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The Road to Surmang, 1987-2010

A blog by Lee Weingrad

September 4, 1987: Yushu to Surmang, part I


Lee Weingrad with his son Josepsh on route to Dorje Khyung Dzong. (Click to enlarge)

Lee Weingrad is the CEO of Surmang Foundation, which has operated a primary care clinic in Qinghai Province since 1992. He lives in Beijing with his 14 year-old daughter, Iana, his 12 year-old son Joseph, his wife Wenjing, and his three dogs: Bodhi, Sanggye and Snowpea. For more information on Surmang Foundation, please visit surmang.org

Photographs courtesy of Surmang Foundation (Click to enlarge)















































"It will be like going back 500 years in time."
-Tai Situ Rinpoche’s advice before I left

"Don’t get lost in history"
-Kobun Chino’s advice before I left

The day before I left, Gozi Along told me he was issuing a travel permit to Surmang Dutsi-til monastery, the seat of my late teacher Chogyam Trungpa. Of course I was grateful, but in a way it was expected, or I should say I had, from the beginning, unshakeable confidence that I would get there.

“Just one more thing,” I said as I received the permit, “I want that map.” I was pointing to a large Chinese classified military map of Yushu Prefecture, which clearly showed the road to the monastery. Along took a puff of his cigarette, winced and made a motion that meant, “take it.”

23 years later I still have the map.

The road was very funky and laden with muddy ruts. The valley east past Benchen was surrounded by snow peaked mountains, the grass green and studded with grazing horses, yaks and sheep. Then there were the yak caravans bearing barley, led by whistling Khampas on horseback. It was as if I’d entered a time machine. At the end of this valley the road swung south, beginning the ascent of 16,000 ft Ge-la, the mountain that defines the northern boundary of the Surmang region.

The road had no bridges and so instead of crossing over a stream, we had to cross the stream itself. I don’t remember how many times we did this, but I think it was at least 6. The one crossing I remember most was the worst of all. The water in the middle of the stream was so deep that it covered the exhaust pipe and stalled the engine.

Tenzin, my driver, stripped down to his shorts to disconnect the exhaust manifold from the exhaust pipe, so the exhaust would come somewhat directly out of the engine, and above the water line. He came back about 5 minutes later totally hypothermic. I covered him in a Tibetan blanket and when he warmed up we were able to restart the car and get out of that river.

June 8th: Yushu: Rubble and a Sea of Blue Tents

Compared to the reality-show-level overland trips of the past 23 years from Xining to Yushu, today’s plane ride was a lay-up. However somewhere over the Yangtse River valley, we hit heavy turbulence and a total cloud cover. I was just praying that the pilot could see the way clear of some of Yushu Prefecture’s 900 peaks over 5000 m (16,400 ft). Once we got below the cloud cover we were beginning our approach to Batang and spent a bit of time lower than the multitudes of snow covered mountains. We were the only people on the plane who were not with the government, that was clear. Once we hit the ground it was also clear that we were the only foreigners in Yushu.

It was also snowing.

Senior Surmang physician Phuntsok was there at the airport to greet us, looking thinner and a little older than last year. It was really good to see him again, as he was happy to see us. He said hello to Sara, the creator of the Surmang community health worker project back in 2006, and Beibei my assistant, he knew from last year.

The 20-minute ride to Yushu took us past Thrangu Monastery, an important monastery of the Kagyu Buddhist lineage, where we stopped, mouths agape. I’d been there a few times over the years and even met Thrangu Rinpoche there on one of his infrequent visits from Kathmandu. Now, there’s only one building left. Apparently the first quake hit at about 5 am, a small one, and the monks, in the middle of a ceremony, rushed out. After waiting awhile they decided that it was no biggie and filed back in. Minutes later the big one came and destroyed everything, killing over 40 monks. Now, from my vantage point, it was basically some broken stupas amidst fields of rubble.

We were taken to one of twenty or so tent cities in Yushu created by the government. One was assigned to each of us, all blue, all government-issue, and all quite sturdy, waterproof, windproof and insulated. It was great to be here and to feel that we were there to help.

Phunstok had been living in a two-storey house, visiting his in-laws, at the time of the earthquake. The whole family was downstairs and the roof collapsed on the second floor. It seems that he, his wife and their two small sons were trapped in the wreckage for over 5 hours before they were dug out. In the process he endured some internal injuries including a slight fracture to his pelvis.

However, as bad as it was, he made out better than others. His wife lost two sisters, including one who was 8 months pregnant. After awhile I got the picture: either everybody had the same story or knew someone who had the same story.

