Tian Yuhua still remembers the first time she was called to help out when a villager started going into labour.

"The woman cried so loudly that I was a little afraid," recalled Tian, who has been a healthcare worker for six years in Cangyuan County's Gongsa.

Despite the fear, she swung into action. She boiled water, sterilized a pair of scissors and prepared clean towels. After the successful birth, Tian cut the umbilical cord and helped clean the baby.

"All of the women in our village ask her to cut the umbilical cord," said Tian Yise, 28, who had her second baby in late September.

With Tian Yuhua lending a professional helping hand, no infants in the village have died of umbilical tetanus - a bacterial disease caused by unhygienic conditions during delivery - over the past six years.

Although Tian Yuhua received rudimentary medical training at the Mengdong town hospital, her work has contributed towards the county's push to bolster medical care for women and children.

Her training and experience has also been incorporated into a Sino-British joint programme to establish a basic but more comprehensive healthcare system in the remote county, which is about 880 kilometres from the provincial capital and borders Myanmar.

Tremendous work had gone into creating the system, Yuan Lizhong, director of the county's health bureau, told China Daily in July.

He said the bureau was attempting to get Cangyuan incorporated into the new national rural healthcare co-operative system. The system would become a major contributor to local social and economic development.

But the application has not yet been accepted, Yuan said yesterday.

A county in need

With a population of about 170,000, coming from 26 ethnic groups, the Cangyuan Wa Autonomous County is still one of the most under-developed in China.

More than 85 per cent of residents are from the Wa ethnic group.

About 143,000, or more than 80 per cent, are farmers who till the land in the mostly mountainous region, which lies between 1,600 metres to over 3,000 metres above sea level. Per capita, the farmers earned 793 yuan (US$96) in 2003.

The county has already created a basic three-level preventative healthcare network, which provides coverage at the county, township and village levels.

Under the network, six medical institutions operate at the county level - two county-level hospitals, a centre for disease control, a medical school, an ethnic Wa medical research institute and a hygienic supervision station.

At the township and village levels, there is one small hospital in each of its 11 rural townships and one clinic in each of its 93 administrative villages.

Healthcare staff like Tian, who works in village clinics, shoulder heavy burdens.

She was keeping an eye on the well-being of about 1,450 villagers by July, especially the women and children.

The Gongsa village clinic has only a single room furnished with a wooden bed, a desk and two cupboards.

Tian is the best skilled at assisting women whom want to give birth in their own homes.

She also encourages the village women to go down the mountains to the township hospital to give birth.

Posters hang in village clinics and township hospitals detailing the benefits of having a delivery in hospital.

However, most village women choose to stay home.

"If I find a woman in labour is showing signs of complications, I immediately call the doctors at the township hospital," Tian said.

In fine weather, the doctors can arrive in about 20 minutes.

The county health bureau has introduced a rule that any motor vehicles, especially those of local officials, must help take expectant mothers who are suffering from serious complications to either of the county's two hospitals once hailed from the side of the road or in a village.

Almost all local county officials have a story to tell when it comes to assisting expectant mothers, said Xu Xiangdong, director of the county's administrative office.

These efforts are paying off, as only one woman died while giving birth last year and 110 children under the age of 5 died of various diseases last year. These figures are the lowest in the county's history.

However, "we still owe our achievements largely to our good luck, in addition to our efforts, because the county's rural medical system is not good enough to allow such achievements on its own," Yuan said yesterday.

Cangyuan has long had higher death rates for women giving birth and infant mortality rates than the national average.

Three women died during labour in 2003, creating a mortality rate of 172 women per 100,000, much higher than the 2002 national average of 50.2 per 100,000.

Also in 2003, some 158 children under the age of 5 died from various illnesses, at a rate of 90.8 per 1,000 children, while the national average in 2002 was only 34.9 per 1,000.

In 2003, less than 15 per cent of expectant mothers from rural areas gave birth in hospitals, even though their local township and county hospitals offered a 50 yuan (US$6) incentive.

Last year, about 21 per cent of the new mothers in the county gave birth in hospital.

The problems of not getting to a hospital are rooted in poverty, under-development and, most of all, a lack of public medical funding, said Yuan.

Healthcare workers in rural villages carefully keep 11 logs that cover people's medical and health records, which range from pregnancies, births and deaths to new mothers and local epidemics such as malaria, tuberculosis and hepatitis.

In their simple notes, they also record the deaths of villagers, especially children under the ages of 5, and the causes of death.

Of the deaths of five children, in one township in the first half of last year, three were from pneumonia and two from diarrhoea.

Both are easily preventable. Pneumonia develops from a cold or flu, but parents are too poor to take their children to see a township doctor.

Similarly, a lot of farmers also delay medical treatment until they can no longer put it off.

And although the medical care is still of a relatively low cost, they often fall further into poverty.

Likewise, because of financial strains, the county has not been able to establish an all-encompassing healthcare system to cover poverty-stricken local ethnic minority farmers.

All the 154 doctors in hospitals in rural towns have only received formal medical training of two years or less.

"We haven't seen a new graduate from a medical college or university for several years," Yuan said.

If Cangyuan was able to take part in the pilot of the new national rural healthcare co-operative system, Yuan said, it would be able to increase its financial input into local medical services by matching central, provincial and prefectural government funding.

With more financial backing, Cangyuan would be able to enhance its multi-pronged medical network, attract more medical professionals, better train medical workers and better equip hospitals and clinics, he said.

An improved medical network would also ensure children got the vaccines they needed and farmers had better healthcare services.

"We want to make sure that farmers will be able to receive good and proper medical treatment when they have a slight illness, and that they won't have anything to worry about when that happens, in addition to there being no delays in treatment when they are seriously ill," Yuan said.

(China Daily 01/11/2005 page5)