Health

Official HIV/AIDS estimates for China gathering dust

“According to official estimates, there are believed to be 650,000 people living with HIV/AIDS in China.”

A line similar to the one above can be found in practically every story about HIV/AIDS in China, from Xinhua to Reuters, published in the last couple of years. The statistic is courtesy of the Chinese Ministry of Health, the World Health Organisation and UNAIDS, but it seems about time this oft-repeated figure is updated, or at least qualified in some way.

A friend of mine - and in fact one of my many nemeses on the high-flying 50-yuan-a-game Beijing poker circuit - Gabe Suk is the head of a non-profit organisation called Prevention Through Education. PTE works to bring HIV/AIDS education to Chinese classrooms, particularly those of middle school students in their final years of compulsory education. He also blogs a bit to spread the word and this is his recent post on news of a sharp increase in new HIV infections in China. It is well worth reading the whole post as it gives an idea of what PTE is trying to achieve.

It starts like this:

China has reported 18,543 new HIV infections in the first half of 2007, which is near the reported number from all of last year.  A figure that is certainly worrying and indicative of China’s growing epidemic …

And then moves on to provide a realistic estimate for the actual number of new HIV infections:

There is always a large discrepancy between the amount of reported cases and the amount of actual or estimated cases.  This stems from lack of surveillance as well as the fact that worldwide only around 10% of HIV positive people actually know they are positive.  If we take a conservative estimate for China and say that 20% of people who are HIV positive know their status we could estimate that 18,543 reported infections translates to 92,715 actual infections.

The overall situation of HIV/AIDS in China is provided in these two paragraphs that PTE quotes from Reuters:

The nation had 214,300 officially registered cases of HIV/AIDS by late July, Xinhua said, an increase of five percent over the figure for April.

The United Nations estimates the true number of the killer disease in the country to be around 650,000.

There’s that stat again. Back to PTE:

Ah the stats, everyone loves the stats.  I don’t really get it in China.  There is one constant number 650,000, that was adjusted from around 840,000 by the  WHO, but never changes despite around 100,000 new infections every year…  I think what we can learn from all the misleading stats and contradictions in information is that no one really knows for sure.  China is so massive that to constantly rely on such a solid statistic seems a little silly.

I’m inclined to agree although I do confess to harbouring a burning desire for stats (which is just as well as a Xinhua news polisher) especially when PTE’s earlier (conservative) calculation method is applied to the figure of 214,300 - the number of officially registered cases in China. If only 20 percent of Chinese people with HIV know they have the disease then the actual figure has the potential to be more than one million - 1,071,500 to be exact. Time for a recount I think.

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Mystery over death of Korean diplomat in Beijing continues

More than a month has now passed since senior Korean diplomat Whang Joung-il died at Vista Clinic in Beijing. Yet the cause of his death has still not been officially confirmed by the Chinese authorities despite the issue being raised at the Ministry of Health press conference yesterday. In fact, the comments by new Health Minister Chen Zhu only served to ensure listeners were even more befuddled. This is the (unpolished) Xinhua report from yesterday:

BEIJING, Sept. 5 (Xinhua) — The death of a senior diplomat of Republic of Korea (ROK) in China was not caused by food-originated diseases, although he died after eating a tuna sandwich, Chinese Health Minister Chen Zhu said on Wednesday.

The death of Whang Joung-il was not caused by food related diseases, and “I was 100 percent sure” of that, Chen said at a press conference in response to a question raised by a Wall Street Journal reporter.

The Ministry of Health has organized authoritative experts to conduct medical test on Whang’s case to find out the cause of his death and the result had been handed out to the ROK side via diplomatic channels, Chen said, adding the ministry was looking forward to exchanging ideas with the ROK in order to further determine the cause.

Chen said he had read a report from a ROK media that quoted a leading ROK institution that Whang’s death was caused by excessive work and cardiologic diseases.

