behind a desk at the Beijing office, I was able to visit Tibet sometime in the middle of the intervention to validate the project’s blood pressure monitor at Tibet’s high altitude (average altitude above 4000 meters) and help monitor the baseline survey for a new county that was being added to the study. From first stepping foot within the walls of the village town hall and seeing the over one hundred Tibetan villagers sitting on the ground waiting for us to start the screening to drinking a cup of home-made Tibetan butter tea, I was finally able to put faces to the research that had traveled over 1000 miles (from Beijing to Tibet) to reach.
During the baseline survey, I was able to see a side of Tibet and its villagers that I did not quite expect. First, the villages we visited were all remarkably similar, a grouping of plain two to three story houses across a large expanse of packed earth surrounded by nothing else but mountains, flat land, and sky lending a quietness and reclusiveness one would be hard pressed to find anywhere else. What was interesting to see at each of these otherwise simple villages, was the guaranteed presence of a religious pagoda with usually at least one villager walking along its side spinning the numerous prayer wheels around the pagoda’s walls. Most, if not all the villagers were religious and during the screening many could be seen manipulating their Tibetan Buddhism prayer beads or portable prayer wheels as they waited or were being interviewed by our screening staff. How much this piety influenced what I discovered next, I cannot be sure, but I was pleasantly surprised at how patient and calm all the villagers were. Despite the limited staff and relatively long screening process, all the villagers who attended would patiently wait their turn, even creating lines on their own accord. At one point, a group of women formed a snug line with each woman tenderly placing their hands over the preceding one’s shoulders. Having lived in Beijing where tussling for a spot in so called “lines” and games of “chicken” between drivers and pedestrians is not uncommon, it was refreshing to see a completely different attitude during my visit to these villages.
Although the villagers only spoke Tibetan, and so I had no way of verbally communicating with them, it is hard to forget the big toothy smiles and other signs of appreciation I would receive for doing nothing more than just measuring their blood pressures. My visit to Tibet was only a short part of my overall stay in China, but it has played a major role in deepening my understanding and appreciation of the research I have been thankful to be a part of.
Tibetan village in the distance
Village pagoda with prayer wheels along the outside wall
Villagers waiting to be screened