Blinded by Poverty

[Peter Dorman <dormanp@xxxxxxxxxxxxx>]

As someone with a great interest in occ. safety and health issues, I
note the passing reference to the mutilated father.  The social cost (in
addition to the devastating personal cost) of such injuries is very high
in poor countries, although they are hidden due to the lack of official
data.  Here we have a kid whose education was cut off along with his
father's arms.  Nevertheless we have apologists who tell us that
countries like China can't "afford" decent working conditions...

Peter

Blinded by Poverty: The Dark Side of Economic Reform
The New York Times, November 21, 2000
By Elisabeth Rosenthal

Shunyi, China  In 15 minutes, Dr. Jiang Lijuan broke up the dense
cataract that had long covered Liang Xingwang's eye, removed the debris
and slipped a new tiny plastic lens under his cornea. She squirted in a
few drops of antibiotic and prepared a heavy gauze bandage.

Before the gauze was applied, Mr. Liang caught a fleeting glimpse of the
operating room light, his first glimpse of anything from his right eye
in years. "I think I could see things!" Mr. Liang, 17, said with
wonderment as he moved to a bed in an adjoining room.

But there is both a happy and a sad story behind the recent surgery in a
small operating room at a community hospital here near Beijing.

Mr. Liang is one of 1.1 million poor Chinese who have had their sight
restored through free cataract surgery in the last four years under the
Sight First project, sponsored jointly by Lions Clubs International and
the China Disabled Persons Federation.

As China has opened its economy and developed its own philanthropically
minded middle class, such charity projects are increasingly common.
That's the happy part.

The sad part is that Mr. Liang, who suffers from an inherited condition
that can be remedied by simple outpatient surgery, spent so much of his
childhood nearly blind, even though the technology to cure him was
widely available in China.

In Beijing's clinics, 40 miles from Mr. Liang's home, people with enough
cash can get top-flight laser vision correction surgery for about $500
an eye. But those clinics might as well be on Mars for people like Mr.
Liang. Today, medical care in China is almost entirely a matter of cash
from individual patients, and there is no public health insurance for
the poor.

Twenty years ago, China boasted the broadest public health system in the
world, offering free (if basic) health care to all. But the country's
shift to a market economy has upended that balance, allowing entry of
more advanced medical techniques but also making even simple procedures
widely unaffordable.

The World Health Organization now rates China last among developing
countries in terms of equal access to medical care. (The United States
is last among developed countries.)

Yang Liqun, a government researcher who has studied social services on
the outskirts of Beijing, found that only 9.9 percent of people in
Shunyi County had any kind of medical coverage. "During the process of
reform, the old system of cooperative medical care has suffered
devastating damage," he wrote in the journal Beijing Social Sciences.

And so, when Mr. Liang's vision began clouding over eight years ago, he
did what rural Chinese often do when they fall ill: he endured. As
cataracts from a congenital condition marched over first his left eye,
then his right, he tried his best to help out in the family fields and
was determined to keep going to school.

Last year, while in the ninth grade, he dropped out of school because he
could no longer see his books. But treatment was not an option.

"I never visited a doctor for this until Oct. 1 this year," he said from
his bed in the recovery room, referring to the day health workers came
to his village looking for patients who might benefit from the Sight
First project. "I knew it could be corrected, but we had no money to see
a doctor, much less have surgery. So what was the point?"

It is a jarring admission in a country once so committed to egalitarian
health care. But during the last decade, as central government financing
for hospitals has plummeted, free medical care has given way to hefty
patient charges for doctors' visits, surgery and tests.

In China today, treatment is often an economic rather than a medical
decision. And charitable donations, often organized by the state, are
unable to cover the huge tab that the government has dropped. Cataract
surgery, done on an outpatient basis, costs about $50 at the township
hospital in Shunyi, about half as much as in hospitals in Beijing.

That is still two to three months' earnings for poor families, money
that is in any case consumed by day- to-day subsistence. Mr. Liang's
mother also suffers from cataracts and his father lost his arms in an
industrial accident. So he lives with his grandfather, who has taken
care of him as he has become progressively disabled.

The Lions Clubs program has helped reduce the cost and improve the
quality of cataract surgery in China. The group has trained 4,000
doctors in surgical techniques, many in outlying areas, and it has
donated some of the latest equipment to diagnose and treat eye disease.

The project helped a factory in Suzhou to gear up to make the little
plastic lenses that are the key to the operation's success. Before late
1998, when the plant started production, Chinese-made lenses were of
very low quality and imported ones were prohibitively expensive.

But the main contribution at this hospital is, plain and simple,
financial. The program pays for the surgery for patients who cannot
afford it, and covers the costs of hospitals that say they cannot afford
to treat patients free.

"Even though the technology exists here, these people just don't have
the money," Dr. Jiang said.

Zhang Bofang, a farmer from nearby Huairou who also had surgery in
Shunyi recently, said his vision started "clouding over" in 1997. For
the last year he has been unable to tend his field or even walk down the
street alone.

With his children grown and gone, his wife tended the family's wheat,
peanut and corn fields alone. "It has really been a struggle," said Mr.
Zhang, wrapped in the tattered brown sweater he wore for his surgery. "I
went to the hospital in Huairou to try to get treatment a few times, but
I didn't have the money, so I just had to go home.

"This time it was free. Now I can start working again."