This Project is to host a three-day health training in Rdo Sbis Township to educate village women about common health problems, the importance of caring about women’s health problems and also the methods to prevent gynecological diseases to improve the health conditions of local women.

The Australian Embassy funded this project

Lumo Tsering is from Xunhua County, Haidong Region, Qinghai Province, China. She graduated with an associate’s degree from Qinghai Normal University’s English Training Program in January 2008. She is currently working as one of the program directors at Shem Women’s Group.
What? To host health training in Rdo Sbis Township to educate village women about common health problems, the importance of caring about women’s health problems and also the methods to prevent gynecological diseases to improve the health conditions of local women.
Who? Women in Rdo Sibis Township, Xunhua Salar Autonomous County, Haidong Region, Qinghai Province.
Photos of project implementation

This is the first day of health training in Rdo Sbis Township governmental yard; because it is too cold to hold the training in the meeting hall in the morning, the participants suggested to hold the training outside the meeting hall in the sun. In this picture the participants were sitting in the circle and listening to the doctor.

The women in the picture is the president of Xunhua County Women’s Federation, Rdo Sibs Township leader invites her to participate the training and in the picture she is giving a short speech about how important it is for the women to be healthy.

The doctor gets feedback from the women after discussing proper hygiene when using the toilet.

Considering that most of women usually don’t have money in their pocket, the project manager decided to give each participant 5 RMB, so that they can have lunch in the afternoon. This woman is named Tsemo and she is receiving the money after she signed the paper.

These are the hygiene materials the project manager bought from Xining City. It includes: one basin, two tubes of toothpaste, one toothbrush, one pair of plastic gloves, one cotton towel, and a packet of napkins for each woman who participated the training. These materials are brought according to doctor’s suggestion and our experiences in the past doing health training projects.

This woman is one of the health training participants on the first day. After the first part of the health training, people ask her to sing song to thank the project manager and the doctor and she offers project manager Kadangk (a traditional Tibetan scarf people offer to thank or greet others) after she sang the song.

This is the second health training in Niamu Village. Women in this village gathered outside of Mani hall and listening to the doctor (the woman with pink scarf, sitting with paper in her hand.) Originally we were going to hold the training inside Mani Hall, but all the women said that Mani hall is too cold in the morning and they want to sit in the sun. Also in the Mani Hall there are some old man chatting, so it is not convenient to talk about health problems. Because women are the ones who need to take care of their children, they are not able to come to the health training alone and most of women came to the training with their children on their back or in their robe like the women in this picture.

This is one of the Salar women participants; because of the language barrier, she didn’t get most of what the doctor talked. However, she had the chances to ask the doctor some questions regarding her own health problems. These Salar women also receive the hygiene materials and living subsidy. The woman with black scarf is Salar, and the other woman is the president of women’s federation in the township government.

These two old women are the oldest ones in this training; they said their daughter-in-laws are not able to come, so they came instead of them. But their ears are not very good, and the project manager asked the doctor to speak loudly so that they can hear her.

When it came to some sensitive topic like sexual diseases or the ways of preventing pregnancy, the participants started to laugh and become shy. Some people even said that in the 21st century people can say anything they want openly. So the doctor told them again and again that there is nothing to be shy of.

In the picture, the project manager Lumo tsering is distributing the hygiene materials as the co-manager Lumo (the woman in the right with blue cap) calls the names one by one.

These women are from Wuma Village and this training in held in the afternoon. All the women, doctor and project managers gathered in a family and held the training. These women sitting in the front are listening to the doctor with great interest, however some women in the back are pretty worried about the family chores they have and are chatting about their work constantly.

This woman is also from Wuma Village, she is signing her fingerprints on the paper before she receives the hygiene materials.

Project summary
Project title: Health Training Project for Tibetan Village Women in Rdo Sbis Township

Project goals: This project is to host three-day health training in Rdo Sbis Township to educate village women about common health problems, the importance of caring about women’s health problems and also the methods to prevent gynecological diseases to improve the health conditions of local women.
Project location: Rdo Sbis Tibetan Autonomous Township, located in southwest Xunhua Salar Autonomous County, Haidong Region, Qinghai Province, is one of five Tibetan Townships in Xunhua County. The others are: Bis mdo (Wendu), Rkang tsha (Gangcha ), KA ring(Galeng), and Se chang (Xichang). There are 27 villages in Rdo Sbis Township, including two Salar, one Hui, and one Han village. Nearly all Rdo Sbis residents are Tibetans.
Total beneficiaries: This women’s health training directly benefits approximately 160 people and will indirectly befit around 800 women in Rdo Sbis Township, as women who attended the training could pass what they have learnt at the health training to their mothers, daughters, sisters and friends.

Implementing organization/individual: Lumo Tsering (project manager), Sangmo (President Women’s federation), Zhoujia (Rdo Sbis Township Leader), Lumo Tsering (co-project manager) and Shem Women’s Group.

Contact Group: Shem Women’s Group

Funding  source, amount, and date received: Lumo Tsering (Project manager) received 5,400 (80% of the project money) RMB from Shem Women’s Group on March 25th, 2010, and will receive 1,350 RMB after the project manager implements the project successfully.

Details of project activities

1. Found out the health problems by talking to Dr.Suonamtso from the hospital in 2008.
2. Developed project by attending an international training on education for sustainable development in Sweden.
3. Discussed the project with the County leader about where and for whom to hold the training.
4. Conducted informal interviews with some women (from?) about the health problems they have.
5. Contacted one of the health workers who used to work on health issues in the village to find out about common illnesses.
6. Contacted Dr. Woxiuji, who gave training to the village women.
7. Figured out the price of materials for the training.
8. Wrioe project proposal.
9. Funds are received on March 25th 2010.
10. March 26th, 2010, contacted County leader and the president of women’s federation to discuss the start date of the project.
11. Prepared announcement of the health training.
12. March 27th, 2010 went to the wholesale market to check the price and quality of the materials.
13. March 28th, 2010 went to Yiwu Market in Xining City to check the price and quality of the hygiene materials needed for the training and bought some of the materials.
14. March 29th 2010, went to the wholesale market to purchase some other materials and co-project manager Duojie Dorlma went to Yiwu Market to purchase hygiene materials again.
15. March 29th 2010, transported some of the materials to Xunwa Village in Xunhua County.
16. March 30th 2010, lunch time went to the wholesale market to buy rest of the materials again and transported them to project manager’s office.
17. April 2nd, 2010, transported the hygiene materials to project manager’s family.
18. April 3rd, 2010, hired a car and went to the Township government to hold the first day of the health training in Rdo Sbis Township governmental yard.
19. Interviewed some of the participants to see the impact of the project.
20. April 4th, 2010, went to Niamu Village to hold second health training for the Niamu Village women.
21. April 4th, went to Bai Zhuang Township to buy more hygiene materials.
22. April 4th, 2010, in the afternoon went to Wuman Village to hold third health training with Wuman Village women
23. Interviewed some of the village women and took pictures.
24. Write project final report.

