Reports

Build a village health clinic, provide a clean and comfortable environment for patients, basic medical equipment such as patient beds, Tibetan medicine and Chinese and Western medicine.

Shem’s private donors funded this project

Lhamotso is from Gonghe County, Hainan Prefecture, Qinghai Province, and China. She graduated with an associated degree in English from the Qinghai Normal University Nationalities Department’s English Training Program in 2005. She is currently working in Shem Women’s Group as one of development program directors and financial officer.

What? To build two rooms, purchase 22 kinds of western and Chinese medicine and 81 kinds of Tibetan medicine, one big bottle of oxygen, an oxygen bag, Injecting Rack, TDP medical equipment, Blood bank meter, Sphygmomanometer and Disposable Medical Equipments.

Who? Huoluoshi Gongma clinic, Huoluoshi Gongma Village, Tiegai Township, Gonghe County, Hainan Tibetan Autonomous Prefecture, Qinghai Province, China.

Photos of Project Implementation

The local villagers are displaying the cinderblocks and tiles from the hand tractor and truck.

The skilled worker is ruling the foundation of the rooms with a very tiny white line.

The villagers are busy to help the skilled worker to fetch water, gather sand and stone.

The school students are helping to pass the red bricks to the skilled workers after their school is over.

This man is mixing the cement, sand and stone for making the wall smooth and nice.

Above two photos are showing that the villagers are constructing the roof of the two new rooms.

The doctor is writing receipt for receiving the second installment of project money from the project manager, Lhamotso.

The five bags of lime are being soaked in the water for several days before it is used for wall.

The doctor with a blue box on his back is watering the wall in order to make the wall nicer with white lime.

This man is the main skilled worker and he is making the floor smooth.

The local villagers are putting enclosed windows in front of the new rooms.

The material for ceiling and floor are bought before it is used and those materials are kept in Huoluoshi Gongma Village public room.

After bought partial Tibetan medicine at Pende Tibetan hospital in Xining city, the seller with glasses is counting money.

This photo is showing the different kinds of medicine are displaying on the medical closet at the new village clinic.

The new medical containers with Tibetan medicine are displaying tidily on medical closet.

 
This is man’s knees got serious illness and he is taking treatment by the new medical equipment from this project.

Project Summary

Project Title: Build a Health Clinic for Huoluoshi Gongma Village

Project Goal: The immediate goal of the project is to build a village health clinic, provide a clean and comfortable environment for patients, basic medical equipment such as patient beds, Tibetan medicine, Chinese medicine and Western medicine.

Location of the project: This project is located in Huoluoshi Gongma Village, Tiegai Township, Gonghe County, Hainan Prefecture, and Qinghai Province in China. Huoluoshi Gongma Village is in the southeastern part of Gonghe County, and it is approximately 170 miles from the provincial capital, Xining.

Total beneficiaries: About 1,125 people in Huoluoshi Gongma Village directly benefit from this project. Also, people from surrounding villages including other Tibetans, Han and Hui people will also get benefit

 Implementation organization/individual: Project manager Lhamotso, Rega Village’s villagers, the village clinic doctor Yeshitsangbo and Shem Women’s Group.

Contact Group: Shem Women’s Group

Funds received: Source, Amount, and Date received
Shem Women’s Group gave 58,660RMB to the project manager Lhamotso on April 30^th 2008

Details of project activities
originally planned project activities
1 Talked to the villagers about what they needed and found the solution, which is to build a village clinic.

2 Talked to the skilled workers.

3 Discussed the price of logs with individual villagers in Longzhang Village and decided on a price for each log.

4 The village doctor talked to Zhuoma Medical Factory in Xining in December 2006 about the price of medicine. He has purchased medicine from this factory before.

5 Wrote and completed the proposal.

6 Secure funding from donor organization.

7 Local people begin to collect the stones from nearby the village and sand from Gonghe County.

8 Buy building materials such as red brick, cement, and steel door and so on from Gonghe County with the village leader and the skilled workers in order to ensure the quality of the materials.

9 Transport the logs from Longzhang Village

10 Build the village clinic

11 Evaluate the clinic

12 Purchase the patient beds and closet for storing the medicine

13 Purchase the Tibetan medicine from Zhuoma Medical Factory in Xining, Hainan Tibetan Medical Factory, and the township Health Center in Tiegai Township. Purchase the bottles for storing the Tibetan medicine in Xining City

14 Take pictures

15 Interview the local people (men and women).

16 Interview the village leaders.

17 Write final report.

18 Send final report with pictures and receipts.

Activities realized in the framework of the project

1)  In 30^th April 2008, Shem Women’s Group informed to support the village clinic project for Huluoshi Gongma village.

2)  On May 1^st the project manager Lhamotso gave first installment project money to the main responsible man doctor Yeshitsangbo.

