Published by: World Tibet Network News Friday - September 12, 1997

Tibet Information Network

London, 11 Sept (TIN) Medical officials in a Lhasa hospital refused to allow a seriously injured French tourist to be evacuated from Tibet until $11,000 had been paid for eight days' stay in the hospital.

A medical evacuation team flown from China was not permitted to take the patient to a waiting Lear jet for two days until well-wishers of the tourist had been found in the US who guaranteed to meet the hospital's fees.

The 56-year old patient, Anne Yschard, had been in a coma for six days with a fractured pelvis when the evacuation team arrived in Lhasa on 20th August.

Comatose patients risk sustaining brain damage or death if they do not have access to specialised medical equipment and diagnosis, which is generally not available in Tibet. Pelvic fractures can also lead to potentially fatal secondary injuries if undiagnosed, say doctors.

Ms. Yschard was held at the Tibet People's Hospital, where Tibetan and Chinese patients are not allowed admission unless they first pay a deposit of 2,000 yuan (US$240) - nearly half the average annual income for city dwellers in the Tibetan capital. Only a few forms of treatment are subsidised by the government in urban hospitals - for example, an abortion at the People's Hospital costs only 10 yuan ($1.2).

Ms Yschard was admitted only after a Tibetan travel agency with which she had travelled earlier volunteered to collect her from the site of the accident and paid a 5,000 yuan ($600) deposit to get her admitted to the People's Hospital.

A new emergency medical centre opened at Lhasa's First People's Hospital this year, supported by an Italian government project which is spending US$280,000 on providing equipment, ambulances and training for the unit.

"After a year of our experts working with local health managers, the local health authorities agreed to put a priority on the life of the patient before the payment," said Gianluca Falcitelli of the Comitato Internazionale per lo Sviluppo dei Popoli, a Rome-based development agency which is carrying out the project for the Italian Foreign Ministry. "Nevertheless, there are still problems that mean the ruling is not completely applied," he told TIN.

"We designed a project that was in principle able to give some benefit to the indigenous Tibetan population and the new Chinese immigrant population," said a source close to the General Directorate for Development Co-operation of the Italian Ministry of Foreign Affairs, the department that oversees the Italian funding.

"But we have to take into account that the general administration is Chinese, and the administration has to make the decision about payment for treatment," he told TIN.

- Accident -

Ms. Yschard, who had been travelling alone for three weeks after a short group tour in Tibet, was found in a coma on 13th August near Nagchu, 250 km north of Lhasa. Her injuries could have been caused by a road accident, but officials have so far given no account of how she came to be injured.

She was discharged from the Tibet People's Hospital on 22nd August as soon as the money was paid by well-wishers and flown to a Hong Kong hospital, still in a coma, for treatment. Ms Yschard, who had insurance cover for evacuation but not for hospital costs, is now being treated in a Paris hospital, and is still unconscious, despite some signs of sensory awareness.

"Yschard suffered serious concussional injury to the brain with very little improvement over the past few days," said Dr Yiu Ting Kan, a neurological surgeon at St Theresa's Hospital in Hong Kong who monitored her progress after she arrived there on 22nd August. "It is impossible to prognosticate her final neurological recovery at this stage, but it is envisaged that her course of recovery and rehabilitation will be protracted," he said.

The evacuation was carried out after intervention by the French Embassy by Asia Emergency Assistance (AEA), a joint venture company which is reportedly part-owned by China's PLA. "We were getting very anxious," said Dr Robert Condon of AEA, who collected Ms. Yschard from Lhasa and provided medical treatment during the flight to Hong Kong via Chengdu. "We carry out many different evacuations of foreign nationals all over the world, but this was one of the most difficult logistically," he said.

The People's Hospital in Lhasa was unable to provide a ventilator for the patient - such equipment is usually only available in Lhasa at the Military Hospital - and oxygen was delivered through nasal tubes.

"A supply of oxygen through nasal tubes is not adequate for someone in this condition," commented Peter Kirkpatrick, consultant neurosurgeon at Addenbrooke's Hospital, Cambridge. "A patient with severe head injuries like this should be transferred immediately to a neurosurgical unit," said Mr. Kirkpatrick. "A delay in treatment could be very damaging," he said.

