MATERNAL MORTALITY IN TIBET: 1 of 4

Why is it “inefficient” to save the lives of mothers?

This is the first in a series of four blogposts on why so many women in Tibet die in childbirth, usually alone, bleeding to death.

As with almost anything to do with Tibet, even the basic facts are contested. As we rapidly approach the fulfilment date for the Millennium Development Goals, including the universally agreed responsibility to reduce maternal mortality by three-quarters, by 2015,            China claims credit for being the exemplary developing country, with a far better record than any in the developing world.

So this first blog seeks to establish some basic ground truths: is it true that the maternal mortality rate (MMR) in Tibet is one of the worst in the world? Is that inevitable, due to the scatter of nomads across a vast landscape, or is this due to state failure? Is it asking too much of China to extend effective health services to remote nomadic pasturelands; or is that by definition inefficient, even impossible? Or is the MMR in Tibet a failure of Tibetan civilisation, of entrenched sexism and complicated pollution taboos that condemn women to give birth alone, in unsanitary conditions?

In the second blog, we look more deeply into Tibetan culture to see what it can offer. In the last two blogs, we look at fresh approaches, and fresh solutions.

This Rukor blog first looked at maternal mortality back in 2011, and a lot has changed since. That’s why the fourth and last blog in this series, despite the appalling statistics, ends on an optimistic note, that things are starting to change, on the ground, in quite remote areas of Tibet. New lessons are being learned, new, decentralised ways of helping pregnant women are being trialled, and taken up by the official public health bureaus.

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 To die while bringing fresh life into the world, giving a new human rebirth a chance to live, is shocking. The maternal mortality rate in Tibet is approximately 400, perhaps even 500, per 100,000 children born live, every year. Yet the rate in China is 45 per 100,000. Why is so little done to help Tibetan women, when most of these deaths are unnecessary, and can be prevented inexpensively?

Why do so many Tibetan women bleed to death? Mobile populations need accessible, mobile health care, which traditional Tibetan healers, or amchis, continue to provide. But sometimes, in an emergency, preventive and restorative medicine is not enough. Maternal mortality in Tibet is among the highest worldwide, and has not been reduced by China’s  urban-centric, user-pays health care delivery system; which fails to meet the needs of a widely dispersed Tibetan pastoral population making skilful use of one quarter of China’s land area. Extensive dryland users’ worldwide need highly decentralised health services, especially for timely access to emergency care when pregnancy complications occur.

In an emergency, not only are existing clinics too far to reach, accessible on roads impassably muddy in summer, but the clinics are also ill-equipped, understaffed, and rely on presales of the most expensive intravenous medicines to make a profit. Upfront payment is necessary before a patient is allowed in the door remains the norm, despite recent reforms. China’s  Rural Cooperative Medical Scheme (RCMS) has reduced outpatient costs for the poor, but remains less effective than planned. Because of the expense, and the need for the right “connections”, women expecting a normal pregnancy are nowhere near a clinic until it is too late. Recorded journey times to reach a maternity clinic in Tibet may be several days.

Over recent decades China’s health system has shunned taking responsibility, having downshifted health care to local levels, making users pay, and leaving poor counties with poor health services. Although recent reforms have ameliorated the situation in some parts of the region, they have not been effective in the poorest and remote areas, including rural Tibet. The RCMS covers the costs of basic medicines, but doctors still have incentives to over-prescribe expensive medicines from which they can profit.

Small-scale pilot projects have shown it is possible to educate community health workers (CHWs) as skilled birth attendants, even in very remote areas of the Tibetan Plateau, who are capable of identifying complications within sufficient time to evacuate to a biomedical clinic when necessary. However China has been reluctant do this sort of community work, instead relying on women to come to hospitals, and blaming them when they do not.

This chapter argues for alternatives to the maternal mortality situation in Tibet, one based on strengthening deeply embedded capacities within Tibetan culture and its sciences of healing; another on upscaling the successful pilot projects training CHW interventions.

Contemporary Tibet is a classic test of the capacity of the modern state to extend its reach into remote areas and deliver the services inherent to modernity, including timely interventions to prevent maternal mortality.

The maternal mortality Millennium Development Goal  (MDG) of the United Nations, set in the year 2000 and culminating in 2015 as the target date for completion, is a specific, deliverable goal well within the capacity of a middle income country such as China, with its strong tradition of social engineering, resource allocation, state intervention and many aspects of dirigiste planning still intact.

What do we know about the maternal mortality ratio (MMR) in Tibet? Few official statistics are available that span the five provinces that constitute the Tibetan Plateau. China claims overall success in meeting the MDG target 5A of a three-quarters reduction  in the Tibetan MMR between 1990 and 2015. And yet:  “The maternal mortality ratio (MMR) for rural Tibet was reported to be as high as 400–500/100,000 in some areas, and infant mortality within the first 12 months was reported to be as high as 20%–30% in some areas.”[1]

In China, the maternal death rate has decreased to 45 per 100,000 births. Senior Chinese health administrators have stated:  “Progress in reducing maternal mortality in China has been impressive; the MMR decreased from 95 deaths per 100,000 live births in 1990 to 45 deaths in 2005, a remarkable success given the size and diversity of the country.”[2]  China takes pride in this achievement that began not just in year 2000, when China pledged to fulfil the MDGs, but goes back to the 1980 Safe Motherhood global conference in Nairobi. But has 35 years of effort made much difference in Tibet?

Using auto-regressive statistical methods, Chinese scientists predict that by the year 2020, China’s MMR will drop to 22 per 100,000 live births,[3] a figure that is comparable to the rate in the USA. While China is confident it will soon be the equal of the US, the maternal death rate in Tibet remains statistically similar to such resource-poor nations as Cambodia, Benin, Gambia, Ivory Coast, Kenya, Madagascar, Senegal, Uganda or Zambia.

In Tibet, the women often die alone. Government hospitals are too far away, and too expensive. International aid agencies have been required to cease working in Tibet. Few now look into Tibet from the outside. Very few reproductive health agencies, multilateral development banks, or health NGOs from around the world are any longer on the ground in Tibet.

In 2015 China has been hailed as a great MDG success story, and as an example to the rest of the developing world, in achieving almost all goals. Yet if the Tibetan Plateau – representing one quarter of China’s area – is disaggregated from national statistics, the available evidence suggests the maternal mortality rate (MMR) remains alarmingly high, at levels found only in the poorest of countries. China now ranks in the middle of countries worldwide assessed by the annual State of the World’s Mothers.[4]   Officially, “In Tibet, the death rate of women in childbirth dropped to 174.78 per 100,000, or nearly six times of the national level in 2010.”[5]

Yet an in depth survey of women in a remote area of eastern Tibet reports the deaths of three women over a 19 month period, in which there were 103 live births, suggesting a far higher MMR. The investigators, a large team from Johns Hopkins University in the United States, and many Tibetans, conclude that: “The majority of women in Surmang were very worried about dying in childbirth, and the report of 3 recent maternal deaths in this small population suggests exceedingly high maternal mortality in this region. Facility delivery rates <1% in Surmang in the 5 years between 1999 and 2004 can be compared with facility delivery rates of 92% for China overall.” [6]

Although this report is from a small study population, and is too anecdotal, to make generalizations (as the authors point out), there are almost no other comparable studies. International health NGOs active in Tibetan areas, mindful that embarrassing statistics represent “loss of face”  for local officials who have power to deny ongoing access to Tibet, are understandingly reluctant to publish their data.

The few other village level studies in Tibet report similarly: “Maternal and child health findings were alarming with high rates of miscarriage and infant loss, with no traditional midwives to assist in pregnancy and delivery. A quarter of all infants born after 7 months of pregnancy in the previous 5 years died. On the other hand, during the same period, none of the pregnant women died, in either township, at any time in pregnancy or within 6 weeks after delivery. In 18 percent of the pregnancies women were reported to have suffered severe swelling of ankles and legs, 12 percent had postpartum haemorrhage (PPH) immediately after birth and 12 percent within a few days of birth, and 37 percent had a fever within a few days of birth. In the focus groups, however, some women described knowledge of maternal death from childbirth—some in first degree relatives.” [7]

In summary, Tibet has one of the highest maternal mortality rates in the world. The alarming statistics of maternal death in Tibet are concealed by the routine aggregation of Tibetan data into large corpus of Chinese national statistics. Comparable rates are found in post-conflict countries recovering from war, but in those nations the data are available for all who care to see. If an extraordinary proportion of Tibetan women haemorrhage and die during or shortly after giving birth, we need to ask why. Several plausible explanations come readily.

Tibet has been isolated more than ever in recent years from global scrutiny.  We can not only ask, but partially answer, the key question of how this shocking death rate of mothers and their infants has occurred.  Although fieldwork surveys and experimental interventions to reduce MMR in Tibet are rare, there is enough known to define the aetiology of this ongoing crisis.

The purpose of seeking the origins of the crisis is not to apportion blame or responsibility.  What needs clarifying is whether the problem is a state failure, a failure of traditional Tibetan culture, or both. Those are the options canvassed in the existing debate, and the answers which investigators reach deeply influence the design of projects intended to improve the situation. Thus, it matters greatly which of the dominant discourses: of state failure or Tibetan culture failure, is to be believed.

This chapter explores both master narratives, finding them both plausible, internally consistent and logical; yet both are seriously flawed. The conclusion is that we need a fresh approach.  Two new approaches are discussed.

THE DISCOURSE OF EFFICIENT MODERNITY

China promotes what could be called the efficiency argument. The six million Tibetans occupy a plateau the size of Western Europe, scattered extensively across a vast area; and not even the wealthiest state can possibly extend health services to small and remote communities. The logic of efficient resource allocation for service delivery requires centralising clinical services in county seats, of which there are 150 in the Tibetan Plateau, in five Chinese provinces. It is thus unreasonable to expect China to extend the reach of the state beyond the county capital, and pastoral nomads should realise that effective clinical treatment for complications of pregnancy is just one of a package of benefits available by abandoning mobile pastoralism for peri-urban settlement. Only when nomads cease wandering will the MMR decline, along with access to general health care, schooling and electricity. The efficiency argument is a familiar one, and worldwide.

Over recent decades China’s health system has shunned taking responsibility, having downshifted health care to local levels, making users pay, and leaving poor Tibetan counties with poor health services. China continues to be largely a user-pays system that favours the rich, privileged and urban, leaving the rural and poor to fend for themselves, with upfront fees payable in advance before anyone can even come through the door of a hospital. China’s maternal mortality surveillance system reports that “Income-related inequalities in institutional births increased in rural areas between 1993 and 2003,”[8] which means that when rural women do get to a hospital, the gap between the poor and the rich who can afford upfront fees for treatment is widening.

Slowly, rural health insurance schemes are extending into remote areas, but Tibet remains too remote, after decades of neglect, and health post staff having to earn most of their incomes by selling expensive medicines. The Rural Cooperative Medical Scheme (RCMS) has gradually increased its scope, yet RCMS: “had little impact on reducing its participants’ out-of-pocket payments for outpatient services.”[9]

China, it seems, has science and statistics on its side. Giving birth in Tibet is inherently risky, Chinese scientists say, because of the high altitude, and made riskier by primitive beliefs in spirits that are offended by the messiness of birth. The state can do only so much in the face of such superstitious attitudes.

 

THE DISCOURSE OF CULTURAL FAILURE

A different argument shifts the focus to Tibetan tradition. This argument, sometimes advanced by NGOs active in Tibet, notes the absence in Tibetan culture of skilled traditional birth attendants (TBAs or SBAs), women in the community known for their capacity to support pregnant women and identify complications early enough to ensure emergency medical help is accessible when needed. This TBA argument is, like the efficiency argument, plausible and based on worldwide experience in more densely settled areas of the developing world, where community health workers (CHWs) with TBA experience are common. This argument sometimes goes a step further, suggesting the Tibetan traditional healing system of sowa rigpa, being a branch of Buddhism, is largely delivered by male practitioners who have neither the knowledge nor understanding of the urgent circumstances in which a pregnant woman can bleed to death. Traditional pollution taboos force women to give birth alone, in unsanitary places.

Taken together, the efficiency and TBA arguments are complementary, and seem to encompass a full, if depressing, explanation of why MMR in Tibet remains alarmingly high. The conclusion is grim – the modern state has failed, and so has Tibetan tradition. Only eventual urbanisation offers a long term prospect of reducing MMR. At best, China may outgrow its urban-centred clinic model and employ community health workers.

 

STARTING OVER

Plausible as these two arguments are, they require critical evaluation to discover their many assumptions, which may not be applicable to the actuality of being a Tibetan woman about to give birth. Starting over, we might seek a different approach, utilising the strengths of sowa rigpa traditional healing, and the global TBA movement, and the capacity of modern states to extend their reach (using new technologies) into even the remotest communities. Instead of seeking whom to blame, this alternative approach seeks solutions that build on existing capacities.

Unless and until all Tibetans acquiesce to China’s plans for urbanization as the solution to all problems of development, MMR included, viable alternatives are needed. The CHW/TBA midwifery approach has worked all over the world, and  in Tibet, where low population densities mean little scope for vocational specialisations of any sort, small scale NGO projects have experimented with training skilled birth attendants. This seems a very promising strategy, in that it provides early warning of pregnancy complications, allowing women in danger time to get to a centralised clinic or hospital in a county capital. In Tibet, widespread rural poverty and bad, potentially unpassable, roads, especially in the wet summer months, can mean a trip of days, or even a week, to get to a hospital. Thus, early detection of pregnancy complications is essential to bridge the gap between decentralised populations and centralised biomedicine.

However, small scale experimental training and support programs for birth attendants seem hard to replicate, and to subsequently expand to cover the entire Tibetan Plateau, unless integrated into the existing, decentralised, trusted rural health service provided by the Buddhist sowa rigpa healers, or amchis.  Some programs import a western feminist model that lacks a basis in Tibetan tradition, as well as lacking support from official health delivery ministries, though that is beginning to change. Implementation of such a programme depends on international NGOs whose presence in Tibetan areas within China is precarious in a state preoccupied with threats to stability, and wary of foreign agencies. They may yet succeed in persuading local governments to embrace the CHW approach.

Proponents of the CHW/SBA movement are quick to relegate Tibetan culture to irrelevance, on the basis that there is no such customary profession in which independent, self-actualising, empowered women earn their living as specialist professionals exclusively providing birthing services. Tibetan culture and Tibetan Buddhism are said to be silent, or even inimical, to this global movement which is now blossoming in Tibet into a wider feminist challenge to traditional patriarchy. The CHW/SBA movement and clinic-based biomedicine are alike in their impatience with Tibetan tradition. The complex choices faced by Tibetan women – where and how to seek help – are seldom noticed. One exception is anthropologist Kim Gutschow, whose fieldwork in the Indian part of upper Tibet, Zanskar, offers a fine-grained depiction from the perspective of the new mother.

Because hospitals choose institutionally to be wilfully ignorant of traditional rituals to protect mother, baby and the community from the dangers of childbirth, the hospital has no idea of what is occurring in the mind of the mother of a newborn. How can I get back home with my baby without crossing streams where the water spirits will be offended if I cross before I can ritually purify? How can I tread the mountain paths home without going too close to a shrine, polluting it and angering the protector deities? “When a new mother returns home from the hospital, she puts herself and her child in danger, as her unpurified presence angers household, village, regional, and monastic protectors whose shrines she passes on the way home, “ Gutschow says.[10]

Because the hospital chooses to ignore such complexities, many Zanskari women feel uncomfortable giving birth in the presence of strangers, Gutschow reports. Because hospital staff are seen as arrogant and aloof, women delay going to hospital unless and until medical intervention is a necessity, for which they are scolded by staff. To the staff, this is further proof of the superstitious, primitive mentality of pregnant women; to the pregnant women it is further evidence that the hospital refuses to be part of the community. What is true of Zanskar and Ladakh is more so in Tibet, where there is a stronger assumption that Tibetan women are, as is often said,  cai (stupid bumpkins), mian gua (idiots), and ruo zhi (dull witted).

Hospitals are temples of scientific modernity and reductive simplification, Gutschow argues, which choose to ignore the traditional Tibetan complexities of drib (ritual pollution) caused by birth, and the behavioural taboos that go with the woman taking care to minimize any offence that might be taken by local spirits of earth and water. Hospitals insist on radical dualism; confident that they alone have the technologies to reduce maternal and infant deaths.

Tibetan women, in such circumstances, face difficult choices. A woman who mixes customary and modern healthy behaviours soon finds that: “Her body became the ground upon which modern subject-citizen making took place.”[11]

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A version of this blog series will be published in 2015 by Nova Science Publishers, in a global textbook called ‘‘Maternal Mortality: Risk Factors, Anthropolo​gical Perspectiv​es, Prevalence in Developing Countries and Preventive Strategies for Pregnancy-​Related Death”, edited by David Schwartz.

