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August 10, 2005 @ 9:35 pm | Comment

Johnny, help me here – what’s this about? Are you “Ivy Leaguer”?

August 10, 2005 @ 9:41 pm | Comment

I had a post back in July on smaller bombings in Beijing, but thankfully nobody was injured in those.

August 10, 2005 @ 10:12 pm | Comment

Who are these people at littlegreenfootballs ? The delusionary scenarios and explanations they come up with are pretty amusing.

August 10, 2005 @ 10:43 pm | Comment

I used to live in Shijiazhuang, which had a pretty nasty bombing a few years ago which turned out to be the work of someone trying to kill his mother-in-law – a tad excessive, one thinks.

August 10, 2005 @ 10:46 pm | Comment

When I see a bombing on a bus the first inclination for me these days is to think that it could be a muslim terrorist action. When I see something explode in China my first inclination is to see it as possible further evidence of societal breakdown. The anti-Japanese riots, the peasant uprisings in reaction to corrupt officials and businesses and now bombings.

In the reports on this bombing the bomber is said to be a farmer. A farmer without medical care who was angry with the government. In terms of the stability of China this is perhaps more worrying than Muslim bombers. The peasants, the backbone of China, are out of touch and disaffected from their government and some are turning violent. Not a good sign for stability in China.

August 10, 2005 @ 10:53 pm | Comment

My guess on this one is that he’s done about 20 years in either factories or coal mines and has contracted lung cancer as a result (official stats, for instance, state that since the 1950s more than 500,000 people have contracted pneumoconiosis on the mainland, of which around 140,000 have died – 12,000 new cases emerge every year). The bomber in this article was from Fujian (a province about which I know little when it comes to occupational disease), but to give you some idea, there are only 60 qualified occupational disease (OD) check-up centres and 48 OD prevention centres in Guangdong – catering to 20 million migrant workers in hundreds of thousands of factories (and half of the OD prevention centres are not up to standard – a local health professional’s assessment, not mine). OD is on the rise in Guangdong (I spent a week recently interviewing MoH officials on OD and some of the trends they’re seeing now are frightening – new OD emerging, upsurge in cases, etc), and costs – human and financial – will soon be overwhelming (and in fact, they are already enormous). Couple this with these facts from Chinese sources (sorry no links – you’ll just have to trust me that they’re from mainland sources):

Since the 1980s, GDP per capita in China has risen by nearly 500%, but hospital beds per 1,000 patients have risen by less than 20% and doctors per 1,000 patients have risen by less than 30%

Between 1990 and 1998, the number of medical clinics in central and western China declined by 3.3 and 6.3% respectively.

100 million people in China do not have adequate access to the public health system.

30 million people have no access to the public health system at all.

In Guangdong there are 1,100 OD professionals: they service 3 million workers with OD [that is, 2,727 affected workers per professional].

In the last 3 years, Guangdong has registered 15,000 new cases of occupational lung disease, and seen 5,000 such patient die (many of whom contracted the disease prior to the last three years, of course).

I could go on and on, but I think my point is clear. It is less likely that the bomber in Fujian was Muslim than a migrant worker with nowhere to turn (and this is not to condone the bombing at all).

It is worth noting that the figures above are not presented as a criticism of the government. I personally know MoH officials who are as offended and angry as people everywhere about this. And they shut down factories, try to provide services to prevent OD or to alleviate problems for those who are already suffering, and can now veto new investment on the basis of a lack of OHS spending. Yet their hands are tied in many instances by more powerful departments for which FDI trumps workers’ rights. It’s easy to criticise them, but they are men and women like many here who talk of social justice and try to act within a system with few openings. But openings exist, and I hope to be working with some of those for whom such spaces have opened over the next few years in an effort to improve the situation. It will, in the grand scale of things, be a drop in the ocean. But rather than complain that workers are paying a high price for industrialisation, we need to be supporting locals who want to do something about at least capping and hopefully reducing the toll.

August 10, 2005 @ 11:50 pm | Comment

In my wanderings around Sichuan two weekends ago I met up with a tragic situation. It is a 8 month old minority nationality (Li su) boy who has “water on the brain.” His cranium was the size of a football.

From what I could discern he had had no medical treatment or evaluation because the family was too poor. A long story shortened. I paid to take the boy from the village to the nearest hospital in Xichang. and paid to get him admitted for evaluation.

