contact A publication of the W orld Council of Churches

REFORMING HEALTH IN CHINA

StrengtheniStrengtheningng thethe ww eak? eak?

STRENGTHENING THE WEAK? 12 Wholeness No 166 Faith, healing, church growth 2 Editorial 14 Wholeness July- 3 Introduction God’s expression of loving care September 1999 15 Resources Paying for health: new lessons from rural China 16 Bible Study 7 Experiences To destroy or not to destroy? Healing the weak 17 UPDATE 10 Alternatives NETWORKING What it takes to become a villageStrengtheni18 Useful publications,ng th letters, e w eak? doctor announcements EDITORIAL

China, a vast country with a large The Amity Foundation, a Christian population, has witnessed fast economic initiated organization, aims at promoting growth since the late 1970s. However, health, education, social welfare and there still exists an income gap between rural development, in order to share the eastern and western parts of China. God’s love with fellow Chinese and to The church in China has grown care for the weak — things that ought be phenomenally in the past 20 years. done by Christians. Friends both at home and abroad often By the end of 1998, 42 million Chinese asked me, “Why was there such a were still living under the official poverty growth?” My observations are as follows, line. They have neither clinics nor 1. The comparatively relaxed political doctors. Women and children do not The faith-based atmosphere provides enough have access to health care nor do they approaches to healing of freedom for Chinese people to focus have provision for basic prevention of the church in China is a on spiritual issues. The earlier diseases. They suffer from illnesses of emphasis on class struggle gave poverty while poverty leads to further ill living witness to the neither time nor energy to search for health. Amity helps them meet their compassion of Christ. the spiritual dimension of peoples’ basic needs by offering medical training lives. programmes at the grassroots level, so that the trainees can go back and serve 2. God’s word has spread rapidly the local communities. Amity also helps because Chinese Christians witness them establish village clinics so that through their actions, as well as by medicines for treating simple illness is their words. easily accessible. The prevalence of 3. It is estimated that the majority of faith healing practices in rural areas is rural Chinese Christians have come considerable. However we encourage to faith through physical healing. the sick to take medicine, because we The growth of the church in China believe that medicine is also one of depends on the message of the church. God’s creations. The opening up and adoption of the As this issue of Contact goes to press, reform policy in the late 1970s enabled humankind is moving into the new the church in China to do many things millennium. At the turn of the century the that could not be done earlier. Chinese church faces the challenge of Two examples illustrate this: the Amity new leadership and promotion of Printing Company, a joint venture theological thinking. Meanwhile, we will between Amity and United Bible continue to strengthen our social Societies, which gives priority to printing ministry. We ask for your prayers that Christian literature,was established through our concerted efforts, our church in1987 and has printed more than 22 will grow steadily and accept challenges million copies of the Bible. This is God’s in the new millennium. miracle in China. Such an establishment Wenzao Han would not exist if the Chinese President, China Christian Council government had not opened up and Nanjing, China. adopted a reform policy. Dear Readers, Twenty-seven years ago Contact 12 (1972), praised the Chinese system because of the stress placed on rural health care, and on preventive rather than curative services. We Amity Foundation have put together this issue on health reforms in China, when the world is facing structural adjustment, political instability and fragile economics. This issue of Contact has several Chinese view-points that look at the effects of market Cover reform on health in China, and the role of the Churches in health care during a period of Give others a hand. privatisation and greater fredom. It is their message to readers in other countries. A true This drawing is by Ming Yun, an eleven- exercise in sharing. year-old girl from Wuhan Orphanage, a social welfare institution sponsored by Amity Foundation, China. Darlena David

2 contact n°166 - July-September 1999 INTRODUCTION

PAYING FOR HEALTH NEW LESSONS FROM RURAL CHINA

Shenglan Tang, who teaches both at the Liverpool School of Tropical Medicine and at the Shanghai Medical University, believes that sustainable health care requires long-term commitment by leaders at all levels of government. Amity Foundation A Chinese village health worker weighing herbs.

Before the founding of the People’s Key Demographic and Health Republic of China in 1949, the Chinese Indicators population was among the least healthy in the world. The great burden of disease Variable Year 1970 1995 resulted in the nation’s poor economic Mid-year population performance. From the 1950s to the total (millions) 818.3 1201.4 1970s, the health status of the Chinese Life expectancy population improved significantly. The at birth (years) 61.4 69.4 very effective health service ensured Crude death rate per 1,000 people 7.6 7.5 that a vast majority of the population Infant mortality rate (%) 69 38* received treatment for illness, and help Under-five mortality rate (%) 115 44* From the 1950s to the and advice on how to prevent Total fertility rate 5.8 1.9 communicable diseases. Percent of population 1970s, the health status over the age of 60 6.8 9.6 Improving health conditions Percent of urban population 17.5 3.3 of the Chinese improved Notes: * Data based on the 1990 statistics significantly. Success in improving health conditions Sources: in China is attributed to two notable 1. The World Bank, 1996. China: Issues and Options in Health achievements. One is the establishment Financing.Report No. 15278 – CHA. of the cooperative medical schemes 2. The World Bank, 1993. World Development Report 1993 – Investing in Health. in the rural areas, covering the population

contact n°166 - July-September 1999 3 INTRODUCTION

in almost 90% of the villages. Financed and prevention activities and its curative by the central and local governments, care section provided outpatient and local agricultural collectives and inpatient services. At the county level, individual households, the cooperative general hospitals and other preventive medical schemes reimbursed the health facilities not only provided various With the three-tier participants for most of the costs, or health care services to local people, but network of health care, provided free medical consultations and also offered technical support to lower preventive services. levels of health facilities. Consequently, “barefoot doctors” the system resulted inremarkable gains Another is that since the early 1950s the provided basic health in health status at affordable costs. Chinese government has developed a care and organized three-tier network of health care in Impact of economic reform on preventive care both rural and urban areas. In the rural financing and organization of health programmes in the areas, village health stations with 2-3 services “barefoot” doctors provided local villages. Since the implementation of economic people with essential clinical services, reform in the early 1980s, rural health and organized preventive care services have been facing problems in programmes. The township health ensuring access to basic health care for centre is the lowest tier where qualified the population. The cooperative medical doctors are stationed. Its preventive schemes in most of the rural areas care section organized health promotion collapsed, owing to the weakening of

Period Political movement and economic development Health development

1949-1957 l The Three “antis” (anti-corruption, anti-waste, è Development of health policies focusing on preventive and anti-bureaucracy) services and infectious disease l The land reform è Many infectious diseases were under effective control and l Establishment of the joint producers’ the health status of the vast majority of the population was cooperatives in the rural areas improved. l Public-private joint operation for enterprises è The employment related medical insurance schemes in and business in the urban areas the urban areas were established.

