Lying in bed Tsering Drolma looked a bit tired. The day before she had given birth to a baby girl. "It's my first child," said the 25-year-old Tibetan woman. On her right side sat her husband and her mother-in-law. "I feel so grateful to Doctor Tsoyung. She has helped me have this baby safely," she said.

Tsering Drolma is a farmer in Bujiu Township, some 40 kilometres away from the hospital. The township is located in Nyingchi Prefecture in southern Tibet Autonomous Region.

She suffered from high blood pressure in gestation not long after she became pregnant.

"I chose to receive regular treatment in the maternity and child care hospital in the town," she said. "I believed I could have better care in the hospital."

Tsering Drolma said her daughter had been vaccinated twice within 24 hours of birth - one was BCG (Bacille Calmette-Guerin) against tuberculosis and another against hepatitis B. She said she would leave the hospital for home in five days with her new-born baby.

She would take with her a medical form, with which she would be able to get her baby girl vaccinated against several infectious diseases at the township clinic.

"I will take my daughter to a lamasery and let the master give her a name," she said.

Tsering Drolma shared the ward with two other Tibetan women, one of whom was waiting for her baby to come. That night, 17 beds out of 28 were occupied.

"Many women here would like to give birth in the hospital, where they can enjoy the privilege of medical treatment," said Doctor Tsoyung, who is also the deputy director of the Maternity and Child Care Hospital, which was set up in 1992 in Bayi Town, Nyingchi Prefecture, with investments from Guangdong and Fujian provinces.

"Not only do we offer services for the people in town, but also for farmers and herdsmen around the region," said Tsoyung. "We especially take up serious cases the township clinics are unable to deal with," she said.

According to Tsoyung, some 30,000 people reside in the town, with 160,000 scattered in 55 small towns and villages in the area of 117,000 square kilometres.

"We received 188 pregnant women last year. In the first half of this year there were 158," Tsoyung said.

It has long been a tradition for the Tibetan women to give birth at home, as a result of the scarcity of medical care previously.

"To follow their mothers' way was only one of the reasons," Tsoyung said. "The major problems have been poverty and poor communication and transportation," she said, "although many of them still think it's shameful to give birth in front of other people."

Forty years ago, the maternal and infant mortality rate was high in Tibet.

The maternal mortality rate was 5,000 per 100,000 and the infant mortality rate was 430 per thousand, according to sources from the health department of Tibet Autonomous Region.

"During the past two decades, we have tried to improve maternity and child care by cutting down the maternity mortality rate and eliminating tetanus among new-born babies," said Wang Jianpeng, director of the Maternity and Child Care Section of Tibet Autonomous Region's Health Department.

In recent years, with a large investment from the central government and co-operation between China's Ministry of Health and the United Nations Children's Fund (UNICEF), the maternal and infant mortality rates have decreased sharply in the region.

The statistics from the health department of Tibet Autonomous Region show that the maternal mortality rate decreased to 310.43 per 100,000 in 2004, while the infant mortality rate dropped to 24.53 per thousand.

With health care for women and children spreading far and wide in the region and with more financial aid from the central government, more and more local Tibetan women come to hospitals to enjoy the privilege.

New dress

"It costs only 300 yuan (US$36.99) for a natural labour," said Tsoyung, adding that every pregnant woman is able to get 20 yuan if she gives birth in hospital, and each of her companions can get 10 yuan. The new-born baby also gets a set of new dress.

"Many rural doctors have played a crucial role in helping women in labour," said Xiao Li, deputy director of the Health Bureau of Nyingchi Prefecture. "Apart from spreading knowledge they have taken full responsibility of taking care of the villagers."

Every township clinic has to cover four sections including medical treatment, medical care, epidemic control and planned immunity.

In Puqu Township, Tamdrin, 28, a native of Lhasa, is one of the four doctors in the local clinic. After graduating from Jiangning Medical School in Nanjing, Jiangsu Province seven years ago, she was assigned to work here. She has mainly taken charge of maternity and child care.

"Once in a while I will visit the nearby 13 villages one by one. What I do most is to encourage local women to have gynaecological check-up," she said.

She also makes a list of pregnant women on her rounds, bringing them vitamins and giving on-the-spot check-ups. There are about 2,400 villagers in the region.

She still remembers her first experience of being a midwife.

"I was frightened but succeeded with the help of the director of the clinic," she said.

She has so far delivered 30 children. When it comes to the time for vaccination, Tamdrin, like other village doctors, must visit from door to door to give children injections.

She said that she planned to have further training in Chengdu. "I want to be a good doctor."

Not only do village doctors do regular medical rounds on the vast grassland, but those from regional hospitals also carry out the same routines.

In Shannan Prefecture, also in southern Tibet, doctors in Shannan People's Hospital take turns to tour the rural areas.

"Three doctors go to the rural areas every year to help train local doctors," said Tsamjo Drolma, director of the department of gynaecology and obstetrics of the hospital.

They usually stay for half a year in one place. There are 12 counties in the region with 320,000 people. They cover three counties at one time.

"Village doctors quite appreciate the help from the prefecture hospital," said Tsamjo Drolma.

"Thanks to the economic growth and wide spread of maternity and child care, more and more people prefer to give birth in hospital," said Tsoyung.

"But it's still hard for us to take care of them all because the villagers are sparsely scattered around, particularly those herds people who live a nomadic life," she said. "Sometimes it takes us the whole day to visit only one family," she said.

"We still need more hands to do the job. There are now 20 doctors and nurses in my hospital. The number is far from enough," Tsoyung said.

(China Daily 08/26/2005 page13)