Project Finance

Note: For some costs, the project manager was not able to get receipts, because the shopkeepers in the township are not able to write. So some receipts are not formal receipts. Also because the training happened on weekends, the project manager decided to not have group photo and give photos to each participant, because in that way she needed to go to Xunhua again to distribute photos. Also the participants are very worried about their works when having the training, so project manager decided not to waste their time any more by taking photos. Therefore, there is no cost for photos.

Also, because of having no experience, project manager didn’t know it is better to provide participants some money since most of them don’t have money to eat lunch, so project manager decided to give each participant 5 RMB, so the meal fee is higher than the original budget.

The total donor contribution of this project is 6798.5 RMB and project manager paid the rest of the 48.5 RMB.

Delays, Difficulties, and Lessons learned
Delays
The starting date for the project was delayed for half a month, because when the project manger received the funds, the villagers in Rdo Sbis Township were cultivating their fields and it usually takes about 15 days for the whole township to finish the work. Considering it is their busiest time, project manager decided to wait until the villages finished cultivation. In that way, selected women can come to the training without needing to worry about their work.

Difficulties
In order to start the training earlier on Saturday morning, the project manager went to Xunhua County on Friday night after she finished her work, and it is about 4 hours from Xining City to the project manager’s home. So when the project manager arrived in the County town it was too late and there were no taxis, and project manager had to hire a very expensive car..

On Saturday morning, the project manager and the project co-manager went to the township to prepare the project before the training, like buying fruits, drinks and other needed things. However, the county leader didn’t show up until 11 am, which is one hour later than we scheduled, although the project manager contacted him very earlier to tell him to be on time, so the project managers and participants had to wait for long time to start the training.

Also originally, the project manager planed to have a female doctor who is very experienced with health training to facilitate this health training. However, because of their institute the doctor needed to go to Beijing and was not able to go to the training. The doctor helped the project manager to find another female doctor. Since it is her first time to facilitate training, she is not as active as the project manager expected. However, she did a great job with making the training plans and all important topics were presented at the training.

Additionally, in Rdos Township, there are two Salar (an ethnic group in China) villages and the county leader also announced the training to them. So there were five Salar women attending the training, however, they don’t understand Tibetan and hardly understand Mandarin. So there was a very big communication problem between the doctor and the Salar women. We had to speak Tibetan to all the participants, and ask the Salar women to ask questions after the training.

Changes
There were three small changes with this project. Firstly, according to the original plan, Doctor Woxiuji was going to facilitate this health training. However, she had to go to Beijing suddenly, and was not able to go to Xunhua for the training. So Doctor Woxiuji helped the project manager to find another doctor.

Originally, the project manager planed to have three days training in Rdo Sbis: first day in the township, second day in Niaba Village, and last day in Helongbu Village. In the actual project implementation, the County leader suggested that it is better to have two days training, because most of the villagers are busy with building walls and if project manager held the training for one village each day, then it would take lots of work time away from the villagers. So the project manager decided to have two days training instead of three days. So they held first training in the township for whole day, second training in Niamu Village for half a day and third training in Wuman Village for half a day.

The villages that the project manager originally planned to hold training in also changed, because when project manager was talking to many people regarding where could be the best place to hold the health training is, villagers said that most of the projects go to the villages that we originally planed because those villages are located beside the road. So for this training, the project manager decided to go to villages which are very remote and very poor, and Niamu and Wuman Villages are the poorest and most remote villages in Rdo Sbis Township. Although the road to these villages is not very good, this project would help these villages more than others.

Lesson learned
During the implementing of this health training project, one thing which the project manger learnt was that it is very important to meet the project target group personally, in that way it will be very clear about what they need and how one can help. Also by meeting with the target group, one can avoid misunderstanding, because the project manager and target group can always explain to each other and make sure they understand each other. The project manager went to the project location when she first designed the project and she communicated with the county leader clearly why this training is needed and how the government can help. However, she was not able to go home when the project was funded. So she contacted the county leader through phone and that is not good way of communicating, since the phone is sometimes unreliable. The project manager thinks that maybe that’s one reason why the leader was late for the training.

The project manager learnt from one of the officials that sometimes it is better not to contact the big leader directly, because they have lots of things to do and sometimes they would forget or will have no energy to focus on one thing. So he suggested project manager to contact the woman who is in charge of the women’s federation, in that way she can fully focus on the training and can help the project manger fully without being disturbed by other things.

Participants Name list

Rdo Sbis Township participants name list

Niamu Village participants name list

Wuman Village Participants Name List

Interviews

Dorlma Tso
Dorlma Tso is from Wuman Village, and is one of the participants of this heath training. Among all the women participants, she is the most active. After the training the project manager interviewed this woman for five minutes. The project manager mostly asked whether they had such training before and what does she think about women’s health condition in Wuman Village. She said that since Wuman Village is a very remote village in Rdo Sbis, they hardly receive attention from government. These kinds of training go to villages that are near the road. Also because they are very far from the township, when there is training in the government, women can’t go, because they need to walk, which takes them about 2 or 3 hours. She also stated that since their village is very remote, women don’t go to the hospital when they are sick, because it takes lots of time away from their work. If they feel really sick, then they will just take a short sleep. So it is very important for them to get basic knowledge about women’s health to prevent them from getting sick. The project manager asked this woman the ways of preventing pregnancy and she easily answered the questions. She said if we can do something then that’s good, but they can’t ask their husband to do anything. So the project manager had the idea that maybe they can organize health training for men next time.

Ayi NanmaJyi
Ayi Nanma Jyi is 81 years old. She said she has being living in this village for her whole life and has never had a chance to listen to such training. She said since they never had the chance to hear knowledge about women’s health, they don’t know whether what she knows is correct or not. This time she heard from the doctor that their way of cleaning after they went to the toilet is wrong. They did that for their whole lives, and didn’t know it is wrong until today. She laughed and said she can tell her daughter to do the right way from today. She also asked the project manager that if in the future they can still organize these kinds of training, she will ask her daughter-in-law to come since she couldn’t come this time. She said that women are doing all the works at home and never have time to take a rest, so if a women in the family gets sick then all the family members’ lives will be affected. So she said women need more doctors to teach them the health knowledge.

Tsomo
Tsomo married into this village a long time ago, and she said few people want to marry into villages like Wuman Village, because it is very remote. She said they even can’t get vegetables most of the time, let alone health education. She said “women never know how to take care their health, what they know work, work and work. Even though I didn’t catch any serious sickness, the small illnesses always bother me. I always have backache, and my lower abdomen is very painful during the menstruation period. What I do is just bear it, but today the doctor said all these small sickness create big problems. So I should more aware of my own health, if something happened to me, then what would my children do.” Tsomo answered with a very sweet smile. Then the project manger asked whether she knows how to prevent oneself from being pregnant. She didn’t answer these questions but became very red. So project manger didn’t ask her any more.