He is saveable, but needs medical treatment. It can’t be done in Xichang, but can be done in Chengdu or Guangzhou, BJ.

For the family it is impossible. Cost estimates are 30,000-50,000RMB for treatment, plus travel costs and accomodations for the parents, maybe.

I have three questions.

Does anyone know or can find out if there are any free or extremely reduced cost medical services for poor Chinese and especially a national minority person?

Anyone have connections with any generous medical facilities, foreign or otherwise, that would do the treatment for free?

Would anyone join me in raising the money to pay whatever it takes to get the boy treated?

I believe this situation was not a set up. I had gone out to the countryside from Xichang by bus. I got off and started asking people if any Li people would like to sell me any of their authentic handmade trinkets or jewelry. A roadside fresh grape seller talked to a group of three Li people. They said they have somethings to sell at their house. So we four trudged off about a kilometer or more to their house. One woman was carrying a child on her back under a wrap. After a while they unwrapped this enormous head. Jeez, a big shock.

Their house was one room with 3 beds. The things they had to sell were not much, but they want big prices from the foreigner. I offered very low and they said they want the high prices to get treatment for the boy.

I found out after some inquiry the had never been to a doctor, at least that is what I think they told me. The boy can see and hear and make noises.

I told the mother, father and grandmother that I would pay a normal price for the jewelry, a ring, but would pay to get the boy to the hospital in Xichang and get him in for observation and evaluation.

Now I want to see he gets the treatment. Any good ideas, or sugestions?

August 11, 2005 @ 1:35 am | Comment

Richard could you, if you have the time, put my comment above on your next open thread, at the top? Any help on this project to help the boy will be greatly appreciated.

August 11, 2005 @ 1:39 am | Comment

Stephen Frost: a few comments. Your remark about FDI trumps workers rights is rather puzzling to me. Although I do not have statistical data, from my personal anecdotal observations, FDIs from North America, Europe, and Japan operate their facilities in the same fashion as in the originating country. In other words, occupational disease and occupational accidents are rather minimized. From the few observation of Korean facilities, they also appear to be fairly safe (these are large multinational Korean facilities). In other words, it would appear that FDIs are improving the situation, not adding to the problem.

Likewise, in your compilation of data, you indicate that the increase in hospital beds per 1,000 populatin was less than 20% while the GDP increased over 500%. I am not quite sure what correlation is implied here. Prior to my coming to China (again), I spent a couple of years in Alaska as a consultant on two hospital projects. One was an 80 bed facility replacing a 250 bed hospital. This was not because the area had a diminishing population, but because advances in medical technology and better hospital management required a smaller facility. Again, from anecdotal experiences, what I see here (granted, in a properous and well developed part of China) are a lot of hospitals with too many beds, hospitals poorly organized with facilities poorly designed for modern needs. They are building a new hospital complex not too far off from where I live; it is far too large, etc. Although there are some private hospitals and clinics being constructed in China, most are still state supported, and a lot of money is being invested in the wrong part of the health care system.

You mention a decline in clinics in Central and Western China. This may be serious, but if significant improvements were made in the specific areas in communication and transportation, then there may be justification in the decrease. In other words, the statistics are not telling anything in themselves about the state of health care there. There needs to be other correlations to determine what problems have developed from such a decrease.

You mention that since the 1950s over 500,000 people have contracted pneumonoconiosus with 12,000 cases being reported each year (I presume this is recent years). Simple math informs one that the problem appears to be rather stable for 50 years or so. In other words, it appears to have been a problem from the beginning and no effort was made to control it for all these years. Also you mentioned that it derives from either factory work or mining. That is only partially true. Not all factories are a source for this problem, only a subset of factories. Also, not even all mines are a source for this problem, just a subset of mines. In other words this is analagous to saying that all black kids are nasty monsters because one beat the snot out of your boy. The solution is rather specific with specific source targets.

Linking this episode to the general stress in China is debateable. A number of years ago a dentist in NC, I believe, contacted aids. Before he died he infected several of his patients. You may want to link that to stress in aids infected people, but I tend to think that some people, when bad things happen to them, just want to harm other human beings needlessly.

I also believe the social economic stress here in China is serious. I also agree with you about the situation with health care in general and occupational disease and accidents in particular.