 

 

 

[1] Vincanne Adams, Suellen Miller, Jennifer Chertow, Sienna Craig, Arlene Samen and Michael Varner, Having a “safe delivery”: Conflicting views from Tibet; Health Care for Women International, 2005, 29 [9], 821-851

[2] Feng X, Zhu J, Zhang L, Song L, Hipgrave D, Guo S, Ronsmans C, Guo Y, Yang Q.; Socio-economic disparities in maternal mortality in China between 1996 and 2006; British Journal of Obstetrics and Gynaecology, 2010, 117, 1527-1536

Juan Liang., Xiaohong Li., Li Dai, Weiyue Zeng, Qi Li1, Mingrong Li, Rong Zhou, Chunhua He, Yanping Wang, Jun Zhu; The Changes in maternal mortality in 1000 counties in mid-western China by a government-initiated intervention, PloSOne, May 2012 | Volume 7 | Issue 5

Beibei Yuan, Xu Qian and Sarah Thomsen; Disadvantaged populations in maternal health in China: who and why? Global Health Action 2013, 6: 19542

Qing Du, Oyvind Nass, Per Bergsjo, Bernadette Nirmal; Kumar determinants for high maternal mortality in multiethnic populations in western China; Health Care for Women International, 2009, 30:957–970,

[3] Ren Zhenghong, Forecast of the indicators on maternal and child health of China in 2020; Health Sciences Journal of Peking University, 2010, 42 [2], 221-224

[4] State of the World’s Mothers 2014: Saving Mothers and Children in Humanitarian Crises; Save the Children 2014

[5] Life expectancy in Tibet nearly doubled over last six decades: white paper; Xinhua, 11 July 2011, http://news.xinhuanet.com/english2010/china/2011-07/11/c_13978305.htm accessed 7 December 2014

[6] Mary Wellhoner, Anne CC Lee, Karen Deutsch, Mariette Wiebenga, Maria Freytsis, Sonam Drogha,

et al., Maternal and child health in Yushu, Qinghai Province, China; International Journal for Equity in Health 2011, 10:42 http://www.equityhealthj.com/content/10/1/42

[7] Peter M. Foggin, Marion E. Torrance, Drashi Dorje, Wenzha Xuri, J. Marc Foggin, Jane Torrance; Assessment of the health status and risk factors of Kham Tibetan pastoralists in the alpine grasslands of the Tibetan plateau, Social Science & Medicine; 2006,  63, 2512–2532

[8] Feng at al., Socio-economic Disparities op cit.

[9] Wei Yang and Xun Wu; Paying for Outpatient care I Rural China; Cost escalation under China’s New Co-operative Medical Scheme, Health Policy and Planning, 28 Jan 2014

[10] Kim Gutschow, From Home to hospital: the extension of obstetrics in Ladakh; ch 8 in Vincanne Adams, Mona Schrempf and Sienna Craig eds., Medicine between science and religion, London, Berghahn, 2010

[11] Jennifer Chertow, Gender, Power, Space: transnational bodies and the cultures of health in contemporary Tibet, PhD dissertation, Stanford University, 2007, 94

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MATERNAL MORTALITY IN TIBET: 2 of 4

Traditional Tibetan sciences of healing, and Community Health Workers

Second in a series of four blogs on why so many Tibetan women die in childbirth, and what fresh solutions may be possible.

The first in this series canvassed the conventional explanations, which both reach the pessimistic conclusion that as long as Tibetan nomads occupy remote rangelands,  it will never be economically efficient to extend effective prenatal health checks, that can pick up early signs of pregnancy complications, and help a women to get to a clinic or hospital, if necessary, in time.

The first blog also canvassed the view,  commonly found among NGOs and international development agencies, that the absence of professional birth attendants, or community health workers (CHWs) trained in providing health checks in remote areas, Tibetan culture has nothing to offer, and Tibetan women will continue to die.

But, if we take a deeper look at Tibetan culture, what are its relevant strengths?

 

A THIRD ALTERNATIVE:  CONTINUITY OF CULTURAL TRANSMISSION

In the projects, statistics and published literature regarding maternal mortality in Tibet there is little advocacy for approaches grounded in Tibetan culture, that is, until very recently. It is time to reintroduce core Tibetan values, and to examine them to see if they are suited to an active effort to reduce MMR.

Demographers and anthropologists argue that the fertility transition evident worldwide is now also occurring in Tibet, as women are choosing to have fewer children.[1]  Tibetans, however, are acutely aware of being utterly outnumbered by Han Chinese, and are strongly pronatalist.  China has a policy of allowing two or more children in ethnic minority families. The strong expectation that Tibetan women should have more than two children is due, in part, to the ongoing high MMR, and in part to nationalism. However, it is also because, from a Buddhist viewpoint, to give a sentient being, in the limbo between exiting one life and entering the next, a chance of human birth, is an act of great compassion. Tibetan women feel strongly that one of the most deeply compassionate things they can do in life is to create another precious human rebirth.

This is a reminder of how pervasive Buddhism is in shaping the Tibetan culture, including the Tibetan sciences of healing. The healing sciences, sowa rigpa in Tibetan, are embedded in the monastic curriculum of comprehensive training in wisdom and active compassion, in understanding the nature of reality, and how to liberate others from their sufferings. Sowa rigpa has medicines specifically for women giving birth, although this is seldom acknowledged in the MMR literature. Among them is a “precious pill”, or rilbu in Tibetan, specifically for postpartum haemorrhage, called zhijé 11, which contracts the uterus and controls bleeding. It has been known and used for centuries, and has long been widely available throughout rural Tibet as an inexpensive treatment. Zhijé 11   can be bought well in advance, in areas where doctors and clinics are far distant, for a women giving birth to self-administer.

Zhijé 11 is now well-documented, with an English language biography of it as a medicine, a medical anthropology account of its contemporary use, and a clinical investigation of its efficacy.[2] Its ingredients are well-known, and their action well-documented. The most recent review article concludes that: “Our analysis supports ZB11’s [zhijé 11] safety and effectiveness as a uterotonic with the potential to decrease the risk of PPH, particularly in low-resource settings, where current allopathic uterotonics face significant barriers to use. ZB11 has several qualities that make it an attractive uterotonic for prevention and/or treatment of PPH at the home or community level in Tibet. With over 700 years of history, it is widely culturally accepted by birthing women, Tibetan healers, and family members in Tibet. At the same time, it is highly affordable (USD 0.04 per dose) widely available, does not require electricity or technology for effective storage, and requires minimal training for administration. Its safety profile is similar to misoprostol, the current standard of care. In places where access to a steady supply of “Western” medication may be limited, this offers an important, less costly alternative.” [3]

Although many English language sources state that there is no Tibetan tradition of skilled birth attendants, and that giving birth is considered polluting, classic sowa rigpa instructional paintings do show women giving birth attended by several helpers.[4]

In Tibetan Buddhism, at an early stage of the path, the practitioner learns what constitutes active compassion, on three levels. The first but least effective kindness  to pacify the suffering of others is to offer them material assistance that alleviates the situation temporarily. This is to be done without thought of reward. The second kind of generosity is to offer refuge, or shelter, to those in danger to their lives; again to be done without expectation of reciprocity. The third, and most effective way of cultivating and enacting generosity is to enable others to access the nature of mind, which is the only lasting and reliable source of alleviating suffering.

Medicines to alleviate postpartum haemorrhage are part of this holistic approach, in which temporary interventions are needed, but in the longer term, what is most beneficial is to understand the cause of suffering and the path that ends suffering, through awakening to the nature of mind. Zhijé connotes pacification of suffering, a term used both for specific medicines, and for one of the many Buddhist lineages. Sowa rigpa has a comprehensive discourse of the entire cycle of birth, ageing and death,[5] with a detailed embryology, as seen from the perspective of the foetus.[6] Rather than atomistically isolating childbirth as the basis of a stand-alone mode of medical intervention, sowa rigpa understands birth as part of a cycle that repeats over generations. This healing system is usually termed (outside of Tibet) Traditional Tibetan Medicine (TTM), as if its herb and mineral pills are its sole mode of treatment.

However, sowa rigpa’s strength is in its diagnostics, which frequently detect incipient problems well ahead of the appearance of overt symptoms detectable instrumentally. Diagnosis is usually followed by behavioural advice, and suggestions about adopting a constructive mental attitude, as one might expect of an integrated mind-body therapeutic grounded in Buddhism. Only after proposing dietary, behavioural and mental changes does the amchi prescribe medicines. Early diagnosis of pregnancy complications is the key to MMR reduction, and early diagnosis of somatic imbalances are the great strength of the skilled amchi.

Whence this strength? The authors of a recent anthropological book call it a science of healing, a phrase chosen not only as a meaningful translation, but because “sowa rigpa is epistemologically subtle, crossing as it does the boundary between science and creative practice, between knowledge and experience. A sowa rigpa sensibility is efficacious both in its coherence and its permeability.” [7] This openness to the empirical, coherence and permeability enable sowa rigpa to be effective, and to adapt to new circumstances, even to its present constriction under modern state control as a technology stripped of its religious psychophysiology.

While sowa rigpa has its diagnostic categories, its mapping of the human body/mind and theories of aetiology and course of diseases, it also counsels a receptive mental quietude in the physician as an essential preliminary to effective diagnosis. The root text of the whole sowa rigpa system, in the section on skilful diagnosis, advises: “Taking one’s time refers to sitting near the patient for a while, during which time one should carefully listen to each word of the patient without being distracted by one’s own mind and speech.”[8]

Developing the capacity to put aside ego and its ideations is a skill specifically taught, as an aspect of the mind training that is part of learning to be an amchi. Each morning, before clinical practice begins, it is customary for all clinical staff to jointly recite a text such as the 21 Praises of Tara, to renew a selfless, altruistic state of mind.

The classic texts on pulse diagnosis methods are highly visual, in a densely packed series of 79 thangka paintings, each of which may contain dozens of instructions, scenarios and prescriptions.  Much of the key thangkas depicting the precise methods of pulse diagnosis are reproduced in a 50 page section of a recent catalogue (and translation) of sowa rigpa paintings.[9]

The pulse diagnosis for which sowa rigpa is known is an intersubjective encounter of doctor and patient in which the doctor has been trained in putting the self aside, an encounter of equal sentient beings, not a transaction driven by desire to profit from unequal power.

Diagnosis is best done early in the morning, when the pulse is not perturbed by the day’s activities, mental or physical. The Tibetan texts use a rich terminology for the many different pulses to be identified, starting with the baseline pulse, which itself varies with the seasons. A normal summer time pulse, for example, should be full and robust, like the call of the cuckoo. The autumn harvest season pulse is short and rough like a redheaded Tibetan bird; the winter pulse is retarded, soft and gentle, like the singing of the gull. The spring pulse should be tense, like the song of the skylark. When it comes to further pulses, overlaying these baselines, indicative of disease, the Tibetan training manuals use a wide vocabulary, such as floating, sunken, full, fine, large, small, slippery, puckering, solid, void, retarded, rapid, mild, tense, weak, rough, hard, soft, flat, slow, intermittent.[10]

The result is that not one but several pulses are detected, leading to a specific diagnosis and treatment. Amchis are remarkably consistent in their diagnoses, especially of chronic conditions that enable comparisons across time and between practitioners. They have a capacity to diagnose signs of imbalance well before overt signals detectable by instruments are manifest.

As a branch of Buddhist practice, sowa rigpa trains its practitioners to eschew personal competitive advantage in the healing encounter. This  is inbuilt in the mind training slogans widely memorised in Tibet among lay and monastic Buddhist practitioners: Don’t put an exchange value on things. As one exegete explains: “This slogan is about the need for sincerity and honesty in our spiritual pursuits. We should never use spiritual activities to further our own dubious and self-centred motivations. We are trying to manipulate a situation to our own advantage so that we don’t have to relinquish our egoistic domain, like adopting a trader’s mentality to spirituality.”[11] This extends the Marxist argument for a use economy as preferable to an exchange economy, into the personal sphere, as a standard for interpersonal behaviour as well as economic behaviour.

The cultural maintenance of active compassion as the driver of healing practitioner behaviour is embedded in the emphasis on continuity of transmission in sowa rigpa tradition, not only of technical knowledge but of cultivating the proper mental outlook. Even though this means the training of an amchi is much more demanding than that of a biomedicine practitioner, making sowa rigpa uncompetitive in a newly competitive world, the teachers of sowa rigpa are trying to maintain that continuity of inner motivation training.[12] A conference at Oxford in 2014 on sowa rigpa transmission was led by amchi  Mingji Cuomu of the Tibetan Medical College in Lhasa, who argued that “based on the fieldwork funded by the Wellcome Trust between 2011-13 in three provinces of China (Tibet Autonomous Region, Qinghai and Gansu), Dr Cuomu found that receiving a ‘sacred transmission’ involves incorporation into a living lineage (rgyud) and becoming part of its trajectory of medical transmission. This learning comprises acquisition of knowledge, ethics, practical skills and a sense of care and commitment not only to the patients but also to the lineage and its future.”[13]

This renewed emphasis on medical knowledge as sacred and profoundly liberating is all the more remarkable at a time when the commodification of sowa rigpa reduces the practitioner to a dispenser of formulaic pills manufactured on a huge scale, as the fame of sowa rigpa now encompasses markets among the Han Chinese and other nationalities. The institutions providing sowa rigpa training are caught between neoliberal China’s commodification, and  China’s ongoing apprehension that institutionalised Buddhism competes with the state for popular loyalties. These forces have greatly constrained initiatives to maintain sowa rigpa as a central aspect of modern Tibetan life.

Most Tibetans are rural, although urbanization is accelerating.  The sowa rigpa amchi is a familiar, trusted part of local rural communities. Tibetan culture is not a monolith, although it may seem so when viewed from afar through the lens of both the efficiency and the SBA arguments. One abiding contested fault line entrenched in rural Tibetan society is a widespread fear of the evil eye and malevolent spirits. One of the most careful and sensitive surveys of such beliefs shows that they greatly inhibit nomad and farming women from going for help, or accepting the interventions of strangers, for fear of attracting pollution and danger.[14]

THE AMCHI AS COMMUNITY HEALTH WORKER

The amchi, often the most literate person in a remote community, has the potential to be part of the solution, overcoming the barriers to eliciting timely care. Tibetan women know that they, and their babies, are vulnerable. They vividly imagine “that spirits can be brought into the home by strangers. The spirits ride ‘piggy-back’ on a person entering the home, without them knowing it. Infants are particularly vulnerable to spirit attacks. If the baby cries just before the arrival of a guest, this can mean that the infant ‘sees’ or intuits the arrival of some spirit beings. If the baby cries a lot when the guest arrives, this too can be taken as a sign that the baby’s own ‘soul’ or ‘essence’ (bla) is uncomfortable with the visitor, for reasons of spiritual incompatibility.”[15]

This recourse to local spirits as causative agents of illness is pervasive. Anthropologist Stan Mumford tells a story of his landlady: “When her daughter had a toothache, she concluded that it was the goddess of water (chu-gi lha-mo) living in the stream who had caused the affliction. She seized a stone in the stream and tied a string around it, gradually pulling it out of the water and saying, ‘If you feel this pain, then don’t send pain!’ Nyima Drolma [the landlady] interpreted this to mean, ‘If the water goddess agrees to stop causing the toothache, we will stop doing the same to her,’ using the model of reciprocity in negative form. The model was dramatized by hanging the stone over the hearth (to feel heat) and wrapping prickly leaves around it. After a few days the goddess seemed to get the message: the toothache subsided, and the stone was put back into the stream.”[16]

A standard scientific response to such stories, which keep women from seeking help when giving birth, is to smile at the “superstitious” explanation of toothache. But “religion” and “science” are very modern concepts, as is their supposed mutual exclusivity. In the nineteenth century Japanese, subsequently Chinese, and then Tibetan languages had to come up with neologisms to convey each of these imported categories which modernity treats as natural.[17] There is no traditional Tibetan word for Buddhist, other than “one who goes within.”

The amchi, having trained in not only medical arts but also in a Buddhist understanding that all phenomena are empty of substance, is aware that traditional Tibetan beliefs in earth and water spirits is just a story. But, having also trained in active compassion, the amchi refrains from denouncing the water goddess aetiology of toothache as nonsense. The amchi is in and of the local community, yet also apart.

The local amchi, having trained for many years in a Buddhist monastery, is aware that these easily offended local spirits are creations of the mind, and not to be taken too seriously. These spirits are personifications of human jealousies and anger projected onto rivers, rocks, trees and mountains. Far from bluntly contradicting the villagers and camp-dwellers, the amchis participate in rituals to placate, tame and subdue these ghosts and demons, but they also do what they can to loosen their hold on fearful minds.

