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Left behind but not forgotten: AIDS-devastated villages
By Zhang Feng (China Daily)
Updated: 2005-10-27 06:03
Yin Zuluan wanted to cry every time Wu Ming came to ask her to take care of
her mother.
"Auntie, would you like to come to my home to give an injection to my mummy?
My mummy is dying."
Yin said that Wu Ming, the assumed name for the HIV-infected girl, would say
these words whenever she went to her clinic in the village named Guangsong in
Dehong Dai and Jingpo Autonomous Prefecture of Southwest China's Yunnan
Province.
The girl, now 9 years old, started taking care of her mother in 2000 when her
mother fell ill and was diagnosed as an AIDS patient.
In the four years before 2004, Wu undertook all the household work, such as
carrying home buckets of water on a shoulder pole every day, and asking the
village doctors to treat her mother.
Her father caught the virus through drug abuse, then transmitted it to her
mother and died before 2000.
Her mother also died from AIDS in 2004, leaving nothing valuable to her. Wu,
however, was infected with the deadly virus at birth.
"The child is indeed a poor child, and what I can do is really limited," said
Yin, 34, a doctor in the village.
Wu's family is one of the dozens of families affected by the virus in the
village, where Yin and her father are the only two doctors.
Guangsong and another village named Mandan are included in a pilot project to
provide comprehensive care and to control HIV/AIDS.
The project, sponsored by the central government and organized by the local
government of Dehong Prefecture, is the reason Yin's tiny, old clinic has been
replaced by a bigger one with much better facilities. But the villagers aren't
getting adequate medical services due to a lack of funds to pay doctors, to
provide sufficient medicine and facilities, and to support villagers in living
and education expenses.
Before the government started the free anti-virus treatment on HIV/AIDS
victims in her village in 2004, patients couldn't get any suitable medicine at
all, Yin said.
Yin said she could only give some common anti-virus medicines or injections
to those like the girl's mother.
But the family couldn't afford her medical service and still owe much debt to
her clinic.
The orphaned girl, already displaying some symptoms, is able to continue
studying in a primary school only through the local government's support. She is
now living with her aunt.
"She is the best student in her class," Yin said.
Still, Yin has another reason to feel like crying.
"Up to now, there is no suitable anti-virus medicines for child sufferers,"
she said.
Financial problems
One mission of Yin and her colleagues is to investigate the real situation of
the orphans and the elderly people left behind by AIDS patients who succumbed to
the disease.
They report the difficult situation of these families to the local
government, striving to get more support from the local civil affairs
departments.
In the pilot site of Guangsong and Mandan villages, 54 orphans and eight
elderly people have been left behind by deceased HIV/AIDS victims. "They are all
very poor and as a village doctor with poor facilities, I can do little to help
them," Yin said.
In the past years, villagers have owed a debt of 20,000 yuan (US$2,466) to
her clinic for their medicines and treatment. "I know there is no hope that the
debt will be paid," Yin said.
Except for the money they get from doing the follow-up visits, the village
doctors have very little or no salary paid by the local government, said Mei
Hongying, director of HIV/AIDS Control and Prevention Centre of Longchuan
County, Yunnan Province.
In Longchuan County, where the pilot site is set up, the average salary of a
doctor is 60 yuan (US$7.40) a month.
However, she said that these village doctors are very important in doing the
prevention and control work of HIV/AIDS in rural areas.
In the county with 214 natural villages and 1,865 reported HIV carriers,
there are only 13 professional workers of HIV prevention and control. About 88
per cent of the HIV carriers are in villages.
The whole Dehong Prefecture with 333 villages and 27 communities has only 47
professionals doing the prevention work, such as public education, HIV tests,
high-risk activities interventions and follow-up services.
The majority of doctors who are treating the patients can't meet the
increasing demand as they aren't well-trained professionals, and they come from
the infectious disease department of local hospitals.
In this sense, the work must depend more on the village doctors, Mei said.
However, the poor salary and support seriously affected the enthusiasm of the
village doctors, Mei said. And the basic conditions and equipments of the
township hospitals or village clinics are very underdeveloped, Mei said.
Still, people and doctors of the 17 villages included in the pilot site are
much luckier than those outside the project, Mei said.
Lack of money is the biggest problem now, Yin said, not only with the
doctors' salary, but in many other aspects, such as with providing orphans
living and education expenses, and granting loans to HIV-affected families for
their farm production.
"HIV/AIDS families usually lose their main livelihoods first," Yin said.
"They often have no money to buy chemical fertilizers, and become poorer as time
goes on."
In Dehong Prefecture, which is one of the dozens of State-level pilot regions
making comprehensive efforts to control HIV/AIDS, people can get free anti-virus
medicines, free HIV virus tests, free education for orphans and some other
support from the governments.
In Yin's village, every orphan of HIV/AIDS can get about 50 yuan (US$6.17)
and some rice a month.
The majority of the money for these project villages or counties is provided
by the central government. Still, the local governments can only give very
limited financial support to these victims.
The revenue of Longchuan was about 60 million yuan (US$7.40 million) last
year, but the expenditure was 120 million yuan (US$14.80 million), Mei noted.
"Top officials of our county government often have to call on the enterprises
and individuals to donate money to help the orphans get education," Yin said.
New roles
Besides the traditional role of providing basic public health service to the
villagers, Yin and several other doctors from Guangsong and Mandan villages are
organized by the government to do some primary care and intervention activities
among local residents.
Spreading condoms among HIV/AIDS-affected families, following the changes of
HIV carriers' health conditions, and supervising the use of anti-virus medicines
are the main tasks of these doctors.
Meanwhile, they organize the AIDS patients to go to the disease control
centre of the Longchuan County to do health examinations for timely and proper
medical treatment.
"It is a big burden for the patients, who usually become very poor due to
drug abuse and loss of working ability, to afford the cost of the trip to the
county," said Luo Lu.
Luo, 32, is a doctor from the Mandan Village working for the newly-built
pilot site.
Many villagers refused to go to the county to do the HIV/AIDS test because
they can't afford the ticket worth about 3 yuan (US$0.36), Luo said.
The local health authority plans to take blood samples of the villagers in
the pilot site and send the samples to the county within six hours for
examination, said Mei Hongying.
The village doctors collecting the blood samples will be paid about 20 yuan
(US$2.4) for each.
They can also get 10 yuan (US$1.2) from the local authority each time they
finish the follow-up work on one patient.
"As I do the follow-up visiting on HIV sufferers, I record all their health
conditions, give them proper suggestions on health care and care about their
living conditions," Luo said.
Luo is in charge of following up on 26 HIV carriers, and every month she will
visit them at least once. "It is hard work actually," Luo said. "One patient of
mine lives in the mountains. I have to walk for more than 20 kilometres."
Usually, Luo can only do one follow-up visit in one day because of the long
distance, or the difficulty of finding the right person.
Many times, she couldn't find them at home and had to wait for them or return
another day, Luo said.
But both Luo and Yin said they feel much better now because the local
residents are showing more understanding and acceptance thanks to the education
efforts in the past months.
"At the beginning of the pilot project, one patient even asked her dog to
bite me as I tried to visit her house," Yin said.
"The residents all trust me very much because I am their doctor. But they
would become very cold if I talked about HIV/AIDS. So you can imagine if a new
doctor did the work, it would be much harder."
Fortunately, the infected villagers have now begun to regard her as their
best friend again, Yin said.
(China Daily 10/27/2005 page12)
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