Letter of appreciation from the Government

The translation of thank you letter

Thank you letter

Dear Shem Women’s Group,

On April 3^rd and 4^th in 2010, Township Party committee, Township government, County women’s federation and your organization organized health training in Township Government, Wuman and Niamu Villages. The family planning advocator from 34 villages, the directors of women representatives in the Village, and Township women officials in total of 218 people participated the training. The project manager invited gynecologist Hua Sai Tso from Qinghai Tibetan Hospital to our township and passed on knowledge that is related to our daily life. They also provided some daily needs and living subsidy. This training enhances women’s health care knowledge and it created a strong foundation for women to have a healthy and happy life in the future. Therefore, on behalf of 3,617 women in Rdo Sibs Township Party committee and Township government would like to thank the leader and all members of Shem Women’s Group, especially project manager Lumo Tsering for your great work.
Thank you!

Xunhua County Salar Autonomous County Rdo Sbis Tibetan Township

April, 11^th 2009 (Stamp)

The list of Receipts

Receipt # 1

Doctor Training fee 500 RMB

Receipt #2

Transportation fee: 1,200RMB

• Project manager Xining to Xunhua 100 RMB (50 RMB Xining to Xunhua +50 Xunhua to Home)
• Car Rent Fee: 400RMB/day*2days=800 RMB
• Doctor (Xining to Xunhua) 200 RMB: Doctor rented a car from Xining to Xunhua on Saturday morning
• Project manager and Doctor Xunhua to Xining 100 RMB

Receipt #3

Hygiene materials (towels, basins, toothpastes, toothbrushes, plastic gloves and napkin) cost: 917.5+300+480+480+40+150+245+576=3188.5 RMB

Receipt 4

Meal cost: The project manager and Doctor stayed in the project manager’s aunt’s home and ate there, so project manager gave 200 RMB to buy meat and vegetables.

Also considering that most women usually don’t have money in their pockets, the project manager decided to give each participant 5 RMB, so that they can have lunch in the afternoon. Also other women participants received 5 RMB each person, so in total it is 800 RMB. In total it is 1,000RMB.

Receipt 5

Desert fee: Project manger brought fruits, drinks, cookies, one time used cups and other needed materials which cost 150/training*3=450RMB. However, the shop keeper couldn’t provide a receipt, since she doesn’t know how to write and she even didn’t have a receipt book, so the project manager was not able to provide formal receipts for this cost.

Receipts 6

Project Manager Expenses: project manager phone bill 50 RMB + Shopping helper Phone Bill 20 RMB + Taxi fee 110 RMB + Food Fee 160RMB + co-manager transportation fee 20 RMB + project manager transportation fee 100(when she first design the project). In total 460 RMB

Note: For food fee, there are together 10 pieces of receipts and for taxi fee there are together 11 pieces of taxi fee, which the project manager used when she implemented the project. Also some of the taxi receipts are the ones taken from the bus station to the project manager’s office. Since there are lots of receipts for food and taxi there, the project manager only post one to represent them all.

Original Proposal

Brief Introduction of the Facilitator Doctor Woxiu Ji
Woxiu Ji is a Tibetan woman who graduated from Qinghai Tibetan Medical College in 2006 with a major in Tibetan medicine. Currently she is working at the Qinghai Tibetan Medical Research Center. She has being working on women’s health for a long time and has been invited to give a health training in Xunhua County before.

Brief Introduction for Organizer Shem Women’s Group (SWG)
Shem is a women’s group dedicated to empowering Tibetan women and their communities through grassroots development. We focus on increasing the well-being of people in impoverished communities by providing access to basic needs such as water, fuel, electricity, health care, and basic education. We fulfill our mission by training educated Tibetan women to design, implement, and manage sustainable grassroots development projects that will successfully alleviate the problems that their communities face. SWG has so far successfully completed 29 small-scale humanitarian projects in provinces all over the Tibetan plateau.
At the village level, while our projects fulfill basic survival needs for village women and their families, our project managers, educated Tibetan women, present villagers with strong female role models. The work of these young women raises villagers’ confidence in women’s abilities and encourages villagers to value women’s education.
At the university level, we offer discussion groups and workshops designed to empower educated Tibetan women, and we provide women with the resources and training they need to put their ideas into action.

Project location
Rdo Sbis Tibetan Autonomous Township, located in southwest Xunhua Salar Autonomous County, Haidong Region, Qinghai Province, is one of five Tibetan Townships in Xunhua County. The others are: Bis mdo (Wendu), Rkang tsha (Gangcha ), KA ring(Galeng), and Se chang (Xichang). There are 27 villages in Rdo Sbis Township, including two Salar, one Hui, and one Han village. Nearly all Rdo Sbis residents are Tibetans.
There are around 12,000 people in Rdo Sbis, a township in a valley surrounded by mountains. A road runs through the valley center between these mountains. Villages are located on either side of the road. Some villages are on the mountainsides; their fields are watered only by rain and such villages are called ri ma. Villages at the foot of the mountains and on the valley floor, called chu ma, have fields irrigated by the river.
These villages are agricultural villages. Local people grow barley, wheat, and potatoes on their land, which is irrigated five or six times every year between the fourth and sixth lunar months. Wealthy families owning 8 mu can sell surplus barley and earn about 800 RMB per year, since 1 mu of agricultural land can produce around 700-800 jin(350-400kg) of barley. However, most village families do not have this much land. Usually two or three households share about 8 mu of land between them. Such families can only grow enough barley for their own subsistence.
Villagers earn cash income from livestock; each family usually owns at least one cow. From the cow’s milk, villagers produce butter and cheese which is not eaten but sold to generate income. A family can earn about 600-800 RMB per year selling butter and cheese. Most households can make about 25 to 30 jin of butter and 30 jin of cheese annually. Also, villagers work as migrant laborers. Almost every able adult leaves the village in May and June to dig caterpillar fungus, a medical herb which grows in high altitude areas. In 2007, each caterpillar fungus could be sold for ten to fifteen RMB. During good seasons, each person can earn 2,000-3,000 RMB.
All money earned is spent on children who attend school and family costs such as New Year festivities, fertilizer, electricity, and other essentials. In total, the average family can make approximately 3,700 RMB in cash income per year, and they must spend approximately 3,500 RMB per year. This leaves the average family with 200 RMB in surplus income each year. If the family has students who are going to university then they need to borrow money from others to afford their tuition.

