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Impoverished Ningxia struggles against virus
By an ATol correspondent

HONG KONG - China's central government has made repeated calls on all Chinese to help prevent the spread of severe acute respiratory syndrome (SARS) into the country's impoverished countryside. As Asia Times Online has witnessed in western China's Ningxia Hui Autonomous Region, a small, predominantly Muslim administrative region, this concern is not unfounded.

In Yinchuan, the autonomous region's capital, the Yinchuan People's Hospital has established an outpatient fever clinic that has become a hive of activity. Since late April the clinic has been averaging between 30 and 40 patients each day. The patients exhibit symptoms such as fever, severe cough and/or breathing difficulty, all of which are associated with SARS. A nurse in the clinic said, "Now we are even running short on masks. [Mask] production has had to be increased."

The clinic has reserved isolation wards for observation and diagnosis of patients suspected of being infected by SARS. Ever since the arrival of SARS in Ningxia, the People's Hospital No 110 ambulance service has been extremely busy picking up suspected SARS cases. Medical staff donning protective clothing and goggles escort patient after patient out of the ambulance and into the clinic for diagnosis. Those with fevers higher than 38 degrees Celsius (100.4 degrees Fahrenheit), heavy cough or breathing complications receive lung CT (computed tomography) scans or chest X-rays and await the results in the observation room. Patients with abnormal results are referred to specialists. If a patient is confirmed to have contracted the virus they are immediately placed in quarantine.

Ningxia Medical College's affiliate hospital is rather deserted in comparison to the People's Hospital. Residents are afraid to see doctors there because it is well known in Yinchuan that the college's hospital has admitted confirmed SARS patients. Medical staff with every centimeter of their body covered except their eyes appear terrified of any people who approach the clinic, as the stranger may very well be infected. The entrance to the clinic is quite inconspicuous. A notice posted outside the entrance encourages the staff to fight the virus to the end, comparing the staff's struggle to the war more than 20 years ago between China and Vietnam. There is an honor roll composed of the names of health workers who are on the front lines of the battle against SARS, describing them as "white-coat warriors". The hospital has admitted six confirmed SARS patients coming from hard-hit Inner Mongolia since early April, including Ningxia's first confirmed infection.

Staff say none of the clinic's workers have been infected with the virus, as has been common in Hong Kong and Canada, because of adequate precautions being taken. The protective apparatus used in treatment of patients takes half an hour to prepare. The frontline staff work in six-hour shifts. They try to augment their immune systems through globulin injections and traditional medicines believed by Chinese to be effective in preventing infection by the virus.

What has displeased one doctor is the mandatory off-duty self-quarantine. Before the establishment of the SARS isolation zone, he had been living with his family opposite the isolation zone. But now he can no longer enjoy family life - his family has moved out and can only be reached by telephone.

Aside from isolation pains, there is another problem in Ningxia: SARS-related profiteering. The Center for Disease Control and Prevention of Yinchuan, in its urgent need for a large quantity of masks, jointly bought some 3,000 masks with a local hospital for frontline medical staff. Some of the staff felt something unusual while wearing the masks. When torn open, the so-called "16-layer masks" had only six to eight layers. Aside from the outside layers, all middle layers were merely scraps of white clothing with no protective function at all. Medical authorities immediately quarantined medical workers who had used those masks and worked to find the origin of the goods. Local inspection officers later labeled them as "Three No" products, meaning no trademark, no origin and no manufacturer on the packages. Unqualified for processing or selling medical instrument, the company that provided those masks also made 50 protective suits for the Center for Disease Control and Prevention. The 130-yuan (US$15.70) suits had been worn by frontline medical workers.

Despite intense efforts in parts of Yinchuan, residents of Ningxia feel that local authorities have not done enough to protect the rest of the region's population from SARS. They say that Ningxia is the land of the "Three Nos" - no money, no supervision and no vigilance, an ideal situation to allow the further spread of the virus. Once one leaves the capital, this becomes immediately apparent.

The loosely guarded No 2 Shuangzhuang residences of Honghua village in the outskirts of Yinchuan provide a sharp contrast to the capital's strict quarantine measures. Two guards wearing gas masks rather than surgical masks serve to alert passers-by that something unusual is happening there. A two-meter-wide walkway separates the quarantined residences from the non-quarantined residences. Isolated residents need only raise their voices a bit to make conversations with neighbors. Fearing contracting the virus, a resident living opposite the isolation region walked by quickly, covering his face with his collar. Members of the anti-SARS inspection team once saw residents held under quarantine directly tossing money to shop owners to buy food. Additionally, the disinfecting and handling of garbage in the isolation region was overlooked.

Ningxia's government has said that no infections have been discovered in the countryside. It has vowed to strengthen prevention work in the impoverished rural areas. The authority has dispatched seven medical teams consisting of more than 800 medical workers to the countryside to assist in the preventive effort. In some villages in Huinong County, the slogan deeply rooted among the masses is "Do not come into contact with strangers!" Children coming across visitors will cover their mouths and say, "Teachers tell us not to come in contact with strangers. Have you been infected by fei dian [SARS] or not?"

Money is the key headache in the region's rural areas. A peasant in Baoma New Village said that although authorities had posted notice in the village, disinfection or cleaning workers had yet to come. "Our village has no money, the common folk here aren't worth money," he said. He expressed concern about the virus and also disclosed that schools had been closed for 10 days. According to the villager, only the few locals with a bit of money can afford to buy medicines that supposedly protect against SARS. A dose of Chinese herbal medicine costs more than 30 yuan and only three or four of the 50-60 families in the village were buying those herbs. His annual income is only about 2,000 yuan ($240). Buying medicine is beyond his means.

A propaganda banner posted at the exit of the sparsely populated Hongguozi village reads: "Rely on science. Be steadfast in belief. Unite to combat SARS!" A peasant woman said people recently came to advise villagers on how to prevent the disease, but offered no practical assistance at all. With an annual income of only 600 yuan, she has little in the way of options.

In addition, the Epidemic Prevention Station of Huinong County has posted notices advising against inviting people outside the county, especially relatives and friends from SARS-affected regions, to attend ceremonies such as weddings and funerals. Villagers returning from SARS-affected regions are required to report to the station and undergo inspection.

A herdsman tending his sheep on an almost grassless field said he learned about SARS from television. In his opinion, he only needs to separate his sheep from those of others to avoid infection. As to whether he should feed sheep some anti-SARS medicine, he complained that the local government had forbidden him to tend his animals on the nearby mountains so as to prevent erosion and promote mountain vegetation. The barren opening has so little grass that his sheep are getting thinner and thinner. With not enough grass for his sheep, this man has enough worries of his own that he doesn't care about whether someone nearby has SARS.

Problems in China's rural areas are difficult to manage. With no money to allocate, Ningxia's government can only allocate authority. Village-level authorities have been authorized to seal off an entire village immediately once a SARS case has been detected. Delegating such authority to the lowest of government officials in what is normally a very centralized hierarchy indicates the desperation to which the Chinese government has been driven by this virus that the World Health Organization says has yet to peak in the country.

(©2003 Asia Times Online Co, Ltd. All rights reserved. Please contact for information on our sales and syndication policies.)
May 9, 2003

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