Whang, 52, a major diplomat at the ROK embassy in Beijing, suffered severe stomach pains and vomiting after eating a sandwich bought nearby on July 28. He was brought to the Beijing’s Vista Clinic the following morning and died two hours later.

“Minister Whang was an old friend of China. We feel grieved about his death, and I want to take the opportunity to express our condolences to Whang’s family and the ROK People,” Chen said.

He said Whang had made great contribution to the Sino-ROK relationship, and “any media reports that play up his death were a disrespect to him and not humanitarian”.

Back to the beginning of this mess. On July 29, Korean newspaper Chosun Ilbo reported that Whang had died while being treated at a Beijing clinic. The Korean embassy believed his death was caused by either a sandwich he had eaten the previous evening or by an injection of Ringer’s solution he had received at the clinic. The Ministry of Health “seized the solution for investigation”, performed an autopsy on the body and promised to deliver the results to the Korean embassy as soon as possible.

Chosun Ilbo then went on the attack the same day with arguably premature speculation.

Whang’s sudden death reminded us in Beijing of the fact that we live under the threat of tainted food and bogus drugs in China. Right now there’s a controversy over whether Chinese vendors really sold steamed dumplings stuffed with chemical-laced cardboard masquerading as pork. There have also been reports of shipments of bogus human blood meant for transfusions. It’s a sad reminder that 600,000 Koreans working and living in China, including diplomats, corporate executives and students, are exposed to very real dangers posed by phony food and medicine.

Two weeks later the same newspaper produced a strangely brief two-par story which said the Chinese health authorities had unofficially confirmed that Whang had died from an injection of the antibiotic Rocephin which can be fatal when mixed with drugs containing calcium. However these results had not been conveyed to the Korean embassy. It also said the Chinese health ministry had promised to punish Vista Clinic, who denied it had done anything wrong and claimed Whang died from a heart attack.

Nine days later and Chosun Ilbo was back on the offensive with this biting editorial, which included:

When Korean officials raised the possibility of a misdiagnosis or wrong prescription to the Chinese official, he responded by asking why Whang chose to go to such a “low grade” hospital. His tone was as if Whang was to blame for his death for choosing the wrong hospital. But that hospital happens to be a prominent one in Beijing and is frequented by foreigners. Nor is it some cheap clinic either. It charges US$140 for an initial exam. If such a hospital is truly “low grade”, then perhaps Whang should have used a hospital catering to Beijing’s elite bureaucrats. Judging by Beijing’s nonchalance in dealing with this incident, one perforce feels that China has a long ways to go. It may appear to be on its way to becoming a global leader. But it seems there is no way that country will be able to assume such a responsible role as long as it behaves this way.

A day later Associated Press released this report (via The Boston Globe) which featured reaction from Whang’s family, who said the Korean embassy had been informed earlier in the month that Whang died of a heart attack.

The family is also pressing to see the autopsy findings, calling it an unusually long delay considering the case involved a high-level diplomat.

The family is “deeply concerned that his death will be erased,” Whang’s son, Tae-ho, said in a statement yesterday.

The AP report also featured a quote which demonstrated the unwillingness of the Korean government to criticize China openly.

“We’ve asked China to give us an outcome that is fair, objective, and acceptable,” a South Korean Foreign Ministry official said on the condition of anonymity, citing the issue’s sensitivity.

Another week passes and along comes an intriguing article from Asia Times, which comments on the diplomatic complications that seem to be at the heart of the snail-paced investigations. The lead par sets the tone:

The low-key, drawn-out inquiry into the death of a senior South Korean diplomat in China makes pundits wonder what’s really behind the actions - or inaction - of Seoul and Beijing in this highly sensitive yet very much under-reported case.

