Despite the solid entrepreneurial spirit that characterizes many Chinese, not many are able to start and expand small businesses. Access to credit is often no more than a dream for most of China’s 300 million people living below the poverty line in China. An attractive option for them is microfinance, commonly defined as small loans - as small as US$100- for impoverished individuals to help them achieve financial self-sufficiency.

Wokai.org is a “capital-contributing microfinance intermediary” trying to bring money to Chinese entrepreneurs who want to set up their own small businesses, by raising loan capital online from individual contributors for microfinance institutions (MFIs) in China. Its goal is to expand financial opportunities for the country’s poor (and mostly rural) population.

Though its primary goal is fundraising, Wokai also provides “capacity building” for microfinance organizations, which can mean anything from emotional support for first-time borrowers to computer training for loan managers.

Wokai.org American founders Courtney McColgan and Casey Wilson think that the website will not only be a fundraising platform, but also a community for people interested in supporting microfinance in China.

Through Wokai, people will be able to make loans online directly to individuals who have been selected by Wokai’s local partner MFIs. These MFIs in select clients, whose profiles are then posted on the Wokai website through profiles that outline their business ventures and loan request.
Contributors browse these profiles, select who and how much to finance, and then transfer money to Wokai through our online payment system. Once funds are transferred, Wokai distributes this loan capital to partner MFIs for allocation to micro entrepreneurs. At the end of the loan cycle, partner MFIs collect loan repayments and re-issue loans.

Like other “capital-contributing microfinance intermediaries’ Wokai is not legally a financial service organization, so it does cannot receive savings deposits, which means that the pool of money cannot grow and requires constant capital injections.

The website is scheduled to be launched in Mod-November, so stay tuned.

For many in China, the costs of health care are simply too high.  It was a cost that the state itself bore for many years, however as the country has grown the Chinese citizens themselves now carry the burden of paying for health care.

China’s wealthiest have access to the best money can buy of course, but for China’s vast majority, access to healthcare often does not come so easy. In fact, given China’s policy of pay as you go, for many who are at the bottom of the pyramid, gaining access to even some of the basics is a luxury that many cannot afford.

A point that was hammered home to me while visiting the children at a Shanghai children’s hospital, I found that many of the parents who had children with leukemia and other ailments were having to making huge sacrifices to get the proper care and medications.  Quitting jobs and moving to Shanghai as a first step, many families were actually selling their homes, selling their possessions, and taking out huge loans to pay for the treatments.

Sadly, efforts to raise money though were rarely enough and parents would simply pull their child out of the program until they were able to afford the treatments again…

This is a situation that the recent Shanghai Daily article Cancer pair’s orange lifeline that described the efforts of one couple to be able to afford their own health care treatments

The Chongming couple, who suffer from cancer, are depending on their Mandarin orange harvest to fund their treatment. And it just might not be enough.

To help them raise money, the Jing’an District Cancer Rehabilitation Club recently bought 1,500 kilograms of oranges from Shen for 2,000 yuan (US$293).

and worse yet, they seemed resigned to their fate:

“It’s very hard for us to continue living. We can afford only in half doses of our medicine,” Li said.

“We are doomed to lose money this year. We had planned on my surgery after we raised money from the sale of oranges. But now, I don’t think we can earn enough.”

As a westerner living in China, the above situations are hard for me to understand. that to ride in an ambulance you must pay first, that to see a doctor you must pay first, to have surgery pay first, and so on.

There is no credit. There is not life over limb. It simply is a cash based process that one needs to be able to afford in order to gain access.

In China, one must learn to understand that not everything is as it seems, and that even when something is known… it is not.. and even if it should be known.. it may not be…

In China, it is called an “open secret”, where it does not necessarily have to be published or spoken of on TV… but a lot of people know about it.   Sometimes it is benign, but more often than not it is not.

The recent report Report: China’s animal feed tainted with melamine highlights just how serious the issues underlying “open secrets” can be… and just how dangerous they can be:

Animal feed producers in China commonly add the industrial chemical melamine to their products to make them appear higher in protein, state media reported Thursday, an indication that the scope of the country’s latest food safety scandal could extend beyond milk and eggs.

The practice of mixing melamine into animal feed is an “open secret” in the industry, the Nanfang Daily newspaper reported

for me, this story highlights several huge gaps in China’s system.

1) How is it that a large number of people can be in the know about adding a precursor chemical to milk and dairy, and no one say anything?

2) How is it that leaders of industry, regualtory agencies, and government bodies fail to act when such “open secrets” are so abundant?

At the same time, a story/ condition like this show me the following:

1) “face”  still hold priority over safety - including those who are supposed to be protecting the public

2) There is a dire need for independent parties who inspect products and can warn consumers

Now, I realize that this is a lot to ask, and I do not deny that I am throwing stones at a glass house (my own country just failed to protect our citizens from greed), but in the long run China is going to need to begin proactively steming problems before something goes horribly wrong.  To have an issue of face inhibit a process that protects the general public is not only criminal, it is counter productive, and had the authorities take steps early on the would have actually gained more face.