 

NEW ALTERNATIVES ONE: MODERN MOBILE AMCHIS

In these situations, the familiar amchi can ease the entry into modernity, and add to the value of prenatal health checks by visiting health workers. The amchi is a bridge between tradition and modernity; and need not be dismissed as another brick in the androcentric wall of Tibetan tradition, necessitating the invention of an entirely new CHW profession. The amchi is both insider and outsider, accepting of conventional realities and of transcendant ultimate meanings. This is the epistemological subtlety, the coherence and permeability of sowa rigpa. Even though sowa rigpa has not yet had much to offer a woman in imminent danger of postpartum haemorrhage, and even has some distaste for the polluting blood of birth, it is adaptable, available and widely trusted.

The all-encompassing sowa rigpa system has obvious potential to go beyond its customary role in the management of chronic conditions, to also detect signs that a woman nearing term is likely to experience complications that necessitate quick emergency access to clinical care. Rather than inventing a totally new vocational specialisation of skilled birth attendant, the amchis could train in prenatal diagnostics. Given the scatter of Tibetan population, its low fertility rate and declining population growth rate in recent years, it is hard to see how professional birth attendants could make a living, unless they travelled far from home regularly, which undermines the whole concept of the TBA as part of the local community.

     Sowa rigpa, although banned altogether during China’s revolutionary era, has revived, and ethnographers have observed close collaboration between amchis and biomedicine practitioners in the leading Lhasa sowa rigpa institute: “In the women’s division, a biomedically trained physician worked alongside Tibetan doctors. Among these doctors we observed an easy mapping of one set of names for disorders onto others. For example, of the nine types of growth in women’s reproductive tract, there were seven that corresponded to known biomedical conditions: cervical cancer, fibroids, ovarian cyst, endometriosis, polyps, ectopic pregnancy, and molar pregnancy. The non-matched diseases were considered so rare that they were largely ignored.”[18] However, this compatibility of disease categorization is predicated on a unidirectional logic, of sowa rigpa adapting to fit with biomedicine, in keeping with the anti-religious bias of both the ruling party-state and of science. Tibetan sowa ripgpa tradition is acceptable insofar as it conforms to the categories of biomedicine, and downplays its origins as a tantra of liberating the mind. As the anthropologist Vincanne Adams notes: “the direction of transfer was almost always toward use of biomedical knowledge to expand Tibetan understanding…. forcing Tibetan medicine to conform to biomedical standards rather than the reverse, even while publicly advocating and advertising the ‘alternative’ qualities of Tibetan medicine.”[19]

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A version of this blog series will be published in 2015 by Nova Science Publishers, in a global textbook called ‘‘Maternal Mortality: Risk Factors, Anthropolo​gical Perspectiv​es, Prevalence in Developing Countries and Preventive Strategies for Pregnancy-​Related Death”, edited by David Schwartz.

[1] Geoff Childs,  Tibetan fertility transitions: comparisons with Europe, China, and India; Journal of the International Association for Tibetan Studies, December 2008,  no. 4 http://www.thlib.org/collections/texts/jiats/#!jiats=/04/childs/#ixzz3HbRXv5NH

Geoff Childs; Tibetan Transitions: Historical and contemporary perspectives on fertility, family planning, and demographic change; Leiden, Brill, 2008

[2] Sienna R. Craig, Healing Elements: Efficacy and the Social ecologies of Tibetan medicine, Los Angeles, University of California Press, 2012, 215-252

Rebecca Lynn Coelius, Amy Stenson, Jessica L. Morris, Mingji Cuomu, Carrie Tudor and Suellen Miller;  The Tibetan Uterotonic Zhi Byed 11: Mechanisms of action, efficacy, and historical use for postpartum hemorrhage; Evidence-Based Complementary and Alternative Medicine; Volume 2012, 1-9

[3] Rebecca Lynn Coelius et al., op cit

  1. Miller, C. Tudor, V. Thorsten et al., Randomized double masked trial of Zhi Byed 11, a Tibetan traditional medicine, versus misoprostol to prevent postpartum hemorrhage in Lhasa, Tibet, Journal of Midwifery and Women’s Health, vol. 54, no. 2, pp. 133–141, 2009.

[4] Romio Shrestha and Ian A. Baker, The Tibetan Art of Healing, San Francisco, Chronicle Books, 1997, 40-1

[5] Tsering Thakchoe Drungtso, Tibetan Medicine: The Healing Science of Tibet; Drungtso Publications, Dharamsala, 2004, 80, 113, 140, 182-192

[6] Frances Garrett, Narratives of Embryology: Becoming Human in Tibetan Literature, PhD dissertation, University of Virginia, 2004

Frances Garrett,  Religion, Medicine and the human embryo in Tibet, London, Routledge, 2008

Laila Williamson ed., Body & Spirit: Tibetan medical paintings, New York, American Museum of Natural History, 2009,  29-30

[7] Vincanne Adams, Mona Schrempf and Sienna Craig; Introduction: Medicine in Translation between Science and Religion; in Vincanne Adams, Mona Schrempf and Sienna Craig eds., Medicine between Science and Religion, London,  Berghahn, 2010, 5

[8] Yuthok Yonten Gonpo, The Root Tantra and the Explanatory Tantra, From the Secret Quintessential Instructions on the Eight Branches of the Ambrosia Essence Tantra, Dharamsala, Men-Tsee-Khang Publications, 2008, 247

[9] Laila Williamson and Serinity Young eds., Body and Spirit: Tibetan Medical Paintings, American Museum of Natural History and University of Washington Press, 2009, 153-202

[10] Zhen Yan and Cai Jingfeng, China’s Tibetan Medicine, Beijing, Foreign Languages Press, 2005, 73

[11] Traleg Kyabgon, The Practice of Lojong: Cultivating Compassion through Training the Mind, Boston, Shambhala, 2007, 191

[12] Tibetan Medicine in Contemporary Tibet, Tibet Information Network, London, 2004

[13] The Transmission of Tibetan Medicine: Spiritual Growth, Questions of Method and Contemporary Practice, Oxford University, http://www.isca.ox.ac.uk/fileadmin/ISCA/LATEST_EVENTS_SEMINARS_CONFERENCES/Argo-SacredTransmission-abstracts-22_5_14.pdf  Accessed 7 Dec 2014.

[14] Vincanne Adams, Suellen Miller, Jennifer Chertow, Sienna Craig, Arlene Samen and Michael Varner; Having a “Safe Delivery”: conflicting views from Tibet; Health Care for Women International, 2005, 26, 821-851

[15] “Safe Delivery” in Tibet, op cit. 827

[16] Stan Royal Mumford; Himalayan Dialogue: Tibetan Lamas and Gurung Shamans in Nepal, Madison, University of Wisconsin Press, 1989, 94-5

[17] Isomae Jun’ichi The conceptual formation of the category “religion” in modern Japan: Religion, State, Shintō; Journal of Religion in Japan 2012,  1, 226-245

Wang Hui, Scientific Worldview, culture debates, and the reclassification of knowledge in twentieth-century China, 2008, boundary 2 35:2 (

[18] Vincanne Adams and Fei-fei Li; Integration or erasure? Lhasa’s Mentsikhang, 105-131 in Laurent Pordié ed., Tibetan medicine in the contemporary world: global politics of medical knowledge and practice, Routledge, 2008, 113

[19] Ibid, 115, 110

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MATERNAL MORTALITY IN TIBET: 3 of 4

Reaching out to remote women:

Sciences of healing, Sowa Rigpa and Community Health Workers

In the first two blogs, we asked why it is that well into the 21st century, on the eve of declaring China the great success story of the Millennium Development Goals, so many Tibetan women still bleed alone to death as they give birth to a new precious human rebirth.

Conventional wisdom is that if Tibetans persist in spreading across a vast plateau the size of Western Europe, not even a rich state could afford to provide them with effective health care (blog one) and Tibetan culture has also failed the women of Tibet, although Tibet’s traditional sciences of healing, or sowa rigpa, actually have a lot to offer, both in a crisis, and in the long term.

All along the third alternative, of trained midwives and birth attendants, employed as community health workers (CHWs) has been tried on a small scale, with good results. Is it now time to scale up those pilot projects? Are there signs that, at last, Tibetan women might get accessible, affordable, timely health checks that pick up early signs of pregnancy complications, and save lives, of both mothers and babies?

Despite the negativity of the first two blogs, is this a story with a happier ending in sight?

 

NEW ALTERNATIVES TWO: TRAINING COMMUNITY HEALTH WORKERS

In the MMR debate, in developing countries the new normal is the CHW skilled birth attendant, who embodies both traditional roles and modern biomedical training. Much of the reporting on MMR in Tibet highlights the absence of traditional birth attendants; and some go further, suggesting that the largely male practitioners of sowa rigpa have little interest or understanding of women’s problems around birthing. There is much evidence of an androcentric bias in Tibetan culture and Tibetan religious institutions.[1]

Does this mean the only solution is to invent a new specialised vocation, because Tibetan tradition cannot adapt? Specialised division of labour is inherent to modernity. Proponents of efficiency often call it the engine of economic growth. Well-intentioned interventions in Tibet often propose occupational specialisation as an essential step in raising productivity; for example, by persuading pastoral nomads to also become farmers – fencing, ploughing, sowing, weeding, harvesting and storing fodder crops as winter animal feed. Similarly, the invention of the CHW/SBA has obvious appeal, as a new profession of women for women, but it ignores the widespread Tibetan reality of scarcity of labour, and limited opportunity for specialisation.

There are now signs that the patient work of international health NGOs in Tibet, running pilot projects on a local scale, have had an exemplary effect, and that at prefectural level in largely Tibetan areas, local Public Health Bureaus are increasingly interested in training community health workers to fill the gap between a scattered population of mobile women pastoralists and the sedentary, urban-based health care system.

 

MOBILIZING PERSONNEL

Amchis are still common throughout Tibet, both in rural and urban areas. Can they also be trained to provide the four prenatal  diagnostic checkups that worldwide achieve so much in reducing MMR? This should not be too difficult.

The attraction of this, as an alternative and more effective strategy than the statist centralized clinical model, or the heroic invention of a pan-Tibetan cohort of CHW/SBAs, is that it is practical and likely to succeed in reducing MMR. Further, it provides an integrated mind/body approach, avoids medicalizing pregnancy except in emergencies where biomedical intervention is essential, and provides helpful advice on maternal mental attitude choices conducive to successful pregnancy and delivery.

What is striking is that, despite the ongoing high rate of maternal deaths in Tibet, no-one has proposed strengthening sowa rigpa as a solution. The state now supports “Tibetan medicine” but remains suspicious of its positioning as one of the classic sciences of Tibetan Buddhism. “These elements were thought to be residual features of a feudalistic social order and not an essential part of medical efficacy. Such policies resulted in efforts to simplify Tibetan medicine into simple disease and treatment lists, and either to ignore theory altogether or to strip it of any of its ‘superstitious’ features, including references to karma.”[2] A recent  360 page textbook on sowa rigpa manages to say almost nothing about Buddhism, other than to suggest that the sowa rigpa root text “had the appearance of a Buddhist catechism, because contemporary people readily accepted the Buddhist canon and instructions from a god.”[3]

However, immediately adjacent to upper Tibet, in the uplands and empty plains of Ladakh, in India, the women of the Association of Traditional Tibetan Medicine are out in the remote villages, training local midwives in how to diagnose and treat early signs of a difficult pregnancy, using the herbs and minerals of sowa rigpa. This new generation of Tibetan midwives also trains in diagnosing those uncommon circumstances that do require hospitalisation, in time for a medical evacuation, by helicopter if necessary, to a hospital.

Tibetan amchis by now are quite familiar with biomedicine and its strengths in dramatic interventions in obstetrical emergencies. The adaptability of amchis, as they negotiate between incommensurate bodies, between the psychophysical energy flows of the Tibetan body and the nervous system of the biomedicine body, is well established. For example, the common, chronic gastritis problems of Tibetan monks in exile, traditionally explained as untreatable, now respond well to standard treatments for Helicobacter pylori infection; and biomedical treatments are now standard.[4] This is “a tremendous adaptability to local environments, cultural differences, spiritual and practical resources for practitioners and patients.”[5]

A third alternative exists – it is a revitalised, modernised Tibetan sowa rigpa system, drawing on the existing network of thousands of amchis across Tibet, building on existing strengths in prevention and early diagnosis, to embrace new capacities, especially emergency interventions to treat post-partum haemorrhages.

What is missing is active participation by the amchis of the sowa rigpa system, through the established training colleges such as the Mentsikhang in Lhasa in expanding the curriculum to more fully meet the maternal health challenge. Faced with official hostility to religion, sowa rigpa struggles to assert a new role in what the state defines as the exclusive domain of biomedicine; which has become the norm, to which sowa rigpa must adapt. At most, sowa rigpa medicines may find an accepted place in the pharmacopeia of biomedicine, but can claim no more.

This third way is to build on the strengths of existing Tibetan culture, in contrast to both the efficiency model and the CHW/SBA model, which tend to bypass and ignore the sciences of healing deeply embedded in Tibetan life. This putative third way, however, is an aspiration with few active advocates. Sowa rigpa exists in a subordinate and even subaltern position in China. The basis of sowa rigpa as a spiritual understanding of the nature of body/mind is seen as a superstitious intrusion of religion into the objective science of biomedicine. The religiosity of the Tibetans, as well as the central role of Buddhism in Tibetan culture, remain at the heart of official fears and apprehensions. The manifest loyalty of the Tibetans to their lamas, amchis, sciences of mind and of healing continues to be seen from afar as a failure to trust or even show the required gratitude to the modern nation-state. If sowa rigpa is intrinsic to the Buddhism of Tibet, it too is suspect, and is restricted to its role as a pill manufactory.

There is thus little opportunity for the sowa rigpa medical colleges to initiate new roles, in treatment of emergencies such as postpartum haemorrhage. Such possibilities cannot be publicly discussed in a public sphere dominated by official discourse.

 

 

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A version of this blog series will be published in 2015 by Nova Science Publishers, in a global textbook called ‘‘Maternal Mortality: Risk Factors, Anthropolo​gical Perspectiv​es, Prevalence in Developing Countries and Preventive Strategies for Pregnancy-​Related Death”, edited by David Schwartz.

[1] Kim Gutschow, from home to hospital: the extension of obstetrics in Ladakh, ch 8 in Vincanne Adams, Mona Schrempf and Sienna Craig eds., Medicine Between Science and Religion, Berghahn, 2010

[2] Adams, Integration or Erasure,  op cit., 108

[3] Zhen Yan and Cai Jingfeng, China’s Tibetan Medicine, Foreign Languages Press, Beijing, 2005, 19

[4] http://www.youtube.com/watch?v=2hgyS6gjo28  Accessed 10 December 2014

[5] Adams, Integration op cit.,Introduction, 6

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MATERNAL MORTALITY IN TIBET: 4 of 4

New hope for the women of Tibet:

Sciences of healing, Sowa Rigpa and Community Health Workers

This is the fourth of four blogs on the number of Tibetan women dying in childbirth, at a rate equivalent to some of the poorest places on earth, and what can be done.

The first blog took up two common arguments why little can be done. The “efficiency argument” of the economists is that a developing country such as China can at best afford centralised, urban health services, not extension services in remote areas. The first and second blogs looked more closely at strengths and weaknesses of traditional Tibetan attitudes to women, birth, death, cleanliness and pollution; to ask if these are the obstacles to improving the  appalling maternal mortality rate (MMR).

EFFICIENCY REVISITED

The other master narrative that warrants a fresh look is the efficiency argument, which on economic grounds, concentrates investment in centralised locations where factor endowments are concentrated. In this argument, it will never be economically viable to deliver effective health care outside an urban hub, not only because of economies of scale but also because of the scarcity of trained staff, who are unwilling to work in remote areas.

This standard argument needs unpacking, partly because new technologies can overcome the spoke-and-hub logic of centralisation; and because the modern exchange economy is not the only way of working in Tibet.

The key to reducing MMR is by reducing post-partum haemorrhage (PPH), which can often be risk-assessed well in advance of labour, and the danger period for PPH. There is opportunity for alternative approaches that emphasize prevention, early diagnosis and remedial measures that do not require routine medicalization of pregnancy, or hospitalization as the default setting for delivery. Tibetan culture is a use economy, not an exchange economy. Sowa rigpa practitioners are usually not paid for diagnosis, dietary, behavioural and mental advice, because sowa rigpa is intrinsic to Buddhism, one of the tantras. Buddhist mind training exhorts practitioners to heal for the sake of healing, not for personal advantage or profit. A classic slogan of the lojong cycle of mind training is: “Don’t put exchange value on things.”