1958-1960 l The Great Leap Forward è Health centres at most of the towns (communes) and l Establishment of commune system in the general hospitals at the county level were rapidly established. rural areas è The barefoot doctors began to play an important role at l Abolishing of private sector the village level health services. è The Cooperative Medical System (CMS) was first developed in a few villages and townships. è The number of private health clinics declined dramatically.

1961-1965 l The Socialist Education Movement è The three-tier network of health care in the rural and l Decentralization of agriculture production urban areas was gradually developed, facilitating access to basic health care for the vast majority of the population. è The CMS continued to develop in the rural areas. è The health status of the population was further improved. 1966-1978 l The Great Cultural Revolution è The three-tier network and the CMS had been well l Slow development of agriculture production established in almost all of the rural areas. affected development in the late 1960s and a è Many health professionals were sent to the rural areas for reasonable recovery later in the urban “re-education” and providing health services to local people. industries è The health status had significant improvement over the period.

1978-now l The economic reform with de facto privatization è The CMS in most of the rural areas collapsed in the early of agricultural production in the rural areas in the 1980s and had a slow and unsatisfactory recovery in the early 1980s and the reform of the state-owned 1990s. enterprises in the urban areas in the 1990s è The cost of health care, particularly in the urban areas grew rapidly and the employment related medical insurance schemes are in financial crisis. è The health status of the vast majority of the population continued to improve, albeit slowly.

Sources: compiled by the author

4 contact n°166 - July-September 1999 INTRODUCTION local collective economies and the lack of political backing in China’s transformation from a planned economy to a market economy. The percentage of the population covered by any form of health insurance schemes including the cooperative medical schemes declined dramatically from 71% in 1981 to 21% in 1993. The share of government’s and the collective expenditure on health has greatly declined. An increasing number of people have to pay for health care from their pocket, and some of them cannot afford these medical fees

and therefore fail to receive needed Illustration by Xi Feng care. Serving another purpose... Almost all the health facilities are household contributions have been encouraged to generate revenues sought to support the construction of the through user charges. Making profits health stations, to supply needed medical from drug sale is common in most of the equipment, and to attract skilled staff to health facilities in China. The preventive work in them. Government and health care programmes, particularly in the poor authorities at higher levels have allocated areas, also have suffered under these special funds to help the village stations resource constraints. It would not be in one way or another to sustain the surprising, therefore, that some health health stations. indicators have consequently not Strengthening township health changed since the mid-1980s, according centres, particularly in the poor rural to a recently published World Bank areas, is another action taken to ensure An increasing number of report. that the rural population can get access people living in rural to basic health care of reasonably good Actions being undertaken areas have to pay for quality. In the richer areas, the county Having recognized these problems, the and township governments have been health care. Those who Central Committee of the Communist requested to support the development cannot afford medical Party and the State Council of the of their township health centres. In the Chinese Government convened a fees fail to receive poor areas, funds from the central national conference on health needed care. government, and international funding development in November 1997. The agencies have been sought to support conference called for strengthening rural the health centres. health services and re-establishing a variety of the cooperative medical Re-establishing the cooperative schemes. The ministry of health has medical schemes responded to these problems by urging The above two actions are important local governments and health authorities and necessary, but insufficient in to develop innovative schemes for improving access to basic health care financing and for delivery of health for the rural population. Re-establishing services. the cooperative medical schemes is an Rebuilding village health stations has effective way in facilitating people to been proposed in many rural areas, as obtain health care. Many local a vital strategy for providing basic health governments in China, have since the care to the rural population. A variety of early 1990s, made progress albeit not sources of finance, including World Bank significantly. The key is how to mobilize loans, village collectives financing and potential sources of finance for the

contact n°166 - July-September 1999 5 INTRODUCTION

cooperative medical schemes and mobilized people to participate. Our research findings show that, once central or local governments show willingness to subsidize the cooperative medical schemes, individual house-holds would most likely be willing to make their financial contributions. The poor should not be asked to pay premiums to the cooperative medical schemes. The cooperative medical schemes need to define a minimum package of basic health care services it should cover. The package (see box) should include preventive programmes and access to outpatient care and basic inpatient treatment. One function of the cooperative medical schemes is to re-distribute resources from those who are healthy to those who are sick. People contribute to protect both themselves and others against the high cost of treating a serious illness. Therefore, if possible, it is important to make participation compulsory in a community. New lessons learnt from rural China It is not necessary to wait for economic development for the health status of the Chinese population to improve. Likewise, economic development of a nation does not automatically result in improvement

Peter Williams/WCC of health status for all. As China itself Young woman and child on and regions within other developing tricyle in Jiang Pu Country, 40 km north-west of Nanjing. countries, such as Kerala in India have Health services to be covered by learnt, health status can improve even the cooperative medical schemes when the national economy is weak and household incomes are low. However, l Children under seven get free vaccinations a long-term commitment to ensure the access of the population to health care l Pregnant women get free prenatal and by leaders at all levels of government is postnatal care and safe delivery of their babies vital in making health development sustainable. China is planning to l All childbearing women get family Shenglan Tang, Lecturer in International Health, strengthen rural health planning services Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK services and re-establish l Participants in the schemes get partial E-mail: [email protected] reimbursement for medical care cooperative medical expenses schemes.

cooperative medical schemes. In some areas, local Chinese political leaders have successfully re-established the

6 contact n°166 - July-September 1999 EXPERIENCES

HEALING THEWEAK AMITY IN HEALTH AND DEVELOPMENT

Yu Qun, Publications Secretary with the Amity Foundation in Nanjing, China, outlines several creative initiatives Amity has launched to bridge the health care gap between the urban and rural areas as well as the west and east of the country. Amity Foundation In the countryside, the whole family helps cultivate crops on every bit of their small plots.

