Safe sex and healthy babies

English-born Frances Howland, a health care provider who works at the American Embassy in Kathmandu, Nepal for six months a year, also spends part of each year working in Tibet. She tells of her work with a few of the many international non-governmental organizations (INGOs) working in Central Tibet.

“I first went to Tibet with Lama Zopa Rinpoche back in 1987. Today there are 20 INGOs in Central Tibet alone working on projects as varied as healthcare, education, water and sanitation, eco tourism and environmental protection, and poverty alleviation programs including small loans for rural people,” she explained.

“Because of my background,” (she is a trained nurse and midwife with a Master’s Degree in Public Health,) “I have spent the past two years working on a training program for rural health care workers in safe childbirth methods, and mother and infant health. Deaths during childbirth and infant death are common in rural Tibet. Health workers often have to work alone in very remote and difficult situations, so we bring them into a hospital environment for two months. There we can make sure they receive both practical and theoretical training that will be useful to them in their rural setting. When they complete the training they return to their clinics with a full set of medical equipment.”

A recent article in the Sunday Times puts the figure of commercial sex workers in Lhasa at between 3,500 and 9000.

The urban areas of Tibet have a different health care problem, which is growing at an alarming rate.

“There are increasing numbers of commercial sex workers, both Tibetan and Chinese, in the city. It’s hard to estimate how many sex workers there really are. They are usually young and, in the case of the Tibetans, are more often than not illiterate farmers or nomads. Poverty and the wish for a better life drive them to the city; when they are unable to find work they end up as sex workers rather than return home. Their families have no idea what they are doing. The majority of them have never heard of HIV or AIDS, and many of them don’t know what a condom is.

“When they do seek medical attention for a sexually transmitted infection, they don’t want to go to a hospital so they go to one of the many small private pharmacy clinics where no one will know who they are. There they get charged lots of money for inappropriate intravenous antibiotic treatment; they don’t get any better and they just carry on working,” Frances said.

“This year I coordinated the setting up of a clinic to treat sexually transmitted infections, aimed primarily at sex workers and their clients. The clinic will provide the right treatment at an affordable price and will also provide free condoms and health education on HIV/AIDS and safe sex.”

Frances has been assisting with another INGO project, which involves the harvesting and drying of herbs to be made into traditional Tibetan medicine, the sale of which provides income to nomads.

“The area is in Eastern Tibet, in Kham. It is really remote, an area where only nomads and their animals live, and it takes many days of driving to get there. The altitude is very high, and most of the year it is snowed in. My role is to train the students of traditional Tibetan medicine in concepts of Western medicine. They have to train as traditional doctors for many years and it will be useful for them to have some Western medical knowledge regarding maternal and child health, infectious diseases, and so on. It is a three-year project so I will have to keep returning to this area.”