Health fix
Li Li

The most eye-catching items in Yan Li’s nine-square-meter office are piles and piles of case histories on her narrow table and a makeshift bed for patients in this community of 10,150 people from 4,083 households. Yan Li, a 27-year-old doctor in a community health clinic in Xicheng District of downtown Beijing, said 300 of the 1,000 cases were “active,” which means the patients visit the clinic regularly as per their doctors’ instructions. Yan is so familiar with these documents that people will be amazed by the speed with which she can locate a specific case history.
Of course, Yan knows the patients even better. On a typical working day recently, she saw eight patients in the morning, ranging in age from 55 to 83 years old, and suffering from chronic diseases.
Throughout the morning, Yan talked slowly and loudly to her patients, repeating herself often. Spending 20 to 25 minutes on each patient, she hardly stopped for a break. But, she said, the time she got with every patient is what distinguished her from her peers in big hospitals. “People always complain about doctors’ nonchalant three-minute talk in big hospitals, yet I can understand their difficulties; after all, they have long queues of patients waiting outside the door,” said Yan Li.
China is ending a 20-year-old medical reform that has been “basically unsuccessful” as concluded by a two-year study by a think tank under the State Council released last July. In 2000, the country bore the humiliation of being ranked 188 among 191 countries by the World Health Organization in terms of the fairness of medical resources. The Chinese Government is changing course toward a community-based health care network consisting of tens of thousands of doctors like Yan Li to serve the health needs of its urban population.
After reading a blood test report, Yan praised a 59-year-old diabetes patient for controlling his blood glucose level well and asked her details of her diet control that she could share with other patients. An 82-year-old victim of heart disease, who came for regular medication for blood pressure control, grumbled about his wife’s reluctance to go to hospital for a blood test despite the symptoms of diabetes. Listening to the old man complaining about the tension over disagreements, Yan said the wife might be suffering from depression and suggested she should be taken to see a professional psychiatrist. Lu Fengzhang, 75, who has been suffering from heart disease and diabetes for years, came for a blood test. Based on his weight and height, Yan calculated the amount of rice Lu could take every day and instructed him to eat more vegetables. Before Lu left, Yan told him that she would call to inform him of the time of an upcoming lecture on stroke prevention.
“Brand-name” care
“The characteristic of medicare in China is that it has become both inconvenient and unaffordable,” said Li Ling, a professor at the China Center for Economic Research of Peking University, at a symposium last December. She said such a situation was unthinkable in a well-functioning medical system, where expensive health services are always of high quality and convenient while services that people have to queue for are usually inexpensive and even free.
Chen Yude, professor at the School of Public Health of Peking University, pointed out that an important reason for such a situation was that people were rushing to the big, multi-specialty hospitals known for their cutting-edge technology and advanced surgical treatments even for common diseases. Chen said his outpatient surveys in such hospitals in Beijing showed that the most common complaint was upper respiratory tract infection, usually a common cold. As a patient, Chen told Beijing Review, he tried his best to avoid going to The Third Hospital of Peking University, one of the best hospitals in Beijing, despite its proximity to his office. “It is so crowded and I know I will be ‘got rid of’ in no more than three minutes,” said Chen. He said the danger of this “brand-effect” was that patients with a complex disease would not get sufficient time for consultation and check-up.
China embarked on its four-strata national health network in the 1950s. The top three strata comprise comprehensive public hospitals ranked by scale and sophistication of technology while the bottom comprises public clinics at the community level in cities and at the township level in the countryside. Grassroots clinics, amid a market-oriented reform approach and further shrinkage of government subsidies, found themselves short of funds for surgery and development. According to Chen, subsidies have dropped from 30 percent of total medical expenses to around 16 percent. In the process, most people lost confidence in the quality of community medical health.
With the decline of public clinics, private clinics began to mushroom. According to latest figures released by Ministry of Health, China’s non-profitable health bodies stand at 134,000 while profitable ones total 152,000. While only the rich can afford to go to private clinics as such treatment is usually not covered by social security, the majority of the urban population has to choose between the overcrowded big hospitals and the crumbling community hospitals. Although the outpatient registration fee for an expert at a big hospital could be more than 25 times that at a community clinic for a similar service, people often choose the former to play it safe.
“The government’s new move in medical reform is aimed at trying to dilute the middle level of the system and emphasize the bottom level of grassroots clinics,” said Chen. According to the Ministry of Health, by the end of 2005, China had 17,000 community clinics, which is more than a doubling of itself in three years. They serviced 59.4 million outpatients, more than 20 percent of China’s urban population.
According to a circular on the development of grassroots clinics issued by the Central Government this August, community clinics have six objectives: disease prevention, health consultation, medical treatment, rehabilitation, health education and family planning.
According to Chen, another important function of the grassroots clinics is to act as a “gatekeeper” of big hospitals, ensuring that critically ill patients can be transferred to big hospitals on time, besides providing quality service for outpatients.
“The development of grassroots clinics is all about making the distribution of medical resources fairer,” said Chen, “so that every one can share the achievements of our rapid economic growth.”
Limited resources
Statistics from the Ministry of Health for 2005 indicate that doctors at grassroots clinics diagnosed and treated about 13 patients daily on average. This workload keeps doctors busy receiving outpatients and leaves them with little time for other tasks such as disease prevention and health awareness education.
According to the August circular on developing grassroots clinics, they will be staffed with two to three general practitioners, one public health doctor, and three to four nurses for every 10,000 people.
Although Yan Li’s 16-person clinic- including six doctors of traditional Chinese medicine, one general practitioner and three nurses-meet the staffing requirement in terms of numbers, she still feels the acute shortage of hands. For a lecture on diabetes care, for example, she has to carefully apportion the work among her 16 staffers for contacting the expert, preparing the conference room and helping senile attendees climb the stairs, besides regular outpatient care.
But what was even worse than inadequate staffing was the lack of professional training, she said. “I hear that community health care has developed to an advanced level in the United States,” said Yan. “Their community clinics have professional care managers who have received comprehensive training and even their volunteers can educate the public on health awareness in a professional manner. People in that country can have all their health care and consultation needs met from cradle to grave without leaving their community. We still have a long way to go.”
“The quality of the medical staff is the key to a functional community-based clinic network,” said Chen. “China has a very small number of general practitioners of international standards. While foreign medical schools offer a major in general practice, it is a relatively new concept in China.”
However, as community clinics develop in big cities such as Beijing, Shanghai and Shenzhen, more and more comprehensive hospitals are starting their trial programs to train qualified general practitioners. For example, Fuxing Hospital in Beijing set up a training center for general practitioners in 2005. The training programs include offering clinic staff temporary work opportunities in hospitals and starting a master’s course for general practitioners with more than four years’ working experience.
Yan Li, who has been working in the clinic since graduation from a medical college in 2002, assumed the position of acting director this April. When asked whether the promotion was a reward for her diligence, the young doctor said, “A better reward would be sending me to a hospital ward for training. I would look forward to it.”

