By Dr Cesar Chelala
NEW YORK: Recent studies on children’s health in Tibet reveal that almost half of them suffer from malnutrition. As a result, they have stunted growth and potentially defective intellectual development. In spite of the Chinese government insistence on the region’s economic and social progress, Tibet continues to be one of the poorest regions in the world, with a per capita income of less than $100. New public health and social policies are needed to ensure that children won’t continue to be victims of a situation that places them, and their culture, at considerable risk.
In 1996, the Western Consortium for Public Health, a private US-based organisation, had concluded that the height of Tibetan children was a matter of grave concern, and indicated that 60% of the children studied fell drastically below accepted international growth reference values. Their data indicated that children’s shortness was a result of nutritional deficiencies –chronic malnutrition during the first three years of life- rather than the consequence of genetics or altitude, as had been previously suggested.
Chronic malnutrition makes children more vulnerable to diseases common to children in the developing world such as intestinal and respiratory infections, which are frequently fatal. In addition, chronic malnutrition affects children’s neurological and physical development. Although the Chinese authorities proudly claim that they have significantly reduced Tibetan infant mortality rates, those rates are still much higher than the ones for infants in China in its entirety.
The essential findings of the Western Consortium for Public Health were later confirmed by a study carried out by Dr Nancy Harris –an expert on Tibet’s health issues- and researchers from the Public Health Institute in Santa Cruz, California, the University of California at Berkeley, and the Tibet Medical Research Institute in Lhasa.
For over a decade, Dr Harris has spent six months each year in Tibet. She and her partners are bringing basic medical care to more than 8,500 Tibetan children and families, who often live in settlements lacking electricity and basic sanitation.
According to the study conducted on 2,078 Tibetan children up to seven years of age, stunting was linked to malnutrition and was often accompanied by bone and skin disorders, lack of hair’s pigmentation, and other diseases of malnutrition. 67% of the children studied also had rickets, a bone disease most frequently caused by vitamin D deficiency. The study was carried out in children from 11 counties containing more than 50 diverse urban and non-urban communities in the Tibet Autonomous Region (TAR) of China. The children’s health situation is further complicated by poverty and a poorly developed health infrastructure.
In 1993, Dr Harris launched the Tibet Child Nutrition and Collaborative Health Project. Although initially it got financed by Dr Harris herself, since 1994 it has received external funding. Dr Harris and her team are implementing programmes aimed at lowering infant and maternal mortality levels through a health care training and midwifery programme.
Many who were sceptical of the team’s approach to solving health problems now praise its innovative approach to the health emergency situation in Tibet. Dr Harris believes that most of what is needed to improve Tibet’s children health situation already exists in Tibet’s vast array of medicinal plants. In that regard, the collaboration of Tibet’s traditional practitioners has proven to be essential for her program. They, along with the spiritual leaders, are the ones who can lead a community to change their health practices.
To further improve Tibet’s children health and nutritional status, guidelines already successfully used by Dr Harris on a limited children’s population should be followed on a wider scale: a rickets education and prevention programme, encouragement of the use of an indigenous high-protein root called droma, support for traditional Tibetan medicine complemented with allopathic drugs when indicated, and a health care training and delivery programme.
These measures should be complemented by strengthening the infrastructure and access to health services, as well as by policies aimed at reducing poverty and illiteracy. The children of Tibet, for too long the victims of inadequate care and attention, deserve no less.
Dr César Chelala, an international medical consultant based in New York, writes extensively on health and human rights issues. He is the author of Children’s Health in the Americas, a publication of the Pan American Health Organisation.