It is part of Buddhist tradition to emphasize not only acting compassionately, but also with a motivation uninflected by self-interest.[1] Intention matters greatly. China’s for-profit medical clinics distort treatment options, skewing doctor’s behaviour towards overuse of expensive and unnecessary antibiotics, injectable medications, and other biomedicines that may be unnecessary or actually harmful.

From the perspective of Tibetan patients, the institutional pressure on professionals to make money from patients means replacing trust in the disinterested advice of the amchi with a sceptical questioning of the concealed agendas of the clinician. The transition in Tibet from amchi to clinic doctor; from use economy to exchange economy; from generosity to calculation; introduces complexity, ambiguity and distortion, with many perverse iatrogenic outcomes.

The Rural Cooperative Medical Scheme (RCMS) was meant to reduce costs of both inpatient and outpatient treatment, especially the catastrophic costs of catastrophic illness, and the recent successes of RCMS, as it has become more comprehensive in quite remote areas, has also done much to restore trust. However, recent reviews of how this scheme functions in practice suggest that government financing of the RCMS does little to reduce costs to users, and that most of the reimbursement is offset by a rapid rise in medical expenses.[2] There is also consistent evidence that the availability of reimbursements by the RCMS has greatly increased the rate of Caesarian section births, whether or not they were medically necessary.[3] This intensifies the medicalization of pregnancy, and further marginalises sowa rigpa and its amchi practitioners.

Traditional Tibetan doctors, especially the female minority, can be trained in early diagnosis, and as birth attendants, building on their skills in early diagnosis of imbalances, through direct intersubjective pulse readings , without the mediation of instruments. This seems a more promising prospect than creating a new vocation of birth attendants, as if Tibetan tradition has no strengths to build on. Rural Tibetans continue to trust their amchis, who are often the only healers who are accessible.  However, biomedicine is alluringly new, even in remote areas of Tibet.[4] It is not only physical distance from an urban clinic that makes the amchi the preferred source of health services. Even with the funding newly available under the RCMS, urban hospitals still raise much of their funding and staff salaries from patients, which heavily skews treatment towards injections and the overprescribing of the most powerful of biomedicines, whether this is in the patient’s interests or not. Further, cost-recovery and profit-making clinics and hospitals usually require upfront payment even before admitting a patient to the ward; and common prejudices about “dirty nomads” make it hard for a prospective patient to even get in the door unless one has “connections”. For these reasons rural Tibetans are reluctant to go near a hospital unless absolutely necessary.

 

MODERN EFFICIENCY EXTENDED IN OUTREACH TO REMOTE POPULATIONS

Because of these constraints, the few small scale NGO initiatives to reduce MMR have not only trained community health workers as skilled birth attendants, but  have also operated a clinic functioning not as an exchange value for-profit, but as a use-value service that took care to avoid excessive reliance on biomedicines of doubtful relevance.  These experiments have  demonstrated that doctors also need incentivisation to refrain from over-prescribing. While the results of this pilot project are impressive, this model is hard to replicate or upscale, unless it is adopted officially, as it requires of staff a high level of dedication, and considerable external support. Fortunately, official adoption of this incentivised model may come soon.

This trial, over nine operational years in the remote Surmang area, did demonstrate many of the less evident reasons why MMR in Tibet remains so stubbornly high. Even if clinics and hospitals were closer to where Tibetans live, other obstacles remain, and are hard to overcome in the current neoliberal model with Chinese characteristics. This is clear in the assessment of the experimental Surmang clinic by researchers from the Institute of Population Studies at prestigious Peking University. The Surmang model paid medical staff well enough to live without having to make money from prescribing and administering expensive drugs. Health service provision was free, undistorted by the need to overprescribe as a primary source of income.

The Peking University assessors report: “A number of community health workers trained by Surmang charity clinic have become a vital force in providing health services to the local community. While providing free health care services, Surmang charity clinic actively set up a practical operating model in line with the reality in the remote areas, such as practical and feasible management model, methods for training health care staff, and health education for local residents, which has achieved positive effect. “

     ”The survey discovered that therapeutic methods used by Surmang charity clinic are largely different from those used in public, primary medical institutions, by Tibetan doctors and village-doctors.  Doctors in Surmang charity clinic generally resort to the fewest medical measures. Around 40% of the visiting patients are given just health education instead of drugs. The principle for drug use is: minimize the use of multi-drugs, and avoid intravenous injection when possible. In public, primary medical institution, after inquiry about the symptoms, doctors usually prescribe medication as treatment. In using western drugs, over half are injections, of which 90% are intravenous injections. Doctors sometimes sell drugs without any analysis.”

     “In medical services, doctors are both the agents of patients and the ones to maximize their own interests. The interests of patients may conflict with those interests of doctors. If the providers are profitable, there will certainly be conflicts between the two groups. The reason for doctors in Surmang charity clinic to achieve high efficiency and good effects in this non-profit clinic lies in the stimulation to win good reputation. Doctors of the clinic accumulate a wealth of experience by serving local patients and win good reputation. Moreover, they don’t need to consider how to compete in the market for patients. All of these factors encourage the doctors to choose the best treatment programs according to the specific conditions of patients, so as to maximally avoid irrational and nonstandard behaviors.” [5]

The Surmang clinic saw itself as a replicable prototype that could be done elsewhere in Tibet. It could be an exemplary benchmark if the source of its’ strengths are understood. The Beijing-based evaluators have little to say about the core values on which the prototype was built, which are distinctively Tibetan Buddhist. The Tibetan doctors and staff shared with their international project inception team a shared experience of the inner strength generated my mind training in the Tibetan tradition. One aspect of that is what Tibetans call “sacred outlook”, which holds all others in positive regard. The ethos of community service, and a use value economy, pervades the Surmang model, which motivated its staff not with foreign-funded high salaries, but with a classic Tibetan Buddhist cultivation of active compassion for all.

While this use-value model remains deeply embedded in Tibetan culture, where it is widely-recognised and respected, is it practically able to achieve results in reducing maternal mortality? A 2013 review of the Surmang model suggests that, once it focussed specifically on MMR, by training community health workers (CHWs), much was achieved: “The CHW program represented a shift in focus for the Surmang Foundation from an ambulatory clinic operation largely serving male patients to a community-based care model supporting and recognizing the maternal and child health care needs of area women. The primary goal for the CHW program since its inception in 2006 has been to reduce both maternal and infant mortality rates in the Surmang Township catchment area of Qinghai Province, China. the CHWs are interviewed each summer to determine the number of antenatal visits, numbers and nature of births attended, referrals to clinic for pre/postnatal care, referrals to hospital for childbirth, complications, rescues and morbidity/mortality of women and children. The CHWs are paid each summer according to the number of births attended, antenatal care, referrals to the clinic for ultrasound and well-baby checks. Since 2009, the timely hospital referral for complicated and high-risk pregnancy has risen as more CHWs are recognizing warning signs.” The result has been a sharp decrease in MMR, although infant mortality remains worrisome.

The efficiency argument assumes factor endowment in remote areas is so low that it can never be economic to extend such community health services beyond urban hubs.  Recent interest by Yushu Prefecture Public Health Bureau in taking up the challenge of training and employing CHWs may overcome the centripetal tendencies of the current system. New technologies may also help. The crucial importance of ultrasound technologies in timely diagnosis, and cold-chain-controlled availability of oxytocin to stop obstetrical haemorrhage, remain for the moment powerful arguments for ongoing centralised hospitals and clinics. However, technology is changing. It may not be long before oxytocin will no longer need a refrigeration chain, and could be available to birth attendants in remote areas, for oral delivery. Ultrasound no longer means bulky apparatus installed in a clinic, as hand-held, battery-powered ultrasound is now available.

Mobile pastoralists of Tibet do have mobile phones, so maternal health initiatives in China could provide essential prenatal health checks that often identify problem deliveries in advance. Mobile ultrasound devices connected to mobile phones are a promising idea.  However, current m-health (health delivered by mobile phone) in China is solely for those literate in Chinese language, which is very seldom spoken or read by Tibetan nomad women.

 

CONCLUSION

 

Maternal mortality in Tibet remains high, official statements notwithstanding. Until recently, this seemed inevitable, since Tibet has neither a tradition of skilled birth attendants, nor affordable and accessible clinics or hospitals.   The women of Tibet remain caught between two models – the efficiency model and the SBA model – both of which condemn them to giving birth alone and without access to help. Both models perceive the land, the people and the culture of Tibet negatively, defined by what is lacking. From the standpoint of the efficiency model, Tibet lacks, scale, density, concentration, and critical mass. The answer from efficiency model standpoint is urbanization. From the CHW/SBA standpoint, Tibet lacks a tradition of birth attendants; its healing system is male dominated and androcentric. The answer in the CHW/SBA school of thought is to train a new breed of SBA community health workers empowered to challenge the male bias of sowa rigpa. Unfortunately, neither model has the will or capacity to significantly alter the realities of maternal health care in the foreseeable future.

Having dwelt at length on obstacles to reducing the MMR, we may conclude with two promising prospects. One is for a revitalised role of the amchis, if they can be recognised by official health care bureaus as having a more constructive role to play.

The other hopeful development is the prospect of scaling up small-scale projects targeting MMR,  initiated by NGOs, and suffused with traditional Buddhist beliefs of having positive regard for others. They show that active compassion, relevant skills training and new technologies can greatly reduce MMR. This new approach means creating a new profession of community health worker birth attendants.

Much can be achieved, yet China remains wedded to the standard efficiency model of restricting resource allocation to urban hospitals and clinics, and has little inclination to decentralise. However, those centralised services are beginning to trial the training and deployment of outreach staff, as community health workers. In four townships of Yushu Prefecture, CHWs will bring the mothers to the clinic for ante-natal and post-natal exams, and well baby exams in addition to birthing. This project has built-in triple incentivization: incentivization of the mother, the community health worker and the doctor. The method relies initially on training by highly skilled foreign doctors in the four township hospitals. The training is selective and somewhat competitive, unlike the mass lecture training given by UN WHO or the use of the Advanced Life Support in Obstetrics instructional materials. A health policy goal of this training is to reduce the salaries of the trained doctors and introduce a system of incentivization, so that when their performance increases, so does their income.  The measured criteria for increasing the pay of staff is patient numbers, amount of medications prescribed, live births, return visits, referral from village providers, referrals to County or Prefecture Hospitals.

Right now, Tibetan women remain at risk and will continue to experience one of the highest maternal mortality rates in the world. Hopefully, that will change.

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A version of this blog series will be published in 2015 by Nova Science Publishers, in a global textbook called ‘‘Maternal Mortality: Risk Factors, Anthropolo​gical Perspectiv​es, Prevalence in Developing Countries and Preventive Strategies for Pregnancy-​Related Death”, edited by David Schwartz.

 

[1] http://www.rinpoche.com/teachings/paramitas.htm Acessed 7 Dec 2014

[2] Xiaoyun Liang, Hong Guo, Chenggan Jin, Xiaoxia Peng, Xiulan Zhang; The Effect of New Cooperative Medical Scheme on health outcome and alleviating catastrophic health expenditure in China: A systematic review; PLoS One, 2012, 7 #8,

Wei Yang, China’s new cooperative medical scheme and equity in access to health care: evidence from a longitudinal household survey; International Journal for Equity in Health, 12, 2013, 20

[3] Qian Long, Reija Klemetti, Yang Wang, Fangbiao Tao, Hong Yan and Elina Hemminki; High caesarean section rate in rural China: Is it related to health insurance (New Co-operative Medical Scheme)? Social Science and Medicine, 2012, 75, 733-7

Kun Huang, Fangbiao Tao, Lennart Bogg and Shenlan Tang; Impact of alternative reimbursement strategies in the new cooperative medical scheme on caesarean delivery rates: a mixed-method study in rural China; BMC Health Services Research, 12, 2012,  217-228

[4] Tibetan Medicine in Contemporary Tibet, Tibet Information Network, London, 2004, 86-7

[5] Tan Ling-Fang, Huang Cheng-Li,      Yang Cun, et al.;  Physician behavior analysis under a free health care system: an empirical research on Surmang Charity Clinic in Qinghai Tibetan Area, Chinese health economics, Oct 2011, Peking University Institute of Population Studies, http://surmang.org/cms/PKU%20assessment.pdf  accessed 7 Dec 2014

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Making the Mountains Muncipal

What’s in a name:    SHIGATSE AND CHAMDO BECOME CITIES

China has declared Shigatse and Chamdo henceforth to be municipalities, rebadging not only two of the bigger towns in Tibet but their entire prefectures, which are largely rural, mountainous and mineraliferous.

What to make of this? Just a shuffle of administrative nomenclature?

Hardly. In China’s system, municipalisation signals a momentous shift, not only away from the rural and towards an urban destiny, but from darkness to light, from backwardness to civilisation, from lagging to leading, from weak dependence on subsidy to a strong economy based on resource exploitation.

In today’s China, the city engulfs the countryside. The urbs expands far beyond its sub-urbs, deep into the rural districts where most Tibetans continue to live, beyond the reach of the state.

This reclassification is no mere formality: it is the march of progress, the culmination of a teleology of material comfort that is the very purpose of a regime bereft of ideological legitimacy. Far from being an obscure technicality, this legal move, at a stroke, does away with the last pretence of special rights for minority nationalities, and makes land, hitherto classified as rural and thus state-owned, into a commodity to be bought and sold. All of this is achieved by adding Chamdo (Qamdo or Changdu in Chinese)  and Shigatse (Xigaze or Rikaze in Chinese) , plus the long-standing, sprawling Lhasa Municipality, to the ultimate in status: designation as cities.

The end result is that, within the restricted part of the Tibetan Plateau that China calls Tibet –the Tibet Autonomous Region- there are now only three prefectures left , as nominally Tibetan Autonomous Prefectures, and two of those are sparsely populated. In the far west of upper Tibet is the alpine desert of the Chang Tang empty plain, designated as Ngari (in Chinese Ali) prefecture. North of Lhasa is the largely pastoral prefecture of Nagchu (in Chinese Nagqu), where the Mekong River begins its great journey. In the southeast of TAR is Lhoka (Shannan in Chinese), well-watered and with a mild climate, forested and with a substantial Tibetan population, but lacking for the time being in any major city eligible for municipalisation.

The result is that around 40% of Tibet by area is now officially city; and a much higher percentage by population. Yet on the ground, Tibet and the Tibetans remain overwhelmingly rural, scattered, poor and beyond urban service delivery.

For China, this is of course about access to resources, especially water, copper and gold: it is hardly an accident that the new municipalities abound in sites for hydro dams and proven deposits of copper, gold, silver, molybdenum, lead, zinc and much else, perhaps even diamonds. But this is about more than facilitating corporate access to land, rivers and minerals; it is also proof that China is benevolently fulfilling the destiny of all within its grasp, which is to attain the peak of civilised human development, by becoming urban.

When Jirim League, in Inner Mongolia, became Tongliao Municipality in 1999, it lost its Mongolian name yet, in the words of the mayor and the party secretary:  “opens a brand new page [to] further emancipate the mind, grasp the opportunity, speed up the development, and carry a united, wealthy and civilised Tongliao into the 21st century.”[1] Party Secretaries in Lhasa rejoice in identical language, not only for the future of Lhasa, long a huge municipality, but now for Chamdo and Shigatse as well.

How can so many consequences flow from a name change? A clue comes from recognising this as a well trodden path, with a simple name in Chinese. The name of this policy is zhen gai shi (change town to city), xian gai shi (change county to municipality) and di gai shi (change prefecture to municipality). This fits into a much deeper Confucian tradition of “rectification of names”, which elevates the neglected, and restores propriety to the banished.

The most famous example of municipalisation is the carve-up of Sichuan Province in 1997 into Chongqing Municipality, administered directly from Beijing, and the rump 70% of Sichuan, including its capital, Chengdu, as the remaining province. Making Chongqing a municipality was the making of Chongqing. Today Chongqing is the hub of western China, a close rival to Chengdu, both now booming cities that have attracted far inland many of the global brand names that manufacture their high tech in Chongqing and Chengdu factories. The speeding up of Chongqing’s hypergrowth was signalled by its transition from provincial second city to national municipality in its own right, eligible for favoured treatment from Beijing.

The decision to make Chamdo and Shigatse cities was made by the State Council, China’s Cabinet. It remains to be seen whether they will remain subordinate to the Tibet Autonomous Region or will ultimately come directly under Beijing, to expedite their growth, especially the intensified extraction of water, power and mineral resources.

As far back as 2009, in a State Council White Paper on New Progress in Human Rights in the Tibet Autonomous Region, it was announced that: “Municipal construction has been speeded up in major cities and towns, such as Lhasa, Xigaze, Nagqu, Qamdo, Zetang and Shiquanhe.” At the time, this seemed to change very little on the ground.

