Rural China in no shape to fight SARS

By John Pomfret
Washington Post

QINGXU, China — "If I get that disease, I'll just wait to die."

Patients quarantined in the People's Hospital of Peking University in Beijing peer through the gate. There is a ban on migrant workers returning home from major cities to the provinces, which many have ignored. Associated Press

In a worrying development, severe acute respiratory syndrome has entered

China's countryside, which is unprepared and unequipped to fight it. According to Chinese reports, nowhere is the situation worse than in Qingxu, 270 miles southwest of Beijing, where dozens have caught the disease and several have died.

Some 20 miles up the road, in Taiyuan, capital of Shanxi province, doctors estimate there are about 300 cases and that 15 patients died last week at one hospital alone, although the provincial government acknowledged only 162 infections and seven deaths.

A Chinese government spokesman was asked how many respirators were needed to deal with SARS in Shanxi. He said there were currently 80, but hospitals could use another 453.

Life in this gritty mining town has been severely affected by SARS. "Temporarily shut due to extraordinary circumstances," reads the sign on the door of a diner called The Spirits' Meeting Place. Such notices are all over town. There are no pedestrians. Schools are closed, as are discos, Internet bars and karaoke halls. Intercity buses are not stopping in Qingxu. "The place is dead," said Wang Baishan, a local truck driver.

But Zhang and others in Qingxu said they did not think they would have access to that money if they became ill.

"A peasant's life in China has never been worth anything," Zhang said. "I made $300 last year, and I'm rich compared with some of my neighbors. But it costs $250 to go to the hospital. What happened to the money that was supposed to bring us out of poverty?" Millions of dollars intended to alleviate poverty is widely believed to have been stolen by local officials.

Chinese officials are so worried about the disease spreading to poor regions that they have begun to ban migrant workers from returning home, including from Shanghai and Beijing. However, China's size and population of 1.3 billion make such an effort impossible to enforce.

Thousands of workers already have fled Beijing, possibly bringing SARS deeper into the countryside, and police at checkpoints on roads leaving the capital are not attempting to stop every vehicle. "We really don't know what or who we're checking for," said one.

Authorities in Shanxi and other provinces also are worried about SARS patients and suspected cases fleeing hospitals in the hinterlands because they have no faith in the medical system and want to die at home.

The China Youth Daily reported Wednesday that a relative of a SARS victim in Taiyuan, who had a fever and a dry cough, fled when an ambulance came to pick him up. "This is not the first time this has happened in Taiyuan," the report said.

For years, China's government has devoted few resources to healthcare in the interior. State subsidies for provincial hospitals have been slashed.

"If you do not have the resources to deal with SARS, I think we're going for a very big outbreak in China," said Henk Bekedam, the World Health Organization's representative in China, speaking to reporters in Beijing last week.

In a speech last week, Premier Wen Jiabao said the nation's healthcare system was so inadequate that an epidemic could spread "before we know it" and "the consequences could be too dreadful to contemplate."

There are signs that people outside China's major cities do not understand the danger presented by SARS. The government has begun a campaign to distribute information about the virus, but the material apparently has not reached rural populations.

In Shandong province, to the southeast of Beijing, a reporter from the People's Daily newspaper visited several rural regions and reported that taxis and public buildings were not being disinfected as directed by a nationwide "urgent notice" issued by the Commerce Ministry.

Despite the Cabinet's ruling that no patient with SARS should be refused treatment, China's provincial hospitals were still demanding a down payment before treating patients. At a hospital attached to the Inner Mongolian School of Medicine in Hohhot, the provincial capital of Inner Mongolia, seven people thought to have contracted SARS waited seven hours in a common waiting room while they pleaded for treatment, according to Chinese news reports.

They had relatives and friends who had died of SARS, the reports said, and were exhibiting symptoms of the disease: a dry cough, fever and vertigo. The doctor decided they should be admitted, but none had the required $250 deposit, so they were transported to the emergency room, where they lay on stretchers and waited.

Asked by a reporter why the patients had not been treated, the head of the emergency ward, Wang Jianping, replied, "What can I treat them with?" The Cabinet has issued regulations mandating the treatment of all SARS patients, but Wang said, "This hospital has procedures for prescribing medicine."

Shanxi is one of the poorest of China's 31 provinces, regions and major cities. Its medical system is a shambles, according to a source who has worked with the government.

Shanxi medical authorities also are troubled that only 20 of 157 acknowledged cases have been traced to a source of infection, according to a doctor in Taiyuan. "That means that people are still out in public getting sick," the doctor said. "Our tracing system is too weak. We don't know how these people got ill."

SARS is believed to have arrived in Qingxu through Yue Shoubin, the Communist Party secretary of Mayu township. Yue had a reputation as a corrupt leader who demanded personal payoffs from villages under his control.

Local sources said Yue used money collected from Mayu township to go to Beijing in March for a medical procedure at the No. 301 Hospital of the People's Liberation Army, which was treating SARS patients. Yue was infected and returned to Qingxu.

In China, if a party secretary gets sick, local officials are expected to visit him in the hospital. So Cui Yueren, the head of Qingxu's Chinese People's Consultative Congress, an advisory body to the Communist Party, led a delegation to visit Yue in a local hospital. Cui was infected and died in Taiyuan on April 5. Yue's wife, their driver and other local officials also were infected. Yue is still in the hospital.

In Mayu, local farmers say they did not know of any cases of peasants in the area contracting SARS.

"It's just the leaders. We're breathing better air than they are," joked Wang Mei, 27, a farmer who stood holding her baby at the side of the road. "The party secretary deserved what he got. He took our money to go to Beijing to get medical treatment. Now he's infected all the other officials."