Why we need this training (Problems)
1> General understanding: Health issues are not taught in most of the universities and colleges in Qinghai Province, China, except in the Medical Colleges. As a result, university students and college students have very limited knowledge about health issues.
Also, it is culturally sensitive to talk about health problems related to sex or reproduction. Thus most Tibetan women and girls are shy to talk about those health issues openly even if they know they have some health problems. Even if they want to talk about their health problems, they do not have a safe space for discussing these health issues openly or discussing their problems with other women.
Moreover, there are very few Tibetan books, magazines and newspapers that talk about health problems, especially women’s health problems. So students have little access to general information about health. Those women who received school education have problems accessing health information; women who did not have access to education have even more difficulty accessing health information. Even if the village women had access to some health related books from the government, they still cannot understand them. These problems make it difficult for women to gain knowledge about health issues.
2> Problems identified by doctors and health workers: From talking to a woman gynecologist from the hospital we also know that most women never go to the hospital to check for gynecological diseases unless they are very sick. They wait until they are seriously ill to go to the hospital, and by the time they arrive their sickness has already become very serious.
Also, I talked with a foreign student who had worked on healthcare projects in Tibetan villages. While talking to the villagers, she found diseases like tuberculosis respiratory infections, constipation, vaginal infections and cervical cancer are quite common in the villages. She said, “Women get the illnesses I mentioned because they are unaware of vaginal hygiene and don’t regularly wash/clean the vaginal area. Also, never using toilet paper and the fact that their husbands don’t wash their genital area probably plays a role as well. I think villagers tend to not bother about sickness until it’s very serious, because of the cost of healthcare and the distance and difficulty of travel to a health clinic. I think it’s likely that women, even more than others, don’t pay so much attention to their health – they keep waking up early and working hard all day long even when they are not feeling well, and their illness must get very serious before they try to seek health care. I was also told during my interviews that sometimes women are reluctant to ask their husbands for money to seek healthcare, and sometimes husbands don’t care much about their wives’ health and don’t give them money to see a doctor when they are ill.” She said all this happens because village women know very little about their own health and hygiene.
3> What we learned from implementing a health training: Shem Women’s Group held our first health training in Xining with college students. Our hope was that these young women could go home and share what they learned from the training with their sisters and mothers. While holding the training, the doctor asked lots of questions related to women’s health and very few students, even adults, could answer the questions. The students from medical school also had difficulties with answering the questions. So from the training, we could see that women’s knowledge toward their own health is very limited.
4> What we learned from students: This year in 2009, Shem selected its 2009 members and in total we received 37 application forms and among them 20 students mentioned that the reason they want to take our development class is to learn how to write proposals, so that they could help the women in their villages who suffer from health problems. Those students are from different areas of the Tibetan plateau and more than half of the students mentioned something about health problem in their village. From these applications we can see that health is a big concern in many Tibetan areas.
5> Example of my own experience: My mother used to be farmer and worked in the field for most of her life. Because she lacked basic health knowledge, she often drank un-boiled water, especially when she was doing the harvest and was too exhausted to boil the water. Later, every time after she ate cold food (no matter what food) her lower abdomen started to protrude and feel very painful. Also, she said it was very difficult for her when she went to the toilet. Our family has been taking my mother to the hospital to see the doctor many times. She is diagnosed with a type of gyneopathy that is very serious. Even now, she must be very careful with what foods she eats and must eat a lot of medicine to control the illness.

Solution
We will provide a space for village women to discuss health issues and share each other’s knowledge about health openly. We will also invite Doctor Woxiu Ji from Tibetan Medical Hospital to give a training on health issue for those village women and teach the importance of caring for health problems. In addition, we will give each participant an assignment: to pass what they have learned from the doctor or from other participants to their daughters and other women who are not able to attend the training.

Project Goals
The overarching goal of the project is to provide health education in order to prevent diseases and improve the health conditions of local villagers, especially women.
The immediate goal of the project is to host a three-day health training in Rdo Sbis Township and another two villages to educate village women about common health problems, the importance of caring about women’s health problems and also the methods to prevent gynecological diseases.

Beneficiaries
Around 200 village women will directly benefit from the Health Training and these women will be asked to pass on what they have learned to other women they know, so many other women will also benefit indirectly through the 200 participants.

Government approval
On May 5th, 2009, I went to the township government office and by talking to the county leader Zhou Jya, I realized that the government also offered health trainings before, both in the government meeting hall and in individual villages. Their training was mostly about birth control. So the county leader said this is such a nice thing to do and said the government could provide necessary support, like providing a meeting hall for the training, and also make announcements about the training time. I am very happy that they could provide such support, because with government’s help, villagers will be more cooperative.

Gender equality
The project will be implemented and managed by a young Tibetan woman, and this health training will be offered for women. So this training will benefit about 200 women directly and other women will also benefit indirectly since those women who participated in the training could share their new knowledge with them. Also I, the project manager, as a young woman, will manage the project and serve as a role model for women in the village. Hopefully, this will work to change village women’s attitudes toward sending their daughters to school and will encourage the village women to rethink their ideas that boys are always successful than girls.

Brief concept of training
1. Basic knowledge about women’s common health problem like tuberculosis respiratory infections, constipation, vaginal infections and cervical cancer.
2. The importance of caring about and for women’s health problems.
3. The methods of preventing gynecological disease.

The Steps of Project
1. Found out the health problems by talking to Dr.Suonamtso from the hospital in 2008. (Done)
2. Developed project by attending an international training on education for sustainable development in Sweden. (Done)
3. Discussed the project with the county leader about where and for whom to hold the training. (Done)
4. Conducted informal interviews with some women about the health problems they have. (Done)
5. Contacted one of the health workers who used to being working on health in village to find out about common illness. (Done)
6. Contacted Dr. Woxiuji who will be giving training to the village women.( Done)
7. Figured out the price of materials for the training (Done)
8. Write project proposal. (Done)
9. Funds are received.
10. Meet the county leader and women leaders to discuss the start date of the project.
11. Prepare announcement of the health training.
12. Purchase the materials for the training in Xining.
13. Hold the training.
14. Take pictures and interview the village women about the impact of the project.
15. Send final report to donor.

Detailed Schedule:
This project will be held for five hours each day during three days in winter time
First Saturday, invite two women from each village to attend the training in Rdo Sbis Township government meeting hall. Introduce the common health problems and the importance of caring about women’s health problems in the morning. Use the afternoon to share methods for treating common women’s health problems.
The second Saturday, hold training in Helong Be village with the women in that village. Use two and half hours in the morning and another two and half hours in the afternoon to talk about the health problems and care methods.
The third Saturday, Hold the training in Ning ba Village, and use five hours to talk about the health problems and preventitive methods.
Note: The government leader told me that there are two women in each village who are in charge of women’s affairs and women’s health, so if we invite these women to the training, then they will most likely pass what they learned from the training to other women. The government is providing a small salary to these women in the village, so they have the duty and responsibility to attend every meeting and training announced by the government.
Also we are holding two individual trainings in two villages. Firstly, these villages have a meeting hall that we could use for training and, secondly these two villages are somewhat bigger than other village. Therefore, if we hold a training in these two villages, then more women will get benefits from the training.
In addition, this training will be held in the winter time, because it is the time during which women can have more to rest, and could attend the training without worrying about their housework and other duties. Women are always busy during other seasons, because they need to work in the fields and sometime they even need to leave the village to earn cash for their family.

Detailed Budget

Donation requested from the donor in Chinese Yuan: 6,750rmb
Note: transportation fee is for the project manager and the doctor to go to the project location from Xining. The health training will be held on three different days, so we need to go from Xining to the project location three times.

Photos of the project

The project manager Lumo Tsering talkS to the Township leader about the heath training in his office.

She will be one of the participants of health training in Rdo Sbis Township, because she is one of two women in each village who are in charge of women’s affairs and women’s health, so she will be invited to attend the training.

Map of project Location

This project is invite five doctors to Gasar Village to train villagers about how to take care of their health in their daily lives. The gynecologists will particularly focus on women’s health about how women should take care themselves, so whole villagers health knowledge will improve.

