New airline route from southern China to Lhasa as SARS spreads in western regions

by Kate Saunders

24 April 2003
China Southern Airlines, the largest airline in the PRC, has announced that it will begin a new service from Guangzhou in Guangdong, southern China, to Lhasa, Tibets capital, next week, despite current fears over the rapid spread of SARS (Severe Acute Respiratory Syndrome) throughout China to the western regions of the PRC. The World Health Organisation (WHO) has been advising against travel to Guangdong since 2 April. SARS is a new disease, first recognised in late February, that has spread along the routes of international air travel.

The new route is scheduled to be operational twice a week from next Wednesday (30 April) onwards, running from Guangzhou to the tourist area described as "Shangri-La" in Yunnan Province with continuing service to Gongkar Airport, Lhasa. But the announcement of the new service coincides with a renewed impetus by the central government to tackle the spread of SARS, and emerging reports suggest that the authorities may now be seeking to impose restrictions on travel into Tibet from China. China has cancelled the week-long May Day holiday this year, a popular time for Chinese tourists to visit Tibet, which means there may be decreased tourist traffic to Lhasa and other areas.

There are no officially reported cases of SARS in the Tibet Autonomous Region (TAR) and Qinghai province, but there are rumours of a handful of cases in both areas, and health workers believe it is only a matter of time before SARS occurs in Tibet. Several non-governmental organisations, including the New York-based Trace Foundation, have withdrawn their staff from Tibetan areas. Trace Foundation, which has field offices in Xining in Qinghai, Chengdu in Sichuan and Lhasa, said that this was due to a recent sharp increase in SARS cases in China, the continuing uncertainty about actual numbers of cases, the potential of the epidemic to spread rapidly throughout the country, the impact this will have on health services and the fact that any ex-pat contracting the disease will be quarantined in China with no evacuation or access to western medical services.

A report by the WHO yesterday (22 April) stated that SARS has now spread to some of Chinas poorest provinces in the western regions of the country, including northern Gansu and Inner Mongolia. According to the Chinese press, so far there have been 36 cases in Inner Mongolia with six deaths, and eight cases in Sichuan resulting in two deaths. It has not been possible to confirm rumours of four cases of SARS in Lhasa, and several cases in Qinghai province. The implications of the spread of SARS to the western regions of China are serious due to the high levels of poverty and poor health care conditions of health and health care provision in Tibetan areas are among the worst in the PRC. Many diseases that have been endemic to the Tibetan plateau for centuries are still not under control, emergency medical care is virtually non-existent, and the authorities are not yet taking decisive action in developing preventive strategies for emerging conditions such as HIV/AIDS.

The failure of the health care system in Tibet to reach many rural areas, where the majority of Tibetans live, and prohibitive medical costs, means that many Tibetans are still dying from illnesses and conditions that could easily be treated, such as diarrhoea or pneumonia. Pulmonary diseases, such as tuberculosis, pneumonia and asthma are already widespread in Tibet Tibet has the highest rate of tuberculosis in the PRC. The same contributory factors, such as a lack of knowledge about the spread of disease and poor hygiene practices, are also factors in the spread of SARS.

China has announced various measures in the past few days to combat the spread of SARS in the western regions. Ten million yuan ($1.2 million) has been allocated as an emergency fund to combat potential SARS dangers in the TAR, according to the China Tibet Information Centre today. According to the centre, the money will be channelled into establishing inspection points, providing related equipment and medicine, and setting up special wards. A telephone hotline to answer queries about SARS was also set up in Lhasa the official website reported yesterday that so far seven people had used the service.

Obstacles to openness on SARS in Tibet

The extent of the SARS epidemic in China was initially covered up when it broke out in Guangdong last November, coinciding with the Party Congress. But Communist Party chief and President Hu Jintao has now given clear directives that the spread of SARS should now be acknowledged and tackled openly, and several days ago he took the significant measure of removing the Chief of the Communist Party branch of the Ministry of Health, Zheng Wenkang and Beijing Mayor Meng Xuenong from their posts. According to Ming Pao Daily News, the mayor had admitted that when the epidemic broke out in the capital, he was conscious of the Party's stipulation to maintain a "stable political environment" during the Congress. In Tibet there are additional political sensitivities and concerns at a local level that may present obstacles to open communication about SARS and its treatment, even despite the clear directives from the central government. Officials in Tibet are frequently unwilling to report on health issues of particular concern in their local area for instance, high infant mortality rates or incidents of AIDS as they may prefer to convey the impression that the situation in the area under their authority is under control. The general unreliability of statistics on health in Tibetan areas often reflects an unwillingness or fear at a local level of being held accountable for poor conditions of health such as malnutrition or an outbreak of disease. The lack of effective community education on health care in Tibet may also contribute to difficulties over the diagnosis and treatment of SARS.