For logistic reasons, we had to travel from Kunming, Yunnan, and our team only managed to reach the village closest to the main "road" after 18 hours of bumpy car ride in the mountain, having to cross the river several times along the way. For the route up to the furthest village, it would require at least another 40 minutes of speedboat travel upstream, then additional hiking along the river bank. If modern telecommunication coverage were an indication of remoteness, the lack of network coverage of both our mobile phones and newly-rented satellite phones could be evidence of how far away we were from modern civilization.

The force of nature had turned most of the villages into rubbles — 100% destruction for some. Even six months after the earthquake, we found 75% of the families were still living in "anatomy specimen-looking houses", as the powerful earthquake had cut through the buildings and split them into halves. Some households simply camped in make-shift tents next to a pile of bricks and beams while their livestocks were kept under shelter.

Ironically, the global financial crisis had facilitated the reconstruction and rehabilitation. The demographic pattern was different from what we had thought in rural China, which tends to consist mainly the extreme of ages and the sick, while the younger ones leave the village in search of a better living in the city. In the study area, we found strong working-age people who returned to the area because of inability to seek employment in the urban areas. In day time, these young workers were the major working force to rebuild the damaged houses. Women were clearing the debris, children were running around and old people were mixing cement and taking care of the logistics of rebuilding. The process was very slow but everyone was busy.

Public health hazards were prevalent around the area. Although earthquake injury and mortality pattern was comparable to other disasters, major public health concerns have been raised. Results of preliminary investigation indicated that general health knowledge was low. Gastrointestinal, parasitic infections were common. Health cost for preventable diseases was high, and related medical visits had bore a major burden on these families who survived on a monthly household income of less than RMB300. Brushing teeth and washing hands were not regular practiced as water quality was a concern. Empty beer bottles, stagnant sewage water, running poultry and animal excretion were all within the living premises. Children were running on shattered glasses, fallen debris and rusted iron nails with bare feet. However, the villagers were very hospitable. They offered us their best food and drink — beer. No wonder beer drinking was common in the area. Water quality was highly questionable as dead insect bodies were found on almost every water basin. People smoked and cooked indoor, and the small windows offered very limited ventilation. Flies, mosquitoes swamped around our heads as we tried to interpret what our interviewees were trying to hint to us while our official guides were eager to volunteer their answers on behalf of these respondents.

Another invaluable experience was that we were constantly chased by angry dogs and fierce turkeys strolling around these villages to conduct door-to-door survey. Most dogs apparently were not vaccinated with Rabies, and in several occasions, we were confronted with a mad-looking canine, barking and dripping with saliva, chasing after us as we ran in vain around the village to avoid being bitten. The dog owner/villager would soon enter the picture, screaming and trying his best to control his over-excited pet. Indeed, if resources were available, a lot of simple public health interventions could be done. For instance, we might bring medical volunteers and public health students to improve health status and address needs. Nevertheless, from a public health protection perspective, vaccination for dogs might be the first priority!

One night, we had to travel in the dark after working in one of the remotest villages in Jin Sha Jiang. We were all anxious since the return trip to the base camp required us to hike down a 60 degree sand slope to the river bank for our boat. It was completely dark and we had nothing more than our faint flash light. In normal circumstances, we would not have run down that 100 meter sand slope in full speed, but not doing so meant we would quickly sink in the sand almost up to our waistlines. We managed to get back to the boat, but we could hardly speak as we were all exhausted after 14 hours of survey interviews, constant dog chase, hunger, the adrenaline rush from the slope hike. Worst of all, we knew we had no chance of a shower or proper toilet for at least another 5 days. We were in a depressed mode when thinking how far away we were from home. Perhaps the only consolation might be the instant cup noodles and canned sardines that awaited us in the base camp. Once we calmed down in the speedboat, we began to appreciate the silence that filled the air as we sat in awe at the vast wilderness that surrounded us. We were mesmerized by the starlight that fell upon the river, light breeze that brushed our sand/mud filled faces and the calm river with occasional sparkly splashes. At that moment, I wondered what an experience our technical rural public health field work team might bring home.

A road less travelled but definitely worth visiting.

Author: Professor Emily Ying-yang CHAN, Team Leader of SPH Assessment Team, School of Public Health, The Chinese University of Hong Kong