AP:Worries Arise Over SARS Increase in China

April 18, 2003

(Clearwisdom.net) BEIJING (AP) -- It isn't the dozens of cases of the SARS virus in Beijing that worry Henk Bekedam most.

Instead, the World Health Organization official anxiously watches the smaller outbreaks, those towns in China's hinterland with two and three cases. Poor and neglected, their health-care systems lack doctors and resources to cope with the disease.

"When I think about the long-term, I'm more concerned about those provinces who do not have the financial rescues or the human resources to deal with SARS," said Bekedam, WHO's representative in China. "Beijing will be okay, but I'm very concerned about some of the poorer provinces ... how they are able to do it."

Most of China's 1,300 reported cases of severe acute respiratory syndrome are in the southern province of Guangdong, one of the country's best-off regions, with well-equipped hospitals.

But the disease is spreading to poorer regions -- one case confirmed in bleak Ningxia on the edge of the Gobi Desert, 87 in the hardscrabble coal-mining province of Shanxi.

Shanxi offers a bleak picture of what other provinces will face as the mysterious, expensive-to-treat disease moves inland. Seven people have died in the province -- more than 10 percent of China's toll of 65 fatalities.

"We're concerned that China has not really invested in its health care system, and now the system is being tested when the system is not really ready," Bekedam said.

Doctors say most patients recover with prompt treatment. But it is treatment that demands medical resources and skills. They must be diagnosed early and nursed intensively in isolation wards. Treatment involves respirators and expensive steroids.

Health workers must wear anti-infection suits, gloves and masks that they throw away after one use. It's not the kind of thing that most rural clinics can afford, especially amid the loss of government subsidies that has forced many to turn away the public and concentrate on paying patients.

Controlling the disease also demands a system of prompt reporting and tracing of people who might have been exposed to an infected patient.

China has pledged to tighten its system for reporting patients, and Communist Party leaders have warned officials not to hide cases following a revelation that Beijing has more people sick with the disease than publicly reported.

The party's ruling inner circle, at a meeting Thursday led by President Hu Jintao, echoed the government's newly urgent tone after authorities previously assured the Chinese public that SARS was under control.

Chinese health care officials say they're aware of the needs of the provinces.

"For those areas as yet unaffected, we're maintaining a high degree of vigilance and are putting together an effective plan for prevention, reporting and treatment," Deputy Health Minister Ma Xiaowei said at a March 10 news conference.

Their plight highlights the decline of the system of "barefoot doctors" for whom the communists once were renowned, health care workers who ran basic rural clinics.

But support for such activities has dried up and millions of urban workers have lost health care as state industries that once supplied housing and other services go under or turn into private, profit-oriented companies.

Spending on health care fell from 32 percent of the national budget in 1986 to 14 percent in 1993 -- the years of the country's fastest economic growth.

"What we're seeing is that health care is supported by the people's own pockets," said WHO's Bekedam. "There has been a lack of investment in public goods and people aren't going to pay to support other people out of their own pockets."

And what money there is for health care goes to cities, say experts.

"Even then it hasn't been enough ... and everything has to be paid out of pocket," said Anthony B.L. Cheung, professor of public and social administration at City University of Hong Kong.

Health officials in several inland provinces said they'd been allocated additional money by the provincial and central governments. They said Health Ministry specialists are being sent to lend their expertise.

"We've been given special funds from the regional government to buy new equipment such as respirators and now we're asking the central government for funds also," said a spokesman for the Health Bureau in Guangxi, a poor southern region that has reported 12 cases and three deaths. He would give only his surname, Zhang.

Health officials in Shanxi, the northern Inner Mongolia region and Hubei in central China said they received similar support. Governments there are also imitating Beijing and Guangdong by designating a handful of hospitals for SARS treatment to focus scarce resources and reduce the possibility of infection.

"The authorities are aware that, unless they are able to get their house in order and be more vigilant at the local and provincial level, there will be grave implications for China's image, economy and social stability," said Cheung.