The social economic reform implemented Christians among the many in rural China since the early 1980s, has organizations now doing social widened the gap between the urban and development in China. Begun in 1985, rural areas as well as the west and the its projects are situated almost all over east of the country. The household China. In Chinese the word Amity is responsibility system has replaced translated as “love virtue”. Amity collective agriculture, reducing the role demonstrates love through its interest in Amity Foundation, of collective economy. Private clinics the physical, spiritual and health care have replaced village health stations. needs of people. Amity has been through its projects The cost of health care service has endeavouring to meet the basic needs situated all over China, increased rapidly. Eighty per cent of of the grassroots people though the tries to meet the basic medical resources are now involvement and participation of Chinese needs of the grassroots concentrated in urban areas. Residents Christians. people though the in some poor rural areas suffer from Speaking of health transition and shortages of medicine and doctors. The development in China, Ting Yanren, participation of Chinese Chinese government has taken a series Associate President of the Board of Christians. of measures to ensure better quality and Amity Foundation commented, “Amity convenient health care services. really welcomes the great changes Amity in health and development now taking place in health fields in China. With the reform being deepened, Amity Foundation is the only nation- more people get accessible and wide NGO initiated by Chinese contact n°166 - July-September 1999 7 EXPERIENCES

convenient medical services. The six doctors and nurses serve the problem is how we deal with those who herdsmen on Qinghai Plateau in north- are left behind.” west China. Taking advantage of overseas funds Church-run hospitals and non-governmental resources, the To make Christian involvement and Amity Foundation, hoping to influence participation in society more widely the government’s policies and actions, known to Chinese people is one of has pioneered new methods of medical Amity’s goals. Till the end of 1998, Amity Amity’s training training and services. implemented 76 projects in cooperation programme is conducted Bridging the gap with churches at the grassroots level in 23 provinces or regions. Among these in cooperation with the Christians involved in health ministries projects, there are 37 church-run clinics. government health are challenged to respond with creative bureau, using their and effective approaches to bridge the Congregations involve themselves in training centres and health care gap. In the past ten years providing health care. From medical Amity has gradually adjusted its consultations after worship, to well- resources. strategies and launched a series of equipped and warmly-welcoming projects with “Chinese characteristics”. hospitals, such medical centres grow rapidly. The patients include local Training of doctors at grassroots Christians as well as non-Christians. level Ji Sipu, vice- president of Amity Hospital Amity has helped to train more than in Linqu County, Shandong Province, 10,840 village doctors in 14 provinces, said that besides their own efforts, the mostly in the north-west and the south- success is due to support from Amity, west. These doctors provide basic fellow Christians, and the local medical services in the rural government. “We need each other,” he communities (see page 11). added. Their Christian background, Mobile medical services good services and low fees have Village doctors provide basic In mountainous and remote areas in fostered a big demand among the rural medical services in the rural China, people have a nomadic lifestyle folk. The reputation and importance of communities. and live in isolated these hospitals are growing. settlements. Two Laid-off workers train as nursing mobile medical teams assistants set up by Amity travel With the reform in the big state-owned in the mountains to enterprises, thousands of workers laid- make medical treat- off in the cities have become the world- ment accessible. The wide focus of media attention. At the teams consist of beginning of 1999, Amity started training specialized senior courses for women who have been laid- doctors who like doing off in Nanjing (where Amity is based) as voluntary work. They well as in nearby cities. Li Enlin asserts visit poor farmers that, “Women between 35 and 50 years regularly and make who are unable to find work will be diagnoses or do sur- trained as nursing assistants in the gery with the equip- hospitals. It is planned that thousands of ment in the village or in women will receive such training and 80 the township hos- have already graduated.” pitals. At the turn of the millennium, the Board Besides the teams of of Amity has reaffirmed the policy of voluntary doctors, a whole-hearted service to the weak and mobile clinic, a vehicle the poor in China. At the same time, equipped with modern Amity has made new strategies and machines and five to policies to improve Amity’s work such Amity Foundation

8 contact n°166 - July-September 1999 EXPERIENCES

Challenges to the health care in China There is a continuing need to ensure accessible health care facilities in the rural areas, where 75 to 80 per cent live, to develop preventive services and provide clean water for the 40 per cent of rural people who lack it. Many farmers and herdsmen in western China suffer from and even die of diseases that are controlled in the more developed areas of the country. Reaching the nearest medical clinic may require travelling 300 to 400 kilometres, contributing to the inaccessibility of health care. The shortage of doctors is also a problem. Few doctors assigned to work in township medical centres in western China are willing to work there and most eventually find positions in cities or coastal areas. Besides, western China has fewer hospitals and hospital beds. Epidemiologic transition Due to the ageing of the population (by 2020, the number of Chinese over 60 years of age is estimated to increase by 90% to some 240 million people) and the change in people’s living conditions, the causes of sickness and death begin to resemble those of a developed country. The cities in particular are experiencing changing patterns of diseases.Instead of parasitic and infectious diseases and high rates of infant mortality, the incidence of chronic diseases such as heart disease, cancer and hypertension is increasing. The return of endemic and infectious diseases Although from the 1950s to the 1970s, China achieved great success with respect to the control of tuberculosis, the TB infection rate now is increasing in some provinces, and there are about 6,000,000 TB patients in the country. China has the largest number of blind people in the world, Illustration by Liu Yong around 5 million, or about 18% of the world’s blind (more than the population of Denmark). An estimated 400,000 Chinese become blind each year mainly because of cataracts — a new case of blindness every minute. Throwing your life away Newer problems As China opens up to the outside world, the number people with HIV infection is estimated to have reached 5-10 million. In addition, the environmental pollution is gradually becoming severe. In some poor, remote areas, local dwellers suffer from goitre. There are 10 million mentally disabled persons.