It mentions the expected dearth of reporting on the issue in the Chinese media:

The news was suppressed in China - understandably. Among the major dailies in Beijing, only the Beijing News ventured to write about it. But oddly enough, even though the incident had happened in Beijing, the Beijing News’ short piece was gleaned from the Xin Kuai Bao (Express News) - a newspaper in faraway Guangdong province near Hong Kong.

Reaction from unnamed “observers” follows, including the opinion of a South Korean scholar:

“Beijing must have offered some concessions to Seoul. My hunch is that it might be something on the six-party talks [over North Korea's nuclear program] or some economic deals. Otherwise, given the magnitude of the incident, the kind of low gesture by South Korea when its own senior diplomat had died is unthinkable as a sovereign country. Even a country which has less diplomatic muscle than South Korea would have lodged a stronger protest.”

And then the conclusion:

In a nutshell, what appeared to be a poor diplomatic maneuver from South Korea on the death of its envoy in China may actually have been a choreographed deal between the two countries meant to save China’s face, the argument goes.

All this highlights the inadequacy of Health Minister Chen Zhu’s response at yesterday’s conference. He refused to divulge the cause of Whang’s death, saying it had been provided to the Koreans “via diplomatic channels”. I would think Whang’s family might have something to say about that - both to the Chinese government and its own. Chen even started quoting speculation in the Korean media that the diplomat had died from “excessive work and cardiologic diseases” despite having full knowledge of the autopsy results. His closing comments, as detailed above, were made all the more galling by an article in today’s China Daily headlined “New health chief shines on debut” which told, awe-struck, of Chen’s ability to smile throughout the two-hour conference and the spontaneous reaction of all reporters present who rose to their feet at the end of the speeches in order to laden him with applause.

In the meantime, Vista Clinic is continuing to treat patients having not been required to explain itself.

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Pouring scorn on Olympic medical advice

We are all aware that the air pollution in Beijing often makes a dirty weekend away in a Shanxi coke plant seem like a tempter but I’m struggling to take the World Health Organization’s recent warnings to Olympic spectators seriously. I say that, of course, with zero medical evidence to back up my scepticism.

As reported in the Daily Telegraph:

High levels of air pollution in Beijing could damage the health of many spectators at next years Olympic Games, a leading World Health Organisation expert has warned.

Dr Michal Krzyzanowski, said that air quality was so bad in the Chinese capital that those with a history of heart problems and those suffering from asthma should be aware they could be harmed.

And in response to the four-day car removal project:

However, Dr Krzyzanowski, an expert in air quality, doubted the measures would be effective in the long term and said the WHO still feared for the health of many of those planning to attend the Games.

“I’d be amazed if substantial progress is made in the next 12 months,” he said, pointing out that Beijing’s problems are not just created locally.

“It’s possible the beneficial effect of cutting the traffic in the city will be compensated by the transport of pollution from other parts of China.”

“Even by the standards of Asia, Chinese cities are pretty highly polluted,” he said.

“Those who come with asthma may suffer attacks. I would be concerned for those who have some cardiac condition,” he added.

“This might be more serious as it requires a much more specialised medical response.”

Presumably, these warnings are applicable to all tourists with asthma and heart problems who choose to visit Beijing over the next year and not just those who decide to sit in Olympic venues for a few days in August. So should we expect general travel warnings to be issued by the WHO about the dangers of visiting Beijing (when all the cars will be on the roads) and indeed other grubby capital cities like Mexico City?

Asthmatic spectators watching beach volleyball in Chaoyang Park can console themselves by remembering that British marathon runner Paula Radcliffe, herself an asthma sufferer, will be running 26 miles and 385 yards through the streets of Beijing. As relayed in the Scotsman, she is taking it all in her stride:

Radcliffe, who famously broke down during the marathon at the last Games in Athens, is leaving nothing to chance in her bid for her first Olympic gold medal.

The 33-year-old suffers from exercise-induced asthma, and Lough admits that she may have to switch the medicine she takes because of the pollution in Beijing.