Mal-nutrition is a threat to school-age children in rural China: the anemia rate is 18%, stunted growth 26% and vitamin A deficiency 44.1%. A national survey shows wide spread deficiency in calcium, iron, and vitamin A.

Taking a tour to the primary and middle schools in rural China, you’ll see many children there who walk several miles from home to school, eat two meals per days with just simple breads, and have no nutrition catering either at home or at school. Those scenarios you will see are separated but intertwined: because children are living far away from the school, it’s difficult for them to manage three meals per day; because the family is generally lack of knowledge in nutrition, children’s parents or grandparents are just providing whatever they think could fill up children’s stomach such as simple breads; school won’t take this responsibility of catering children’ nutrition needs as they are lacking the resource to handle students’ nutrition issue and at the same time might not lack of the incentives to add this into their Education priority. The school mapping policy (merge different spread out village schools into one Centre Township school so that education resource could be more concentrated to improve the teaching quality) has also significantly impacted rural school-age children’s nutrition in-take as many children have to live even further away from home and do not have sufficient in-take of vegetables and dairy products. Parents lack awareness and capacity to ensure children’s nutrition while no investment is made at school to contra balance the issue. Poor hygiene practice and sanitation facilities also further deteriorate nutrition status.

There are different ways to tackle this issue, either through charitable donation or market solution, but both ways would have difficulties to make a sustainable solution. For charitable donation, it would be very difficult for any organization to continuously provide financial support for food supply within the schools. For market solution, the profit margin will be very little if anyone runs a restaurant in the rural schools, not to mention that rural schools are generally lack of basic facility for restaurant business; also profit driven school restaurant might not be able to meet children’s nutrition needs taken into the consideration of the actual price that rural children’s family can afford.

A good solution that some NGO has been trying to provide is to combine the two, charitable donation and market solution, into one model which is replicatable and sustainable. There has been some School Nutrition Program in Western China run by international NGO and it has proved to be quite useful in tackling the nutrition issue in the rural schools. The idea is to first provide cash donation to help build related school facility such as dinning hall and kitchen in the schools and then start a biding process to recruit local people who are willing to run the restaurant business in the school; there should be a control of the number of restaurants who will get the bid as healthy competition will offer more competitive food price for the school students. After the bidding, specific guidelines on nutrition, hygiene and price will be offered to the school restaurants so that students could enjoy healthy and nutritional food with reasonable price every day at school. As for some expensive nutritional food materials such as meats and milks, creative gift program could be set up to provide subsidies for the students, for example through setting up fundraising campaign to encourage the public to ‘Donate a pig to rural school in China’ and ‘Donate a cow to rural school in China’. Different stocks that have been fundraised could later be bred by either the school or the local village households and be sent to the school restaurants to proceed with a cheap and nutritional menu for school students. In this way, a sustainable model with the combination of charitable donation and market solution is created to help the children in rural schools get the necessary nutrition for a healthy growth.

There are also other ideas to think about along this nutrition program such as: collaborating with the local education bureau, educating the local community -specifically children, parents and village representatives, simple and innovative nutrition measurement system that children will self-administer, integrating external experts support, etc.

The sustainability of a program could always mean creating long lasting motives for community members to work towards the single goal, changing people’s mindset for making better decisions, or advocating a successful model to government so that a right policy could be set to benefit the society long-termly on a while. In the process of designing a sustainable program, it’s worthwhile to always bear in mind that profit generating business model could sometimes be more sustainable than one time charitable donation and this could benefit the some program which could take the advantage of the two.

Over my 7 years in China, I have heard more stories of misguided management ethic than I can sometimes bare, but the worst stories of all come out of the food industry (melamine scandals aside).

On multiple occasions, I have read reports of where rival restaurant operators will literally put poison into the food that wil be served at the other restaurant… I guess the logic being that if the clientele gets sick at the rival store, that they will benefit.

While true that  a restaurant with a reputation for poor quality is less likely to succeed,I am absolutely repulsed to see that there are those who actually have so little regard for human life still exist.  That a strategy for dealing with the fact that someone else is more successful can somehow be dealt with by endangering the lives of others.. countless others who were simply trying to grab a bowl of noodles for lunch…. over and over and over and over again.

Now, perhaps at this point I would be better off stopping, but where I am constantly amazed is that people in China are willing to risk everything for so little..so needlessly… and that the life and death decisions of individuals are made without regard for those individuals

I know that is a broad cultural statement that may land me in comment hell, and I’ll agree that these cases are isolated, but it needed to be said..

for those of you who thought combining 80-100 hours work weeks, eating AMCHAM buffets, binge drinking, smoking and sleeping 4-5 hours, then you should read the third paper of Lancet’s recent China series

As recently reviewed in Newsweek, the recent changes diet, the sedimentary lifestyle, and the added stress of working in one of China’s many new shiny buildings has reduced the life expectancy for many of its middle class.

