Rural China may struggle to cope with Sars

When a visitor from Beijing turns up unannounced at Xiaonanxinbao village hospital in China's northern Hebei province, administration staff and doctors reach for their protective face masks in alarm.

"We are all too busy to talk and everyone has gone out," insists one hospital worker, keeping a careful distance.

Such caution is understandable. In recent weeks, Beijing has become a new focus of the outbreak of the mysterious new form of pneumonia that has infected about 4,300 people worldwide and killed at least 250.

And nobody knows better than village health workers how vulnerable China's rural health system is to severe acute respiratory syndrome (Sars), which has killed doctors and nurses even in the gleaming and well-equipped hospitals of Hong Kong and Singapore.

Amid China's rush to swap socialism for a market economy, the country's 800m rural dwellers have been largely left to pay for health care out of their own, often meagre, resources.

In Xiaonanxinbao that means the hospital is a crude concrete structure with a rickety ambulance and a rubbish-strewn yard. Nationally, it means fears are growing among officials and experts alike that rural health systems will be unable to respond effectively to Sars and so make it impossible ever fully to contain the mysterious virus.

"The medical and living conditions of China's farming villages are comparatively lacking, as are farmers' sense of self-preservation," Gao Qiang, vice health minister, said this week. "If there is any case of infection, then the situation will be extremely serious."

Henk Bekedam, the World Health Organisation's China representative, says decades of state underinvestment have left disease prevention and surveillance systems enfeebled as revenue generation became the priority of the rural health system.

"When you have a crisis like this it will obviously not be ready," Dr Bekedam says. "Sars, as far as we know, has been quite an urban disease - but if it goes to rural areas then you are dealing with a community that does not have the resources for hospital services.

"People who cannot afford hospital services will not go to hospital . . . so they will stay at home as long as they can, and while they are at home being sick they will be spreading the disease," he says.

That is a view shared by the residents of tiny Baizhuang, a ramshackle collection of red-brick houses near the border between Beijing city and Hebei, where incomes have plunged amid irrigation problems and declining prices for the local corn and low-quality apples.

Fear of Sars has rippled through the village, where many have tales of families left deep in debt by ruinous medical fees and few believe they will get quality care if the virus strikes.

"All you can do if you get a serious disease is stay at home and wait to die," says one farmer who struggled to find Rmb400 ($48) for emergency treatment after a traffic accident last year.

The government has already moved to ensure the poorest can get treatment for Sars by ordering hospitals not to turn anyone away and promising more than Rmb2bn in emergency funding mainly for rural areas.

Officials are also sending suspected cases of Sars directly to county hospitals instead of the cruder village facilities of places like Xiaonanxinbao.

But county hospitals also suffer limited space and a lack of equipment, such as the respirators that have kept many urban Sars victims alive. This suggests mortality rates in the countryside would be higher than the 4 per cent claimed for affected Chinese cities.

Some analysts, however, say that such weaknesses do not inevitably mean Sars will become endemic in China's vast hinterland.

The state is beginning to take action to limit movements into many areas, with police in protective suits manning roadblocks on some Hebei county borders to turn back traffic from Beijing and conduct spot health checks.

Tough quarantine rules unveiled in Beijing this week underline the determination to use public security methods to slow Sars' spread.

Song Wenzhi, an expert on rural medicine at Peking University's School of Public Health, says strategies of quarantine and restricted access will be more effective in rural areas, where population densities are lower and people travel much less.

This is a Chinese Chernobyl in replay. The exodus from Beijing is exactly what it needs to spread the decease nationwide. Even a couple of SARS carriers among a train of 600 passengers can bring it to rural China where medical facility is primitive.

WuYi, the iron lay who heads China's SARS fighting command had warned that if the virus hit rural China, it could spread like wild fires. Those jack aSS officials should set up quarantine procedures before they let the millions of people swamp back to their hometown. THIS IS ONE GIGANTIC SCREW-UP. Now, they are all gone and untraceable, it is too late to do anything. Sit back and watch the sh!t hit the fan.

3 posted on 04/25/2003 1:01:11 PM PDT by America's Resolve ("We have prepared for the unbelievers, whips and chains and blazing fires!" Koran 76:4)

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