3)  The cement is transported to the village

4)  Sand and stone are transported to the village

5)  The bricks and the log are transported to the village

6)  Started to build the rooms

7)  Built the foundation and the walls of the two rooms

8)  Fixed the windows and doors

9)  The steels for windows are transported and wielded in.

10) Install the windows on the wall

11) Install the Medical closets in the new rooms

12) Purchased Western and Chinese medicine at Fukang medical chain store in Gonghe County.

13) Purchased Tibetan medicine at Pande Tibetan hospital in Xining city, Henan Tibetan hospital in Henan Mongolia Autonomous County in Huangnan Tibetan Autonomous Prefecture and Hainan Tibetan Medical Research Center in Gonghe County, Hainan Prefecture.

14) Purchased the basic medical equipments in Qinghai Huatai medical company in Xining city, Qinghai Province.

15) Purchased one bottle of oxygen at Fukang medical chain store in Gonghe County.

16) Put all the medicine in the rooms

17) Started to open the clinic and give medicine freely for the villagers for one week

18) Interviewed the local beneficiaries of this project

19) Start to write the final report

20) Send the report with photos and interviews to the donor.

Project Finances

Original Budget						Actual Budget
Rec eipt	Item	Donor Cont ribut ion in rmb	Local Cont ribut ion in rmb	Shem Cont ribut ion in rmb	Total in rmb	Donor Cont ribut ion in rmb	Local Cont ribut ion in rmb	Shem Cont ribut ion in rmb	total in rmb	Differ ence (Betw een or iginal and ac tual budg ets) in rmb
#1	Red brick	16,0 00	0	0	16,0 00	8,55 0	0	0	8,55 0	+7,4 50(1)
#2	Ton of cement (transp ortation included)	3,50 0	0	0	3,50 0	2,40 0	0	0	2,40 0	+1,1 00(1)
#2	Roller bamboo (transpo rtation included)	1,20 0	0	0	1,20 0	600	0	0	600	+60 0(1)
#3	Steel window and steel door (trans porta tion includ ed)	900	0	0	900	3,89 0	0	0	3,89 0	-2,9 90(2)
#4	Log (trans porta tion includ ed)	4,50 0	0	0	4,50 0	2,52 0	0	0	2,52 0	+1,9 80(1)
#5	Ceiling/ square meter (trans porta tion includ ed)	1,60 0	0	0	1,60 0	1,00 8	0	0	1,00 8	+59 2(1)
#6	Tile (transp ortation includ ed)	1,05 0	0	0	1,05 0	1,32 0	0	0	1,32 0	-270 (2)
#7	Lime/ bag (transp ortation includ ed)	400	0	0	400	180	0	0	180	+22 0(1)
#8	Carpen ter fee/ room	800	0	0	800	440	0	0	440	+36 0 (1)
#9	Set up electr icity	1,50 0	0	0	1,50 0	250. 6	0	0	250. 6	+1,24 9.4(3)
#10	Floor 60×60, Floor 14×28	0	0	0	0	1,50 8	0	0	1,50 8	-1,50 8(4)
#11	Gang chuan	0	0	0	0	1,18 6	0	0	1,18 6	-1,18 6(4)
# 12	Tibetan Medic ine	17,7 81	0	0	17,7 81	17,4 88	0	0	17,4 88	+293
#13	West ern and Chinese medic ine	9,42 9	0	0	9,42 9	9,89 5	0	0	9,89 5	-466
# 14	One bottle of oxy gen	0	0	0	0	1,26 0	0	0	1,26 0	-1,26 0(5)
# 15	Medical Equip ments	0	0	0	0	1,82 3	0	0	1,82 3	-1,82 3(5)
	Two rooms	0	0	0	0	0	30,0 00	0	30,0 00	-30,0 00(6)
	Sand/ tractor	0	1,20 0	0	1,20 0	0	840	0	840	+360
	Stone/ tractor	0	1,20 0	0	1,20 0	0	1,32 0	0	1,32 0	-120
	Day labor/ person/ day	0	14,1 75	0	14,1 75	0	7,81 5	0	7,81 5	+6,36 0
	Skilled workers	0	3,15 0	0	3,15 0	0	3,15 0	0	3,15 0	0
	Earth brick	0	1,00 0	0	1,00 0	0	810	0	810	+190
	Medical closet	0	1,40 0	0	1,40 0	0	1,40 0	0	1,40 0	0
	Chair	0	280	0	280	0	280	0	280	0
	Balcony	0	240	0	240	0	240	0	240	0
	Desks	0	300	0	300	0	300	0	300	0
	Patient beds	0	500	0	500	0	500	0	500	0
	Technical containers for keeping medi cine	0	480	0	480	0	314	0	314	+166
	Manage ment expen ses	0	200	0	200	0	400	0	400	-200 (7)
	Manage ment pay ment	0	0	500	500	0	0	500	500	0
	Total	58,6 60	24,1 25	500	83,2 85	54,3 18.6	47,3 69	500	102, 187.6	-18,9 02.6 (8)

Notes:
(1) According to the original project proposal, four rooms will be built as the village clinic but later the local government provided two new rooms for this project therefore all these materials needed for building the rooms reduced as well as money becom less compared to the planned budget.