Asia Foundation Funded this project

Dagmotar is from Zuo Gai Township, Hezuo City, Gannan Prefecture, Gansu Province, China. She got an Associate’s degree in English at the English Training Program at Qinghai Normal University’s Nationalities Department in 2009. She is currently working in Tad primary school in Zuo gai Mema Township, Hezuo city, Gannan prefecture and Gansu Province.

What? This was health training for Gasar village in Hezuo city, Gannan prefecture, in Gansu province. Especially focused on women health issues in this area as well as many women illness exist in this village.
Who? All Gasar village women are able to come to join this training. (It includes students, new bride, elders and kids) total has 132 people participated in this training.

Photos of the project implementation

The village women were the participants of the heath training.

Doctor Danba ,kuoluo, Jimxitsho ang dagmo explain the basic knowledge of cleaning, and how to prevent women from diseases and how to take care after got the diseases.

Each village woman got very basic cleaning tools (a basin, a towel, soap, and napkin) for each participant.

Doctor Danba was asking village women some health problem that they have and answer the questions that women have been asked

Project summary

Project title:  Health training project for women in Gasar village

Project goals: The immediate goal of this project is to invite four doctors for Gasar village. One hundred thirteen households include the training; they will learn how to take care of health in their daily life and how to prevent from flu. Particular gynecologists focus on women’s health and teach women how to take care self as being women. In addition, introduce how their health affects their life and the next generations. The long-term goal of this project is to improve the women’s health condition through the training and the lectures help to relieve the women from their pain. The health information can plant seeds of health care in their mind. This knowledge can be passing down from mothers to their daughters; they will pay attention on daily foods and cleaning

Project location: Gasar (Xinsi in Chinese) is a large village contrast to the neighbor villages in place Zuogai Duoma Township. This village located in Zuogai Duoma and it is 28 kilometers away from Hezuo city the capital city of Gannan prefecture, Gansu province in China.

Total beneficiaries: one hundred thirteen households got benefit from this project and one hundred women participants in this training. Those people include (elder’s kids, students, new bride)

Implementation organization: Dagmotar( project manager), project committee ( Toja Tsering , Sonam Tsering , Tugar) village leaders) Female Doctor  (kuoluo, Jimxitsho ang dagmo) Male Doctor ( Danpa) and Shem Women’s group.

Contact group: Shem Women’s group

Funds receive: Dagmotar received 7, 600rmb from Shem Women’s group on January 27th 2009

Detailed Project activities

What did you learn from this training?

1)      See doctor on early time
The village women in Gasar village said this kind of training is really helpful in their life. They were bothered by the women illness but they don’t have confidence to tell the doctors and their own family members so they hide their illness for longer time. At the end their health became worse and worse. From his training they understood that they shouldn’t act like this again. This stupid act leads toward serious result.

2)      Take care self in special time
Women in Gasar village not much alert the importance of hygiene during the menstrual period. Mothers usually don’t have much idea about to teach their daughters how to take care it. Most of women in Gasar village they said they never take a rest and add more cloth during on period. They spend their time as usual, doing heavy works. After the doctors told them that they should take little rest and do little work in this special time. They will delay their work for a while. If you don’t have good rest, might cause some illness and panic after you get old. Doctor also says they should drink more hot water during this time. Those small useful health ideas are alert local women in effective way.

3)      How to prevent early pregnancy
China birth plan is very active in the local areas so many young women use different way to avoid be pregnancies. But they don’t know specific and health way to do this. Doctor told them how it works if they follow the doctor’s comments to prevent pregnancy. They learnt what kind of medicine and tools very bad for the health and will create a negative result for their health.

4) What is the good way to have a health baby?
The local women generally have several children in the remote areas. Tibetan women usually are different from the other ethnic group. They don’t have much time take rest after gave birth because they need to work. Doctor told them is very important to have good food and good rest after gave birth. Let them aware that nutrition is important for mother and baby.

5) What is really a legal marriage?
The people here costumed to get married in their early age and some of them get married with people who own relatives. They don’t know the genetic problem. Many young people got marry under their eighteen. It against the law but they are not aware it. The doctors told what a legal married is and advised them do not married near relatives that will lead a negative causation toward next generations.

Project finances

Note: *450rmb was left from the project, among 540rmb 150rmb was from the local contribution, and 300rmb is from the donor contribution. The 150rmb was given back to the local people because this was their contribution and now 300rmb is left in total from the donor contribution.

#1 originally we planned to invite five doctors but the training is Tibetan Losar time (New Year) I only had four doctors. We could not invite the other doctor because she said that her husbands’ granny passed away and she had no time for the training. Therefore there left 800rmb from the original training fee.

#2 the training materials fee much higher than the original one because more people came to join the training and added the doctor’s training fee on the material’s fee that who did not come to the training, so that made enough cleaning tools for participants.

#3 Doctors bought bus fee by themselves and not the taxi fee so the transportation fee cheaper than the original one.

#4 more advertise cards are given to the participants than the originally planned because more participants joined the training than we expected and also the price of the cards little became little higher than the original budget.

Notes# 5 the meal fee was much cheaper than the original budget because some villagers went their homes to have meals during the training. So we spent less money for the meal than we originally planned.

#6 and #7 Training house fee originally included in local contribution but the villagers changed the old village leader cause of some problem, so the new leader required small amount of money for the house fee that was much cheaper than the actual price.

Difficulties during the implementing project and what I learn from doing this project

Ø        Firstly, I really should say thanks for this chance. I really learn many things by implementing this project. I feel helpless on the first day of the training. The villagers were not cooperative and hard to convince them to join this training. Particularly young women who are in my age. In front of them my role is changed not a school girl but an educated Tibetan woman to advice and tell how is important to join this training.

Ø       Second, I understood have a plan on a paper doesn’t mean that everything going fine, sometimes the things happened opposite of our plan. Like the situation in my project goods price and time arrangement. So we must think carefully before the implementing the project and have full of preparation.

Ø       Third, through this small-scale project I learn no matter how difficult it is, there is always a way to solve it, when you see the people you helped or did something for people who need it my feeling is hard to explain. This is a kind of happiness when you helped someone who needs help.

Interviews

1)Karmo
Karmo is one of new brides who joined this training; she came to Gasar village three years ago. She was born in a farmer family but she married with a nomadic boy in Gasar village. Since she got marry her lifestyle is different from before. She said before she attended the training she has never realized that what is women health care and no idea about how to take care of her in daily life. In fact what Karmo said is true; according to a Tibetan new bride except her mother no to tell her the importance of women health and danger of unhealthy sexual relationship. Even their mothers knew but they are often not able to meet. She also said that this was a great chance to learn something from the doctors because all the doctors are Tibetan and it is very easy to communicate each other in Tibetan.