(The Daily Mail-Beijing Review Articles Exchange Item)


Islam not against woman’s rule
Col (R) M. Zaman Malik

During 1964 presidential election between Field Marshal Ayub Khan and Miss Fatima Jinnah this issue had come in limelight and at that time almost all the religious parties had supported Miss Fatima Jinnah. Later on, when Benazir Bhutto was holding office of Prime Minister, some of PML (N) Ulema tried to create confusion about this issue. On October 1993 a columnist quoted an excerpt from Maulana Kausar Niazi’s letter to Maulana Maudoodi and tried to give an impression that Maulana Niazi had subscribed to the views of the general body of Ulema who opposed a woman becoming the head of state or government. This, indeed, was a crude attempt at distorting the facts.
Some ulema refer to verse 34 in Surah Nissa which states ‘men are the protectors and maintainers of women’. The Arabic word ‘Qawwam’ does not necessarily mean a ruler as is generally believed. In the two famous works on Arabic Loxicology, namely “Lissan-ul-Arab” and “Taj”, “Qawwam” has been defined as a maintainer and protector. In the above – mentioned verse, the Holy Quran further states “and because they support them (the women) with their means”. This shows that the connotation of the word “Qawwam” refers to the expenditure which the men have to incur on the maintenance of women. As against this, the Holy Quran in Surah Namal relates the story of Hazrat Bilqees who was a democratic ruler. She continued as a ruler of Hazrat Suleman. Maulana Ashraf Ali Thanvi, in one of his famous religious pronouncements, states that there is no evidence to show that Hazrat Bilqees had abdicated power. Based on this, Maulana Thanvi concludes that it has been explicitly proved by the Holy Quran that in a democratic state a woman can be a ruler.” Those ulema who oppose the rule of a woman at best quote only one Hadith in which the narrator says: “during the course of battle of Jamal my fears were set at rest by the saying of holy Prophet (SAW) in which he is reported to have observed that (when Iranians accepted as ruler the daughter of their monarch) that “the people who accepted a woman as their ruler can never succeed.”
This makes it clear that the reported saying of the Holy Prophet was quoted when Hazrat Ayesha (RA) led an army of Muslims demanding punishment for the assassination of Hazrat Uthman (RA). It seems that this saying was quoted to prove that Hazrat Ayesha (RA) was wrong. However, none of the narrators of this tradition belong to Makka or Medina. “Obviously, this tradition is not clearly reliable. Allama Jalalud Din Sayuti (RA) has quoted Imam Shafi as saying that the traditions which are not in the knowledge of the people of Makka and Medina cannot be relied upon.”
Russian Empress Catherine is familiar to all and heir’s was a golden period for Russian history. The peace and tranquillity enjoyed by the Russian people during her reign has no parallel in Russian history. For the three/ four succeeding generations women have been the monarchs of Holland. Empress Will-Hellena ruled over Holland for a long time and when she grew very old she abdicated in favour of her daughter, Juliana, who remained Holland’s queen for over 25 years. She, in turn, relinquished the throne in favour of her daughter who has been ruling Holland for several years. The reign of her mother and grand mother is considered, without any doubt, a golden period of Dutch history.
Queen Victoria is a household name in the Sub – continent. Prior to her, Queen Elizabeth -1 left behind indelible marks on the British history. Both of them considered the British nation’s heroines. In terms of the expansions of the Empire and its armed might, Britain assumed the status of an imperial power during their reigns. Incidentally, Queen Elizabeth-2 has been on the throne of England for the last four decades. Under her a woman Prime minister, Mrs Margaret Thatcher, on account of her aggressive policies, came to be known as the “Iron Lady.” Interestingly enough Pakistani Ulema who chose to criticize woman’s rule consider England the only place where they can get the best treatment for all their ailments.
Luxemburg is a tiny state in Europe. A Dutch queen ruled over Luxemburg for over 60 years to be succeeded by a woman who continued to reign with great success. “Take the case of Golda Meir of Israel, Indirah Gandhi of India and Mrs Bandaranaike of Sri lanka, who remained prime ministers in the recent past.” Muslims can refer to queen Shajarat-ud-Dur, daughter of Emperor Najamud Din of Egypt, Queen Al-Arab Wasalam of Yemen, Queen Turkham Khatoon of Suljuk dynasty. Queen Razia Sultana and Chand- bib of the Sub-continent. Sonia Gandhi was Prime minister of India in the late 1980s and is again the virtual Queen of India.
Times have changed. Presently the Imam of a mosque would not deliver a sermon unless the loudspeaker is switched on. There was a time when anybody who ventured to question the fatwa that film was haram used to be branded as kafir. Religious preachers now consider the telecast of their sermon a great service to Islam. There was a time when men and women could not participate in any meeting together. This was considered anti-Islamic.