(2)Compared to last year’s materials’ price, this year everything’s price increases a lot.

(3) According to the original project proposal, the village clinic will be built in the center of the village, besides the main transportation road. It is little bit
far to set electricity, but now the village clinic is built in the Village Public House and it is very cheap to set electricity because it only needs very tiny wire.

(4) According to the original project proposal, we just planned to build very simple rooms but later the government contributes two rooms with nice floor and Gangchuang. If we build rooms with no floor and Gangchuan then the rooms are not matched therefore we bought floor and Gangchuan which are not in the original budget.

(5)The local government contributes two new rooms therefore they requested project manager to purchase some disposable medical equipment and common and useful tools for village clinic.

(6) The local government contributes two new rooms (they contributed the money for building two rooms) for village clinic.

7) The local paid extra 200rmb for project management expenses.

(8) The original total project cost is 83,285 and the actual total cost is 102,187.6, which means that we still need 18902.6 rmb, so the villagers contributed extra local contribution of 23244rmb to this project and we got 4341.4 (23244 -18902.6=4341.4)rmb left from donor contribution.

Delays, difficulties and lesson learned
Delays
According to the original project proposal, the project should be finished with in 57 days, and specifically this project is to build four new rooms and buy medicine. However the project reduces the number of the rooms into two rooms. According to the common sense the project does not need 57 days to complete. Differently the project spent two months to completely finish there are three reasons for that: 1)The local villagers went out to dig caterpillar fungus and do construction work out side while the project was funded, therefore it is difficult to find the skilled workers and labors; 2)When the project was in the process of implementing, the whole township was busy of constructing the concrete road which is a road project supported by the government, again the villagers had to participate and contribute labor. And the project constantly stopped on the way; 3) the doctor was busy with health training in Gonghe
County and exam in Xining city, and the medicines cannot be bought immediately after the rooms were built because other people do not know about
what medicine they should buy. All above three reasons led this project spends two months to complete.

Difficulties
Since I have done construction project before, I have not met lots difficulties during implementing the project. And some problems and difficulties just happened as I predicted when the project funded. Firstly it is difficult for me as a project manager to go see and supervise the project every week since I am working in Xining city which is about 150 km away from the project site, therefore I tried my best to go to the project location once in two weeks. Secondly lack of labors made me very worried since time goes day by day and the project is still in the same process for several days. Therefore I demanded the main person who is charging the whole project to finish the whole project by certain date. Otherwise the project can not finish even in three months.

Lesson learned
As a project manager, it is better to openly talk to the villagers and should be demandable and decisive no matter you know the villagers very well or the villagers who are charging the project are your relatives. We should make very clear that you can not mix the project with the personal business because the project is for the entire village not for a person or a group of people. One more thing, it is smart action to see whether the most villagers are at home, otherwise it is hard to finish the project on time especially the construction project. If your project can not finish on time as you planned by some reasons it is better to give a deadline.   

Interviews
Here are interviews with some of the villagers who are the beneficiaries of this project


On 12^th of July 2008, the project manager; Lhamotso interviewed one of the project beneficiaries whose name is Tsering. He is 67 years old and there are six people in his family. His only son has attended primary school when he was young but later the son dropped out from school for herding livestock. Now fortunately, his two grandsons are attending in Township Primary school and County middle school. He thought sending children to school was very significant and a wise decision as an example it is hard to find jobs and works in the restaurants and construction fields if you do not have some knowledge. As well as he mentioned that he was a doctor in Huoluoshi Gongma Village, but recent years he got serious sickness therefore he could not treat people. Now he is taking injection in the brand new village clinic with beads in his hands. According to him, he has been taking injection at the new village clinic for two days on July 11^th 2008 his knees got treatment by the new heating tool from this project called TDP. By finishing the interview with him, he thanked a lot to the people who helped this village to have village clinic with good condition and better treatment.

On 12^th of July 2008, his name is Qihailing and he is a Han Chinese. He is from Guiden County and he is doing construction work like building concrete road at different villages in Tiegai Township. He told me that he has already worked for building roads in this place for almost three months. Recently he got serious cold while he was building the roads and it was getting worse day by day therefore he got this new village clinic to get treatment. He mentioned that one of his relatives in Huoluoshi Xuema Village told him that this village clinic was close and you did not need to pay the registration fee. As a result he chose the village clinic to get treatment as well as at the Township Health Center there were no doctors at the weekends.