Now that the change has been made legal, the differences are more obvious. Municipalisation immediately affects land ownership and property rights. In China, all land has been owned by the state, but several years ago there was a fundamental split made between rural land, which remains owned by the state to dispose of as it pleases, and urban land, which can be bought, sold, and owned outright by individuals and corporations.

By declaring an entire prefecture to be a municipality, the rural land surrounding Chamdo and Shigatse thus become urban land and tradeable. This fits closely with China’s plans to intensify agricultural production in feedlots close to cities, where yaks, sheep and goats raised in their early life by Tibetan pastoralists will then be brought to the urban fringe for grain-fed fattening, prior to slaughter. Municipalisation means those feedlots, and greenhouse vegetable farms currently leased by Tibetans to Chinese farmers can now be sold and bought by Chinese enterprises.

So we should not think only of the impact on the town folk, but beyond as well.

One good example, well documented by Prof. Mel Goldstein, is the chicken farming program on the outskirts of Shigatse, in which Tibetan women raise chickens explicitly for slaughter, in the yards of their homes. As Goldstein describes it (as a successful poverty alleviation project) the  women buy chicks that are only a few days old, raise them, then sell them to companies that do the final fattening and killing. This would now be considered an urban enterprise, successful partly because it has persuaded Tibetans to ignore their traditional dislike of raising animals for the sole and explicit purpose of slaughter.

Cities are hungry for the resources of the surrounding countryside. The Mongol anthropologist Uradyn Bulag has followed the municipalisation of Inner Mongolia over the past decade, as it happened, in advance of China’s recent moves in Tibet.[2] He points out that “naming is not a trivial issue. The proliferation of cities or municipalities in Inner Mongolia is, among other things, a reflection of this ethnic struggle, and a strategy of the Chinese to expand their territorial space. Cities are not supposed to be ethnic, or autonomous, as we can glean from the absence of ‘city’ in the definition of autonomous areas in China’s Law on Regional National Autonomy. The rise to city checkmates ethnic sensitivity.”

China has long said that development is the answer to all Tibetan problems, and development invariably means urbanisation, more so than ever under Xi Jinping. Urbanisation could have benefited Tibetans if standard worldwide models of development, building on existing economic strengths, had been implemented. In Tibet, that would have meant ensuring Chinese markets for what rural Tibet does best, which is producing great surpluses of wool and dairy products. Although China’s urban new rich have taken to dairy consumption so totally that prices have shot up, and although Tibet Autonomous Region is connected to lowland China by rail, there has been almost no integration of the Tibetan pastoral economy into the Chinese economy. Tibetan wool, even semi-fine wool, is deemed coarse and unsuited to anything better than beating into felt. Tibetan dairy products lack market access, while China imports huge quantities of butter, yoghurt, infant formula and other dairy produce from New Zealand and elsewhere. Adding value to Tibetan primary produce, in urban factories, never happened.

Now, as the legally enshrined ethnic autonomy of Tibetan counties and prefectures is eroded by municipalisation, a new kind of autonomy is emerging. This is the autonomy of cities, which can dominate their rural hinterlands, capture their waters, dam their rivers and exploit their natural resources, while also claiming from Beijing the right to a bigger share of fiscal revenues.

When China announced its plans for opening up the great West, xibu da kaifa, urbanisation and municipalisation were core strategies. In 2001 Xiao Jinsheng, a researcher for the State Development Planning Commission noted that: “in the western provinces and autonomous regions, due to the small size of cities and their weak functions, there are still 39 prefectures which are yet to become municipalities.” That list has now shrunk.

The State Council’s  2014 decision to municipalise Chamdo and Shigatse was transmitted to the Tibetan masses by Wu Yingjie,   vice-secretary of the TAR Communist Party,    who instructed the new municipalities that: “they should transform the economic mode of the two cities, and better allocate resources.  They should better plan funding programs and take advantage of the central government’s preferential policies well in advance.”

Stand by for further acceleration of the rate of urban development in Shigatse City and its adjacent Shetongmon copper and gold mine; and in Chamdo City, which now controls great hydropower dam sites and the Yulong complex of major copper and gold deposits.

China sees this as the completion of its transformation of Tibet. Before China took command, the entire Tibetan Plateau was what geographers call a production landscape, based on extensive land use, meaning that the people, mostly pastoralists, were scattered more or less evenly across the entire subalpine landscape, using land lightly and briefly, and moving on. China has replaced extensive, light land use, with intensive land use in concentrated enclaves of modernity, notably cities, dams, power stations, mines plus the energy and transport corridors connecting them all.

Time will tell if the Tibetan land can withstand this profound shift, from extensive to intensive. Can the land survive intensive exploitation? Or were the Tibetans right, for 9000 years, to maintain a light touch, because the land and its thin soils are easily degraded by over-use?

Beijing’s preferential policies could in coming years transform Chamdo and Shigatse into big cities, as they did in Chongqing. These cities will be peopled not only by Han Chinese immigrants but also by Tibet’s ex-nomads, required to leave their lands because the nomads are blamed for land degradation. The ending of extensive land use, and the intensification of intensive urban land use also involves the depopulation of the countryside where, in Yushu urban area, for example, it is now illegal to live in a tent.

Urbanisation is China’s version of manifest destiny, and a step towards realising a post-ethnic Zhonghua identity in which there are no longer 56 distinct nationalities, each with rights to specific lands, just one Chinese nation, mingling in cities, where ethnicity is an outdated concept. Lhasa has long drawn in Han Chinese immigrants, becoming home to most of the Han settlers and sojourners in TAR. Until now, neither Shigatse nor Chamdo have had many resident Han Chinese. In the 2000 census 97% of Shigatse Prefecture were enumerated as Tibetan, and 91% of those living in Shigatse county. In the same year, by official count, 96% of all people in Chamdo Prefecture were Tibetans, and 87% of the people in Chamdo county.

All the push and pull factors for renewed Han migration to the newly designated cities are in place. Beijing’s “preferential policies” and flexible rules on hukou residential registration in Tibet will pull in those seeking newly financed jobs; and the poverty of rural Sichuan will push them. The opportunity to buy newly urbanised land is a major pull factor. Jobs in the mines, smelters, hydro dam sites and high voltage cabling will be plentiful for those who speak Chinese, the language of construction. Railway lines connecting Shigatse via Lhasa to lowland China are almost complete, and the rail line to Chamdo is under way.

Declaring Chamdo and Shigatse municipalities, no longer prefectures, means much.

 

 

 

 

 

 

 

[1] Renmin Ribao 6 October 1999 p4

[2] Uradyn Bulag, Municipalization and Ethnopolitics in Inner Mongolia, in Ole Bruun ed.,Mongols from Country to City, NIAS Press, 2006

Uradyn Bulag From Yeke-juu league to Ordos municipality: settler colonialism and alter/native urbanization in Inner Mongolia, Provincial China, 7 #2, 2002

 

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INTO A WORLD LED BY CHINESE CHARACTERISTICS

HOW TIBETANS FARED AT THE WORLD PARKS CONGRESS 2014

When China gains leadership of global institutions, everything shifts. The urbane, talented Chinese who now head the World Health Organisation and International Union for Conservation of Nature (IUCN) are pioneers in what will be an accelerating trend. Talented as these individuals are, China sees their ascent as a national achievement, and many outside China are predisposed to crudely see these advances as China’s “capture” of planetary institutions.

Of course, in reality it is more complex, more subtle and everyone learns from each other. IUCN and WHO gain not only a capable leader with the active support of China’s strength, the leaders gain access to the full suite of modern management methods for wielding power softly, smoothing over contradictions, juggling complexity while still pressing the institutional agenda ahead.

Now that China is in the global leadership club, no longer looking in from outside suspiciously fearing it will always be held at a distance, the knee-jerk reaction of the outsider is fast disappearing. Take the World Parks Congress (WPC), a flagship IUCN event held once in ten years, a major opportunity for the governments, park managers, corporations, conservationists and environmental campaigners of the world to set the planetary protection agenda.

WPC2014 was in Sydney, on a heavily polluted but then remediated industrial complex cleaned up to become the venue in 2000 for the Olympic Games. Now, on the edge of the endless tarmac of halls and stadiums the wetlands and saltwater inlets and waterbirds slowly return, after decades of dumping of industrial wastes. Inside the massive halls, over 5000 conservationists attended not only a week of plenaries and workshops but wondrous indoor evocations of nature: Australian native trees in burlap bags suspended above one’s head as one walked through a jungle of steel scaffolding; pacific dolphins knitted in vibrant colours; multimedia displays of the technological capacity to see everything from space. Meandering the endless screens, presenters and myriad ways of representing nature, one could be seduced into feeling that, as we all work together, the planet can indeed be saved.

Yet a torrent of colour coded satellite data may not save a planet where extinctions are accelerating, economies addicted to growth, corporate profits rising and nature remains peripheral. So too with China’s leadership of IUCN. Zhang Xinsheng, an architect of the Confucius Institutes that project Chinese soft power into school classrooms and universities across the world, is a world away from a China that until yesterday was proudest of its new ability to say no. Zhang is, as his cv says, a professional politician who rose through the ranks of the Chinese Communist Party, graduating from the China University of Military Technology during the Cultural Revolution, when only the military was exempt from the Maoist struggle campaigns against “stinking intellectuals.” He got to Harvard Business School while the Cultural Revolution raged, at a time when almost everyone his age had been sent to rural internal exile, “to learn from the masses.”

When China took its decisive neoliberal turn, under Deng Xiaoping, Zhang, with his Advanced Management Diploma from Harvard Business School, was ideally placed to rise and rise. He became mayor of Suzhou, vice-minister for education, headed China’s Olympic Committee, Chairperson of the Executive Board of UNESCO (2005–2007) and was Chairperson of UNESCO’s World Heritage Committee (2003–2004).

In parallel, his business career took off, especially as boss of an 800 bed hotel in Nanjing, the Jinling, financed by a shrewd Singaporean who brought Zhang in just as he was about to rise to the mayoralty of Suzhou, a locus of Singaporean investment that earlier went sour as Chinese business partners looked after themselves and not their Singaporean partners. Zhang was adept building a private fortune while presenting himself as public-spirited, philanthropic and socially concerned, a familiar career path anywhere in the neoliberal world, but new in China. The fusion of profit and the public sphere, the melding of the languages of capital and serving humanity, were new to China 30 years ago, but Zhang was ready to catch the wave.

With hindsight, now that the CCP has emerged as the greatest corporate franchise in the world, we could say Zhang was an early adopter, a first mover, establishing his niche in the market economy when it was still new. Whether the CCP directly owns or controls corporations is no longer a distinction that matters much in a system where every franchisee, even the biggest of private enterprises, routinely pay franchise fees to the state, and through the state, to the party, in order to get official licences to operate. Zhang was quick to recognise this, with his career as CEO of a big hotel and mayoralty of Suzhou city intertwined. As one of his key Singapore investors puts it, “It was a sweet coincidence that a senior manager whom Mr Tao hired for the Jinling Hotel, Zhang Xinsheng, had become the city mayor when the Suzhou project was on the drawing board.”[1]

In global exile, Tibetans still tend to think of China as command-and-control communism. But the new face of China is a fusion of accumulating capital and party power. Zhang Xinsheng exemplifies China’s new face.

 

ENTER THE TIBETANS

So when Tibetans came to the World Parks Congress, to protest the depopulation of the best pasturelands of Tibetan Plateau, in the name of conservation, even daring to name IUCN as complicit in blaming the pastoral nomads for degradation, both China and the IUCN were ready.

Gone are the days when China, seeing itself as an outsider forever shut out by a world system rigged against it, will instantly and furiously denounce any criticism as an “anti-China” conspiracy, and immediately demand that the protesters be silenced and ejected. IUCN too, with its panoply of World Leaders en suite, was equally ready. The Tibetans handed out thousands of brochures to the protected area professionals, carefully explaining how, in the name of watershed protection and grassland conservation, the pastures of Yushu and Golok prefectures are being emptied of people, yaks, sheep and goats, and filling up with miners now free to exploit the land with no fear of local communities protesting. Park rangers, seed campaigners, indigenous knowledge champions from around the world took and read the Tibetan story and frequently told Jigme Norbu, from Environment Desk of Tibet Policy Institute, how much they sympathised with him. Often they asked quietly if he was in danger. The brochure he handed out at WPC2014 is the previous blogpost on this site.

But both IUCN and China acted as if nothing had happened. When Jigme Norbu approached the IUCN mappers who list the huge Sanjiangyuan Nature Reserve, that covers Yushu, Golok and more, he was politely told that since the database also belongs to the United Nations Environment Program, it must follow UN rules that nation-states define the purpose of their parks. That is why the World Conservation Monitoring Centre’s (WCMC) database, launched at the Sydney congress, argues for the removal of the nomads, saying:  “To protect the grasslands, pastoralists are not permitted to graze their animals in designated ‘core zones’, and grazing is supervised elsewhere in the SNNR. In addition, residents have been resettled from core zones and other grassland areas of the SNNR, and rangeland has been fenced and is in the process of being privatized throughout the Sanjiangyuan Area.”

In this way pastoral Tibet ends not with a bang or even a whimper. It has become an objective scientific necessity that pastoralists and their herds be removed, to grow more grass, to restore the grasslands to wild lands grazed only by the reduced wild herds that manage to negotiate the newly fenced land that prevents their seasonal migration to their birthing grounds.

Jigme Norbu spoke with Brian Mac Sharry, a key number cruncher for the UNEP WCMC www.protectedplanet.org  database, who was entirely open to the possibility that additional data from folks on the ground might alter the satellite data and Chinese definition that constitute the current display, but it seemed a minor, distant prospect. It would be good, Dr Mac Sharry said, if eventually they can supplement the sharply detailed satellite mapping that WCMC proudly launched, with more detailed information from people on the ground. Clearly, it won’t happen in a hurry, especially in Tibet where people are not free to differ from the official mass line. So the Tibetan perception of pointless dispossession is accidentally edited out, as if it never existed, but may somewhere down the line be added to the official version, as a minor detail. The erasure of the Tibetan viewpoint, the displacement of hundreds of thousands of pastoral nomads, the Tibetan loss of food security and deep traditions of sustainably caring for the pasture lands, are gone in a click, at most a minor accidental error.

Since Jigme Norbu raised Tibetan concerns, the protectedplanet website quickly expanded its section on Sanjiangyuan, while keeping not only the quote above justifying grazing bans and nomad removals, but also: “uncontrolled or poorly managed mining, logging, hunting, and grazing have been curtailed. Foreign and other mining firms have replaced the uncontrolled miners, trees have been planted..” Is this belated recognition that this “park” is indeed being mined?

 

INSTITUTIONAL COOL

Individually, Chinese at WPC bristled when offered a Tibetan pamphlet. But IUCN kept its cool, and its silence. It was only at a World Leaders Dialogue (WLD) plenary that a response was forthcoming. At the WLD press conference Myrna Cunningham, the seasoned Nicaraguan campaigner for indigenous rights, appointed by IUCN as a Patron, was quite forthright. Her response was that Tibetans must never give up, even when their loss of land and livelihoods is in the name of creating a park. Tibetans, she said with all her years of tireless campaigning for indigenous people at the UN behind her, should take the campaign to get back on to their homelands to every venue, every forum, every official institution and UN agency and committee and special rapporteur possible, and keep going. The management of protected areas, she said firmly, should be based on human rights. “And by that I don’t just mean individual rights but also the collective rights of peoples,” she said. “That includes rights over ancestral territories, rights that are named in the UN Declaration on Rights of Indigenous People (UNDRIP). All UN agencies formally recognise those rights, even when it is hard to persuade them to do the work of implementation.”

She took a deep breath. “I understand that the Tibetans face more problems than others. Their case is difficult, I know. They maintained their land, and now they are blamed. Asia generally is very difficult; there is no regional instrument or commission to protect human rights.”

She paused. As a Miskita indigenous woman, survivor of a genocidal campaign against her people, and as chairperson of the United Nations Permanent Forum on Indigenous Issues until 2012, she has lived through much. She said, “we do need a paradigm shift, all of us, we all need to change. And that includes IUCN. IUCN needs to change how it looks at the world.”

 

INCONVENIENT GROUND TRUTHS

If IUCN is to get past its erasure of the Tibetan nomad case for their ancestral lands, it will need to reconsider the sloppiness of its language, such a contrast to the granular sharpness of its satellite imagery. The UNEP IUCN WCMC protectedplanet database, designed as a one-stop portal for anyone seeking definitive information on all the world’s protected areas, is so sloppy that its only words defining the purpose, management and operations of the Sanjiangyuan nomad removal zone is attributed to Wikipedia. When one looks up the Wikipedia article which protectedplanet.org cuts and pastes, there is no source at all for the assertion that grazing bans are a necessity, fencing is necessary, that even when grazing is not fully banned pastoralists must be “supervised” and residents “resettled.” No source is given for this concise summary of China’s official policy, since 2003, of “closing pastures to grow more grass”, in Chinese tuimu huancao.