2)Tsering Dorma
She is in her forty, last year she had operation in the county hospital cause of the women illness, doctors said that her illness lead toward serious condition and asked her why she did not see a doctor in early year. She joined this training and after the training we asked her about her idea on this kind of project. She said that she is very lucky to have a successful operation and she is scolded on herself no dare to see a doctor in earlier time. She said in her village they hardly to hear those kind of information, even though there are televisions but don’t understand the Chinese. She thanks for the doctors giving many instructions. She has a daughter who is in her twenty, Tesring Dorma said her daughter is not at home in current but she really wants to tell daughter what she learnt from the training.

Thanks Letter

Translation of the thanks letter

Receipts
#1

The total cost of heath training fee is 3,200rmb (each doctor was 800rmb and there are four doctors)

#2

Total amount of money paid for cleaning material fee is 2,180rmb.

#3

Total amount of money that paid for transportation fee is 160rmb (including bus fee and transport material (foods and hygiene material fee)

 #4

The copy cards for advertise and the total cost was 450rmb (copy fee, scanning fee, printing fee)

#5

Total cost for the meal fee is 1,086rmb (meat, milk, vegetables, tea, fruits fast foods)

#6

House fee for training and the training instrumental fee total cost 330rmb

 #7

It is the tax fee for getting formal receipt and it was 174RMB

Original Proposal
Project Location
Gasar (Xinsi in Chinese) is a large village compared to its neighboring villages in Zuogai Duoma Township. This village is located in Zuogai Duoma Township and is 28 km from Hezuo City, the capital city of Gannan Tibetan Autonomous Prefecture, Gansu Province, China.

Population
Gasar Village has approximately 113 households. There are 909 people in this village, and most of them are Tibetan but there are a few Han Chinese. The Gasar Village population is made up of 374 women, 439 men and 96 children under eighteen.
Education
The education level in Gasar Village is low. This is based on low school attendance and college attendance rates (there are currently 30 middle school students and 6 university graduates). The low rate of school attendance is caused by many factors including, but not limited to: i)low income ii) lack of trust in the school system, and iii) difference in expectations for boys and girls.

In the past many families could not afford to pay school tuition, so the school-aged children were kept at home to help with household labor. In 2006 the government policy “Free Tuition for Primary Schools” was enacted. Some middle schools also offered free tuition. Many poor income families are unable to afford tuition for high school and middle school. Some families borrow money to afford tuition.

Even though tuition is free in these cases, many families choose not to send their children to school because they do not trust the quality of the school system. Some families recognize they will not be able to afford high school and university tuition, so they believe that primary and middle school is a waste of time. Some families who can afford to send their children to high school and university choose not to because they believe the money spent will not guarantee an official government job for their child after graduating. These families believe it is more stable and realistic to let their children continue their way of living as herdsmen.

In addition, female children are especially disadvantaged because many parents prefer that their girls work in the house or marry at an early age. People think that women should learn how to run a household and take care of children.

Cash Income
There are three ways of generating income for Gasar villagers, and there is remarkable income inequality. There are 113 households but only 23 households can be called relatively rich. The rest of the households suffer from low income, labor scarcity, poverty-related health problems, and low education.

The first way of earning income is based on livestock. The richest family in Gasar Village owns four hundred sheep, around one hundred yaks and several pigs. Rich families can earn about 18,000 rmb from selling livestock. They can also sell yak hair (7 rmb per jin [1 jin = 0.5 kg]), cheese (18 rmb/jin), butter (15/jin) and sheep skins (30 rmb per skin) to increase their income.Besides this the women can sell yak dung to the local monks. Usually one basket of yak dung costs 2 rmb and if the small scale business is going well then women can earn 2,000 rmb/year. The yearly income of the richer families in Gasar Village is above 20,000 rmb. These families are able to save some money after all the expenses for family needs. However, if they have a university student or a sick person in the family, this amount of money is not quite enough.

The poor families own around ten yaks and around twenty sheep. Some of the poorest families do not have any livestock and rely on manual labor jobs for a living. The poor families hardly sell their livestock but they store cheese, butter and yak hair to earn about 1,400 rmb in a year. They might be able to sell one sheep that could help them earn around 2,000 rmb, which they could use to buy food and clothing.

The second way of the earning income is to dig caterpillar fungus (a kind of herb) in the spring and to pick mushrooms in the summer. Villagers can earn an average of 1,000 rmb/year from digging caterpillar fungus (one fungus can sell for 10 rmb depending on quality) and around 800 rmb/year for selling dried mushrooms.

The third way is to leave the village to work as manual laborers. The local villagers usually do not have any work skill, so they do physical tasks. Usually the women in the village can find local manual labor jobs. From this villagers can earn 1,000 rmb or more.

The richest families in Gasar can earn around 20,000 rmb per year. They spend 3,000 rmb on food for people and livestock. Another 3,000 rmb is spent on festivals. Families with university students must spend an additional 8,000 rmb for tuition. These families are able to save the left over amount.

The poor families in this village earn around 6,000 rmb per year. Around 1,200 rmb is spent on food for the family. Families with livestock must spend more money on food. If the family has one university student they must pay 8,000 rmb for tuition. Paying for clothes, medicine, and festival expenses costs at least 4,000 rmb total. These families must borrow money from the local bank or relatives.

Herding
Gasar Village is a nomadic village but some families do not have any livestock at all. Most Gasar villagers rely on livestock to live. However, there are fifteen families in Gasar Village who do not have any livestock, so they rely on digging herbs, picking mushrooms and manual labor to survive.

Agriculture
Gasar Village is in a cold climate area that does not support agriculture. Villagers plant grass for livestock, but do not plant crops. They must buy barley and vegetables from farming areas or in the market city of He Zuo.

Project goals
The immediate goal of this project is to invite five doctors to Gasar Village to teach the villagers how to take care of their health in their daily lives and how to prevent sickness. The gynecologists particularly focus on women’s health to teach how women should take care themselves as being women. In addition, the doctors introduce how health practices affect villagers’ lives and the lives of the next generations. The long-term goal of this project is to improve women’s health through the training and the lectures. The health information can plant seeds of health care in their minds. This knowledge will be passed down from mothers to their daughters.

Problems
1. Heavy work burden for women, increased importance of women’s health
Traditionally, women are responsible for the bulk of the labor tasks in a nomadic area. While men share in the herding responsibilities, women are almost entirely responsible for milking yaks, churning milk and storing dairy products. Women are also responsible for all of the household chores. In the local cultural context, women are integral to the functioning of a nomadic household. Thus, there is an increased need for a basic awareness of women’s health.

2. Culturally taboo for women to seek medical help for obstetrics/gynecology
Culturally, Tibetan women are shy to talk about sexual sickness in public, so many women are too shy to see a doctor when get pains or infections. Many women bare the pain until it becomes very serious. Some of the pregnant women also think that to see a doctor to check women’s illness is shameful.

3. Lack of basic information about hygiene and gynecology
Due to the above cultural taboo, there is a lack of information about basic women’s hygiene and gynecology.

4. Lack of information about obstetrics
Many villagers believe that pregnancy should not be treated as a special condition. People believe it is a small thing, one not to pay much attention to. When women in the village become pregnant they usually continue to do heavy work until the time of birth. They are usually expected to go back to work after seven days of giving birth. In many cases there is no mid-wife present. There are high risks for the mother and the child. Additionally, most men believe that giving birth is a women’s duty and her own problem to bare. For example, many men do not know that smoking affects the baby’s health.