Musharraf’s bold initiative on Kashmir
Nasim Zehra

There is a tempest brewing in a teapot over President Pervez Musharraf’s recent remarks allegedly indicating an abrupt change in Pakistan’s Kashmir policy. In his Dec. 5 interview to Indian television NDTV, President Musharraf merely reiterated his position how he believed progress over Kashmir was possible. A similar position was also held by former Prime Minister Nawaz Sharif but media hype and exploitation of the issue by vested interests and politicians combined to promote an uninformed and frenzied discourse on Kashmir. This also mirrors how the Indian opposition party BJP, which actually initiated the peace process and the idea of “give and take” on Kashmir, is publicly resisting any initiative the Congress takes on Kashmir.
In his Dec. 5 interview, President Musharraf again conveyed Pakistan’s willingness to take bold steps to resolve the half-century old issue. Advocating the need for flexibility in traditional positions on Kashmir, Musharraf was clear that if Delhi showed flexibility, so would Pakistan. To illustrate the point he said that were Delhi to move forward on conceding political rights concerning Kashmir, Islamabad too would give up its claim to Kashmir.
Musharraf has proactively sought to break the logjam on the lingering conflict. He has practically pushed forward the Lahore process which zeroed in on seeking a fast-paced solution to the Kashmir issue. He began with the 2001 Agra summit, where he first introduced the notion of a four-step formula, which included knocking out solutions unacceptable to Pakistan and India and to opt for only solutions acceptable to Pakistanis, Indians and Kashmiris.
Subsequently, in his Nov. 18, 2003 interview with Reuters, Musharraf first publicly conveyed the government’s readiness to go beyond “stated positions.” He was clear that a resolution would require that “both sides talk to each other with flexibility...coming beyond stated positions...coming and meeting half way somewhere.”
Finally, in the April 2005 Delhi summit, Musharraf first introduced the four-point-formula seeking a phased withdrawal of troops; local self-governance; free movement of Kashmiris across the LOC and a joint supervision mechanism in Jammu and Kashmir involving India, Pakistan and the Kashmiris. Obviously, Musharraf was not announcing changes in Pakistan’s Kashmir policy but outlined the extent of flexibility Islamabad was willing to bring in its position.
None of this is completely new. Musharraf is attempting to encourage the Indians to move forward. His moves do convey some salient features of a dynamic Kashmir policy. For example, following are five key features of Pakistan’s Kashmir policy. One: Islamabad has demonstrated that while it views the UN resolutions providing the legal framework for the Kashmiri case for the right to self-determination, Pakistan will go beyond the UN resolutions that offer the state-integration option requiring the Kashmiris to integrate into Pakistan or India.
Two: the first clear articulation in recent years of Pakistan’s actual position taken at the UN that Pakistan supports the Kashmiris’ right to self-determination, that is, the right of the Kashmiris to determine their own political future. Pakistan has sought Kashmiri integration with Pakistan.