Sloppier still is the claim that, along with removing pastoralists, “rangeland has been fenced and is in the process of being privatized throughout the Sanjiangyuan Area.” What is meant here by privatization? In an era of neoliberal corporate reach into even the remotest areas, privatization could be a discreet term for the reality, in depopulated parts of the Tibetan Plateau, for mining companies to move in, even in officially designated parks and protected areas. The despoliation of Tibet by mining companies, while pastoralists, removed far from their land are helpless to protect it, is one of the main complaints of the Tibetans. The brochure Jigme Norbu handed to thousands of people in Sydney featured this appalling truth behind the many protests by Tibetans, even public suicides in Tibet, to draw attention to the pillage going on in officially protected areas.

It’s not that sort of privatization that www.protectedplanet.org  means. Privatization is a common translation into English of the Chinese concept of making individual households responsible for what happens on land allocated to them. Since there is no private ownership of rural land in China, privatization is a misleading term. What is worse is that when pastoralists are banned from grazing the pastures that have always been their land, their home and their life, the “privatization” is cancelled, they lose their rights to their land, often the land tenure certificates issued to them 20 years ago are cancelled, and they are destitute, dependent on official handouts, themselves treated, as the pastoralists often say, like animals. What is happening, in the name of conservation and parks is the nullification of the limited “privatization” that gave pastoralists some security 20 years ago, only to have that land tenure once more taken from them, this time in the name of park making. Privatization, and loss of land tenure are opposites.

Maybe none of this matters to IUCN, even though it strongly advocates indigenous management of protected areas. IUCN, like all major institutions in a neoliberal world, is adept at walking all sides of the street at once, at cultivating both the passionate indigenous conservationists and big corporate sponsors. The contemporary art of being all things to all people, while corporate access to the remotest forests, highest pastures and deepest oceans ever expands, is a wonder of modernity. Zhang Xinsheng, a pioneer and prime beneficiary of China’s rise and rise, was an obvious choice for IUCN, as his carefully crafted curriculum vitae on the IUCN website reveals.

IUCN’s capacity to draw together the entire spectrum of those who hope to negotiate a long term future for the earth, is pitched to business as IUCN’s “convening power”, and thus for IUCN as the venue for managing “a continuous and constructive dialogue between business and other sectors of society.” The business of managing Tibetan lands for the ongoing profitability of downstream Chinese city and industrial water supply, by making Tibet a depopulated parkland, is for IUCN business as usual, and Tibetan protests have so far been ignored. Tibet hardly fits IUCN’s business model, or the IUCN slogan, “Nature is our Business.” Nature, especially the mineral wealth under the pasturelands of Tibet, is now China’s business, all the more accessible with Tibetans calling for life, land and livelihood removed to urban fringes.

IUCN, WCMC and also the Global Environment Facility of the World Bank have ended up abetting China’s invalidation of Tibet’s pastoral production landscape.

 

THE NEW MASTER NARRATIVE OF DEGRADATION

Where one ends up depends much on where one starts from.  For all these global conservation institutions, the starting point, where they buy in, is China’s depiction of the pasture lands as badly degraded. If the land is degraded, it should be restored, the kind of narrowly defined, technicised program that the GEF and IUCN are so focused on. Everything follows from accepting China’s rhetoric of degradation, usually expressed by alarming statistics claiming that as much as 90 per cent of Tibetan pasture land is now degraded, and becoming desert. Since there are few independent expert verifications of the alarmist discourse, and Tibetans may not speak for themselves, no-one notices that Tibetan pastoralists seldom see degradation as a major problem, except within the strictly fenced areas allocated to individual families which now, against all custom, must suffice, both in summer and winter, to meet each Tibetan family’s subsistence needs.

All else follows. Once the entirety of Tibet is encompassed by the language of degradation, over-grazing and “fragile ecology”, it seems the next logical step to proclaim grazing bans, exclusion zones, and a goal of greatly increasing the weight of biomass growing above ground. That simple metric is then the sole criterion of success. We now have a technical problem and a technically defined solution.

The aspects of this scenario that don’t fit this chain of logic are swept aside. It is seldom noticed that China’s scientific estimates of the extent of degradation vary wildly, between 30 per cent and 90 per cent. No external agency wants to get into the murky territory of what caused this degradation, especially if it starts to look like successive state policy failures are the primary cause, rather than ignorant and careless pastoralists ruining their own ancestral lands. Little attention is paid to how degradation is defined, even though the claims of 70 or 90 per cent degradation rely on assuming that a totally ungrazed grassland wilderness can be defined as not degraded. A further complication that no-one wants to know about is that the hardy grasses and sedges of the Tibetan Plateau, used to not only grazing but also gales and blizzards, keep most of their biomass not above but below ground. That is awkward, because above ground biomass is measurable by satellite, without any of the hard work of going out into pastoral regions and looking closely; but below ground biomass can’t be measured by satellite. Nor does it matter that the crude slogan of “growing more grass” means in practice that tall, ungrazed grasses shade out the lower growing herbs that are an important source of traditional Tibetan medicines. That means that even as grass grows, biodiversity shrinks, the pasture reverts to shrubland, undoing centuries of careful pastoral stewardship.

To admit such complications adds too many variables, uncertainties and new starting points. To include the pastoralists as part of the solution, however the problem is defined, is also too hard. China is set on sedenetarising the pastoralists of Tibet, especially in the headwaters of China’s great rivers, in the Sanjiangyuan Nature Reserve, and the participation of international partners is predicated on accepting China’s policy.

Thus we end up very far from IUCN’s espousal of indigenous management of parks and protected areas, even though WPC2014 in Sydney featured many workshops on the success of Indigenous Protected Areas around the world. IUCN has yet to notice that, when it comes to Tibet, it is upside down and back to front; and the Tibetan pastoralists are the losers.

IUCN can readily remediate this mistake. It has all the tools, guidelines and policy manuals to do so, in-house. If the Sydney Olympic Park can remediate its heavily polluted past, so can its most recent guest, the International Union for the Conservation of Nature.

When China takes over leadership of major international institutions, those institutions develop institutionalised blindness to the voices of Tibetans. In the case of IUCN, the blindness is entirely curable.

 

[1] Business mind, philanthropic heart, The Business Times, 11 Jan 2011

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PROTECTION OR DESTITUTION?

 

What is really happening in protected areas in China

BY ENVIRONMENT DESK OF TIBET POLICY INSTITUTE, INDIA

For IUCN World Parks Congress 2014

 

Sanjiangyuan county map in English

When a government declares an area protected that’s good.

When state power draws a red line round a large area, designating it a nature reserve, that’s good, right?

Not always. What seems on paper to b e another step in protecting the planet is actually meaningless if, within that red line, miners are allowed in, while authority looks away. That’s bad. That’s what is happening in many of the biggest protected areas in China.

What seems on paper to be protection for all sentient beings is the direct cause of poverty, immiserisation and destitution when the indigenous stewards of the land are forced to lose their livelihoods and leave their ancestral lands, without any consultation. That’s what is happening today in Tibet.

Tibetan nomadic pastoralists are being excluded, without say, en masse, from a huge area of prime pastoral land, in “the second largest nature reserve in the world”, that includes four entire prefectures, more than half the area of Qinghai, a big province, in the name of conservation. Rather than including the pastoralists in solving problems of watershed protection and land degradation, hundreds of thousands of skilful Tibetan pastoral nomads are losing their livelihoods, officially designated as “ecological migrants.”

IUCN classifies the 363,000 sq kms of the Sanjiangyuan Nature Reserve (SNNR), on its protectedplanet.org  database as WDPA315729, home to 100 iconic species, a few of which are classified as endangered. China classifies this vast green pasture as its “number one water tower”, because both of China’s great rivers, the Yangtze and the Yellow (and the Mekong of SE Asia) all rise in Tibetan glacial peaks, then meander all the way through these great grasslands. China, short of water after decades of over-use, has now decided its access to upstream sources is best guaranteed by depopulating the best grazing lands of the entire Tibetan Plateau, and IUCN seems to uncritically agree.

IUCN, on its global database of protected areas, cuts and pastes from Wikipedia: “To protect the grasslands, pastoralists are not permitted to graze their animals in designated ‘core zones’, and grazing is supervised elsewhere in the SNNR. In addition, residents have been resettled from core zones and other grassland areas of the DSCN1378smSNNR, and rangeland has been fenced and is in the process of being privatized throughout the Sanjiangyuan Area.”

The Wikipedia article provides no source for the above statement, which is not a scientific assessment but a summary of China’s official stance.

This narrative makes China look good, and the nomads problematic, irrational and backward abusers of the common pool grassland resource. In reality Tibetan nomads have cared for these lands for 9000 years, the archaeologists say, accumulating deep knowledge of sustainable grazing practices that maintain biodiversity, natural values, carbon capture and water quality.[1]

Worldwide, IUCN encouraSanjiangyuan nature reserve map tashi Tsering 09ges local community engagement with conservation, and indigenous knowledge as a primary asset in achieving conservation outcomes. Yet, on the Tibetan Plateau, where communities have no opportunity to organise their own NGOs, officials have decreed, since 2003, a policy of tuimu huancao, closing pastures to grow more grass. This shows China does not understand how grazing economies work, by balancing livestock grazing pressure with the growth cycle dynamics of indigenous grasses and sedges in the cold Tibetan climate.[2] China says: “there is a contradiction between grass and animals.”[3] The more grass, the fewer possible animals; vice versa, the more animals you have, the less is the grass. This means you cannot have both, it is a zero/sum logic. That is a fundamental misunderstanding of pastoralism, as practiced anywhere worldwide.

Since 2003, China’s steady implementation of its policy of displacing populations in the name of conservation[4] has made hundreds of thousands of nomads redundant, dependent on official handouts, leading marginal existences in peri-urban concrete settlements, often far from their pastures.[5] In most cases they are forbidden to return to livestock production, even when the grazing bans technically are for three or five year experimental periods. They are seldom given training in modern skills, and their traditional knowledge of rangeland dynamics is ignored.[6]

IUCN appears to have made a grievous mistake. IUCN elsewhere has a good record of championing indigenous knowledge and traditional community practices as beneficial for biodiversity conservation. IUCN has frequently published reports and guidelines on how to include local communities in the management of protected areas. Yet in this huge heartland of Tibetan pastoralism, bigger than the UK, nomad voices have been forcibly silenced,[7] leaving only the official voice insisting the exclusion of people is an objective scientific necessity.Sanjiangyuan in China context uncluttered map

IUCN MAP OF SANJIANGYUAN PROTECTED AREA, AND ALL PROTECTED AREAS IN CHINA, MOST OF WHICH ARE ON THE TIBETAN PLATEAU

 

 

WHY IS THIS WRONG?

  1. Excluding the custodians of the land who have intimate knowledge and millennia of experience in sustainable management is a net loss of successful curation of whole landscapes that can never be replaced by the current reliance on GIS satellite data and a handful of research stations.
  2. Tibetan nomads never fenced their land, allowed wildlife herds to mingle freely with domestic animals, their annual migration unhindered. Only since Tibet came under China’s active control since 1960 has biodiversity plummeted.
  3. Past policy failures are unmentionable, shifting the blame for land degradation onto nomads.[8] State failures since 1960 include communisation, compulsory fencing, allocation of land to small family units rather than larger and more flexible traditional tent-circles of many families pooling herds. Rigid stocking rates and carrying capacity regulations have restricted nomads to staying in their fenced winter pastures year-round, putting excessive pressure on small areas, with resulting degradation, which also made nomads poorer.[9]
  4. The Tibetan Plateau, traditionally highly self-sufficient in food production is now rapidly losing food security, relying instead on imports from distant Chinese cities. At a time when food insecurity is a global problem, taking such a big area out of livestock production is folly.
  5. Grazing land from which yaks, sheep and goats have been removed, along with the herders, reverts to unproductive shrubland. Biodiversity reduces as grazing pressure no longer cuts the taller grasses, allowing shorter medicinal plants to flourish in the sward.[10] Scientific research shows that China’s “close pasture to grow more grass” policy is failing to attain its stated objectives.
  6. Mining has proliferated in protected areas, often with the connivance of corrupt local officials. Far from protecting degraded land, official designation of protected areas in Tibet effectively removes the local protectors and allows illegal mining companies in, who further destroy the “fragile ecology” of Tibet. In 2014 the Chinese Communist Party’s anti-corruption squads have many times singled out mining in Qinghai province as an epicentre of corruption. The Sanjiangyuan Nature Reserve is half of Qinghai.
  7. Land tenure rights allocated by the state to nomad families in the 1990s have been abrogated. Often Tibetan families have to surrender their land tenure certificates, even though, when they were issued, they were promised long term land security, as were China’s farmers. In China, perversely, forest dwellers are now gaining better land tenure, while rangeland dwellers are losing theirs.

 

Is this a degraded landscape requiring exclusion of customary livestock production?

Is this a degraded landscape requiring exclusion of customary livestock production?

China buys agricultural land worldwide to meet the accelerating demand of its people for protein; while wasting the best productive Tibetan land. China has discovered a taste for milk, yet Tibet, where dairy products are the main marketable surplus, plays almost no part in meeting urban China’s demand for dairy. The potential benefit of linking the Tibetan economy to modern China has not been realised.

China has designated huge portions of the Tibetan Plateau as protected. Over half of all the protected area in China is on the Tibetan Plateau. China says 1.557 m sq kms are protected. On the Tibetan Plateau, in the 150 counties officially designated as areas of Tibetan ethnicity government, protected areas are 770,000 sq kms. Of that total, nearly half is the Sanjianyuan Nature Reserve of nomad exclusion.

China is praised worldwide for setting aside so big a protected area, offsetting criticism that China is the world’s biggest greenhouse gas emitter, consuming more than half the global coal use each year. China wins points carbon capture by excluding human use and grazing, without evidence that over the long term the net carbon balance is improved.

IS THERE A BETTER WAY?

The nomads of Tibet need not be dismissed as the ignorant source of land degradation. They can be, and want to be part of the solution. Removal of human populations should be the last resort, but in China efforts to rehabilitate degrading rangelands have been sporadic, half-hearted and inconclusive.

The methods IUCN advocates are the answer. Co-management, based on empowering pasture user groups, a partnership of government and the local communities, is the way ahead. This has been proven, many times, around the world, and IUCN has often documented such successes. Instead of fencing nomads out, employing them to re-sow native grasses and tend disturbed areas, under scientific guidance, brings together agricultural extension science, biodiversity ranger employment and poverty alleviation in one package, that results in REDD+, the reduction of degradation and deforestation through payment of local communities for the ongoing environmental services they provide, especially to China’s downstream urban masses.

Climate change makes inclusion, not exclusion, more urgent. The TibetaSanjiang nature reserve mapn Plateau, like the poles, experiences climate change at an especially rapid pace, with earlier spring melting permafrost and draining ice in the soil before plant roots can reach it as the short growing season begins, well before the monsoon rains arrive. As a result, many Tibetan wetlands have been drying and shrinking, which threatens migratory species reliant on the wetlands. Several wetlands, including those with Ramsar listing, were drained at China’s insistence in recent decades, further accelerating the desiccation of these key areas. Much work is now needed to fill the drainage ditches, which also reduces methane gas emissions and peat fires, especially in the Dzoge wetland, a 500 sq km Ramsar site on the Yellow River just east of the Sanjiangyuan Nature Reserve. Poor Tibetans need employment, and land rehabilitation, if done well, is often labour-intensive. IUCN can help persuade China there are better alternatives than exclusion, depopulation and the outdated “tragedy of the commons” argument.

Which human rights are infracted by China, with IUCN’s rubber stamp, depopulating the great grassland of eastern Tibet?

  • The right to food and food security
  • Right to land and secure land tenure
  • Right to livelihood, income and self-employment
  • Right to free speech and assembly, routinely abrogated when Tibetans protest displacement and invasive resource extraction, invariably suppressed violently by state power

These repeated rights violations flout the good work IUCN does worldwide and the approach to conserving the planet IUCN consistently advocates as the right path. These violations have been well known for years, despite China’s efforts to silence Tibetans and forbid external scrutiny. In 2007 Human Rights Watch published an analysis of nomad removals, telling titled No-one has the Liberty to Refuse.

The most recent fieldwork report comes from Chinese ethnologist Qi Jinyu: ”The local people reckon that their behaviour does not cause overgrazing, but although they don’t agree with the official theory of overgrazing, they nonetheless had to submit to the state’s decision to proceed with migration and create a ‘no-man’s land’ wilderness protection zone.”[11]

China has been questioned many times at the UN over the immiserisation of nomads. China’s 2014 haughty official response to UN special rapporteurs is that: “China’s nomadic pastoralists have been following a lifestyle of moving from place to place in search of water and grass for the past several thousand years; this kind of lifestyle is characterized by instability; not only does it adversely impact their productivity, but it also influences their lives. Appropriately settling them could change their lifestyle, not only benefiting the development of production but also helping these nomadic pastoralists to further develop themselves and enjoy modern civilization. The specifics of where to settle them and by what means should be scientifically designed and comprehensively arranged by the local government.”