 

On 12^th of July 2008, her name is Songmingfeng and she is 19 years old. She just took high school entrance exam. And now she was waiting for the score of high school entrance exam. She is a patient at the new village clinic because she got scrofula one year ago. Her family thought it was no problem and did not go to the hospital to see the doctor. Gradually her sickness becomes serious then she went to Hainan Prefectural Hospital for only checking. She is taking injection at the village clinic because her family’s living condition is poor and you need to pay treatment fee right after you take injection or medicine at the big hospitals. But at the village clinic you can owe treatment fee for sometimes because everybody knows each other well.

On 13th of July 2008, I interviewed one village women from Huoluoshi Gongma Village. Her name is Gasangtso and she is 34 years old. She is originally from Lazi village which is 15km away from this village and she came to Huoluoshi Gongma Village 15 years ago. She came to the village clinic for repaying the treatment fee 25rmb from last year. She could not pay the treatment fee because due to the poor condition of her family. She mentioned the same thing that you don’t need to pay money right after the treatment which was very helpful for her and it was easy for her to communicate with the doctor about her requirements because the doctor who speaks the same Tibetan dialect as her from Huoluoshi Gongma Village.

Letter of appreciation 
1) Thank you letter from Huoluoshi Gongma Village Committee

Dear Shem Women’s Group,
The village clinic has completely finished building on June 26^th 2008 and right after the completion of the clinic it has started to treat the local villagers. By building the clinic for the villagers, it provides a great convenience to the villagers; bring better condition for the village clinic and the villagers have access to get treatment when they get sick. I as the village leader of Huoluoshi Gongma, present all the villagers to thank Shem Women’s Group’s great help to this project.

Many thanks,

Huoluoshi Gongma Village
July 13^th 2008

 2) Thank you letter from the village clinic doctor

Dear Shem Women’s’ Group,
Huoluoshi Gongma Village is an agricultural village and the village is composed by around 900 people. Before this project, Huoluoshi Gongma Village’s
health condition is very poor. The project manager, who is from Huoluoshi Xuema Village helped this project with financial support, all the villagers are very supportive towards this project and all the villagers from Huoluoshi Gongma Village helped to carry stone and transport sand for building the village clinic. Now the project is completed with different kinds of Tibetan and western medicine, and some disposable, simple and helpful medical equipments. As a doctor of this clinic, I represent all the villagers to say thank you for your help and all the people in Shem Women’s Group.
Finally, I wish all your work is going well and everything that you are doing and will do will have positive result.

Yeshitsangbo
July 13^th 2008

Receipts
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#4

#5

#6

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#8

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#10

#11

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#14

#15

Original Proposal

Project location
This project will be located in Huoluoshi Gongma Village, Tiegai Township, Gonghe County, Hainan Prefecture, Qinghai Province. Huoluoshi Gongma Village is in the southeastern part of Gonghe County, and it is approximately 170 miles from the provincial capital, Xining, P.R.C.

Background
Huoluoshi Gongma Village is historically an agricultural village. The village used to be located opposite of Longyangxia Town, but during 1987 and 1988, the village migrated to the Mahantai area because the government planned to build a hydroelectric station on the village’s land. Therefore the village had to move.

Population
In Huoluoshi Gongma Village, 65% of residents are Tibetan and 35% are Han. There are 227 households consisting of 1,125 residents in the target village. There are 435 women, 390 men, and 300 children.

Education
In total, there are approximately 247 school-aged children. Of these, 172 are currently attending school: 74 are in primary school (43 male students and 31 female students), 52 are in middle school (31 male students and 21 female students), 37 are in high school (19 male students and 18 female students), and nine are in college, (six female students and three male students).
A number of children have attended primary school and dropped out of the system after because their families could not afford to pay the expensive middle school tuition fees. The primary school’s tuition was about 60rmb and the middle school’s tuition was more than 500rmb per year. Since many students end up dropping out, currently there are only nine college students from Huoluoshi Gongma Village. Generally, most villagers who are older than 30 years of age have not attended primary school.

