C. Common Illnesses Among Tibetan Children

In 1990, the infant mortality rate of the Tibetan nationality, according to a study in the Chinese Journal of Population Science, was 92.46 per 1,000 live births, roughly triple the national average for China. Part of the explanation for this state of affairs lies in the higher incidence of childhood disease and other chronic health problems in Tibet, particularly in the rural regions in which most Tibetans live. Based on our interviews with children and discussions with physicians from Tibet, the most common serious health problems for Tibetan children appear to be acute upper respiratory infections (such as pneumonia), diarrheal diseases, hepatitis, hydatid disease and tuberculosis.

Most Tibetan doctors and healthcare workers whom we interviewed said that dysentery - which can be caused by parasites, a bad water supply or spoiled food - was one of the most common ailments for Tibetan children. In fact, though dysentery represents a symptom, not a discrete illness, Dr. Sadutshang noted it as the single greatest cause of infant mortality in rural regions of Tibet. Dr. Norbu also said that, while practicing in Amdo, he encountered many cases of dysentery among rural Tibetan children. If severe, these cases frequently led to death. According to unofficial statistics from an anonymous source, 46% of child mortality in the TAR results from diarrheal illnesses. Many of these deaths may be preventable. The World Health Organization has noted that to prevent most deaths caused by 'diarrheal disease, there exists a simple, inexpensive and effective intervention: oral rehydration therapy.'

Tuberculosis (TB) is also a serious and widespread problem among Tibetan children. One anonymous source estimated that TB rates are as high as twenty percent in some areas. A former Tibetan medical aide estimated that five percent of the people in his village suffered from TB. The prevalence of TB again suggests that China's treatment programs generally do not reach Tibetan children, particularly in remote regions of Tibet. Another source emphasized that hydatid disease (echinococcosis cysts in the liver, lung and brain) infect about ten percent of the population, particularly nomads, and lead to many deaths among Tibetan children.

Other health problems among Tibetan children may be more localized. For example, most physicians did not consider rickets to be endemic, although they remarked that it is more prevalent in Kham. One former Chinese medical aide from central Tibet, however, reported that rickets afflicted many Tibetan children in his region, and an anonymous source emphasized that rickets is a serious problem throughout Tibet.

Goiter is a serious problem in many areas of Tibet. According to Dr. Sadutshang, it is especially a problem in certain regions of western Tibet because China's iodized-salt program has not reached these areas. Iodine deficiency also leads to stunted growth and in some cases to mental retardation. According to UNICEF, China's salt-iodization program, initiated in 1993, had reached eighty-nine percent of the PRC as of the year 2000. 'Yet the country must reach a small percentage of the population that still does not consume the fortified product. Many of these people live in coastal or lakeside areas, where easy access to raw salt cuts down on the demand for iodized salt.' This appears to be the case in some regions of Tibet, where nomads have traditionally collected and sold raw salt (colloquially referred to as 'chunky salt'), instead of the processed iodized salt provided by the government.

Another localized illness - the prevalence of which is unclear - is leprosy. According to some sources, it is a problem in some areas of eastern Tibet, particularly regions of Amdo. In our interviews, we encountered only one case of what may have been leprosy, a seventeen-year-old girl from Kham who described the development of sores on her toes, their subsequent shrinking, and nodes on her arms.

D. Malnutrition and Growth Stunting -->