Specifically focussing on the Sanjiangyuan protected areas, China tells the UN it is “organizing the transfer of human populations from the Sanjiangyuan core region for ecological purposes, thereby protecting and restoring the region’s ecological function, and encouraging sustainable development and harmony of humans and nature.”

The Himalaya and Tibetan Plateau is warming three times faster than the global average. Tibet is on the frontline of global climate change. This is not the time to exclude those who can replant and rehabilitate degrading areas, by including them in the design and actual work of repairing damage done by past state failure and accelerating climate change. The Tibetan Plateau, close to two percent of the land surface of our planet, needs all the help it can get. Exclosing people from protected areas should be the last resort, after all other methods have been tried. In China, it is the first resort a social engineering solution to a problem that originates in state policies that over recent decades concentrated both Tibetan nomads and their herds on smaller land allocations, removing much of their customary seasonal mobility, the key to reducing grazing pressure and preventing degradation.

 

 

[1] Georg Miehe, Sabine Miehe,  Knut Kaiser, Christoph Reudenbach, Lena Behrendes, La Duo, Frank Schlütz; How old is pastoralism in Tibet? An ecological approach to the making of a Tibetan landscape: Palaeogeography, Palaeoclimatology, Palaeoecology 276 (2009) 130–147

[2] National Research Council, Grasslands and Grassland Sciences in Northern China, Washington, National Academy Press, 1992

[3] BAO Fenglan A Study Of The Countermeasures Of Optimizing Animal Husbandry Structure Of Inner Mongolia; Journal of Inner Mongolia Normal University (Philosophy & Social Science) 2005-06

Du Xiaojuan ; Cheng Ji-min; Analysis of Formation Causes of Grassland Degradation in Damxung County of Tibet and Its Exploitation and Utilization; Journal of Anhui Agricultural Sciences , 2007

[4] Emily T. Yeh, Greening western China: A critical view; Geoforum 40 (2009) 884–894

[5] Jarmila Ptackova, The Great Opening of the West development strategy and its impact on the life and livelihood of Tibetan pastoralists: Sedentarisation of Tibetan pastoralists in Zeku County as a result of implementation of socioeconomic and environmental development projects in Qinghai Province, P.R. China: PhD thesis, Humboldt University, Berlin, 2013

[6] Maria E. Fernandez-Gimenez … [et al.].,Restoring community connections to the land : building resilience through community-based rangeland management in China and Mongolia, CAB International,  2012

[7] http://www.rfa.org/english/news/tibet/resist-11072014165412.html

[8] Geoffrey Wandesforde-Smith, Kristen Denninger Snyder & Lynette A. Hart (2014): Biodiversity Conservation and Protected Areas in China: Science, Law, and the Obdurate Party-State, Journal of International Wildlife Law & Policy, 17:3, 85-101,

[9] DEE MACK WILLIAMS, Grassland Enclosures: Catalyst of Land Degradation in Inner Mongolia, Human Organization, Vol. 55, No. 3, 1996

[10] J. Marc Foggin and Andrew T. Smith . 1996.Rangeland Utilization and Biodiversity on the Alpine Grasslands of Qinghai Province, People’s Republic of China. in: Conserving China’s Biodiversity (II) (PETER Johan Schei, WANG Sung and XIE Yan eds.). China Environmental Science Press. Beijing. 247-258p.

[11] James Miller ed., Religion and Ecological Sustainability in China, Routledge, 2014, 371

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THE LHASA CONSENSUS

“LHASA CONSENSUS” AND CHINA’S WESTWARDS DEVELOPMENT

A gathering in Lhasa in August attracted brief headlines, generated less by its’ dry subject –the future development of Tibet- than by the intriguing announcement of a “Lhasa Consensus.” This knowing nod to the once-famous “Washington Consensus” held out the enticing prospect that the Tibet problem is now solved, consensus has now been reached.

The assembling in Lhasa of a smattering of establishment intellectuals from China’s official think tanks and universities, plus a few little-known scholars from around the world hardly justifies the issuing of a grandly-named “Lhasa Consensus.” The declaration is far less impressive than its’ title. It amounts to saying Tibet is doing just fine as China’s outpost and raw materials extraction zone for the world’s factory, and there is little else to say. The problem of Tibet is solved, Tibet is China’s, there is little more to discuss, we can revert to ignoring it altogether.

Probably the “Lhasa Consensus” will go the way of its model, the famous “Washington Consensus” of the 1990s, a brief moment, it turned out, when the US could congratulate itself on having won the Cold War, becoming the sole global superpower; neoliberal market economies were certain to forever rise, financial crashes were a thing of the distant past; and nationalism a fading force. How wrong all of that was. All of it.

At a time when both China and India have strong leaders, on whom many hopes are pinned, the “Lhasa Consensus” is a relic of a fast fading era. Tibet and “the Tibetan question” remain frozen in  stale all-or-nothing clichés, with little sign of fresh thinking anywhere. In part, this is because so few Tibetans had a speaking role in this Forum on Development of Tibet, as is evident from available online footage. As usual, the Tibetans in the room were largely sherpas, the logistic facilitators essential to all conferences worldwide, helpers of those entitled to speak.

The “Lhasa Consensus” has risen without a trace and will not be heard from again. So ephemeral is this “consensus” it may have seemed a good idea to give a conference declaration a grand moniker, but it didn’t fly.

The notion of consensus suggests finality, a settled truth, a comity of minds in harmony. But, as any MBA teacher will tell you, today’s consensual truths cause tomorrow’s problems. Today’s solutions, and their unintended consequences, create perverse outcomes and new problems. That is why the Buddhists always urge us not to take those happy moments of consensus too seriously.

But the consensus among obscure academic hacks that Tibet is doing just fine under China is far from the only complacent consensus around. In addition to the Washington and Lhasa consensualities, we could also suggest there are entrenched Beijing, Delhi and Dharamsala Consensuses, in all but catchy name.

The Beijing Consensus is perhaps the most familiar. It is embraced not only by the party-state but by Chinese critics of the dominant elite as well. There is consensus, both tacit and explicit, that China is on the right path to prosperity, which is the purpose of life. The key to not only comfort but even opulence is to persist with development and urbanisation as fast as possible, while taking greater care to ameliorate the worst of environmental impacts. Urbanisation and fast growth are the cure to all problems, applicable to all areas within China’s borders, including Tibet. If the Tibetans are unhappy, this is just the growing pains of a prehistoric and primitive folk adjusting to urban modernity and life as factory workers. Like the rest of China, they will come to realise that they can learn to become consumers, and will inevitably outgrow their anti-modern stubborn clinging to the past.

The Beijing Consensus, and its echo, the Lhasa Consensus, are deeply flawed in their assumptions, perceptions and even basic understandings of what Tibetans actually think. Like all tribal consensuses, it is self-perpetuating and self-deluding; editing out of sight all that contradicts it.

The Delhi Consensus, by comparison, seems an improbable concept. In a brawling, restless, democratic India, there seems to be little consensus on anything. It may be that only when a consensus starts to fall apart that it becomes obvious how entrenched it was, how much it defined what is normal. And, if the Modi government lives up to half of what its backers expect, that consensus may rend.

Today, on the cusp of Modi’s adoption of China’s 1980s model of Special Economic Zones (SEZ) of intensive industrialisation, immune from ordinary Indian laws and rules, we can perhaps sketch the existing Delhi Consensus. Domestically, the  Consensus is that India is best ruled by its upper castes, its’ industries protected from global competition by “intra-ministerial disagreements, mystifying constraints, narrow visions and a reluctance to involve competent people, heavy handedness and restrictions imposed by bureaucrats.”  Those are the words of Tansen Sen, author of deeply reflective histories of India-China relations. He speaks from experience: “Mutually suspicious bureaucrats have hesitated to facilitate people-to-people, industry-to-industry or sub-region-to-sub-region exchanges and collaborations. This is clear by the limited educational interactions between the two countries due to the Indian Ministry of Home Affair’s reluctance to issue visas to Chinese students and instructors and the failure of the Bangladesh–China–India–Myanmar sub-regional collaborative initiative.”

The Delhi Consensus has long agreed on warily, even fearfully keeping China at a distance, while treating South Asia as a region India can dominate. The 1962 war with China is as if it happened yesterday, or as if China has never changed its aggressive ambitions. There is no domestic constituency within India that speaks up for China, other than The Hindu.

This is about to change, if we are to believe Modi can implement his known strategy.  By adopting the SEZ model, India will create extra-territorial enclaves where Indian norms and laws barely apply. If he succeeds in attracting Chinese investment into the SEZ, in partnership with India’s biggest corporations and best known brands, he will replicate what Deng Xiaoping did in the 1980s. Coming at a time when China’s comparative advantage of endless cheap labour is fast fading, this could be India’s big breakthrough, and India’s industrialists know it.

“What Modi plans to do, his advisers say, is end India’s reliance on procuring from China, and instead, bring Chinese companies to India to invest and manufacture locally. Doing so will fundamentally transform the nature of India-China relations. No longer merely transactional, the relationship will be driven by Chinese companies manufacturing in dedicated industrial parks in India. Now that Modi is the man at the Centre, the expectation in China is that Prime Minister Modi will not be all that different from Chief Minister Modi, who made four visits to China and travelled widely around the country, visiting Special Economic Zones (SEZs). As National Security Adviser Ajit Doval puts it, Modi has, through his travels, ‘condensed the Chinese achievement into three words: speed, scale and skill. And Prime Minister Modi believes India should benefit from that’”.

If India is about to upspeed, upscale and upskill, with SEZ in the lead, India will be transformed, both as an exporter of manufactures, and as a consumer nation in which the big corporations finally succeed in pushing aside the myriad small merchants and shopkeepers. As in 1980S China, and throughout the industrialised world, big corporations will boom, and they will have a vested interest in China as a major source of their prosperity, inheriting China’s mantle as the world’s factory. For the first time, India will have a powerful domestic pro-China lobby. Ananth Krishnan, in India Today, speculates that Chinese investment: “ will fundamentally transform the nature of India-China relations. No longer merely transactional, the relationship will be driven by Chinese companies manufacturing in dedicated industrial parks in India.”

The longstanding Delhi Consensus, preoccupied with China as a danger, sees the Tibetan presence in India as a way of maintaining leverage in dealings with China. Once the biggest of Indian corporations discover they can profit more by partnering with China’s biggest corporates, this consensus will fragment.

In the longer term, it may even be that the almost defunct vision of regional economists, of mutually complementary economies lifting each other, may revive the plans for effective linking of China’s western development thrust with the future of northeastern India, Bangladesh and Myanmar. The potential for economic take-off is evident, with the electricity essential to intensive industrialisation coming from Arunachal Pradesh and, further upriver, Tibet, powering Kolkata, Kunming and everywhere in between.  This vision of a regional trading boom is almost forgotten, kept alive only by the Asian Development Bank. It is also championed by Delhi University’s Institute for Economic Growth.  Similar visions of complementarity drove Australia, in the 1980s, to integrate its economy with China. Australia boomed. This may well appeal to Modi’s liking for greater speed, scale and skill.

This economists’ dream is known only as the unmemorable BCIM Corridor, starting in Kolkata, heading east to Dhaka, Manipur, Mandalay and finally Kunming.  The Corridor will have its own hinterland from which to draw raw materials, including the rich mineral resource endowments of India’s northeast and the Tibetan Plateau. It could take decades for these potentials to be realised.

The Washington Consensus, in retrospect, seems at best an embarrassing convergence of causes and conditions that led to ridiculous assertions of an uninterrupted unipolar Americanised world. However, its doctrine, of free trade and neoliberal markets, may yet breathe life into Modi’s India and even into the BCIM Corridor.

The Delhi Consensus may fracture for the same reason. India’s biggest businesses now stand to gain more from partnering with Chinese SEZ investors than from keeping them out. India’s globalised corporations now dream of India becoming 1980s China, its’ cheap labour inexhaustible. India will for the first time have a powerful domestic lobby arguing for accommodating China.

There is another way in which the “Lhasa Consensus” truisms of a happy, harmonious and prospering Tibet do a disservice to the actual debate. On the ground, there are not only Tibetans who hope for an authentically Tibetan but also modern future, there are others who sincerely hope for development with Tibetan characteristics. One can find Han Chinese, in senior positions, even within the same State Council that sponsored the “Lhasa consensus” conference, who are unusually open to Tibetan voices. They advocate development in Tibet, by Tibetans, for Tibetans; rather than the imposition from above and afar of a new economy of resource extraction and mass tourism, all with distinctively Chinese characteristics and Chinese beneficiaries.

The Tibetans, Chinese and westerners who propose strengthening Tibetan enterprises, civil society, rural communities, growth that is from the ground up, are in a precarious middling position. They come to conferences on development in Tibet, not to sign on to spurious consensus, but to do the actual work of strengthening Tibet. They are usually misunderstood. On one side is a highly interventionist central state with a long tradition of social engineering and a model built for China, not Tibet. On the other side are Tibetan exiles and external critics, who routinely misunderstand those who seek to strengthen Tibetan schools, clinics, businesses and cultural maintenance, as traitors to the Tibetan cause. Those working the middle ground in a polarised world are liable to being mistrusted by one or both sides.

Behind the “Lhasa Consensus” headline are the few who eschew political polarities, and get on with actual development work. One day it may be their turn. There is a new participant in conferences on development in Tibet: the modest NGO trying to make a difference on the ground, by encouraging Tibetan entrepreneurs. One such attending this State Council conference and its declaratory “Lhasa Consensus” was a young German language teacher immersed in helping Tibetans create small businesses.  Otto Kolbl is one of several westerners trying to find practical empowerments for Tibetans to enter modernity on their own terms. It does not help that China’s central propaganda office cites him in its upbeat coverage of the new “Lhasa Consensus.” A middle way is hard to find in a bipolar world where everyone is deemed for or against.

China’s official media made much of this event as “the first international conference themed on the development of Tibet”, or at least the first such conference held in Lhasa. This is an odd boast. As early as 1998 Brandeis University, Boston, held conferences on development of Tibet. I convened a panel on development of Tibet at the 2003 seminar of the International Association for Tibetan Studies. China has ignored these and many other meetings on development, at which development NGOs, now largely excluded from working in Tibet, shared their practical experiences.

At least the researches of economist Andrew Fischer on Tibetan development have been translated into Chinese. Far from proudly announcing that at last a forum on Tibetan development has been held in Tibet, China might wonder why it has taken so long.

The simple idea, too simple to be noticed, is that genuinely helpful development should be based on the existing strengths and comparative advantages of the traditional Tibetan economy. Rather than imposing from above an energy-intensive, capital-intensive enclave economy from above, as China has done, Tibetans need help adding value to their wool, dairy products and livestock. Tibet needs fewer proclamations of “Lhasa Consensus” and more actual work rehabilitating degrading pastures and getting Tibetan yoghurt and butter to the booming Chinese urban market.  Hardly a headline in any of that, but it would achieve a lot.

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CAN XI JINPING CREATE A NEW REALITY?

BUT FIRST, DO THE DIRTY DISHES

The previous blog on Steve Jobs and Xi Jinping made the seemingly counter-intuitive case for likening Steve Jobs and Xi Jinping. It’s not just the sheer force of will both embody, but the capacity to proclaim new realities, a new normal that fuses a mass of contradictions into a coherent narrative that everyone can buy into, and feel part of. That magical ability satisfy yearnings lasts as long as the magician is a step ahead. Almost the moment Steve Jobs died, the magic died, we got to see behind the façade, to discover that magical tricks are just tricks, some of them tawdry.

Can the same be said of Xi Jinping? The magic is flowing and new realities are aborning. Foreign observers, focused mostly on China’s increasingly muscular stance internationally, warn of China’s emergence, under Xi, as a regional bully. But at home, Xi ticks all the boxes, among a public that long ago noticed the Chinese Communist Party’s top priority is to look after its own, and its cronies; and that Deng Xiaoping’s promise that eventually everyone gets to be rich doesn’t actually trickle far out of the sticky fingers of the elite. Now that the gap between rich and poor in China is one of the most extreme in the world, the masses have noticed that the party’s monopoly on political power is directly responsible for concentrations of wealth in a few favoured hands.