Cash income
Many families in Huoluoshi Gongma Village try to earn money as migrant construction workers or dig for caterpillar fungus every spring in other places as far as 200 kilometers away. Generally, the price they get for large, good quality caterpillar fungus is 8 or 10rmb and 5 or 6rmb for smaller caterpillar fungus. There are not many other opportunities to earn cash income. Recently, to protect the ecological balance, a new law was passed that forbids people to dig for caterpillar fungus. Still, the villagers secretly dig for caterpillar fungus in spring and they can earn about 2,000rmb over one month after paying a 500rmb tax for use of the pastureland. Construction workers are often cheated out of their pay: the construction manager promises to pay the workers one month after they finish construction, but when they go to collect their wages, the construction manager cannot be found, and they end up getting paid absolutely nothing for their work. However, some villagers can earn 700-800rmb in one month by doing construction work if they are not cheated. As a result, the average income per family per year is about 2,000rmb; household expenses run about 1,500rmb per year for purchasing tea, salt and other daily necessities, fertilizer and clothes. People spend about 900rmb per year buying fertilizer in the form of urea and amino acids. Each 100g bag of urea is 95rmb and each 100g bag of amino acid is 150rmb. In addition, school fees cost an average of 1,000rmb per semester. At this point almost all the families have to take out loans because they need to buy fertilizer and support their children’s education. When the loans are due, many villagers are busy borrowing money from relatives and friends because they have no money to pay back the loans. Also, some families have to buy flour at the end of the year because their fields do not produce enough food.

Agriculture
Local people usually grow wheat, potatoes, beans and rapeseed. Generally, the climate in Huoluoshi Gongma is not bad. Barring natural disasters, it may be possible to have a very fruitful harvest each year. However, there is a serious problem with the farmlands, which makes it nearly impossible to have a good harvest. Forty percent of the fields are covered with stones and sand and therefore cannot be used. In addition, the irrigation water is hard to access and use because water is pumped by electricity from a place that is located about 7 or 8km from the village. The water pump is of inferior quality, and almost never works, so the fields can be irrigated only two or three times every year. Finally, the amount of land that each person owns is not sufficient to produce any substantial harvest. Each person only has 1.7 mu of farmland. All of the above problems result in very poor harvests. Usually, 1 mu of land can only produce between 300 and 400 jin of wheat.
As a result, some families do not produce enough food even for self-consumption, and they must buy wheat, barley, and vegetables from outside. Since Huoluoshi Gongma Village is an agricultural village, the villagers’ mostly eat flour based foods (made from the wheat they grow in the field) and vegetables (some vegetables are grown for self consumption such as carrots, and onions, but most vegetables are bought from Gonghe County). People seldom eat meat because they have to buy it. They only eat meat (pork) during festivals. Local villagers mostly eat only one kind of vegetable, the potato, during the year.

Herding
Most households do not have livestock such as cows, sheep, goats, donkeys or horses. Only a few households have small numbers of sheep, goats and cows. Forty-six families in the village own livestock: sheep total 107, cows total 23, and goats total 345. The villagers usually do not sell their livestock, but use them to produce milk and meat. If the villagers need money to pay their children’s school tuition or people get a serious illness, they will sell livestock to raise cash.

Basic information about the clinic and the doctor

This is the doctor, Yeshitsangbo, in his private clinic.

Yeshitsangbo is Huoluoshi Gongma villager and is the only village doctor in Huoluoshi Gongma Village. Now he is forty years old and as a village doctor he has never studied at any regular medical school, such as Qinghai Medical School. He has studied medicine from his father because his father was a very well known local doctor in all of Tiegai Township. Moreover, Yeshitsangbo has learned medicine by taking part in short medical trainings. He started studying and seeing patients when he was 18 years old. He is trained in Tibetan and Western medicine.

Yeshitsangbo wrote several applications to register his clinic as a formal one and finally on May 27^th, 2004, he opened a very small private clinic beside his house as a private clinic and he has registered the clinic at the local village level. He built the two rooms and purchased all the medicine by himself without help from the local government. Each year he earns a very limited salary – about 600rmb. There are five people in his family. He needs to support his brother because he is chronically ill and cannot work for cash income. Also, Yeshitsangbo’s niece goes to university in Xining, the capital city of Qinghai Province, and helps support her. Therefore, it is difficult for him to make the clinic’s condition improve. He is spending about 9,000rmb each year to support his niece and his own son. As a result, he has a very hard time because as a doctor he cannot go outside to work and earn money, and he has to spend one or two months each year collecting Tibetan medicinal herbs.

In 2006, Yeshitsangbo’s clinic was recognized as the second best one in all of Tiegai Township. The government decided that is clinic should be upgraded to a village level clinic because of the size of Huoluoshi Village. However, it expects Yeshitsangbo to do this himself, and he does not have the means.

Project Goals and beneficiaries

The overarching goal of the project is to provide health education and prevent diseases in order to improve the local villagers’ health conditions.

The immediate goal of the project is to build a village health clinic, provide a clean and comfortable environment for patients, basic medical equipment such as patient beds, Tibetan medicine and Chinese and Western medicine.

About 1,125 people in Heluoshi Gongma Village will directly benefit from this project. Also, people from surrounding villages including other Tibetans, Han and Hui people will also benefit.

