A Self-Sustaining Perinatal Care System for Tibet

在过去的几十年里，中国人民医院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的mnmr仍然较高。由于西藏自治区的农村和贫困性质、生物医药供应的后勤和财政限制以及历史上隔离孕妇和产妇的文化习俗，西藏自治区的孕产妇死亡率继续显著高于全国。该项目的调查人员早在1993年就记录到，西藏自治区农村地区几乎不存在产前护理，很少有熟练助产士接生。此外，西藏自治区没有有组织的医疗运输系统。概述了解决这些问题的多学科方法，其中将包括来自医学人类学、美国生物医学、西藏生物医学和西藏传统藏医学的代表。这次合作所代表的个人的独特能力和成就将允许测试假设：1)通过对藏族妇女的民族志研究，可以明确孕产妇和新生儿护理和运输的现状和障碍；2)通过制定具有文化敏感性的传统-生物医学围产期培训和护理计划，可以提高熟练助产士的产前护理和围产期护理率；3)可以开发和利用功能性的孕产妇运输系统。拟实施的项目将在西藏自治区拉萨州的两个县实施，同时有两个匹配的县作为对照。4)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）将进一步改善孕妇及其新生儿的结局，无论是在本提案实施期间还是之后。

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.