5. Lack of information about safe sex
There is no open discussion about STDs or family planning, especially for younger people. Villagers are not aware of safe sex practices or the potential outcomes of not practicing safe sex.

6. No access to doctors and difficult transportation
Villagers need to herd their livestock in different pastures. They change their pastures three times in a year. They live for months at a time in remote valleys where there are no doctors. Some families who live in their summer pastures must ride a horse or take a long truck ride to see a doctor. Even when families are in the village it is very inconvenient to go to the clinic. Only one bus goes to the village and it can be difficult to hire a car in case of emergency. Because it is very inconvenient, women often would rather “tough it out” than go see a doctor.

Benefits
1. Basic health awareness (i.e., hygiene, nutrition, etc.) will benefit all people, especially women. After the training, there will be a good foundation of knowledge about women’s health.
2. Women will be able to talk about women’s illnesses in an open forum. They will see from the training that it is not shameful to talk about women’s illnesses. Also, they will be encouraged to see a doctor when they have health problems. If doctors tell them face to face about the causes of certain infections and STDs then they will at least be aware of the problems. As the training will also focus on preventative health measures, the villagers will know the causes of some basic health problems and will know what to do to prevent them.
3. Men and women will have a basic understanding of gynecology and hygiene.
4. Villagers will be more aware of complications related to pregnancy and child birth. Women will be encouraged to go to the hospital for pre-natal care and to go to the hospital to give birth.
5. Information about safe sex will prevent unwanted pregnancies and the spread of STDs.
6. Villagers who attend the training will be able to pass on their knowledge to neighbors and family members. So, even if access to a doctor is limited villagers still have access to information.
Beneficiaries
The project will directly benefit 250 women from Gasar Village in the Zuogai Duoma Township. The other 563 villagers will indirectly benefit. So in total 813 people in Gasar Village will benefit from the project.

Gender equality
This project promotes gender equality in the following ways. By bringing educated women doctors and professionals to give the trainings, the villagers of Gasar will interact face to face with empowered women. Also, as a female project manager I will show the villagers the importance and value of education for girls.

Government approval
On September 5th, 2008 I received permission from the local government to implement this project. The local government leader Sangji approved this project and they also said that their office will send an assistant if it is necessary during the training.

Project steps
1) Hold meeting with the village women and the leader with the doctor.
2) Collect information from locals villagers and talk with the person who has done this kind of project.(done)
3) Contact the hospital in Gannan, Baojianzhan. (done)
4) Ask three gynecologists, one medical school teacher and one nurse to train the local villagers. (done)
5) Figure out the price of the training fee and the other materials fee that will be needed in the training.(done)
6) Write a proposal.(done)
7) Receive the funds.
8) Purchase the materials with villagers.
9) Invite the doctors to Gasar Village.
10) Hold a meeting with the villagers and select five men to give announcement to each family. There will be between 160 or 200 women attending the training, but for men it is an optional training.
11) Hold 5 days training.
12) Take pictures of the process of project.
13) Write final report.

Time Frame
The implementation of the project will take 8 days.
1day: Invite the doctors to Gasar Village.
1day: Give the announcement about the training and the time when should villagers come. Manage the doctors living.
5days: Training the villagers. Take photos.
1day: Interview the village beneficiaries

Health issue is not taught in most of the universities and colleges in Qinghai Province, China, except in the Medical Colleges. As a result, university students and college students have very limited knowledge about health issues and hardly aware health issues

Laurence from Australia funded this project

What? Shem women’s group invited Doctor Sonamtso from Number Two Hospital to have a short time health training especially women health issues.

Who?  Shem members, the students who got help from Mother’s Wish Foundation, some young women from Shokay , the Shambala Connection, and other women from variety working fields like Qinghai TV station and Qinghai Tibetan Medical Research Center, some business women as well as some students who are interested to participate this training.

Photos of during the training

All The participants are listening the training.

The doctor, Sonamtso is explaining some serious sexual diseases by using some photos from the book.

Some participants are looking at some photos of serious diseases which usually happen with reproductive organs during the break time.

All the participants are writing what they have learned from the training, as well as suggestions and comments for the whole training.

On the final training day, the organizer, Shem is offering white silk(Khata)to the woman who have been very supportive to Shem’s work.

All the participants who have participated in the health training.

Project summary

Project title: Health Training for young women

Location of project: Xining City, Qinghai Province.

Implementation organization/individual: Shem Women’s Group

Contact Group: Shem Women’s Group

Telephone: 0971–6302115

Email: info@shemgroup.org

Web site: www.shemgroup.org

Post: mailing labels

Lamaocuo
Qinghai, Xining
Xining Shi You Zheng Ju
Xin Ning Lu You Ju
20-5 Xin Xiang
China,
810008

Detail of project activities

 Project Finance

Lessons learned and suggestions

A) From the participants
On the final day of training, we let all the particiapants write down what they have learnt from attending the health training and the comments they have. Here we have summarized some key points from their writing.

1. Has a better understanding about our body as a woman
The majority of participants have never been to medical school and in their schools there are not health related course or class, and the participants do not have idea about their body. Therefore the doctor explained in a very detail way of female body structure and especially the reproductive structure which can be easily affected by different disease. And the doctor supervised and urged all the females to clean their bodies and taught us some very practical and effective approaches to take care our own bodies from being affected by variety diseases and sicknesses.    

2. Learnt some common healthy knowledge and appropriate habits in our daily life
Because of the very limited medical knowledge, most people in local areas are used to eat one kind of common medicine for every sickness no matter you get stomachache, cold or food poison. Also people usually eat food or drink water which is from overnight but actually it is not healthy. Get idea of what kind of food will be healthy to eat and what kinds of food one should not eat during the sick time and so on. All those small habits and behaviors are not difficult to practice; the only problem is people do not know these things. In addition, we learnt some very easy ways to prevent the sickness in our daily life like eating garlic before getting cold.

3.Cause and prevention of the women’s health problems
Getting a general idea what kind of diseases women can easily get, and the prevention of the disease and causes. Different aged women have different sicknesses and married women and unmarried women have different sicknesses. People should go to standard hospitals to check the health every year once at least, especially married women because those women can get more complex sickness as well as that woman are the future mothers they can not transfer the disease to their babies. As the doctor said improve the mothers’ senses of checking their health means to improve the whole nationality. People should get treatment before the sicknesses become worse and incurable disease, so all the people should have the common senses of seeing the doctor if you get sick.

4.the importance of the sanitation during menstrual period
All the participants in this training are young women and all of them really concern a series of issues and problems during their menstrual period. During the training, lots of young women asked questions to the doctor which happened to themselves or their female friends and relatives because of the menstruation. For instance, during menstrual period, women should not do any intensive actions, drink cold things, and wear very tight clothes and so on. Even those easy things people still do not know, because people do not have any hygiene education in the school.