August 11, 2005 @ 10:08 am | Comment

The problem is not the number of beds or Docs for patients, but the medical cost that only few people can afford.

The problem is that doctors in hospital are not prescripting but sell medicines to patients.

The problem is that medical professionals are not getting their money from salaries but bribes.

The problem is that the state do not take care of its patients as state owned enterprises, rural village party cadres and town chiefs did before.

The problem is that the prices of common medicines have been inflated so much because of the bureaucratically regulated supply chains.

The problem is that no medical school graduate like working in the rural area.

The problem is that hospitals’ daily expensure is on themselves and they have been transformed into profit oriented businesses.

The problem is that there are not many charity organizations in mainland China.

The problem is that the medical reform originally initialized by Zhao Zhiyang was continued by Jiang and Zhu.

The problem is that medical insurance industry in China is so weak for both docters and patients.

The problem is that Chinese peasants are very nice people to deal with.

The problem is that there are too many problems……………………….

Fortunately, the current government at least acknowledge the problem and is trying to come up with new solutions.

There are smiliar problems in high educational and governmental reforms starting from Jiang and Zhu. These should be all rated as failed projects which have posed huge social costs to Chinese people. The only consequence of these reforms is turning these traditionally nonprofit organizations into money sucking monopolies, and this has to be stopped.

On these issues, China has to be turned to the LEFT! The voices of people have to be heard!

August 11, 2005 @ 2:03 pm | Comment

Lin, I emphatically agree. I am no leftist, but I like the thinking of the “New Left” movement in China, at least in theory. Government and society is about more than the bottom line. This attitude is what made America great, and China needs more of it.

August 11, 2005 @ 2:11 pm | Comment

Lin and Richard;

Most hospitals and clinics in China are already state owned, that is pretty left leaning. So you must mean to apply even more ‘leftist’ policies, I am not sure what they are? For instance, you say that the doctors are taking bribes and not working for salary (I have been to a local hospital, this did not occur with me nor am I aware of anyone personally required to bribe a doctor), so it appears to be a policing issue-do you want to shoot the doctors? New Doctors after receiving their license do not want to work in the rural areas (this appears to be a universal phenomena)-do you want to force them to live and work in an area they do not wish to live or work?

You write that the people are not getting the medical care they formerly received-medical care during the Maoist era was not all that great.

Where I am, I know many people who are waiting for a new Hong Kong clinic to be built and operated. They actually want a modern system, not one run by bureaucrats.

The main problems with ‘leftism’ anywhere is that economic relationships (economic laws) are not the results of political fiat, so no matter what law or regulation is passed, supply and demand relationships still exist, marginal utility still exists, time preference still exists. All that political fiat or regulations do is distort the distribution, not solve the problems.

August 11, 2005 @ 6:56 pm | Comment

People in rural areas sorely miss one of Mao’s few successes, the “barefoot doctors” program. They feel they’ve been left in the lurch, and horror stories abound of hospitals taking injured or seriously ill patients who can’t pay and dumping them in the woods or on a deserted road. I’m not sure what the perfect solution is, but there’s going to have to be a compromise or anger may boil over. There has to be some safety net as there was in the past. We have this sort of thing in virtually all developed countries, and it works pretty well. It’s not impossible and it doesn’t have to be a nightmare of bureaucracy. Let’s think outside the proverbial box a little.

August 11, 2005 @ 7:02 pm | Comment

Dear JFS: thanks for your long response. It took a while to realise you agreed with me, but perhaps I can clear up a few of your queries.

1. FDI trumps workers rights. Most FDI in China doesn’t orginate from the US, EU or Japan as you seem to imply. It originates in HK, Taiwan and Korea (eg., HK investors have 60,000 factories in the PRD). FDI aimed at capturing markets (eg., Nokia, GM, etc) results in completely different workplace outcomes than FDI aimed at minimising costs (eg., HK low end manufacturing). Eg., employees at GM work in a great environment. Employees at GP Batteries factories in Huizhou have cadmium poisoning. But Huizhou is not about to kick GP out over breaking local laws and failing to meet local standards. GP’s investment is too important. Thus, FDI trumping workers’ rights is no puzzle at all, and something most officials in China understand perfectly well (certainly in the Pearl River Delta). If you don’t believe me, build some relations with them and talk about the topic of FDI versus workplace standards with them off the record.