The previous leaders, Hu Jintao and Wen Jiabao, said as much, many times, but did little to curb the princelings. Many times they warned that extreme concentrations of wealth are a threat to the stability of the party-state regime. Now, Xi Jinping and his supporters are in “their protracted war to save the Communist Party from what they see as terminal decay.” So says John Garnaut, an acute observer with remarkable insider contacts. Garnaut reminds us of the deeply dualistic you-or-me world top party leaders inhabit: “Mr. Xi was raised in a you-die-I-live world where leaders who failed to destroy potential rivals were constantly at risk of losing far more than their jobs. Gradually, the weaker leaders who rose after the massacres and purges of 1989 extended a bargain of market opportunity and immunity to one another, as they worked to fuse the post-communist Communist Party back together following the Tiananmen crackdown. Stability prevailed but so too did corruption. Bureaucracies and state-owned companies became empires unto themselves. Leaders’ families grew fabulously rich. The compact of market opportunity and political immunity held for members of the Politburo Standing Committee for 25 years, until Mr. Xi tore it up late last month.”

Official media call the current campaign Xi’s “iron-fisted corruption crackdown that is winning the peoples’ hearts”  铁腕反腐,“拍蝇打虎”深得民心. There is a lot of winning to be done. What is at stake, as Xi Jinping clearly knows, is nothing less than the fraying of the implicit social contract between rulers and the ruled, as Professor Zheng Yongnian pointed out in May 2014. He went so far as to say that Xi realises he needs to change China’s political ecology. No longer does the legitimacy of the emperor rely on proclaiming the blessings of “heaven’s mandate”, Prof Zheng points out, yet today’s rulers do need to re-establish a source of legitimacy, if the party-state is to survive.

What happens after the purge? Will Xi Jinping then go on to build the China Dream he so often speaks of, and make it available to all, not just the well-connected? That might be a lot to ask of anyone who inhabits a you-die-I-live world, which is the most literal translation of Xi Jinping’s calls for a “life or death” struggle to cleanse the rot.

Assuming the purge succeeds in weakening entrenched resistance to major change, will Xi then launch deeper reforms that enable China’s emergence as a normal neoliberal competitor, in which the rule of law becomes more than a selective weapon to be used against those in the losing faction? Will a new reality emerge, a believable master narrative that persuades the masses to trust a party-state that has lost credibility?

For decades China accepted Mao’s master narrative, a dominant discourse of past humiliation and current renewal, a narrative of victimhood and loss. Now that China is so much wealthier and more powerful, the attractions of ongoing victimhood remain. Whenever China feels its rise is obstructed, the old cry: “Never forget national humiliation!” comes quickly to the lips of leaders, Xi Jinping included.

But the hope of the world is that China outgrows victimhood and a belief in an eternal foreign plot to keep China weak, grows genuinely confident and relaxed, and can take its place in the world. That too has long been the hope of the Dalai Lama, a scenario he has always seen as the best prospect for allowing Tibetans the cultural autonomy they yearn for. A more honest China, not captured by oligarchs, has better prospects for avoiding the “middle-income trap”, a vague term used by economists for the many ways emerging economies slow or come to a halt, their ongoing growth and widening prosperity stymied by entrenched rent seekers.

If Xi Jinping recognises this familiar capture of an entire economy by vested interests as China’s biggest challenge, then he is out to create a new reality –as Steve Jobs did- and the war on corruption is just a clearing of the decks.  Whether this is his long-term intention, and whether he can succeed, are far from clear at this point. But if he is to succeed, more of the destructive aspect of capitalism’s creative destruction is ahead.

That is the big picture Xu Gao invites us to consider. Xu, economist at a leading SOE brokerage, says: “From a longer-term perspective, fighting corruption will actually create more healthy and sustainable economic growth, and therefore its impact on the economy is positive. The reason many including middle-income countries fall into the trap, for example the Philippines, Argentina is the prevalence of crony capitalism. This leads to the allocation of resources by the powerful, and does not depend on the market, resulting in extremely unfair distribution of national income, and  economic growth potential cannot be realized. If you do not oppose corruption, the greater is the probability of the Chinese economy falling into the middle-income trap, and corruption fighting  can reduce this probability.”

That is the long term prospect, but as soon as October 2014, at the Fourth Plenum of the CCP, we may see more clearly whether the rule of law, genuine competition and a modern market economy will emerge.

MINING THE HEART OF DARKNESS

But right now Xi Jinping has his hands full catching the tigers of corruption. The purge has caught many, enough to discern a pattern, making it possible to identify which sectors of the economy have been most attractive to the corrupt. Top of the list, as mentioned in the previous blog, is mining.

Mining is ideal for crooks, for lots of reasons. The profits can be massive, and if they are generated in obscure places, they are readily transferred to private hands, even literally smuggled out as bars of gold. Mining tends to be in obscure places far from effective official regulatory scrutiny, and these days Chinese mining companies are likely to be operating in Zimbabwe, Peru or Tibet. For state-owned mining companies –and most are- its gets better: the finance needed to build a mine comes from the public purse, to which SOEs have privileged access. Further, the SOE resource extraction  companies are the pioneers of China’s global reach, and have often worked closely with China’s central leaders to get the contracts to extract the oil of Angola or the copper of Congo. On top of that, the importation into China of metals mined around the world has also been a major temptation for the corrupt, who use stockpiles of metals in Chines port warehouses as collateral for financialising further borrowings, giving them access to cheap money to sink into quick money but high risk investments.

In fact, it was the widespread practice of using metal stockpiles as collateral for loans, over and over, rather like mortgaging your house four times over to four banks at once, that led to the exposure of mining, and specifically mining in northern Tibet, as an epicentre of corruption.

What is the evidence for this? The corruption at the Qingdao port is documented in dozens of reports, as the biggest of banks and other lenders, rushed to Qingdao to verify whether the  metal stockpiles, putatively exclusively theirs should the borrower default, actually exists. The biggest of global commodity traders and lenders had the capacity to send their own investigators to check. The Tibetans have no such capacity so safeguard their landscapes, their sacred mountains and lakes, from mining. When they do protest, ever so politely, quoting Xi Jinping’s own words on environmental protection, they are teargassed, forcibly dispersed, often arrested and tortured.

Mining now takes place all over Tibet, nearly all of it technically illegal since all but the biggest and most modern mining was banned, especially in Tibet Autonomous region, by decree, almost a decade ago. In today’s China, what is technically illegal often flourishes, under local government protection, while national leaders proclaim themselves good global citizens. If illegal golf courses can pop up all over China, right next to major cities; it is not hard for illegal mines in remote areas to function. A new book on the proliferation of illegal golf courses, gobbling up prime arable land needed for food production, has just been published. The only book on the new mines in Tibet is the one I wrote a year ago, before the recent revelations of corruption. So this is an update on that book, Spoiling Tibet: China and resource nationalism on the Roof of the World.

Wang Qishan, secretary of the Communist Party’s Central Commission for Discipline Inspection singled out mining and resource extraction at the top of his list of industries prone to corruption. In mid July 2014 he”urged inspectors to watch closely over corruption in mining, natural resources, land transfers, real estate developmentconstruction projects, public and special funds” according to the official Xinhua news agency.

The metals warehouse rehypothecation scam is connected to an inner-party investigation into Western Mining, the only major Chinese mining company headquartered in Tibet, in Xining city. Western Mining, on its website, is ambitious about getting big and going global, and is in a hurry to arbitrage its base of assets in Tibet into something bigger: “WMG’s overall objective in the 12th Five Year Period [ending 2015] is to become a major force in Chinese mining sector through continued structural readjustment, better recycling and brand building in our main businesses, lead, zinc, aluminum and copper and improved our overall competitiveness and profitability. Our goal in the coming five to seven years is to make total assets and sales revenue both hit the threshold of RMB100 billion so as to build WMG into a renowned multinational corporation and offer better assistance to Qinghai province in transforming its modes of economic development and adjusting its economic structure.”

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The rise and rise of Western Mining began with a zinc and lead mine in northern Tibet, on the northern edge of the mineraliferous Tsaidam Basin. Starting life in the 1980s as the Xitieshan Mining Bureau, a branch of the Ministry of Land and Resources, it later rebadged itself Western Mining, under the  adroit leadership of Mao Xiaobing who was so well-connected he eventually became mayor of Xining city, capital of Qinghai province, in which position he was arrested in April 2014, accused of widespread and long standing corruption.

Mao Xiaobing (ABOVE) pulled off many acquisitions of key mines in Tibet, and  got Western Mining into the club of major mining houses to be bulked up by the party-state to become one of China’s “national champions.” This story is told in my 2013 book, Spoiling Tibet: China and Resource Nationalism on the Roof of the World, Zed Books, London.

Now, it seems, Mao Xiaobing cut too many corners, and has come undone.

 

 

 

 

 

 

 

 

 

 

 

 

 

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STEVE JOBS AND XI JINPING

WHAT DO THEY HAVE IN COMMON? MORE THAN YOU MIGHT EXPECT

 

What could Xi Jinping and Steve Jobs have in common? To liken them is surely a stretch?

Maybe not. It’s not just the personal psychologies of two alpha males driven to tightly control all aspects of their mighty enterprises. There are plenty of men who are control freaks, few of whom achieve total command of anything as big.

What these two do share is an extraordinary will to conquer all obstacles, to create new realities, invent new human needs and then establish elaborate processes for meeting needs people didn’t know they had.

Steve Jobs was famous, for as long as he lived, for creating realities, not only getting away with behaviour that in others would be deemed reprehensible or even criminal, but making it a virtue. Only after his death has it become apparent that he would stop at nothing in his quest for a machine that met needs others hadn’t even imagined. Only now is it coming to light that he struck collusive deals with competitors to avoid hiring each other’s staff,  creating an “orderly” labour market in which skilled employees lost their bargaining power. What seemed at the time to be light-bending magic now turns out to be obsessive ruthlessness. http://www.scribd.com/doc/201651711/October-24-2013-Class-Cert-Order 

Xi Jinping has likewise made a seamless whole out of a mess of contradictions, and now offers his customers –the Chinese people- an exemplary model of all that is modern, advanced, civilised, and successful, the fulfilment of the China Dream. He has concentrated power in his hands personally, in order to revitalise a flagging brand, rooting out endemic corruption with a relentlessness that has surprised everyone. At the same time he has persecuted and gaoled competitors, community activists and lawyers, writers and intellectuals who had exposed corruption and rot it causes. Xi Jinping has made it clear that the only corruption that will be exposed and stopped is the corruption he and his inner party attack dogs expose.

Like a new CEO helming a failing corporate conglomerate, he wields the razor in his purge of the boyars, the fiefs and chiefs whose rackets had been untouchable. His weapon in doing so has nothing to do with the law; the courts and the law are at best an afterthought, after his own inner-party Discipline Inspection troops have detained, interrogated and obtained confessions from their targets and those who surrounded them.

The world now looks on, and marvels, as is did for Steve Jobs when Apple could do no wrong, as Xi Jinping cuts away at those who could have stood in the way of his ultimate goal of re-legitimating the Chinese Communist Party by major economic reform. Like Ivan the Awesome (or Terrible as the English say) in a Russia emerging from its Mongol servitude, the enemies close to you are the worst, and first to be purged. Ivan slaughtered the nobility and Xi is on the heels of the new nobility, the princelings of red chip stock who control the huge state owned enterprises (SOEs) that dominate the economy, monopolise the capital market, rely on subsidies, distort prices and exclude competition.

Xi Jinping, like Steve Jobs, is a master of creative destruction, of the core dynamic of capitalism that must destroy as well as create in order to be ready to catch the next great wave. Xi fully understands that China’s basic business model has reached its use-by date. China no longer has an endless supply of cheap labour as its outstanding comparative advantage. Nor can China for much longer finance extraordinary rates of growth by massive capital expenditure on infrastructure by a state that  favours its’ own, the big crony SOEs bulked up by fiat as China’s national champions. That is financed by borrowing from future generations, through the bond market.

Xi understands that China’s global reach for raw materials, and markets for the manufactures of the world’s factory, also means greater scrutiny. Some of the deals that enabled China to not only source oil and other energy supplies but also to own oil fields, for example off the Angola coast, are now being exposed as collaborations between China’s intelligence agencies and its biggest SOEs.[1] Many more such revelations seem likely.

Xi Jinping and Steve Jobs both understood that the time to prepare for the future is now, especially in good times when there are plenty of cash reserves to draw on, rather than wait for the crisis, because then it is too late. China is now post-revolutionary, post-communist and, with the looming curtailment of SOE power, China will become post-socialist; at a time when Xi Jinping has simultaneously revitalised Marxism as a compulsory learning for party cadres, and is purging the Chinese Academy of Social Sciences to ensure strict adherence to Marxist orthodoxy. Only a clear head and strong will can keep this together.

We are witnessing the construction of a new reality. In Chinese, the communist party is literally the public ownership party, and now the party, to preserve its institutionalised power, proposes loosening that direct ownership of the SOE means of production, so private enterprise can dominate. Seldom has a ruling party, deeply entrenched at all levels in power, been so able to renew itself after six decades in power, and maintain its ability to set the dominant discourse. This requires a helmsman who sees beyond the horizon.

Steve Jobs was close to fanatical about Apple, as a corporation, and persuaded investors to stay on for the ride, even when it seemed the company was going nowhere. A major source of his success was his full embrace of outsourcing the actual work of construction of Apple devices to China, to underpaid, overworked staff in rigidly disciplined factory towns wrapped in secrecy. That too has since unravelled. In hindsight, it seems extraordinary that one man could have held together such a global enterprise for so long.

Renewing the legitimacy and thus the power of the Chinese Communist Party is even more extraordinary. Jim O’Neill, former chairman of Goldman Sachs, says “the Chinese Communist Party is essentially the biggest business organisation in the world.”[2] Oddly, that is seldom said outside China, even though the deep mistrust of most Chinese towards the CCP is due to more than endemic corruption, it is a result of the uniquely Chines effusion of enterprise ownership and control. Almost everyone in China knows that effective control of an enterprise is, if anything, more important than legal ownership, and control is in the hands of the party elite.

If the CCP is to remain the world’s biggest business, it must rid itself of the rent seekers whose control is grounded in their negative regulatory power to refuse necessary permits. If China, as a business, is to thrive despite rising incomes, economic slowdown and the “middle-income trap”, the fiefdoms much be rooted out, the enervating licence raj liquidated, and China Inc. must become a lot more like Apple. China must be able to foresee the next big thing, the newest disruptive technology that changes the game, and dominate it. China’s central planners, of whom there are still many, may struggle to discipline a wildly oversupplied steel production industry, but they do have their eyes on the new markets a rising China Inc. can dominate, such as solar panels, nanotech and the dozens of new industries named by the central planners as China’s best chance of staying ahead.

So the current purge of corrupt bosses is not about getting the party out of business, or standing back with a lighter neoliberal governance touch, it is about renewing the party as the greatest business conglomerate of all time. The party will continue to control and profit from what it technically does not own, no longer through franchised rent seeking, but through the more sophisticated and up to date processes of contemporary neoliberal capitalism worldwide. The party will thus remain at the heart of the state it controls, at every level, while giving rein to entrepreneurs able to catch the next disruptive wave, thus ensuring China’s growth and stability. The party-state will not only survive but thrive. The rent seeking of the present phase of primitive accumulation will give way, if Xi Jinping succeeds, to a knowledge economy, intellectual property licencing fees and mass entertainment, as China prospers. The society of the spectacle is arising, and Tibet, as China’s most exotic domestic destination, plays a major part. Tibet is available for consumption, and China’s urban masses are responding, as tourism teaches them how to be a self-made, consuming individual.

If Xi Jinping succeeds, he will be more successful than Steve Jobs, whose reputation and corporation suffered quickly after his death, in part because China found Apple a tempting target to pressure.

But Xi Jinping’s immediate task, before he can move on to making private enterprise, with Chinese characteristics, the dominant driver of the economy, is to clean out the corrupt tigers and flies. Not surprisingly, his team of investigators, the party’s Central Commission for Discipline Inspection are focussing intensely on mining and resource extraction, which have been major opportunities for bribery.

As author of the only book on China’s mining company practices in remote areas, I never imagined the crooked deals would come to light. When my book, Spoiling Tibet: China and Resource Nationalism on the Roof of the World, (Zed Books, London) was published 10 months ago, in October 2013, the dodgy deals were clear, but getting no publicity. The book exposes, for example, how a state owned mining company got China’s central government to shift the mapped boundaries of the primary source, in Tibet, of the Yellow River, to enable it to get at the copper and gold beneath.

Now, less than a year later, story after story of resource extraction, and metals trading, as major opportunities for illicit profiteering pour out of China’s official media, as Xi Jinping proves he is serious about rebuilding the CCP brand.

 

Gabriel Lafitte

 

 

 

[1] http://www.ft.com/cms/s/2/308a133a-1db8-11e4-b927-00144feabdc0.html#ixzz39wZtgSdm

[2] books.google.com.au/books?isbn=1780769105

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