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NGOs flex their muscles to bridge the urban-rural rehabilitation divide

Date:2018-06-28 10:00:00

Charities and hospitals are working hard to reverse an imbalance in the supply of services between cities and less-developed areas, as Li Lei, Li Xueqing and Huo Yan report from Fuping county, Shaanxi.

The provision of physical rehabilitation and restorative care services has been expanding nationwide since 2008, when the central government decided to include them in the basic healthcare insurance system.

However, despite the developments of the past decade, supply is being strained by rising demand from the nation's 85 million registered disabled citizens, people who require assistance in the wake of surgery or other illnesses, and the rapidly aging population.

The imbalance between supply and demand is most acute in the vast rural areas, where rehab facilities are rare but disabilities resulting from strokes and farming accidents are common.

Operation Concern, a charity in Hong Kong, is among the groups attempting to reverse the urban-rural shortfall by sending orthopedic surgeons and physical therapists to the countryside and funding surgery for the rural poor.

Zhang Jinjin, from Fuping county, Shaanxi province, is one of thousands of people benefiting from the program.

The 32-year-old has had three consultations with Leung Ping-chung, a surgeon and university professor from Hong Kong who founded Operation Concern. Leung gained fame in the 1970s when he grafted a toe onto a man's hand to replace a finger that had been severed in an accident. It was the first time the procedure had been carried out in the city.

Zhang worked at an electronics factory in Shenzhen, Guangdong province, until 2014, when she became so ill she could hardly walk. She returned to Fuping, and was diagnosed with progressive muscular dystrophy - a degenerative disease in which the skeletal muscles waste away, leading to complete immobility.

Now, she lives with her mother and survives on State benefits. Daunted by the disease and high medical costs, Zhang almost abandoned treatment. In 2015, though, she learned about the financial support Operation Concern offers to rural residents who require physical rehab, and turned to it for help. The amount each patient receives varies according to their illness and circumstances.

Hearing that Leung was visiting Fuping County Second People's Hospital, Zhang successfully applied for a consultation. Following a physical examination, Leung decided to have Zhang fitted with a specially made spinal brace and asked her to follow an exercise program devised by rehab professionals.

The brace enables Zhang to stand upright and perform the exercises, which are designed to slow the progress of the disease. "I would have been confined to a wheelchair and died a gradual death if Professor Leung hadn't helped me with the spinal brace," she said.

More than 5,000 rural patients have received rehab assistance from Operation Concern since it was founded 25 years ago. Moreover, the charity has also provided training sessions in Hong Kong for more than 200 rural doctors from the mainland, with some of the courses lasting as long as six months.

Statistics supplied by the China Disabled Persons' Federation show that rehab services are gradually expanding from cities to rural areas, where 75 percent of those in need reside.

However, these services and related facilities are still luxuries in rural areas, and that could have huge consequences, according to Kwok Wai-leung, associate professor at the School of Medical and Health Sciences at Tung Wah College in Hong Kong.

"In rural China, there are large numbers of elderly stroke patients who become bedridden as a result of a lack of rehab exercise and guidance," said Kwok, who joined Operation Concern in 2013. He added that the situation is a slight on patients' dignity, can cause mental health issues and adds to the burden on family members.

Leung started Operation Concern in 1993 after a period spent acting as a consultant for Operation Smile, a charity from the United States based in Hangzhou, Zhejiang province. The NGO was providing free surgery for children with cleft palates in less-developed regions.

He realized that the charity's approach provided a short-term fix, but didn't solve problems in the long run. "It usually sent a group of specialists to replace local doctors, but they left after performing scores of surgeries," the 77-year-old recalled.

The experience inspired Leung to do something different. Later that year, Operation Concern was born when he recruited several medical professionals from Hong Kong who were willing to spend their spare time visiting the mainland and providing services free of charge.

From the start, Leung focused on rural hospitals, because a lack of experienced doctors meant they were most in need of support, and he also paid great attention to training local professionals.

The program has evolved, so doctors in rural areas now learn by working alongside their counterparts from Hong Kong, while the charity also signs contracts to enable promising young medical professionals to travel to the city for advanced training.

Leung started the Operation Concern Foundation, which acts as a funding vehicle for the charity, as a way of paying for the doctors' visits to the mainland, the medical bills incurred by the rural poor and the training sessions in Hong Kong.

In light of major advances in the skill levels of rural doctors in recent decades. Operation Concern has switched its focus to a more arduous task - post-surgical rehabilitation.

Last year, the charity began working with the Fuping County Federation for the Disabled, the Second People's Hospital and Qinhuai, a local NGO, to establish a rehab center in Beiling, the county's most populous village.

The center provides services for people living outside the county's urban areas, helping to restore their physical functions to a level that will allow them to live relatively normal lives.

Yao Weixing, deputy Party secretary of Beiling, said the center was a totally new concept for most of the residents, and they were initially unenthusiastic about its presence.

"Farmers like us believe we get enough physical exercise through farm work, but in fact that work may not provide the right sort of exercise, so it's different from using the rehab facilities," he said.

To help villagers understand the benefits provided by the center, social workers from Qinhuai visited those who required rehab and invited them to sample the services on offer. The residents quickly began to appreciate the program, according to Qin Hailong, the director of Qinhuai.

Shi Yinhu has certainly benefitted. In 2013, he was partially paralyzed by a stroke that left him unable to speak. He now visits the center twice a week for exercise and rehab guidance.

"With the help of the rehab exercise program and professional guidance, I gradually began to take care of myself, which has relieved the pressure on my wife," said the 57-year-old from Gunshi, a village near Beiling.

"About 30 villagers come to the center every day, and during the peak hours the building seems quite crowded."

According to Leung, rehab programs are not like surgery, where the results can be seen instantly. However, while the lack of instant recognition makes it difficult to establish facilities in rural areas, the services are essential.

"Surgery to repair a fracture would not be successful if we healed the bone, but failed to restore the functions of the muscles and joints," he said.

He Jiamei, a 29-year-old physical therapist at the Second People's Hospital, said many rural seniors are willing to follow rehab guidance at the center, but it can be difficult for those who live alone to attend because the residents are scattered across a wide area.

"During home visits, we meet many elderly people who display the warning signs of a stroke. In such cases, we strongly urge them to make use of the services provided by the center as a precautionary measure, but many say they cannot make it to the center regularly because they have no one to help them get there," she said.

Qin, from Qinhuai, has often heard similar sentiments expressed. In response, the NGO is trying to engage senior residents' children - many of whom have moved away to large cities in search of work - in the rehab process by establishing chat groups on WeChat and QQ, two of the most popular social messaging platforms in China.

"This year, we started collecting contact information about the family members of elderly residents. Of course, that won't solve all the problems for good, but it will allow us to contact them to discuss ways of helping in the event of an emergency," he said.


Source: China Daily