China is the largest consumer of tobacco in the world. A 1984 study showed that 61per cent of the men and 7 per cent of the women smoked. According to WHO’s regional office for the Western Pacific, during the mid-1990s, there were between 500,000-700,000 tobacco-related deaths annually. This is predicted to rise to 2 million by 2025.

Fan Jie, Medical and Health Division, Amity Foundation as widening the resource channels and Yu Qun, Publication Secretary, Amity Foundation, 71 Hankou Road, Nanjing 210008, P.R. China. Women who have been strengthening the supervision and Phone: (86-25) 331-7093/ 331-7034/ 331-4118/ laid-off from state-owned evaluation of the projects. We hope that 663-8128. Fax: (86-25) 663-1701. E-mail:[email protected] with the effort of Amity and other enterprises are being development organizations in China, the trained as nursing whole nation will get stronger. assistants in hospitals. contact n°166 - July-September 1999 9 ALTERNATIVES

WHAT IT TAKES TO BECOME A VILLAGE DOCTOR

Many who have graduated from Amity’s village doctor training programmes find it difficult to establish health care work.

Whoever his treatment and hoping for a cure. enters Chen Creating a clinic out of nothing Zhanyuan’s health station Flooded with patients Chen was cannot unable to buy even the most basic overlook the medicine or the simplest equipment.

Amity Foundation scroll on the The seriously ill he had to turn away. Chen Zhanyuan in front of his wall in the village doctor’s own He needed start-up capital for a health village clinic. calligraphy: station of his own. In the spring of 1994, Chen set out for the mountains “Searching high and low to relieve with a group from his village to dig up people from their miseries!” Chinese caterpillar fungus, a rare and On September 1993, seventeen year- precious plant used in traditional herbal old Chen Zhanyuan graduated from a medicine. Climbing through difficult one-year Amity training course for terrain for days, they searched for the village health workers and returned little sprouts of the fungus breaking happily to his home in Xiamei Village, through the earth. The ground was Gonghe County. Ready to cure his wet, their feet froze, and their backs villagers from all their illnesses, he ached from the constant bending and waited for days, but not a single person digging. To make things worse, altitude knocked at his door for treatment. The sickness overcame them one after country folk, most of them ethnic the other. At night, Chen treated his Tibetans, were extremely poor. When group and himself with acupuncture people fell sick, their only option was and other methods of traditional to turn the prayer wheel, hoping that healing. Two months later Chen Many people who saw the gods would heal them — not returned home, weighing twenty Chen, lacked money for a because they mistrusted modern pounds less but with 4000 yuan more health care, but simply because they in his pockets. He threw himself into doctor’s consultation. lacked the money to pay for a forming mud bricks, felling trees, Instead they had visited consultation in town. Chen Zhanyuan sawing beams, and purchasing shrines and temples and decided to go out looking for people. medicines. consulted holy scriptures. And old herdsman named Zhao Youcai Chen’s health station opened in suffering from acute rheumatoid November. He called it “Amity Health arthritis could hardly walk. With Chen’s Station”. People seeking Chen’s acupuncture treatment within days the treatment come from at least three old man’s legs had recovered enough other villages nearby. With the radius to carry him through the village. From of the area he serves increasing, he that day on, people started calling on now tends to the needs of a population Chen with all their ailments, seeking of 1,300.

10 contact n°166 - July-September 1999 ALTERNATIVES

Training village doctors

Amity’s training programme, conducted in cooperation with the government health bureaux at provincial and county levels, uses their training centres and resources. The Amity medical coordination office in Lanzhou, capital of Gansu Province in Western China, coordinates the training held at 22 medical schools, selected from the 315 medical schools in China. The curriculum is modified in keeping with Amity’s training objectives. The

training emphasizes prevention, rural Darlena David/CMAI hygiene and the administration of village A group of village doctor clinics, including the keeping of case government is aware that cultivating trainees in Gansu Province, China. notes. It includes one year in the community health workers is a way to classroom, one semester as internship extend the rural health work ”. in a hospital and one month for a Amity covers two-thirds of the tuition community investigation project. fees and contributes towards textbooks Training covers the use of 40 basic and maintenance and provides “seed drugs and encourages referral of more money”, usually needed for the purchase complex conditions. of necessary equipment and basic Li Enlin, head of medical and health medicines. division in the Amity Foundation, New education methods explains, “The provincial health bureaux have shortened the training from three Amity with the Huaxi Medical University years to one and a half years, and have has produced 210 videotapes, as part of let the trainees master practical skills in a set of distance educational materials the most limited time. To ensure that the for doctors and health workers at graduate really works for his or her grassroots level. The local doctors are fellow villagers, the license to practise is required to take examinations based on only valid in the particular village. The the content of the videotapes. Amity has translated and adapted such books as Where There is no Doctor by David Werner and Helping Health Workers Learn by David Werner and Bill Bower for medical workers in rural China. Amity has also developed several posters, videos and pamphlets for the To ensure that the HIV/AIDS projects in south-west graduates really work for provinces, Yunnan and Guangxi. their fellow villagers, the Coordination license to practise is only To keep in touch with Amity graduates valid in their own villages. and provide further professional support, the office publishes The Rural Doctor Quarterly, a Chinese newspaper distributed free of charge to grassroots medical personnel. Based on an article from the Rural Doctor Quarterly, Darlena David/CMAI by Wang Jianshen and Zan Jianqin and translated by An Amity trainee. Gotthard Oblau, published in the Amity Newsletter. With further inputs from Yu Qun.

