Yin Zuluan wanted to cry every time Wu Ming came to ask her to take care of her mother.
"Auntie, would you like to come to my home to give an injection to my mummy? My mummy is dying."
Yin said that Wu Ming, the assumed name for the HIV-infected girl, would say these words whenever she went to her clinic in the village named Guangsong in Dehong Dai and Jingpo Autonomous Prefecture of southwest China's Yunnan Province.
The girl, now 9 years old, started taking care of her mother in 2000 when her mother fell ill and was diagnosed as an AIDS patient.
In the four years before 2004, Wu undertook all the household work, such as carrying home buckets of water on a shoulder pole every day, and asking the village doctors to treat her mother.
Her father caught the virus through drug abuse, then transmitted it to her mother and died before 2000.
Her mother also died from AIDS in 2004, leaving nothing valuable to her. Wu, however, was infected with the deadly virus at birth.
"The child is indeed a poor child, and what I can do is really limited," said Yin, 34, a doctor in the village.
Wu's family is one of the dozens of families affected by the virus in the village, where Yin and her father are the only two doctors.
Guangsong and another village named Mandan are included in a pilot project to provide comprehensive care and to control HIV/AIDS.
The project, sponsored by the central government and organized by the local government of Dehong Prefecture, is the reason Yin's tiny, old clinic has been replaced by a bigger one with much better facilities. But the villagers aren't getting adequate medical services due to a lack of funds to pay doctors, to provide sufficient medicine and facilities, and to support villagers in living and education expenses.
Before the government started the free anti-virus treatment on HIV/AIDS victims in her village in 2004, patients couldn't get any suitable medicine at all, Yin said.
Yin said she could only give some common anti-virus medicines or injections to those like the girl's mother.
But the family couldn't afford her medical service and still owe much debt to her clinic.
The orphaned girl, already displaying some symptoms, is able to continue studying in a primary school only through the local government's support. She is now living with her aunt.
"She is the best student in her class," Yin said.
Still, Yin has another reason to feel like crying.
"Up to now, there is no suitable anti-virus medicines for child sufferers," she said.
Financial Problems
One mission of Yin and her colleagues is to investigate the real situation of the orphans and the elderly people left behind by AIDS patients who succumbed to the disease.
They report the difficult situation of these families to the local government, striving to get more support from the local civil affairs departments.
In the pilot site of Guangsong and Mandan villages, 54 orphans and eight elderly people have been left behind by deceased HIV/AIDS victims. "They are all very poor and as a village doctor with poor facilities, I can do little to help them," Yin said.
In the past years, villagers have owed a debt of 20,000 yuan (US$2,466) to her clinic for their medicines and treatment. "I know there is no hope that the debt will be paid," Yin said.
Except for the money they get from doing the follow-up visits, the village doctors have very little or no salary paid by the local government, said Mei Hongying, director of HIV/AIDS Control and Prevention Centre of Longchuan County, Yunnan Province.
In Longchuan County, where the pilot site is set up, the average salary of a doctor is 60 yuan (US$7.40) a month.
However, she said that these village doctors are very important in doing the prevention and control work of HIV/AIDS in rural areas.
In the county with 214 natural villages and 1,865 reported HIV carriers, there are only 13 professional workers of HIV prevention and control. About 88 per cent of the HIV carriers are in villages.
The whole Dehong Prefecture with 333 villages and 27 communities has only 47 professionals doing the prevention work, such as public education, HIV tests, high-risk activities interventions and follow-up services.
The majority of doctors who are treating the patients can't meet the increasing demand as they aren't well-trained professionals, and they come from the infectious disease department of local hospitals.
In this sense, the work must depend more on the village doctors, Mei said.
However, the poor salary and support seriously affected the enthusiasm of the village doctors, Mei said. And the basic conditions and equipments of the township hospitals or village clinics are very underdeveloped, Mei said.
Still, people and doctors of the 17 villages included in the pilot site are much luckier than those outside the project, Mei said.
Lack of money is the biggest problem now, Yin said, not only with the doctors' salary, but in many other aspects, such as with providing orphans living and education expenses, and granting loans to HIV-affected families for their farm production.
"HIV/AIDS families usually lose their main livelihoods first," Yin said. "They often have no money to buy chemical fertilizers, and become poorer as time goes on."
In Dehong Prefecture, which is one of the dozens of State-level pilot regions making comprehensive efforts to control HIV/AIDS, people can get free anti-virus medicines, free HIV virus tests, free education for orphans and some other support from the governments.
In Yin's village, every orphan of HIV/AIDS can get about 50 yuan (US$6.17) and some rice a month.
The majority of the money for these project villages or counties is provided by the central government. Still, the local governments can only give very limited financial support to these victims.
The revenue of Longchuan was about 60 million yuan (US$7.40 million) last year, but the expenditure was 120 million yuan (US$14.80 million), Mei noted.
"Top officials of our county government often have to call on the enterprises and individuals to donate money to help the orphans get education," Yin said.
New Roles
Besides the traditional role of providing basic public health service to the villagers, Yin and several other doctors from Guangsong and Mandan villages are organized by the government to do some primary care and intervention activities among local residents.
Spreading condoms among HIV/AIDS-affected families, following the changes of HIV carriers' health conditions, and supervising the use of anti-virus medicines are the main tasks of these doctors.
Meanwhile, they organize the AIDS patients to go to the disease control centre of the Longchuan County to do health examinations for timely and proper medical treatment.
"It is a big burden for the patients, who usually become very poor due to drug abuse and loss of working ability, to afford the cost of the trip to the county," said Luo Lu.
Luo, 32, is a doctor from the Mandan Village working for the newly-built pilot site.
Many villagers refused to go to the county to do the HIV/AIDS test because they can't afford the ticket worth about 3 yuan (US$0.36), Luo said.
The local health authority plans to take blood samples of the villagers in the pilot site and send the samples to the county within six hours for examination, said Mei Hongying.
The village doctors collecting the blood samples will be paid about 20 yuan (US$2.4) for each.
They can also get 10 yuan (US$1.2) from the local authority each time they finish the follow-up work on one patient.
"As I do the follow-up visiting on HIV sufferers, I record all their health conditions, give them proper suggestions on health care and care about their living conditions," Luo said.
Luo is in charge of following up on 26 HIV carriers, and every month she will visit them at least once. "It is hard work actually," Luo said. "One patient of mine lives in the mountains. I have to walk for more than 20 kilometres."
Usually, Luo can only do one follow-up visit in one day because of the long distance, or the difficulty of finding the right person.
Many times, she couldn't find them at home and had to wait for them or return another day, Luo said.
But both Luo and Yin said they feel much better now because the local residents are showing more understanding and acceptance thanks to the education efforts in the past months.
"At the beginning of the pilot project, one patient even asked her dog to bite me as I tried to visit her house," Yin said.
"The residents all trust me very much because I am their doctor. But they would become very cold if I talked about HIV/AIDS. So you can imagine if a new doctor did the work, it would be much harder."
Fortunately, the infected villagers have now begun to regard her as their best friend again, Yin said.
(China Daily October 27, 2005)