The Lhasa hospital has X-ray equipment but apparently did not carry out any X-rays, according to the Hong Kong medical staff who received the patient.

The Lhasa doctors did not provide any medical records with the patient and her belongings have also disappeared.

The hospital's demand of $10,000 for the eight day stay was sent to the Beijing office of Ms Yschard's insurance company, Worldwide Assistance. "Advise as soon as possible if the medical expenses in Lhasa hospital can be guaranteed otherwise patient cannot be discharged tomorrow," the insurers wrote to former colleagues of Ms Yschard who had enquired about the delay in her evacuation. "The hospital expenses incurred in Tibet People's Hospital are over RMB 80,000 [yuan] ($10,000) now," the insurers reported on 21st August.

By the next day the International Campaign for Tibet, a Washington-based organisation for which Ms. Yschard had occasionally worked as a volunteer, had guaranteed to pay the hospital fees, which had by that time risen to $11,000, in order to allow immediate evacuation.

The organisation and friends also had to pay a further $3,500 to cover additional costs incurred in transporting the patient to the hospital in Lhasa and for medicines administered to her while she was there, as well as $5,000 for her admission to a hospital in Hong Kong.

A typical charge for foreigners in a top quality hospital in China is about 1000 yuan ($120) a day, according to one Westerner who stayed in a Chengdu hospital last month, although intensive care treatment would be more expensive.

The International Campaign for Tibet has set up a fund to pay for the costs of Ms. Ms Yschard's treatment in Lhasa and Hong Kong, and for on-going needs. French and US Government officials had gone out of their way to help in the evacuation, and the medical evacuation company had waived some of its fees to fly her back to France, said John Ackerly, a spokesman for the organisation.

Ms. Yschard, a French citizen who lived in Virginia in the US, where she worked as French-English translator, has no close surviving relatives and may need long-term care, he said.

- Tourist Risks -

Tourists travelling in Tibet face particular risks from altitude sickness and accidents because there is no established system for evacuating tourists who are in a critical condition.

Western tour experts operating in Tibet estimate one death per year from acute altitude sickness, some of which are unavoidable if the patient is in a remote area when they became ill. Others occurred because local doctors or tour officials were unwilling to organise evacuations.

"Their medical training is not crisis-oriented," said one Westerner with experience of several evacuations from Tibet. "They don't seem to have a mechanism for dealing with seriously injured people, unless there is a determined companion or local friend who will insist on them being flown out," said the Westerner, who asked not to be named. Costs charged to tourists by the main hospitals in Lhasa are extremely high, often around $1,000 a day, he added.

A British tourist died from altitude sickness in the Tibet People's Hospital in August 1991, three weeks after admission, after repeated requests by a western doctor to evacuate him to Chengdu were overruled by senior medical staff at the hospital who said that the patient had no signs of cerebral oedema and would recover.

"His lips, nose and nail beds were blue and he was gasping for air," said an American tourist who visited the 78 year old man, himself a doctor, at one point during his time in the People's Hospital. "We checked his oxygen tank, and found it was empty... There was no sense of emergency on the part of either of the nurses," she said of the patient, who died from cerebral oedema five days later.

Acute altitude sickness can only be cured by moving the patient to a lower altitude, and the symptoms are detectable in advance in most cases.

The following year a Swiss woman with the same life-threatening condition was evacuated from Lhasa only after the Swiss Embassy in Beijing, tipped off by a Westerner of her condition, sent a team to collect the patient, overruling local medical opinion. A German tourist died in similar circumstances last November after her tour group left her unattended when she developed symptoms of altitude sickness.

12,000 foreigners visited Tibet last year, plus 20,000 domestic tourists, according to some official reports, a figure which the local government hopes to double this year. Road travel in China is relatively dangerous, with 29% of road traffic injuries resulting in death within 30 days - a proportion that is 59% greater than in India, and 23 times greater than in the United States, according to Chinese statistics issued in 1995.