When surgeon Dorje Tsering finally stepped out of the operating theater after taking the lead on a major procedure for the first time in June, he felt utterly drained.

Dorje Tsering, 29, performed the orthopedic surgery on a local patient from Lhorong county in the Xizang autonomous region, who suffered from Kashin-Beck disease — a chronic joint disorder characterized by painful swelling and stunted growth.

Despite spending about a year training under the guidance of medical experts from Fujian province, Dorje Tsering said during the procedure his concentration was intense.

"Perhaps because I was completely focused on recalling each surgical step and heeding my supervisor's guidance, I felt no nervousness during the over two-hour-long operation and my hands remained remarkably steady throughout," he said. "But the instant I left the operating table, overwhelming exhaustion set in."

The surgery tested both Dorje Tsering's medical expertise and mental resilience, and its success has hardened his resolve to hone his skills in treating this debilitating condition that has plagued rural communities across Xizang for generations.

Kashin-Beck disease is endemic in 379 county or district-level regions across 13 provincial-level regions in China, including Xizang, the provinces of Sichuan, Qinghai and Heilongjiang.

The disorder primarily manifests during childhood and adolescence, with risk factors including selenium deficiency, malnutrition and exposure to toxins or fungi in contaminated food. However, medical researchers have yet to determine its exact cause.

Through comprehensive prevention measures such as dietary improvements, introductions of new, clean water resources and relocations, China has reported no new cases of Kashin-Beck disease in recent years.

However, official statistics show there remain some 170,000 existing patients, some of whom are severely deformed by the disease and unable to work.

In Xizang, about 60 percent of Kashin-Beck disease cases cluster in six counties within Chamdo, including Lhorong county.

At the Lhorong County People's Hospital where Dorje Tsering practices, the arrival of medical aid professionals from more developed regions over the past decade has dramatically enhanced local treatment capabilities and transformed the lives of many patients.

Gao Yipeng, the hospital president and head of a medical aid group from Quanzhou, Fujian province, said that most local patients are aged 50 or older, and those with serious cases may not be able to stand.

The most common treatment for serious Kashin-Beck disease cases is hip or joint replacements — an invasive and complex surgery previously inaccessible locally.

Since 2015, medical assistance programs led by experts from Beijing have enabled a growing number of patients to travel to the capital to receive high-quality treatment. Starting in 2021, Quanzhou was tasked with sending medical aid groups to Lhorong county, with a focus on not only bringing advanced medical technologies closer to patients' homes, but also nurturing local medical professionals.

Gao said that the hospital has completed over 720 surgeries for Kashin-Beck disease patients.

"Since I arrived in August of last year, more than 170 operations have been carried out locally. They were all successful, with zero complications or infections," he added.

Last year, the hospital established a dedicated Kashin-Beck disease treatment center, aiming to provide comprehensive care spanning diagnosis, surgical intervention and rehabilitation.

Yang Yang, head nurse at the hospital's orthopedic department, said that while Kashin-Beck patients typically discharge after one week in urban hospitals, local cases often stay several days longer to ensure proper wound healing and prompt care for lingering symptoms.

"Rehabilitation is essential for orthopedic surgery patients," she said. "Just hours post-operation, we guide them to try lifting their legs and bending their knees, then progress to specialized equipment in the rehabilitation room for walking and stair-climbing practice. Before discharge, we teach simple rehabilitation exercises for continued home recovery."

Dorje Tsering, the junior surgeon, was originally trained in general clinical medicine, but now wishes to specialize in orthopedics. He credited his mentor, Zhan Zhiqiang from Quanzhou Guangqian Hospital who finished a one-year aid mission in July, with providing him with foundational skills and the inspiration to pursue this specialty.

"At the beginning of his stay, I followed and observed him receive patients, analyze cases and conduct ward rounds, then I gradually began participating in surgical preparations," Dorje Tsering said. "I made up my mind to finish one operation by myself before he left, and I achieved my goal."

Dorje Tsering said that Zhan stressed the discipline of being meticulous and precise.

"After my inaugural operation, he suggested lowering the operating table height to better suit my stature," Dorje Tsering said. "He also reminded me to pay attention to details. Even when placing a seemingly unimportant tool, it is important to stay precise and sharp.

"Though his assignment here concluded, his teachings remain with me as I continue developing my skills alongside other medical experts," he added.

Zhang Conglin, a surgeon from Huian County Hospital in Quanzhou, Fujian province, is among the newest aid members who arrived in Lhorong county in mid-July.

One evening, while strolling through the town center, he noticed an elderly man with swollen joints walking in labored, halting steps.

"He clearly had Kashin-Beck disease so I approached him and asked if he had ever thought about going to the hospital," said Zhang. "But he simply shrugged off the idea. At over 70, he didn't believe treatment was worth the trouble for an old man."

Zhang said that many patients postpone treatment during the busy barley harvesting season of July and August despite open appointment slots and readily available hospital beds. "The peak season for surgeries usually starts in October," he said.

Zhang added that aside from improving local medical capabilities, public health education needs to be improved to spread greater awareness of treatment options and the risks of delaying care.