After settling in, we went on a tour of Yushu. It isn’t a place I remember at all: all my reference points, so carefully collected and archived over the years, (the place where I got amazingly drunk, the place that had the only showers in town, the place we used to stay at until the good hotel opened, the market I used to shop at, blahblahblah) all gone, replaced by rubble and a sea of blue tents. The few buildings left standing are all unoccupied-–some looking okay, others like they are on their last legs and in danger of collapsing. Everyone is either living and or doing business in blue tents.

The crowds, the marketplaces, the hordes buying and selling cordyceps sinesis, yoghurt, deer antler are still there, but surrounded by a cordon of blue tents and that by another cordon of condemned buildings. A monk was buying shoes.

We went to a place that had a 3 storey school that collapsed, killing 60 students. Rubble. We went to the Horserace Festival Grounds, now a blue tent city. And there was an odd vibe about the place too – a kind of no-big-deal quality in the air, and absence of ashes and sack cloth. It seemed from a human point of view oddly uplifted. I asked Sara about this, since she’d worked in Darfur, Somalia, in the vast refugee tent cities there. She had a similar impression. Could the Tibetans really be that strong?

June 6, 2010: Yin Long Binguan, Xining

At 7200 feet, Xining is a perfect entrepôt for travel to Yushu –- you can introduce newcomers to Tibet through Kumbum monastery, the birthplace of Je Tsonkapa (founder of the Gelugpa sect of Tibetan Buddhism). It’s one of the 5 big Gelug monasteries, and its support by the national government gives it a kind of museum status and quality. For the non-religious minded the surrounding area is great shopping. For the adventurous there is Qinghai Lake (Kokonor, Tib.), where the famous lama Phagpa spent many years in retreat.

But we are not here to tour, so what makes Xining something short of fun is its user-friendly quality. You can get a Caesar salad here. Last burger before Tibet.

Flying to Yushu makes it possible to actually spend a few days here without the ordeal of the kind of travel we did before (as recently as last year)– driving overland in two stages: one day, a 3 hour jaunt to Gong He (600 m higher). And the second day about 14 hours, almost all of which is over 4000 meters (13000 ft), being brought down by nausea or migraine-like headaches. 4000 meters is what I think of as “the death zone.”

I used to think that the two eternal truths of traveling to Yushu were: 1) the roads were better last year and 2) this is my last trip.

But tomorrow we are actually flying and despite my romance for the days of yore, I view this as a very positive development. Acclimitization to 3500 m (Yushu) is much easier than two days on the road at 4000 m. By the time we get to Surmang at 4000 m, everyone will be acclimatized. I hope.

Ok. Waitress, where’s the balsamic vinaigrette dressing?

June 3rd, 2010 part II Gozi Along and the salt

Yushu, September 1987.

It is difficult to explain why I was able to convince Gozi Along--himself a very dark-skinned Khampa Tibetan--to grant me a travel permit to go to Surmang without going back to the last day I spent in the previous May at Karme Choling Meditation Center in Vermont. I was there for about a month to photograph the cremation of my Buddhist teacher Chogyam Trungpa, Rinpoche. He had passed from this mortal coil the preceding April.

The 6 or so weeks between his passing and the cremation were a huge pause in my plans to go back to China, for a second try at going to Surmang. I made an unsuccessful attempt in 1986 from Lhasa. This time I would be going from the east, from Chengdu, Sichuan, by way of a detour though Beijing. In a way the cremation became the reason why I was able to go to Surmang at all.

The day before I was to leave Karme Choling I was standing in the living room, right in front of the big rock. At some point David Rome and Marty Janowitz came up to me with a 2 quart styrofoam container, the kind they put wonton soup in for Chinese take out. This one was sealed with duct tape. David said it was some of the kosher rock salt that they had packed around Trungpa Rinpoche's body to preserve it between his death and his cremation. One of them, maybe Marty, said they wanted to make sure this got to Surmang.

For Tibetans this is what they call a "salt relic" and its presence is as sacred as that of the lama himself.

When they handed it to me, I could feel heat coming out of it. It was noticeably warm to the touch. I mentioned this and passed it around. Everyone could feel it.

I wrapped it in a khata (white ceremonial cloth denoting respect), and took it to China. Three months later I found myself in Gozi Along's (head of the Yushu Prefecture Religious Affairs Bureau) office complete with peeling plaster, open window and an electric kettle heater burning bright red to heat the frigid air--apparently it didn't matter whether the air stayed in or went out. Gozi Along was smoking cigarettes, a lot of cigarettes, in a very rumpled suit. I think I was too nervous to notice the hard-wired expression of bemused irony that over the years I came to appreciate, and sort of love.

