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Klaudia Lee

Silence enveloped  the corridors of the earthquake patients rehabilitation centre at Sichuan University's West China Hospital  in Chengdu  late one afternoon. It was punctuated only by the sounds from a physiotherapy room, where a few patients were practising walking or doing body-strengthening exercises.
Inside a ward on the second floor, a little girl was putting together a Fuwa jigsaw puzzle. Sitting on a chair, three-year-old Xinyi  looked a picture of concentration, seemingly oblivious to any outside distractions, though from time to time she managed a smile for the two nurses accompanying her.
A closer look, however, revealed that her right leg was fitted with a prosthesis.
The little girl was saved by the protection of her parents under the rubble in Beichuan ,  which was levelled by the May 12 quake. Sadly, her parents didn't make it.
'I didn't tell her anything, but one day she suddenly uttered: 'Father and mother are dead.' I don't know if she truly understands what it means,' said her uncle, Song Gang ,  as he glimpsed inside the ward where the little girl was staying. 'She's very afraid of talking to strangers or sleeping at night ... I think I will only tell her everything when she grows up a bit,' he added.
For many quake victims like Xinyi, the road to rehabilitation - both physical and psychological - is long and winding. Indeed, for many, the long battle has just started - four months after the devastating quake that killed more than 80,000 people and injured a further 370,000.
Despite the official rhetoric, questions remain about how well the health system - long plagued with problems such as a shortage of rehabilitation specialists and the separation of rehab and prosthesis installation services - can cope with the demand created by the quake.
For the victims, there is not just the issue  of a physical recovery, but also healing their psychological wounds - a particularly daunting task on the mainland, where clinical psychology remains in its infancy and there are few experts in the field.
Fears are growing that some patients, especially amputees, are missing out. Frontline staff worry that some patients may have to be released earlier than they should be  because of the economic pressure on the hospitals.
'For such a large disaster, there should have been a central commander at provincial level to  co-ordinate efforts on medical treatment, rehabilitation and prosthesis fitting,  but there was none after the quake. Thus, some patients will probably miss out because there's simply a lack of co-ordination among various organisations doing similar things,' said a prosthesis specialist who did not give his name. West China Hospital is one of three hospitals at the provincial-level in Sichuan  that have  opened a rehabilitation centre for earthquake patients. Similar centres have also been established in Chengdu, Deyang , Mianyang , Guangyuan , Yaan  and Aba .
Xinhua has reported that 1,278 quake patients were being treated in these nine rehabilitation centres, with a further 6,146 patients being treated at county and village levels or recovering at home.
Many others are staying at hospitals in other provinces.
Huang Xiaolin,  the deputy director of Sichuan Health Bureau's  department of medical policy, said they are still in the process of collecting the final data on the number of amputees from the quake, but they estimate there are around 1,000. This figure is doubted by some experts, who believe the exact figure might be higher given the sheer scale of the disaster.
Conceding the lack of both experts and facilities for rehabilitation services, Mr Huang said the provincial authorities had allocated 18 million yuan (HK$20.5 million) to urgently install and develop such facilities, as well as inviting experts from other provinces to provide staff with training in rehabilitation and psychological counselling.
Yet it remains to be seen whether these measures will be enough.
The mainland has long followed the Soviet system, in which fitting prostheses  comes under the jurisdiction of the civil affairs bureau, while medical treatment and rehabilitation come under the  health bureau. At present, the China Disabled Persons' Federation  - under the civil affairs bureau - oversees the fitting of prostheses  in Sichuan.
'In many other developed countries, fitting prostheses  is part of the rehabilitation service and comes under the same government department, to offer a comprehensive treatment for patients. I think China should change the current system, and the health bureau should also oversee prosthesis fitting,' said the specialist.
Indeed, the drawbacks of the present system are obvious.
Sichuan Orthopaedic Centre  in Chengdu, formerly the Sichuan Prosthesis Factory, is the largest centre in Sichuan that produces prostheses and offers a fitting service.   The centre treated 151 patients following the quake, and  more than 40   are still there.
'Here, we help the amputees to [fit]  a prosthesis and we also train them to walk. But we don't have clinical experts, as medical treatment is outside our scope of responsibility. So we can't do anything if they have complications, such as urinary-tract or wound infections. They have to go to other hospitals for treatment,' said the centre's deputy director, Liu Xidong .
Hospitalisation and treatment for quake patients are  free,  but hospitals are already feeling the budgetary pressures of having to cope with a large number of patients in need of long-term rehabilitation services.
The hospitals have to shoulder the cost themselves, with provincial authorities pledging that they will ultimately be reimbursed by various schemes, such as medical insurance and money from donations.
West China Hospital, for example, has been running its own budget  for treating the quake patients. At present, there are more than 120  quake patients at the hospital, 80 of whom are staying in  its earthquake patients rehabilitation centre, which was established on July 3.
'We need to spend around 6,000 to 12,000 yuan on rehabilitation services for each of our quake patients each month. It's a huge fiscal burden,' said Ding Mingfu,  deputy director of the hospital's earthquake patients rehabilitation centre.
The hospital is also facing manpower shortages because some of the rehabilitation specialists that were working at the rehab centre have been transferred to  the new earthquake centre.  Services to other patients were affected, said Dr Ding.
Indeed,  the quake had exposed deep-seated problems in the  development of rehabilitation services, including a regional imbalance, he said.
The mainland has long lagged behind the west in this field and the state needed to pump in a huge amount of money.
'Besides, rehabilitation services in the western part of the country, including Sichuan, have lagged far behind other parts of China - especially the wealthier eastern and southern regions - in terms of facilities, the standard of services and the number of experts,' he said. This also explained why a large number of patients needed to be transferred to other provinces and cities for treatment.
Zhou Yige,  who is on temporary assignment from Nanjing No 1 Hospital,  said that when he first joined the rehabilitation section  in Jiangsu , in 2005, only five of the 10 medical officers came from a rehab background.  Dr Zhou, who has an orthopaedic background, said that he learned the skills needed in rehabilitation only after transferring to his new department.
On a more individual level, Dr Ding said there was a general lack of awareness of the importance of rehabilitation. Added to this are the travel difficulties faced by many people who need regular treatment but live in remote parts of the province.
'Many ordinary folks feel that if they're injured, they just need to stay in the hospital for a few days then they will be fine. They don't know there's still a process of rehabilitation to help them recover,' said Dr Ding, who expressed hope that the quake could finally bring about changes in attitudes, both at the individual and state level.



System under strain