2. GDP rise vs hospital beds. The correlation is clear, but let me make it clearer. The rise in GDP has not translated into similar gains in public health. Let me quote from one of the most senior Ministry of Health officials in China who has drawn a correlation: ” Economic development has not led to improvements in public health or social development.” I can’t provide a link because the document I’m quoting from is not online. Your Alaskan experience is interesting (as is your experience in what seems to be a relatively wealthy urban area), but bears no resemblance to reality for most Chinese. I’m not going to repeat myself: the data on facilities and experts catering to OD patients tells the whole story (China is woefully short of facilities to deal with workers with OD or industrial injuries).

BTW: the state now contributes just 10% of funds required to run the hospital system.

3. The decline in clinics in central and western China has nothing to do with “improved transport”. It is the result of declining expenditure leaving people with no or inadequate services for which they cannot pay. BTW, these are conclusions from MoH officials; they are not mine.

4. Pneumoconiosis. Yes.

5. Stress: no idea what the point is.

China’s own MoH officials at the most senior level understand they are facing a public health crisis. The current five-year plan on health has listed OD as one of the five key areas of concern. Some of your comments fly in the face of everything the Chinese government understands. To repeat: the comments I’m making here are not my own conclusions and data – these are the conclusions based on Chinese data by Chinese officials who see what’s happening up close every day. The levels of despair among MoH officials at the provincial, municipal and county level are palpable. Many in the PRD understand that without some serious attention, China will find it difficult to contain the disaster that is already looming.

You can read a lot more about this at our website (especially in CSR Asia Weekly – our newsletter), or go back through the archives at Asian Labour News.

August 11, 2005 @ 11:25 pm | Comment

JFS:
You’ve gotten very good points which deserve serious consideration. I have been thinking these days about underlying causes for the failure of medical reform. There are two directions that we can think of. One is that the market oriented reform is on its half way and the competition has not been successfully introduced which led to the problems. Another direction is that government didn’t play its referee role very well in this reform, which led to the fact that all enterprises in medical industry(including hospitals, drug companies, distribution channels….) cooperatively squeeze the customers(patients).

Both directions seemingly have nothing to do with leftist policies.
I actually would agree with you that market oriented reform should be continued, but only if china’s medical market is mature. If it is, the we can conclude that bad service today results from the insufficient competition. Look like it in urban area in China.

However the considerations above all neglect that the major problem is in rural area.
There are vast majority of potential customers(peasants) who don’t have purchasing power at all. (it’s like workers in 1929’s crisis)
whatever you do, they won’t be able to afford. The minor problem are the bad services and inflated price in urban area. To solve the minor issue, probably introducing more competition(turn right) may eventually solve the problem.

Even for this minor aspect, still I got problem: just like market oriented educational reform, the market oriented medical reform will creat the situation that the poor and the rich won’t be treated equally. The poor won’t be able to afford the medical assistance, which, unlike other products, principally should be equally accessed by people no matter how much you earn. Do you think the poor deserve to die more than the rich?

(This category of unusual merchandies includes
the rights being medically assisted equally, the rights being able to grab the educational opportunities equally, the rights being treated by the government equally no matter how much you earn. The market oriented reform of this category much lead to unfairness in the society, anyway, these are all about the minor problem)

Now let us talk about the major problem(no medical coverage of peasants), my conclusion is that government must strongly interfere. There is no way around unless you can suddenly create purchasing power for those poor peasants. There is a huge demand and a supply but these two curves just don’t cross each other unless government push these two curve to reach a possible transaction price.
Currently, i can only think of governmental coverage, this is what I indicated “turning left”!

August 12, 2005 @ 9:40 pm | Comment

Forgot to mention that China government has a pilot work in Suqian, Jiangsu province. Since year 2000, almost all public hospitals in Suqian have become private owned business. The result is exactly what we’ve seen in US and hence been called American style medical reform. The government now have more money to spend on disease preventive departments and private medical service quality is better. The medical assets in Suqian have increased a lot.
HOWEVER, similar to US, the medical expense soars. The main objective (let local people be able to see doctors) of medical reform has not been achieved.
This is a very interesting result. Every result is almost exact like the sympotoms seen in US.
It’s strange to me that price soared after reform, which wasn’t supposed to, because of full competition.
Now we really need economists here both for what we’ve seen in Suqian, China and US.

August 13, 2005 @ 12:02 am | Comment