A Self-Sustaining Perinatal Care System for Tibet

在过去的几十年里，中国人民的克普努克（P C）在孕产妇和新生儿死亡率（MNMRs）方面取得了巨大的进步。然而，某些地理和文化区域继续具有较高的MMR。西藏自治区（TAR）的产妇死亡率仍然明显高于中国整体，原因是该地区的农村和贫困性质，生物医学的可用性受到后勤和财政限制，以及历史上隔离孕妇和劳动妇女的文化习俗。该项目的调查人员从1993年起就记录了在西藏自治区农村几乎不存在产前护理，而且由熟练助产士接生的婴儿很少。此外，西藏自治区没有有组织的医疗运输系统。一个多学科的方法来解决这些问题的概述，将包括来自医学人类学，美国生物医学，西藏自治区生物医学和西藏自治区传统藏医的代表。这种合作所代表的个人的独特能力和成就将允许测试假设：1）对藏族妇女的民族志研究可以确定孕产妇和新生儿护理和运输的现状和障碍，2）通过发展一种文化敏感的传统，生物医学围产期培训和护理计划，以及，3）一个功能性的产妇运输系统可以开发和利用。该项目将在西藏自治区拉萨地区的两个县实施，两个匹配的县作为平行对照。4)一个同时进行的孕产妇和新生儿死亡率审查机制（持续质量改进）将使孕妇及其新生儿的结果在本提案有效期内和以后得到进一步改善。

The People s Kepunuc of China (P C) has made dramatic improvements in its maternal and newborn mortality rates (MNMRs) over the past few decades. However, certain geographic and cultural areas continue to have higher MNMRs. The Tibet Autonomous Region (TAR) continues to have significantly higher MNMRs than the overall PRC due to the rural and impoverished nature of the region, logistic and financial constraints on the availability of biomedicine and cultural mores that have historically isolated pregnant and laboring women. Investigators on this project have previously documented, beginning in 1993, that prenatal care is virtually non-existent in rural TAR and that very few births are attended by skilled birth attendants. In addition, the TAR has no organized medical transport system. A multidisciplinary approach to these problems is outlined that will include representatives from medical anthropology, United States biomedicine, TAR biomedicine and TAR traditional Tibetan medicine. The unique capabilities and accomplishments of the individuals represented by this collaboration will allow testing of the hypotheses: 1) ethnographic research in Tibetan women can identify the current status of, and barriers to, maternal and newborn care and transport, 2) that rates of antepartum care and peripartum attendance by skilled birth attendants can be increased by development of a culturally sensitive Traditional- Biomedical Perinatal Training and Care Program, and, 3) a functional maternal transport system can be developed and utilized. The proposed project will be implemented in two counties of the Lhasa prefecture of the TAR, with two matched counties serving as concurrent controls. 4) A concurrent maternal and newborn mortality review mechanism (Continuous Quality Improvement) will allow further improvement in outcomes for pregnant women and their newborn babies, both during the life of this proposal and beyond.