Problems

1. The local villagers have difficulties explaining their illnesses clearly
In Huoluoshi Gongma Village, the majority of villagers are uneducated and cannot read either Tibetan or Chinese. It is very difficult for the villagers to explain properly what kind of sickness they have to the doctors and the nurses when they go to the hospital in the county town. The reason is the villagers can speak Chinese but only Qinghai dialect, which makes it difficult for them to get good treatment in the big hospitals. The doctors and nurses treat these people poorly and irresponsibly because they do not understand the villagers’ dialect. Moreover, because most villagers are illiterate they spend much more time looking for the right exam rooms, where to give money, and where to pick up medicine.

2. Risks for pregnant village women and infants
According to the village doctor, Yeshitsangbo, on average three or four infants are dead upon delivery and about one woman dies due to childbirth each year in Huoluoshi Gongma Village. The reasons are the poor condition of the village clinic, the distance to the big hospital in the county town if it looks like a birth will be complicated, which is about 15 km away, and poor living conditions in general.

3.Expense
When the villagers go to the big hospitals in the county town, the villagers always have to pay 2rmb as a usual registration fee for getting treatment and even buying medicines no matter if the medicines cost 100rmb or 1rmb. If the villagers want to see experts, they have to pay 8rmb just on a registration fee. And also the villagers need to spend 8rmb on the roundtrip bus fare from Huoluoshi Gongma Village to the county town. One more thing is that most big hospitals usually have the same problem, which is they want more money from the poor and powerless villagers so the doctors make the village patients take many irrelevant examinations and prescribe expensive but unnecessary medicine in order to get more profit.

4. Waste
If the villagers go to the big hospitals in the county town they need to spend at least one whole day in the county town because the county town is about 20 kilometers away from the village. This wastes a lot of valuable time, which could be saved if Huoluoshi Gongma Village had a more adequate clinic.

Benefits of the project

1. Easy to communicate with the doctor
If there is a village clinic in good condition in Huoluoshi Gongma Village, it is much easier for the villagers explain what kind of sickness they have and what kind of medicine they need because they can speak either Tibetan or Qinghai dialect to the doctor since the doctor is from the same village.

2. Reduce the risk rate for pregnant women
If there is a village clinic in good condition in Huoluoshi Village, then pregnant women and their babies will face few risks. The new village clinic would have better patient beds and and sufficient medicine.

3. Save money
If there is a village clinic in good condition in Huoluoshi Gongma Village, then the local villagers do not need to spend as much money on travel and hospital costs. As discussed above, the county hospital takes advantage of countryside patients by selling them unnecessary medicines and giving them irrelevant tests. The travel costs and hospital registration costs alone total about 20rmb, which should be enough simply to purchase medicine in a new and improved village clinic.

4. Save time
If there is a village clinic in good condition, then the villagers do not need to waste time going to the big hospitals in the county town. Travel to and from the county town usually takes a whole day. We estimate that most patients would need to spend 30 minutes or an hour in the village clinic.

Gender equality
Firstly, an improved village clinic will make it safer for pregnant women, whose health and chances of uncomplicated deliveries will improve. Most women will not have to make journeys to the county town, which can jeopardize a pregnancy.

Secondly, this project is being designed by a woman and this project will be managed and implemented by the women. By doing this, the project manager sends an important message to the local women and girls that woman and girls also can make useful contributions to the community. In addition, while writing the project proposal, the project managers can learn many useful computer skills such as Photoshop, Excel, how to scan and so on. Also, the project managers can gain some practical experience such as communicating with different people (local governmental leaders, the local villagers and so on). In this case the female project managers can gain valuable skills and be able to do more development projects in the future for impoverished communities.

Governmental support
The villager leader, Nanla, was very supportive when the doctor Yeshitsangbo asked him about building a village clinic on 13 November 2006. Nanla wrote a letter granting permission to do this project:

The steps of the project

1 Talked to the villagers about what they needed and found the solution, which is to build a village clinic.

2 Talked to the skilled workers.

3 Discussed the price of logs with individual villagers in Longzhang Village and decided on a price for each log

4 The village doctor talked to Zhuoma Medical Factory in Xining in December 2006 about the price of medicine. He has purchased medicine from this factory before.

5 Wrote and completed the proposal.

6 Secure funding from donor organization.

7 Local people begin to collect the stones from nearby the village and sand from Gonghe County.

8 Buy building materials such as red brick, cement, and steel door and so on from Gonghe County with the village leader and the skilled workers in order to ensure the quality of the materials.