contact n°166 - July-September 1999 11 WHOLENESS FAITH, HEALING, CHURCH GROWTH

The church in China, emphasizes prayer and physical healing. There are numerous accounts of healing through prayer. Faye Pearson, from the Amity Printing Company, takes a closer look at the extraordinary impact of faith healing on the growth of the Chinese Church. Peter Williams/WCC Shanghai “house church” in the Taopu Villas suburb. In 1949, there were approximately living without the amputation of her leg. 750,000 Christians in China. Today the Her parents prayed for her and Binjun official figure is 13 million, although herself, frightened at the prospect, joined evidence indicates there could be as them in prayer. She was healed. For Prayer, faith and healing many as 20-30 million Protestant most of the past 70 years Lu Binjun has have become major Christians and an additional 10 million served as an evangelist, pastor and factors in the growth of Catholics. How does a person explain seminary professor. Dr. Hong Bihua, a what is happening in China? It can only the church. retired physician who works with Amity be explained as God’s work. Foundation, was partially blind as a Prayer for healing young child. She recalls that when her Christian mother prayed her eyesight Although born in a Christian family in was partially restored. Prayer for the Shandong Province, East China, sick, continues in the community of faith 18-year-old, Lu Binjun had no desire to within China today. follow her parents’ faith. In 1929, she developed a serious health problem. While many urban churches emphasize The local doctors gave little hope of her prayer and physical healing, in rural

12 contact n°166 - July-September 1999 WHOLENESS

China there is an even stronger a handful of requests emphasis. Some of China’s Christian asking for prayer leaders believe that approximately 90% regarding physical ill- of the converts in rural China come to nesses — cancer, faith in Jesus Christ through some type stroke, blindness, of physical healing. blood problems, etc A healed and healing church in the various churches where he A young woman, who was healed after preaches. On being prayer in a church, started a group to asked his response, “pray for the sick”. That group is now his reply was, “I take one of Jiangsu Province’s leading the requests home churches. The pastor continues to pray and I pray for each for physical healing because for many, person. As God’s “physical healing” points them to the servant, I would not One who gives spiritual healing. think of not praying Downside for the people.” Some churches or groups overly It is unlikely that semi- emphasize physical healing. They have narians, theologians bizarre meetings. Recently a man died or missiologists can explain the extra- and the Christians in the church would Peter Williams/WCC not allow the family to bury him because ordinary and mys- terious faith healing and its impact on the Chou Rong Ming, theology they believed God would restore the student. dead man to life. Due to the neglect of growth of the Chinese Church. It can be sound doctrine stemming from a lack of explained only as the work of a loving theologically trained leaders, it is easy and holy God, interested in the total for many cults to develop within the person — physical, mental, emotional, Christian community. Despite the social, and spiritual. potential for misuse, Bao Jiayuan, one Faye Pearson, Amity Foundation, 71 Hankou Road, Nanjing 210008, P.R. China. of the Vice-Presidents of the China Phone: (86-25) 331-7093/ 331-7034/ 331-4118/ Christian Council says that he receives 663-8128. Fax: (86-25) 663-1701

Faith and Healing

“Family members of our patients see the “In 1976, at the end of the Cultural Revolution, love of God demonstrated in how the patients my mother became ill. One of the women are treated. They ask questions. They ask from her work unit visited her. The colleague for Bibles. They come to church. They told my mother that she was a Christian and attend inquirers’ classes. They believe.” would ask the living God to heal her. The Hospital administrator of a 40-bed church-run hospital woman prayed for my mother. My mother in Hubei Province in central China. was healed. She believed that the living God healed her. She became a Christian. I v am not a Christian but my mother says she “People know the hospital is Christian prays for me every day.” because of its name. The hospital is known A young woman. Amity Foundation v as a place where the staff are not only A Basket of Flowers competent but they minister to the patient “Our hospital is called the Jesus Hospital. with kindness and love. We are the expression Many patients come looking for Jesus to of God’s love, loving others for His glory.” heal them. They are looking for both physical A Christian doctor in the city of Dalian in north-eastern and spiritual healing.” China, who with the local churches has started a A hospital administrator from in Shandong clinic, a rehabilitation centre and homes for the elderly. Province in eastern China. v v contact n°166 - July-September 1999 13 WHOLENESS

God’s expression of loving care for people in need

Contact asked Li Enlin, medical director of the Amity Foundation why she thought prayer for healing was widely practised within the church. Excerpts from the interview.

Amity representatives distributing medical kids and equipment to Tibetan monks, who were trained in Amity’s village doctor training course. Li Enlin is first from the left.

Contact: Why is there such a difference Contact: What is the position of the between rural and urban areas regarding China Christian Council? spiritual healing? Li Enlin: Visiting and praying for the Li Enlin: It is mainly related to the access sick is the common practice in almost to medical care. Urban areas have all of the churches both in urban and hospitals with sophisticated medical rural China. China Christian Council equipment and well trained medical staff. neither encourages nor discourages While most theologians To a certain extent, most urban resi- the local congregations to show their believe congregations dents either enjoy free medical care or fellowship in such a natural way. must be encouraged to have medical insurance. Contact: What do Chinese theologians seek medical treatment There is now a shortage of doctors, think about it? because medicine is one especially in poverty-stricken areas. Li Enlin: Local congregations and those That and the collapse of the cooperative of God’s creations, some involved in in theological education think medical care system have made the that “the harvest is large, but there are theologians think that medical service for the rural population few workers to gather it in”. While there healing is an expression even worse. Besides, the rural has been no special theological of God’s loving care for population has to pay out of their own research on faith healing, some pockets for medical treatment. Due to the people in need. theologians think that expectation of poverty and the inconvenience of seeing healing is the sign of “poor quality of a doctor, seeking spiritual healing faith”, due to the shortage of trained becomes the only option for many rural preachers and lower education among people.

14 contact n°166 - July-September 1999 WHOLENESS rural people. Some theologians think activities or activities that disrupt social that healing is an expression of God’s order, harm people’s health, or obstruct loving care for the people in need. Most the educational system of the country.” theologians believe we must encourage Contact: Can spiritual healing be congregations to seek medical combined with community-based health treatment because medicine is one of care? God’s creations. Li Enlin: If community-based health care Contact: How does the Chinese can provide qualified service, government react to spiritual healing? congregations will have one more option Li Enlin: Freedom of religion has been to solve their physical problems. The protected by the Chinese Constitution. decision is left to each believer to either “The state protects legitimate religious combine spiritual healing with activities. No person is permitted to use community-based health care or to religion to conduct counterrevolutionary choose either one.