“She may have to adapt her doses or medication - but as long as we’ve done enough research and thought about it, we hope it won’t be an issue,” he said.

“There’s no point in us being especially concerned, because pollution’s not really something you can control.”

Lough added: “We’ve known about this issue for a while, and it hasn’t influenced Paula’s decision to compete in the marathon at all. You should respect conditions - whether it’s hot, cold or polluted - but never fear them.

Fine advice for beach volleyball fans.

 

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Please, no more rural healthcare propaganda!

China’s health service is in total disarray. Government officials freely admit it and Xinhua has carried numerous stories highlighting the problems of bribery, extortionate medical costs and fake medicines. The latest post on Time’s China Blog has a few stats. But just recently there has been a drive by propaganda chiefs to extol the virtues of the new rural co-operative health system.

Under the scheme, each person pays a mere ten yuan a year, while the state supplies another 40 yuan for each participant to the cooperative fund. Members of the scheme are then entitled to discounts on their medical fees using the fund pool. The idea is a very good one. The difficulty of providing medical care to 1.3 billion people can not be underestimated and China is a developing country. So let’s be honest about it. Yes, the situation is better than it was five years ago but it is still virtually unworkable in practice. Report the problems the Chinese government faces and how it proposes to overcome them.

Last week, Xinhua released this feature with the headline “Chinese government under pressure to make rural healthcare system work”. Ok, it’s long and not sparkling journalism but worth a read I reckon. Some of the quotes are very telling:

 ”With an average reimbursement rate for hospital fees only standing at a meagre 27.5 percent, the current subsidies are still utterly inadequate in dealing with grave and terminal diseases,” said Wu Ming, professor with the Medical School of Peking University.

and:

Zhao Jiqing, director of the Public Health Bureau of Beipiao, believes that the funding is not enough.

    ”Without the consistent support from central government coffers, the new scheme can hardly sustain itself. It is imperative the government increases the fund pool to make hospital fees more affordable for farmers,” he said.

and:

According to Wu Ming, professor with the Medical School of Peking University, the problem of rural healthcare should not be underestimated.

    ”The fact that 900 million farmers have limited access to medical care is so grave that it could diminish the government’s efforts to close the yawning wealth gap by throwing disease-plagued farmers back into poverty,” he said.

Given these opinions, it was immensely frustrating that the story had to go through four revisions before all of them were included in the story. Of course, there is always going to be a problem if a story is written with the specific aim of “showing the world that China’s rural healthcare system is better than it was” as one editor put it. This led to a glowing appraisal of the whole scheme with the reality buried in the second half of the story. A polishing colleague saw this story before I got my grubby hands on it and became embroiled in arguments with the writer about how we should be reporting the whole picture. The writer believed that the co-op scheme deserved high praise. But gradually she managed to pull out more information to the contrary.

She even managed to change one farmer’s quote which finished up looking like this:

Farmer Ma Yongshan, in Beipiao County of northeast China’s Liaoning Province, was stricken by colon cancer and a brain infarction. He received a reimbursement of 6,590 yuan for his hospital fees after joining the scheme.

But he still has 10,000 yuan left to pay by himself, which is not easy for a farmer whose annual disposable income is around 3,000 yuan.

“The program eased my burden - at least I could pay the bill on my own without borrowing. But if 60 percent of the expenses could have been refunded, that would have been a great blessing,” Ma said.

The first version of the story had no acknowledgement of the difficulty Ma faced in forking out 10,000 yuan. The original quote went something along the lines of “The program is fantastic”. Who knows if Ma exists, who knows what he really said, but the writer was willing to change his quote into something more believable.

It is not the first time, a story on rural healthcare in China has had to be turned on its head and it won’t be the last. But there are now three features on the Xinhua database and, more importantly on the Internet, depicting something approaching the reality. (The third is here). So surely, there can’t be many more occasions when a piece of blinkered rural healthcare propaganda lands on the polishing desk …

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