9 Transport the logs from Longzhang Village

10 Build the village clinic

11 Evaluate the clinic

12 Purchase the patient beds and closet for storing the medicine

13 Purchase the medicine from Zhuoma Medical Factory in Xining and the bottles for storing the Tibetan medicine in Xining from Hainan Tibetan Medical Factory and the township Health Center in Tiegai Township

14 Take pictures.

15 Interview the local people (men and women).

16 Interview the village leaders.

17 Write final report.

18 Send final report with pictures and receipts.

Timeframe of the project

This project will take 57 days to complete:

• 1 day for a meeting with the entire village
• 7 days for making the bricks
• 1 day to transport the logs
• 7 days to go to Gonghe County to buy materials and transport them to Huoluoshi Gongma Village
• 10 days to collect stone and sand
• 19 days to build the clinic
• 10 days to purchase the medicine and the patient beds and the storage closet
• 1 day to set up lights in the village clinic

Detailed Budget

Item	Price per item rmb	Number of items	Donor Contrib ution in rmb	Local Contrib ution in rmb	Other resource (Shem Women’s Group)			Total cost rmb
Red brick (transportation included)	0.32	50,000	16,000	0	0			16,000
Ton of cement (transportation included)	350	10	3,500	0	0			3,500
Roller bamboo (transportation included)	30	40	1,200	0	0			1,200
Steel window (transportation included)	50	3	150	0	0			150
Steel door (transportation included)	250	3	750	0	0			750
Log (transpo rtationincluded)	50	90	4,500	0	0			4,500
Ceiling/square meter(transpo rtation included)	20	80	1,600	0	0			1,600
Tile (transportation included)	0.7	1,500	1,050	0	0			1,050
Lime/bag (transp ortation included)	20	20	400	0	0			400
Carpenter/ room	200	4	800	0	0			800
Set up electricity			1,500	0	0			1,500
*10% /boxPutaotang (500ml)	78	20	1,560	0	0			1,560
*5% /boxPutaotang (500ml)	70	20	1,400	0	0			1,400
*50% / boxPutaotang (20ml)	8	50	400	0	0			400
*0.9%/ boxLuhuana (500ml)	38	20	760	0	0			760
*Huanbingshaxin/ bottle (100ml)	4.5	100	450	0	0			450
*Yangfushaxin/ bottle (100ml)	4.5	100	450	0	0			450
*Jiaxiaozuo/bottle (250ml)	5	100	500	0	0			500
*Qingmeisu/ box (160wan)	50	10	500	0	0			500
*Baimeisu/box (20wan)	53	3	159	0	0			159
*Anbianqingm eisu/ box (1g)	50	7	350	0	0			350
*Qingkailin/box (10ml)	20	10	200	0	0			200
*Shuanghuan glian/box (20ml)	10	50	500	0		0	500
*Danshengzheng/ box (10ml)	10	50	500	0	0			500
*Shengmai/box (10ml)	26.5	20	530	0	0			530
*Amoxoling/ pack(0.25g)	2.6	100	260	0	0			260
*Fupaisuan/pack	1	100	100	0	0			100
*Anneijing/box	27	30	810	0	0			810
·Rinche-mngs byor-cenmo/ bag	24	50	1200	0	0			1200
·Rinche-bchobkru- zlsel/bag	18	60	1080	0	0			1080
·Gyurning- nerlng/ bag	23	40	920	0	0			920
·Mutig-nerlng/ bag	26	35	910	0	0			910
·Zlsel-cenmo/ bag	12.8	50	640	0	0			640
·Sgyurru-nerlng/ bag	13	50	650	0	0			650
·Mcinnd-gunpn/ bag	25	30	750	0	0			750
·Gslbyed-lcgsril- cenmo/bag	23	55	1265	0	0			1265
·Roch-gunpn/ bag	24	50	1200	0	0			1200
·Byudmr-nerlng/ bag	15	50	750	0	0			750
·Grubtob-rildgr/ bag	7.6	40	304	0	0			304
·Sningnd–kunpn/ bag	31	55	1705	0	0			1705
·Rlungnd- kunpn/ bag	19	50	950	0	0			950
·Krgnd-kunpn/ bag	9	45	405	0	0			405
·Gsobyed- ngidkyil/bag	6.5	60	390	0	0			390
·’Olse-nerlng/ bag	23	40	920	0	0			920
·Glond-kunpn/ bag	12	35	420	0	0			420
·Osm’pel-nirbu/ bag	9.5	40	380	0	0			380
·Zngstl-nerlng/ bag	8.9	30	267	0	0			267
·Pond-kunpn/ bag	36	30	1080	0	0			1080
·Mkrisnd-kunpn/ bag	44	25	1100	0	0			1100
·’B’sm-smnmr/ box	11	45	495	0	0			495
Sand/tractor trip	60	20	0	1200	0			1200
Stone/tractor trip	60	20	0	1200	0			1200
Day labor/ person/day	45	45days*7 people	0	14175	0			14175
Skilled workers	70	45	0	3150	0			3150
Earth brick	0.2	5000	0	1000	0			1000
Medical closet	700	2	0	1400	0			1400
Chair	70	4	0	280	0			280
Balcony	120	2	0	240	0			240
Desks	100	3	0	300	0			300
Patient beds	125	4	0	500	0			500
Technical containers for keeping medicine	4.8	100	0	480	0			480
Management payment			0	0	500			500
Management expenses	Photos and transp ortation fee, etc.		0	200	0			200
Total cost			58,660	24,125	500			83,285

Notes: All Chinese and western medicine is marked with a * symbol.
All Tibetan medicine is with a · symbol.