RESOURCES This list contains useful publications on the issue of health care in China. WHO PUBLICATIONS The reform of the rural Primary health Care, The of the Chinese Ministry of World Health Organisation cooperative medical Chinese Experience, is a Republic Health considered 1211 Geneva 27 system in the People’s report of an inter-regional China’s three level health care Switzerland, Republic of China - Initial seminar held in Yexian network; the involve-ment of Fax: 41 22 791 4167. design and interim Country, Shandong Pro- the people; health manpower E-mail: [email protected] experience, Technical vince, People’s Republic of development; and the paper, “Macroeconomics, China in 1982. The seminar, financing of rural health care. Health and Development” jointly organized by UNDP, ISBN 92 4 56077 0, 1983. Series Number 20, 1996. Free UNICEF, the World Bank, of charge. and WHO, with the support OTHER PUBLICATIONS

Health in transition: for individuals is Pound Intervention Study on 35-41 Lower Marsh, reforming China’s rural Sterling 18.00. The journal is Health Financing System in London SE1 7RL. health services IDS Bulletin available from China Desk, China’s Poor Rural Area, Fax: 44 171 928 0010 (Volume 28, Number 1, Churches Together in Britain (Ed) Gu Xinyuan. 1998, Price E-mail: [email protected] January 1997, Editors: and Ireland. 28 Yuan. Shanghai Medical Amity Foundation Gerald Bloom and Andres A Pilgrim in Chinese University. Overseas Coordination Office Wilkes), is a very useful and Culture- Negotiating Amity Newsletter, is the 4 Jordan Road, Kowloon, informative compilation of Religious Diversity by quarterly Bulletin of the Hong Kong SAR articles about health reforms Judith A Berling, is an Amity Foundation. Free of Phone: 852-27238011 in China. Published by the introduction to cross-cultural charge. Fax: 852-23662769 Institute of Development and interfaith issues. Faith E-mail: Studies (IDS). Price £9.25 Meets Faith Series, Address Box [email protected] (plus post and packing). ISBN 1-57075-152-8, 1997, Institute of Development Healing Prayers and published by Orbis Books. Studies Orbis Books Healing Testimonies in Price US$ 18. University of Sussex, Brighton BN1 9RE UK PO Box 308, Maryknoll, Mainland Chinese Children in China by Tel: +44 1273-678 269 New York 10545-0308 USA Churches by Claudia Michael Karhausen, a photo- Währisch-Oblau, (translated E-mail: journalistic book with ninety Shanghai Medical from German by Ian Groves), [email protected] photographs brings the University in China Study Journal, Chinese culture alive through China Desk, Churches No-138, Yixueyuan Road, August 1999 is an extremely the faces and activities of Shanghai-PO-200032, Together in Britain and interesting study about faith children. Published by Orbis China Ireland healing in China. Annual Books. ISBN 1-57075-1447. Phone: 86 216 403 7310 Inter-Church House, subscription (surface) rate Price US $ 25. Fax: 86 216 403 7395 contact n°166 - July-September 1999 15 BIBLE STUDY

TO DESTROY OR NOT TO DESTROY? LUKE 9:51-56

The following reflection has been prepared by Chen Xida, a theologian at the Nanjing Union Theological Seminary, China

The two disciples of Jesus, James and John, to use their hearts, to appreciate cultures that they want to destroy a Samaritan village by fire sent do not understand, and to value the life of people from heaven. The reason being that the village who are totally different. Jesus knew that his people did not receive Jesus, whose “face was disciples would fulfil his mission only if their violent set toward Jerusalem”. hearts learnt to value the lives of people who might A reading of the passage makes it clear that the even reject them. Samaritans rejected Jesus in order to protect him Jesus’ strong sense of purpose, “for the son of from the danger ahead of him in Jerusalem. But Man has not come to destroy the lives of human the disciples misunderstood that seeming beings but to save them,” (Luke 9:56) did not allow rejection. They wanted to show their zeal “for the him to destroy the Samaritan village. The Saviour honour of their master” wanting to make everyone would never bring salvation by destruction. submit to their master — like Chinese Emperors At the top of Jesus’ agenda is to save lives. It is who expected absolute loyalty from their the only reason for him to “set his face to subordinates and destroyed all Jerusalem,” to fulfil his mission, by opponents. sacrificing his life on the cross in Jesus, unlike a Chinese Emperor order to save people. is determined not to acquiesce to As Jesus “went on to another a request to send fire from heaven village”, we too must travel on when to destroy the Samaritan village. we meet with rejection. Jesus He did not take the opposition’s tolerates objections and rejections if power as seriously as his disciples only lives can be preserved. did. Jesus did not want to be treated like a Chinese Emperor who always It seems that our world is full of “right expects a “yes”. He always gives people reasons” to destroy lives. We have the freedom to say “no”. “just” wars to protect human rights; we try aggressively to secure our doctrines; we create By the Heart economic wars to guarantee the financial security Jesus measures people by their spirit, not just and political wars to maintain our power. War according to their attitudes, opinions or reasoning. seems to be the only solution to deal with Jesus rebuked the disciples for not being able to differences, obstacles and rejections. Lives are judge by the “spirit” and “heart”. He says, “You do pawns to be destroyed in the marketplace of war. not know what spirit you are of” (Luke 9:55). The Questions for discussion word “spirit” has been translated in the Chinese Bible as “heart” (xin). The Chinese translation of l Have people had enough room to express their this sentence is, “You do not know what your opinions and are they allowed to solve problems hearts speak”. Jesus judges people according to in their own way? their hearts. l Has “heart” been given priority in judging the Now read Luke 10: 5-37 value of people? In telling his disciples the story of the Good l Is our primary purpose to save lives of people? Samaritan, Jesus wanted to help them learn how

16 contact n°166 - July-September 1999 UPDATE

PERINATAL HIV TRANSMISSION

Now more than 1600 children are infected every day with the deadly AIDS virus through mother-to-child transmission. Christoph Benn shares with Contact readers the hope that preventive therapy and methods to decrease HIV-transmission from mother-to-child, will be available and affordable to all women wherever they live.

