Some in China poorly informed about SARS outbreak

April 16, 2003|By Michael A. Lev, Tribune foreign correspondent.

DATONG, China — If suspected victims of the dangerous disease known as SARS appear at Datong's No. 3 hospital in Shanxi province, doctors and nurses are ready with a newly designated isolation ward.

The only apparent glitch: There is nobody at the information booth in the main lobby to steer coughing, feverish patients to the ward's separate entrance, creating an opportunity for the highly contagious infection to spread to others.

As China's government finally takes action after an uncooperative start in battling severe acute respiratory syndrome, it must deal with a highly imperfect health-care system, a secretive, poorly skilled bureaucracy and an inadequately informed public.

In Shanxi, 87 cases and seven deaths have been acknowledged, but the provincial government refuses to disclose where the disease has struck. So no one in Datong can say for certain whether SARS has crept into their poor coal-mining town.

Local residents giggle at visitors from Beijing who wear surgical masks. Most assume the epidemic is centered in Taiyuan, the provincial capital.

Wu Cheng Jian, a taxi driver waiting fearlessly outside the No. 3 hospital on Tuesday, figured Datong was safe because he had not noticed government officials wearing masks.

"And their lives are more valuable than ours," he said.

The overall sense in Datong is that residents have heard about this dangerous disease but are not overly concerned. This is partly out of confidence in their government, though ignorance and fatalism also play a role.

WHO concerned

The international medical community is far more troubled. The World Health Organization warned last week that the "poorer provinces may not have adequate resources, facilities and equipment to cope with outbreaks of SARS."

China is only partway along in its transition from socialism to a private enterprise-based economy, leaving many who once relied on their work units for care without health insurance. Today, people pay for their health care, while hospitals must earn a profit to stay afloat.

The result is that some people are cut off from information about SARS and are uncertain whether they could afford treatment. Government public awareness campaigns might fill the gap, but China's bureaucracy moves slowly.

There is evidence to suggest that China has some advantages: plenty of well-trained doctors and an authoritarian government that can whip into action if given the word.

"If they manage it right, SARS will make the Chinese health-care system appear better than it actually is," said Ray Yip, a health officer with UNICEF.

SARS appears to have developed in southern China last November and spread through Hong Kong to 20 other countries, infecting more than 3,200 and killing 154 so far, according to the World Health Organization. A record nine SARS deaths in one day were reported Tuesday in hard-hit Hong Kong, including one case where doctors performed a Caesarian section to deliver the premature baby of a pregnant woman two weeks before she died.

In China, the government initially suppressed information, making it hard for the public to assess the risks.

But progress is being made. On Tuesday international health officials were granted permission to visit military hospitals in Beijing to check for unreported cases, the WHO said.

Around Datong, there were mixed reactions to SARS.

At a bare-bones private clinic in a dilapidated high-rise housing complex, the medical student on duty, Wei Qin, knew to carry a mask and disinfect the office. But there were no contingencies for treating suspected SARS cases and no contact or instruction from health officials.

So when a new patient appeared unexpectedly Tuesday, Wei was not wearing a mask. Luckily, the patient had a skin condition, not a cough.

Standing on a corner, several acquaintances seemed unsure whether the government would help cover SARS treatment. Cao Yuan, a retired coal miner living on a $110 monthly pension, expected government help.

"Why should the government pay to treat you?" responded Feng Yong Jun, a tailor who gets by on $70 a month.

Li Zhong Hua said: "If I got really sick, I'd just end up dead."

"Couldn't you borrow the money?" Cao asked.

"Who's going to lend me money?" Li retorted. "Will you? Are you a rich person?"

`How do you get infected?'

Most people said they got their information from television and newspapers, which have not been aggressive about covering the story. Tuesday's Datong newspapers didn't give reminders of symptoms and precautions.

A store clerk named Chen laughed at the sight of surgical masks on two customers, but then she realized she didn't know much about SARS. Then she got nervous.

"How do you get infected?" she asked. "If you get sick, how many days before you die?"

The situation was much better at the No. 3 hospital, which opened its emergency SARS treatment center three days ago.

There have been no patients, but doctors say they have prepared an isolation chamber and have ventilators if needed.