Total amount of donation requested in RMB 58,660 = $8,276US

Sustainability of the project
The clinic will last more than fifteen years because it will be built with red brick, not earthen brick. Also, more and more villagers will come to get treatment and buy medicine in the village clinic, because the village clinic will be able to provide many more services and medicine than before.

This project also will purchase Tibetan, Western and Chinese medicine. Fair prices will be set and the doctor will be able to use his increased revenue to maintain the new supply of medicine. The doctor will be fully responsible for the village clinic and using his revenue to make repairs or additional purchases if necessary.

Additional information

Lhamotso (Lily), the project manager, has already successfully completed five small-scale development projects.

The first was a solar cooker project, funded by The Canada Fund in the summer of 2004, which provided 20 solar cookers for the village where the village clinic project is located. During the same year, in the winter Lhamotso managed another solar cooker project funded by the Canada fund, which provided 30 solar cookers for Heluoshi.

Lhamotso also successfully completed two second-hand clothes projects in 2004 and 2005. These clothes were provided by the British Consulate in Shanghai. There were two boxes of second-hand clothes that included shirts, trousers, bags, shoes, hats, toys, sweaters and other things.

Moreover, Lhamotso completed a greenhouse project last October, funded by the Australian Embassy. Now the project is completely and successfully finished. The whole project cost about 60,000rmb, not including the local contribution.

In addition, Lhamotso completed a solar cooker project in December of 2006, funded by The Shambala Connection. The whole project cost about 14,300rmb, not including the local contribution.

Interviews with some of the villagers who will benefit from this project

Interview One

On 20th February 2007, Lhamotso (the project manager) interviewed a local villager named Huajitai. He is seventy-one years old. There are seven people in his family and currently three of his children’s children are attending school. Only one of his children did not go to school after she finished grade five in primary school. He told me that at that time they had a very difficult time financially because they just move from another place. Therefore, he thought that letting the girl stay at home would be very helpful. He has had a lung disease for almost twenty years but because of the family condition, he has only tried to go to the hospitals and get treatment over the past few years. Unfortunately, his illness has not gotten better. Conversely, his illness became worse. So he just has started to get treatment in the clinic and get Tibetan medicine from this clinic. He mentioned that he could not say that his illness has been cured but his illness has not become worse. Finally, he was very supportive about this project. Since he is old it is very convenient for him to get treatment because the clinic is about one hundred meters away from his house.

Interview Two

On 20th February 2007, Lhamotso interviewed Qingju. He is forty-four years old and there are four people in his family, including one boy and one girl. His son graduated from Hainan Teacher’s School in 2005 but he has not been able to get a job yet, which causes a lot of problems for his family. Qingju said he was very disappointed that there have been no good results so far for supporting his son to attend school from primary school all the way through to Hainan Teacher’s School. His daughter has been away from home for almost one year, performance dancing in the eastern part of China in places such as Guangdong, Shanghai and so on. His family’s life is difficult, even though there are only four people in his family, because he has had gastric disease for three or four years. He informed me that building a village clinic would be very helpful because he could take medicine and get treatment in the village clinic without paying the fee for medicine and treatment immediately because he knows the doctor well and the doctor understands his condition. In the other hospitals this is totally unacceptable.

Interview Three
On 14th February 2007, Lhamotso interviewed Khamshijie. She is fifty-four years old. There are five people in her family. She was very thankful to the doctor of the clinic because the doctor saved her daughter from death when she gave birth. Lhamotso also interviewed the doctor, Yeshitsangbo, and he also mentioned this. Khamshijie’s daughter came to the doctor but it was too late; also there was no advanced equipment, medicine and so on. So the doctor gave some medicine for emergency treatment and suggested they go to the hospital in the county town. On the way to the hospital the baby was born and died after staying in the hospital for two days. Fortunately, though, the baby’s mother was saved. Therefore, Khamshijie truly thinks that Yeshitsangbo saved her daughter’s life.

Photos

These Tibetan herbal medicines in the three different basins are mixed by the doctor, Yeshitsangbo. He also collects some Tibetan medicinal herbs.

This is the only patient bed in the clinic and is provided by the doctor.

There should be proper containers for storing the Tibetan medicine, but the clinic uses some simple small glass bottles to store medicine.

Engineer’s plan for the village clinic

Digram of the project location

Map of Gonghe County