With the help of a very intoxicated translator and my driver from Lhasa, with whom I communicated in my then-pigeon Chinese, I learned that I was to present my case the next day: why I should be allowed to continue my journey and not be given the bum's rush back to Chengdu.

Back in my room at the Yushu Binguan, I decided that basically this was a sale and I had just come from spending the last 6 years of my life selling Hondas, something I was pretty good at. At that point I started to feel that it had nothing to do with politics and it had nothing to do with religion. It had to do with selling.

So the next day I went back to Gozi Along's office, and he was sitting in the same place, with the same rumpled suit, with the same window open and the same tea kettle stove coils buring bright red. There were about 6 people around a big table, including my driver and the drunken translator. I took out a map of the world and put the 2 quart wonton soup container of the salts on it, still wrapped in the khata. I pointed to New York. I said, "This is where I've come from" and then pointing to Surmang on a map of Yushu Prefecture, I said, "and this is where I want to go."

Gozi Along gave me the permit to go to Surmang. He also became a good friend over the years. About 10 years later he said to me, "We didn't understand your driver's Tibetan, and we didn't understand your Chinese. But we understood that salt."

June 3rd, 2010: our plan

This year's delegation consists of 10 people: Ralph Allen, architect (Ralph is the designer of the largest pediatric hospital in Asia, the Shanghai Children's Medical Center); Gary Swenson, structural engineer specializing in earthquake construction; Sara Saad el-Dein, MPH and designer of our Community Health Worker project; Sara's husband Jon Hall, EMT; Ms. Gao Yu from the Institute of Population Studies, Peking University; Janis Tse Yong-jee, interpreter (her 6th year!); Christie Huang and myself from the Surmang Foundation.

Our purpose is to assess the situation at 5 township clinics, with an eye to rebuilding at least 2 based on the Surmang model. This 'community-based medicine,' depends on deep community buy-in through a corps of Community Health Workers and a couple of motivated local primary care providers. Like Surmang, the design of the projects will be closely managed, and CHWs and doctors will be highly incentivized in terms of pay and housing perks, not to mention residential training, not only on-site, but also in Beijing. Our two Surmang docs, Phuntsok and Drogha, are local heros and have the status of Rinpoches in the region due to their work and kindness. We need to grow that.

There will also be Surmang-like IT components consisting of satellite dishes, meds inventory management and distance referral and consultation.

The latter is being developed in partnership with Chindex/United Family Healthcare. UFH operates the first and largest of the international-standards hospitals in China. The idea is to be able to send digital images of X-rays, wounds, or ultra-sound, to a dedicated computer terminal at UFH in Beijing. There specialists--radiologists for example--could help diagnose and advise these rural doctors.

The choice of which clinics to rebuild depends on how closely they follow the qualities of the Surmang Clinic in a geographical and cultural center. One of the things we will probably ignore is "the catchment size," meaning how many people are served by the clinic. What we learned with Surmang is basically following Lama Kevin Costner's proclamation in "Field of Dreams": "build a field and they will come." The Surmang clinic went from a summertime drop-in clinic to a local institution that attracts patients from within a 200 km. radius, attracting over 10,000 patients a year.

(By contrast the government township clinic sees 500 hundred patients a year with a staff of 9).

When we told the head of the Yushu Public Health Bureau that we wanted to rebuild 5 clinics, he said, "Why 5? if you rebuild one run like your Surmang Clinic, all you need is to rebuild one."

June 1st, 2010: my city was gone

I went back to Ohio
But my city was gone

With 90% of the buildings down and the remaining 10% slated to come down, this is the song that runs through my head for me on our trip to Yushu. I went to Yushu for the first time in 1987, beginning my long anomalous love affair with the city.

At 3500 meters or 11,500 ft., and 90% Tibetan, back in 1987 it was also strictly off limits to foreigners and I arrived like a thief in the night, knowing that if I surfaced, my passport would be confiscated and I would be put on the next bus to Chengdu. But that was not my fate.

The three streets in town were funky, dusty, unpaved, with crowds of monks or black-chuba-ed Khampas everywhere as was the blare of folk music from shop's street-level speakers set on tweeter-busting high gain. Yet, having apparently just alighted from a spaceship everyone seemed happy to see me; everyone except the government that is. I was the only foreigner in the town back then, as the Religious Affairs Bureau Director Gozi Along reminded me on several occasions.

There was only one hotel in town, the Yushu Binguan, and climbing its bare cement 4 floors to my room was like ascending Everest--in fact due to my frequent stops to catch my breath at the second floor landing, I christened it Surmang Base Camp.