5.Common sexual diseases
By listening the doctor’s teaching, the participants get to know the different kinds of sexual disease more or less and also the prevention of the sexual
diseases and how to identify the disease.

6.It is better to organize this kind of training at large scale
Since there are no hygiene classes in schools even in colleges in Qinghai Province, the participants hope this kind of health trainings can be held more often and more people can have access to attend the training.

7.It is better to hold health training at the village level
The villagers are very different from educated people, they do not have health sense at all, and there is high chance that the villagers get sick very easily, so it is important and necessary to have health training for village people.

8.It is better to have visual aids like projector
The projector can help the participants to understand better and easy for the doctor to explain abstract sickness. Therefore the projector can provide some photos and so on.

9. It is better to use simple words during training
As mentioned above, the participants do not have the knowledge of health scope, so it is very difficult to understand if the doctor uses the professional words, terms, and jargons in health field.

B) From Shem Women’s Group
The followings are some lesson learnt from by organizing this health training:

1. Communicating with the instructor (doctor)
Before the training, we should communicate with doctor about using simple words togive training on health, in this case the participants can easily understand the content of the training fully.

2.Be flexible according to the change of the situation
There were a large number of people attending this health training, and it is much more than we have plant, so the room is not enough to fit all these people in and it seemed much crowed. In this case as the organizer we should change another big meeting hall if the financial condition is sufficient.

3. Communication with the participant
We held all the health trainings during the Saturdays of November, and every week before the training, we communicate with the donor her convenient time for having the training, but not really asked the participant whether it is convenient for them. So one time, lots of Shem members couldn’t attend the training because of the time and we are very sorry about not communicating with them before.

Original Proposal

For Tibetan Female College Students
Facilitator: Doctor Sonamtso
Organizer: Shem Women’s Group
Brief Introduction For Doctor Sonamtso
Sonamtso is a Tibetan woman and she is forty-two. Sonamtso graduated from Qinghai Tibetan Medical College in 1989 and her major is in clinical. She is currently working in Qinghai University Affiliated Hospital Tumor Gynecology Department as an Assistant director doctor.

Brief Introduction for Organizer
Shem is a women’s group dedicated to empowering Tibetan women and their communities through grassroots development. We focus on increasing the well-being of people in impoverished communities by providing access to basic needs such as water, fuel, electricity, health care, and basic education. We fulfill our mission by training educated Tibetan women to design, implement, and manage sustainable grassroots development projects that will successfully alleviate the problems that their communities face. SWG has so far successfully completed 29 small-scale humanitarian projects in named provinces.

At the village level, while our projects fulfill basic survival needs for village women and their families, our project managers-educated Tibetan women-present villagers with strong female role models. The work of these young women raises villager’s confidence in women’s abilities and encourages villagers to value women’s education.

At the university level, we offer discussion groups and workshops designed to empower educated Tibetan women, and we provide women with the resources and training they need to put their ideas into action.

Shem means charity and compassion in Tibetan. Charity and compassion are fundamental to helping others, and are the guiding principles behind our work. The women of Shem hope to serve as inspirational examples for our families, peers, and generations of Tibetan women to come.

Shem began in October of 2003 as an after hours course in gender studies taught by Michelle Kleisath, an English teacher and gender studies specialist. In September of 2004, at the request of the gender class participants, Ms. Kleisath started teaching an additional course in small-scale development to interested women. This class began in hopes of encouraging female students to design and implement their own small-scale development projects. Such a class was unprecedented in Qinghai province.

During the course of the semester, the students learned how to identify the problems of their communities, design sustainable projects that would successfully alleviate these problems, write professional proposals to outside funding sources, and manage the execution of their projects.

By December of 2004, several project proposals were successfully completed and sent to donors for consideration. Once funded, these projects brought potable water to the villages, improved schools, brought solar electricity into the homes of nomadic communities, improved village infrastructure in the form of a bridge, and supported micro-financing in the form of a yak loan.

In an effort to create a sustainable support system for Tibetan women active in grassroots development, Shem was formed in March of 2005.

Since Shem’s inception, its’ members have raised nearly $149,228 in international funding and successfully implemented 32 small-scale development projects. These projects were funded by private donors and international funding organizations, including: The British Embassy, the Canada Fund, The German Embassy, The Netherlands Embassy, and the Shambala Connection.

contact information
Contact Group: Shem Women’s Group

Email: info@shemgroup.org

Phone: 86-971-630-2115

Mailing address:

Qinghai, Xining

Xining shi you zheng ju,

xin ning lu you ju
20-5xin xiang,
810008
China.

Website: http://www.shemgroup.org/

Why we need this training
Generally speaking, Health issue is not taught in most of the universities and colleges in Qinghai Province, China, except in the Medical Colleges. As a result, university students and college students have very limited knowledge about health issues and hardly aware health issues.

Even this is twenty first century and this is a sensitive area to talk about health problem related to sex or reproduction. Thus most of Tibetan women and girls are shy to talk about those health issues openly even if they know they have some health problems.

Also the women do not have a space for discussing health issues openly and share their problems among women themselves. Also people hardly encourage the educated women to pass their knowledge to one another.

Moreover, there are very few Tibetan books, magazines and newspapers talk about health problems, especially women’s health problems. So the students are lack of information of health problems.

In addition, the women almost never go to the hospital to check for Gynecological diseases unless they are very sick, so once they are very sick and go to the hospital then it is already becomes serious.

Due to above problems, the village women’s knowledge about health and health condition is worse than University students or educated Women. Because firstly, they are busy with their heavy work and no time to discuss health problems and gain knowledge about health issues. Secondly most of them never attend school and they themselves have to learn from other people. Thirdly, they are very lacking of health information, especially related to reproductive health issues because most of educated women are shy to talk those issues openly even if they learnt and hardly people encourage them to share what they learnt about health issues.

Solution
We will provide a space for women from different Colleges and Universities to discuss health issues and share each other’s knowledge about health openly. We will also invite Doctor Sonamtso to give training on health issue for those gathered women and teach importance of caring health problems. In addition, we will give assignment for each participant to pass what they have learned from Doctor Sonamtso or from other participants to five other village women. If any of them did not finish this assignment, there will be cash punishment (Each student needs to pay 10rmb for not telling the other village women about health issues that they have learnt and for five village total needs to pay 50 rmb as a punishment. So this mount of money will use to buy some medicines for the village women)

Beneficiaries
Around 50 College/University female students will directly benefit from the Health Training and around 250 village women will benefit through the 50 participants.

Brief concept of training

•1. Basic Knowledge about women’s health issue

•2. The importance of caring women’s health problems.

•3. The methods of preventing Gynecological disease.

Schedule

This project will be held for 3 hours each Saturday of September.

September 6^th 2008, introduction and talk about why this training is needed and the importance of this training, start giving trainings about basic knowledge about women’s health issue.

September 13^th 2008, continue giving the training on women’s health issue.

September 20^th 2008, give training for methods of preventing Gynecological disease.

September 27^th 2008, continue training on the methods for 2 hours, and then give assignment and closing the training.

Detailed Budget

Donation requested from the donor in Chinese Yuan: 4820rmb

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

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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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

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