Two recently published studies might onset of labour and 2mg per kg to the have considerable consequences on baby within 72 hours after birth could current practices to reduce perinatal reduce the transmission rate to only HIV transmission. Up to now 25-35% of 13.1% after 14-16 weeks. That was children born to HIV-infected mothers almost half the rate (25.1%) of the control will receive the virus during pregnancy, group that received the more expensive A study in South Africa delivery or through breastfeeding. drug zidovudine. This result is particularly Methods to reduce this rate such as important as the children were breastfed found that babies who antiretroviral drugs or modification of during the first weeks of life proving that were exclusively breastfeeding practices are available in the drug had a prolonged effect. breastfed had a lower affluent countries but are too expensive This regimen is available at a current HIV transmission rate for resource-poor settings in which more market price of US $4. This price might than 90% of HIV-infected women are than those who were not be within reach of many affected women. living. This situation might change. Policy makers in many countries will breastfed or babies who More effective drug have to consider very carefully were given mixed A study looking at the feeding. possibility to reduce perinatal HIV transmission Healthlink Worldwide with the antiretroviral drug nevirapine whether wide-spread programmes Exclusive breastfeeding for 3-6 was published in September1. It showed months is the best option for offering testing and counselling services HIV-infected women who that a single tablet (200mg) of the drug for antenatal clinics with subsequent choose to breastfeed. nevirapine given to the mother at the nevirapine treatment for HIV-infected contact n°166 - July-September 1999 17 UPDATE

women might be an affordable and options for infant feeding. If the women acceptable option1. choose to breastfeed which is still the best method under most circum- Influence of breastfeeding practices stances, then exclusive breastfeeding on HIV-transmission is to be preferred and should be Another interesting study examined the maintained for 3-6 months. This is influence of breastfeeding practices on certainly reasonable advice and the HIV-transmission.2 This study study might help to dispel fears of women The antiretroviral drug, compared the influence on three different who currently refrain from breastfeeding nevirapine might be an patterns of infant feeding on perinatal because of worries that they might affordable and HIV transmission within the first three transmit the virus through their months of life: no breastfeeding, acceptable option to breastmilk. exclusive breastfeeding and mixed Both studies show that there is a lot of reduce perinatal feeding including water and other liquids. research going on at the moment that HIV- transmission in The result was that those who were might help to find cost-effective and exclusively breastfed had a lower HIV-infected women. practical ways to reduce perinatal HIV transmission rate (14.6%) than those transmission. Now more than 1600 who were not breastfed at all (18.8%). children are infected every day with the The worst method was mixed feeding deadly virus, which is completely with 24.1% HIV-transmission. unacceptable, as methods to prevent Appropriate infant feeding practices this disaster are known. There is hope As this result might have considerable that in the future preventive therapies implications on how to advise women at and methods will be available and risk for HIV infection on appropriate affordable to all women wherever they infant feeding practices, the WHO, live. UNICEF, and UNAIDS have published Christoph Benn, German Institute for Medical Mission (DIFÄM), Paul-Lechler-Str. 24, D-72076 Tübingen, a joint statement on current policy Germany E-mail: [email protected] guidelines. After the publication of this study, (available at: http://www. References unaids.org), they confirm the importance 1. Guay L. A et al, Intrapartum and neonatal single- of the findings of the research team in dose nevirapine compared with zidivodine for prevention of mother-to-child transmission of HIV-1 in Kampala, South Africa but issue a warning that Uganda: HIVNET 012 randomised trial. Lancet 1999, the results of this study are preliminary Sept 4; 354:795-802. and need to be confirmed. Therefore 2. Coutsoudis A et al, Influence of infant-feeding patterns on early mother-to-child transmission of HIV- they do not see the need for a change in 1 in Durban, South Africa: a prospective cohort study. their current policy emphasizing that all Lancet 1999, Aug 7; 354: 471-6. women should have access to HIV 3. The WHO, UNICEF, and UNAIDS joint statement on current policy guidelines for breastfeeding. Website: testing and counselling services and http://www.unaids.org receive full information about all possible

USEFUL PUBLICATIONS

Reconditioned Equipment: Price Guide International gives practical advice for NGOs This price guide lists the cost of reconditioned interested in developing and implementing general hospital and theatre equipment. essential drugs policies for their organizations. ECHO International Health Services Ltd, Available from HAI-Europe, Jacob van Ullswater Crescent, Coulsdon, Surrey, CR5 Lennepkade 334-T, 1053 NJ Amsterdam, 2HR, UK, fax: 44-181-668-0751 The Netherlands. Tel: 31-20-6833684, fax: Email:[email protected] 31-20-685 5002. E-mail: [email protected] Developing essential drugs policies: A The Discharging Ear, Slide set guide for NGOs Loss of hearing caused by lack of proper This very useful revised version of a working medical treatment is a major source of paper published in 1996 by HAI-Health Action disability in many developing countries. This

18 contact n°166 - July-September 1999 NETWORKING slide set shows how to diagnose and treat professionals to the key resources required serious ear diseases which cause a discharge for developing HIV health promotion in of pus or collection of wax or blood in the ear. custodial settings. It has contact details of The set which has 24 slides and a written key individuals, agencies, publications, commentary is available from TALC, P.O. websites and education resources relevant Box 49, St Albans, Herts AL1 5TX, UK. to work in this area. Other publications Price: £9.00 (plus VAT if applicable) including include, Guide 1 Antenatal HIV testing policy postage and packing. (ISBN 07521 1587 1) and Guide 2 HIV health A Resource Guide on HIV Health Promotion promotion with African community groups in in Prisons England (ISBN 07521 1670 3) The third in the National HIV Prevention Free from Marston Book Services, P.O. Box Information Service’s occasional series of 87, Osney Mead, Oxford, Ox2 ODT, UK. Resource Guides, HIV Health Promotion in Telephone: +44 1235 435 565. Prisons (ISBN O 7521 1769 6), is a six-page guide designed to alert health and education