It is a trend that I have seen among many friends who “work hard and play harder” buy putting in 100 hour weeks and blowing off steam in one of Shanghai’s many clubs over the weekends.  It takes its toll… for some it means taking a detox trip to Thailand, for others it means being admitted to the hospital for exhaustion .. or as my friend put it, “paid leave”

For the Lancet, the answer was preventative medicine and a proactive government that would:

promote less salt and more fruit and vegetables in the diet, more exercise, and anti-smoking campaigns

In addition to that, I would also encourage Beijing to focus on developing stronger psychiatry, update their family planning regulations, continue working to improve the overall environment in which people live, and improve the quality of food and water that people are taking into their bodies.

These measures are also very important to the overall health of a person’s mind, body, and soul…

The Lancet, a 180 year old medical journal, has compiled an amazing - and important - collection of health related China articles.

An unprecedented scientific collaboration on China and global health launched by The Lancet, Peking University Health Sciences Centre, and the China Medical Board, was launched in Beijing on Oct 20, 2008.

This Series—focusing on health-system Reform in China—consists of 19 commissioned research papers that bring together the most recent scientific evidence on China’s major health challenges, its health strategies, and China’s health future. The Series was produced by a team of 63 scientists, with Chinese scientists constituting two-thirds of the authors, collaborating with an international team from 10 countries.

There are already over 20 articles that cover health care reform, HIV/ AIDS, China’s Barefoot doctors, Research ethics, and others

There is even a podcast: of Bill Summerskill from The Lancet, and China’s Minister of Health, Chen Zhu.

with the current state of China’s healthcare system being very fragile, and with the needs of the system only increasing, the work that is being represented holds real importance and I suggest everyone take the time to read through the articles that they feel are most important to them, their company, or their family.

Besides water, there is no other topic I believe is more important for China.

Several years back, I had a friend who was going through a rough time.  They were burned out, marriage was busted, and was in need of someone to talk to.

The problem was, that no one was there, and that only added to the anxiety of the situation.

Psychologists and Psychiatrists in China at that time were few and far between, and the ones that were available were often poorly trained to boot.  this was highlighted during the 5.1 earthquake as NGOs around China began announcing their mental health programs… but were unable to find the counselors to do the job.

the article As stress grows, modern Chinese turn to Western psychotherapy, offers some interesting insights into the history of psychiatry in China and the hurdles it faces in gaining wider acceptance:

Psychotherapy, which gained an entry in China with the country’s first psychology institute in 1917, was disparaged as unscientific after the Communists took power in 1949. It was banned during the Cultural Revolution of Mao Zedong, which ended in 1976.

China’s traditional culture values “saving face,” which means emphasizing the positive and addressing embarrassing issues obliquely. This approach conflicts with the process of openly discussing problems that is inherent to most psychotherapy.

Where I see this as especialy troubling is that in no other country have I seen the levels of family displacement as I have seen in China.  families, particularly of the poorer regions, make huge personal sacrifices to attain economic benefit.

My first ayi was a perfect example - she worked in Shanghai for almost 10 years while her husband worked in Guangdong on a construction site.  Their 4 children were living with her parents, and the entire situation was hard on everyone.  Kids were acting out, rebeling in school, and she and her husband were not really living a life as husband and wife.  At the minimum, the children would have benefited, but no doubt were she and her husband able to afford it for themselves, a few sessions would have benefited them as well.

And this story is repeated millions of times over.

In the grand scheme of things, one of the keys to stability in China is the ability of its citizens to remain mentally balanced.

There are a lot of ways that China has incorporated a lot of unhealthy vents into the system to let off steam (alcohol, smoking, massage parlors, internet bars, KTVs, etc), but to achieve mental stabilty long term it will need to address the core issues that people face rather than gloss them over with a bit of “entertainment”.

In doing a little more research on the HIV/ AIDS issues I covered a couple week back, I ran into an excellent paper from the Center for Strategic and International Studies called China’s Civil Society Organizations - What Future in the Health Sector? that documents a study done to understand what the role of civil society organizations (NGO) have in supporting the HIV/ AIDS situation in China.

From June 13 to June 20, 2007, a senior-level delegation organized by the CSIS Task Force on HIV/AIDS traveled to Beijing and Chengdu, China, to examine the current and potential role of civil society organizations (CSOs) in addressing China’s public health care challenges.

As many of you who are long time readers, or are leading an NGO will know, the history of NGO activity and relationship between the government and NGO have been up and down.  There have been times when NGOs have been a reliable partner on a public level (Sichuan earthquake) and there have been times when NGOs have found themselves left out.

This report recognizes that right off, and then moves straight into where they fell CSOs, particularly international CSOs, can play the most productive role:

• Invest greater resources into building the capacity of CSOs in China to make a more constructive contribution to alleviating health care challenges.
• Foster greater governmental and societal support for the valuable work CSOs can offer.
• Expand the role of universities, associations, government-organized nongovernmental organizations (GONGOs) and other government-related brokers.
• Encourage a greater role for the private sector and philanthropic giving.
• Develop near- and longer-term indicators of success for CSOs and their impact on addressing health care needs in China.
• Support a steady evolution and expansion of health-related CSOs, rooted in Chinese pragmatism, values, and sociopolitical realities.

All excellent recommendations, and it is why I highly recommend readers take the time to read the rest of this 22 page report.  Once again, you can download it here.