Hu Yan lives a short 20-minute drive from Lujiazui, Shanghai’s futuristic financial district. She, her husband and their six-month-old son occupy one small dark room, down a stinking alleyway on the banks of a fetid stream. She has no kitchen or sink, uses a chamber pot for sanitation and cooks family meals in a rice cooker.
China may build skyscrapers like any rich country, but Hu’s life is a graphic reminder that, at the heart of Chinese prosperity, millions still live in poverty.
Hu, 25, is part of an urban underclass that scrapes by on the fringes – or sometimes in the centre – of China’s biggest cities. She is one of 230m migrants who have boosted urbanisation to the point where last year, for the first time, more Chinese lived in cities than in the countryside.
Helping those new migrants integrate into a city where long-term residents often openly despise waidiren (people from outside Shanghai) is the mission of the GSK New Citizen Health Care project, funded by GlaxoSmithKline, the drug company, and operated by the Xintu Centre for Community Health Promotion, a local non-governmental organisation (NGO) that specialises in migrant services. The local government in Sanlin town – a crowded urban community of 100,000 migrants that has the feel of a rural village – also supports the project, providing premises for the project’s playroom, classrooms and offices, plus some spin-off funding.
Millions of migrants to Shanghai hold office jobs and own homes and cars. Some have even become multimillionaires. But many newer migrants such as Hu, who arrived from Anhui province only last year, struggle to raise a family without indoor plumbing, and with only the most rudimentary knowledge of hygiene, antenatal care and child development, in communities polluted by industrial waste and environmental toxins.
Her community does have a public toilet, about five minutes’ walk from her home. She must go there every morning to dump her family’s nightsoil – though a sign on one gutter, “Don’t dump your chamber pot here”, suggests residents are sometimes tempted not to go that far.
The World Health Organisation says China has made rapid progress in upgrading its sanitation facilities, and Shanghai has conducted a campaign to install prefabricated public toilets at many intersections. But many migrants cannot hope to afford a home with an indoor toilet.
Keeping infants healthy, toddlers entertained and marriages strong is hard in such circumstances. That is where the New Citizen project comes in. From its annual budget of Rmb 1m ($150,000), it provides an eclectic mix of services, from education on infant care and preventing domestic violence, to lessons on how to shop online, use Skype and celebrate Valentine’s day (the last is to help migrants maintain family relationships, rather than a marketing ploy by confectionary companies).
The centre offers English lessons as a way of getting migrants through the door to hear the project’s primary message on public health. It helps that the project’s New Citizen Life Centre in Sanlin, housed in a government building, is one of the few free air-conditioned venues in town.
Hu has attended sessions at the centre on domestic violence, children’s medicines, antenatal health and even cosmetics for pregnant women. It is not hard to see why she is such an avid student. On the day I visit Hu’s home, she and baby Xing Junhao – clad only in a bib embroidered with the slogan “Happy Baby” – are trying to chase away heat of 36C with the help of a struggling ceiling fan. One neighbourhood toddler, her back scarred by heat rash, lounges in the arms of a local granny while another squats to make a bowel movement on a magazine spread on the ground.
“When I first came to the centre, I was coming for a baby wrap I heard they would give me afterwards,” says Hu. “But I found the content of the lectures interesting and useful and then I came a second time.” After each lecture, she received a small gift, and on her birthday the centre provided cake and a meal of noodles to celebrate. She adds that contact with other mothers in the centre’s cool, toy-filled playroom is a bonus.
Hu is not a legal resident of Shanghai as she does not have the all-important hukou, or internal passport, allowing her to claim the benefits of a Shanghai citizen. But the Shanghai government provides basic healthcare to migrants and residents alike, and Hu says she thinks she has access to the same antenatal care as a resident.
Xintu director Guo Xiaomu, herself a migrant, says many incomers are unaware they may use public services such as free gynaecological screening for women. “There are free health services, but migrants often do not know about them,” she says, adding that communicating this information to the migrant population is one of the primary goals of the project.
The government of Shanghai’s Pudong district (where Sanlin town is) has reproductive health centres that are open to all residents, including migrants, “but they are not very people-centred” and focus more on distribution of drugs, she says.
The New Citizen project, though sponsored by a drug company, does not provide medical care directly or, for that matter, boost sales of GSK drugs, except indirectly through brand building. The centre’s role is health education and to help migrants find the state healthcare to which they are entitled.
In a country where corruption scandals have tarnished the reputation of many charities, including the Chinese Red Cross, the New Citizen project, and its local operator Xintu, have so far avoided any hint of wrongdoing. The project’s accounts are published and audited annually, and the US consulate in Shanghai recently recognised the project for its work in raising awareness of women’s health issues.
“I don’t know of any other project quite like it in Shanghai that combines healthcare with education and other services,” says Corinne Hua, founder of Stepping Stones China, another local NGO that works with migrants. “I believe Xintu has good internal controls and a high level of transparency and accountability.”
The New Citizen project, staffed largely by migrants, is unusual in China in that it asks the target population what they need, rather than telling them what they ought to have. So after one recent lecture on foot and mouth disease – conducted in a village lane so narrow the participants had to make way repeatedly for itinerant noodle sellers, recycling carts and rickshaws – staff passed out feedback forms to find out what residents wanted from such lectures.
The 15 toddlers present made their likes and dislikes fairly clear: once the centre’s director finished telling their assembled mothers and other carers how to stop the spread of foot and mouth disease by burying faeces and avoiding kissing infected children, a young volunteer turned on his iPad to show a music video on the importance of washing hands before meals. Fifteen tiny faces were glued to the screen, and 15 sets of hands mimicked the handwashing motions modelled by the volunteer.
GSK New Citizen Health Care has opened some satellite centres beyond Sanlin town, and there are plans to expand to Beijing. It is a drop in the ocean of Chinese migrants. But with local governments intent on providing better public services to migrants – because they know social stability could depend on it – GSK and Xintu could lead where government will follow.
China will not become a uniformly rich country overnight, but for Hu and her baby, even this small bit of help makes a difference.
Additional reporting by Yan Zhang