LETTERS All God-fearing and health-minded people must close their ranks and tenaciously defend and preserve the concept of PHC as advocated in the Alma Ata declaration. Though the slogan “Health for all by the year 2000” is more than 20 years old, the field of plant medicine — Plant medicine ordained by God, the greatest designer — which the majority of human races depend upon is under-developed. Our centre has made a unique and significant success in curing many diseases using plant materials. Peter Dumoga Ethno Botanical Research and Medical Centre Ammasaman Ghana Overall I became a different professional and a different person because of Contact. Through reading Contact from 1975, I heard about Jamkhed and about the importance of breastfeeding. I read about many interesting experiences, about popular education and about the growth chart. Trying to apply what I read gave me both great satisfaction as well as leaving me Inspiration, support and frustrated. I designed the first breastfeeding educational campaign for Colombia in 1976 and education designed and supported the implementation of a nation-wide growth-monitoring programme in 1978. But what I consider the most important, not being a person affiliated with any specific church, is that every issue of Contact brought me the support of people whose lives were dedicated to making the world a better place for those most in need. Contact brings the inspiration to keep me alive and going. Contact is an important way for me to keep in touch with what is happening in health issues all over the world. Thank you for that. Maria C. Bustillo Barranquilla Columbia

I often recommended articles from Contact to fellow students at Harvard who were searching for alternative, people-centred approaches to international health and health care. There is a wealth of experience, wisdom and knowledge in the back issues of Contact that is hard to find anywhere else! Contact has played a critical role in providing a space for dialogue, debate and education on issues related to the health of the poor and the ongoing struggle to reach health for all. Karen Anderson EPES Casilla 22-Correo 44 EI Bosque Santiago Chile contact n°166 - July-September 1999 19 NETWORKING ANNOUNCEMENTS REMEMBERING MABELLE AROLE

Mabelle Arole, pioneer in community Jamkhed. In a very lucid language, she health, former Commissioner of the shared her experiences with primary health Christian Medical Commission (CMC) of care. Her work was instrumental in the the WCC, and friend and advisor to the spread of the community-based primary ecumenical family passed away in India, health care movement to Latin America, at the age of 64, on 27th, September 1999. Africa, Southeast Asia, and other parts of Mabelle greatly enjoyed her work in CMC the world. and the contributions she was able to Her work in empowering women and make even after her term as Commissioner communities stands as a witness to was over. believing in the potential of humankind and Mabelle and her husband Raj Arole, after bringing out the “image of God” in every completing their studies at the Christian person. Her quiet, gentle spirit and words Medical College, Vellore, worked in several of wisdom will continue to inspire women mission hospitals. They realised that the and men all over the world. We thank God needs of the poor were not met by working for Mabelle Arole’s gift of healing. She is in a hospital. After completing their Masters survived by her son Ravi, daughter Shobha of Public Health at Johns Hopkins and Raj, her husband. University in the USA, they returned to Mabelle’s mission in life was: India and began the Comprehensive Rural Health Project (CRHP) in Jamkhed. The Spirit of the Lord is upon me, Mabelle’s vision was to make this area a because he has anointed me true “shalom” – true wholeness and health To preach good news to the poor. for the people of this area. Contact issues He has sent me to proclaim freedom for 10 and 129 describe the Aroles’ work at the prisoners CRHP. And recovery of sight to the blind, She held various leadership positions and To release the oppressed, received many awards, including the Ramon To proclaim the year of the Lord’s favour. Magsaysay Award and Paul Harrison Award Luke 4.18-19 for outstanding work in rural areas. Along CRHP’s address is: Comprehensive Rural Health with her husband, she co-authored the Project, Jamkhed, Ahmednagar 413201, Maharashtra, India. E-mail: [email protected] book Jamkhed about their experiences in

World Breastfeeding Week WABA materials to produce their own T- WABA (World Alliance Breastfeeding Action) shirts, mugs, balloons, songs, skits or any produces a series of publications for the other material for the World Breastfeeding World Breastfeeding Week (1-7 August) — Week 2000. colouring and comic books for children, WABA,P.O. Box 1200,10850 Penang, Malaysia. postcard, calendar, poster, action folder and E-mail:[email protected]. banner.Contact readers can use or adapt the Website: http://www. elogica.com.br/waba

Contact is the health and (CMAI); German Institute for language version. Tel: 91 11 559 9991/2/3, community development Medical Missions in Tübingen Editorial Committee: Rainward 5521502. Fax: 91 11 5598150. magazine of the World Council (DIFÄM), and Medical Bastian, Christoph Benn, Manoj E-mail: [email protected] of Churches. The publication Coordination Secretariat of the Kurian, Cherian Thomas, Darlena Contact is also available on the deals with various aspects of Netherlands (MCS). It is published David, Christina de Vries, World Council of Churches’ the churches’ and community’s four times a year in English, French Elizabeth Moran. Editor: Darlena website: involvement in health, and and Spanish. Present circulation David; Design: Gurmeet Singh; http://www.wcc-coe.org seeks to report topical, is approximately 15,000. Mailing List: Susamma Mathew. The average cost of producing innovative and courageous Articles may be freely reproduced, Printed on woodfree paper by and mailing each copy of approaches to the promoton of providing that acknowledgement Impulsive Creations. Contact is US $2.50, which health and healing. is made to: Contact, the Mailing list: Christian Medical totals US $10 for four issues. Contact is published by a publication of the World Council Association of India, 2, A-3 Readers who can afford it are partnership of the World Council of Churches. A complete list Local Shopping Centre, strongly encouraged to of Churches (WCC); Christian of back issues is published in Janakpuri, New Delhi 110 058, subscribe to Contact to cover Medical Association of India the first annual issue of each India. these costs.

20 contact n°166 - July-September 1999