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Matters of the heart out in the countryside

  • Source : China Daily Author : Time : 11/04/2019 Editor : Tenzin Woebom

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    Xu Mingjun (second left) directs local doctors to practice chest compression on a mannequin. [Photo provided to China Daily]


    City doctors are lending their expertise to rural colleagues to improve the level of healthcare.


    As rain fell in the township of Tuoding, Yunnan province, one day in July, a group of local doctors and village health workers gathered in a conference room of the township's health center listening attentively to medical experts from Beijing.


    With a row of mannequins lying on the floor, the experts explained how to carry out cardiopulmonary resuscitation, and the local medical workers were soon practicing the skill.


    Xu Mingjun, director of the anesthesiology department at the Beijing Obstetrics and Gynecology Hospital attached to Capital Medical University, walked around the room inspecting the way the trainees were performing their tasks.


    It took Tashi Nyima, one of the locals, a while to successfully administer artificial respiration to his mannequin. He performed several more times under the guidance of Xu and later explained sheepishly that he was not used to the soft "lower jawbone".



    A CPR training. [Photo provided to China Daily]


    He has to administer CPR from time to time in his work. However, when he is overly anxious about a patient's state he sometimes conducts the chest compression phase too quickly, he said.


    Tashi Nyima and his colleagues were also impressed on hearing Xu explain that it is appropriate to compress a patient's chest down to 3 to 4 centimeters instead of 5 to 6 cm, as reference books often suggest, because Chinese people usually have smaller frames than Westerners.


    Xu, director of the Beijing branch of a national committee of CPR training and promotion organized by the Chinese Society of Cardiothoracic and Vascular Anesthesiology, and his team have been holding CPR training events in hospitals and universities, and outside tourist attractions in Beijing, aimed at medical professionals and lay people alike.


    "CPR is an important and practical skill for saving lives, especially of those suffering from asphyxia, but the skill is poorly trained in China," Xu says.



    An orthopaedic examination. [Photo provided to China Daily]


    It is important that more people know about the standard procedure for conducting CPR, which starts by calling for help and judging whether it is needed, he says. He hopes more people will be able to carry out CPR strictly following the guidelines.


    Xu came to the township sitting on the Jinsha River, an upstream tributary of the Yangtze River, with a group of about 50 medical professionals from big hospitals in big cities on July 9. They received 1,126 visits that day.


    They were attending a free clinic activity run by the Chinahearts Organizing Committee of Beijing. About 800 volunteers were invited to Dechen Tibet autonomous prefecture in Yunnan province, to which the township belongs, to provide the service from July 7 to 14.


    It was the 11th year that the committee has organized such free clinic activities in ethnic Tibetan areas in Yunnan, Sichuan, Qinghai, Gansu provinces and the Tibet autonomous region.



    Tashi Nyima (first left) and Amei (first right) in training. [Photo provided to China Daily]


    It was not the first time that medical experts from cities coming to Tuoding township to give CPR training. However, Xu noticed that local medical workers could yell out some words, sometimes wrongly though, but lacked the requisite skills.


    His aim was not only to interpret the technical details and provide demonstrations, but also to let local medical workers practice and gain experience so they would remain calm in real emergencies.


    However, it requires repeated training and practice to fully master the skill, and Xu acknowledged that day time was limited for a detailed lecture and one-on-one coaching.


    Two days after Xu's short training session, though, a local doctor, Amei, with a mannequin Xu's team donated to the health center, independently gave CPR training to doctors of another township in the prefecture.


    Amei, deputy director of Tuoding township's health center, says she is determined to work with her colleagues to teach basic CPR skills in the countryside, a large part of which is hidden deep in the mountains, with scattered villagers who are difficult to get to.



    Basic CPR skill in the countryside is viewed as part of the doctors' work to raise villagers' health awareness. [Photo provided to China Daily]


    She views it as part of their work to raise villagers' health awareness and the ability to help relatives in emergencies, as is required by a system covering rural areas throughout the country in which a family physician is designated to serve particular people.


    The doctors are required to track the physical well-being of those they serve, especially the poor, the aged, the pregnant, the disabled and children, as well as patients of chronic diseases such as hypertension, diabetes and mental disorders.


    The underprivileged people there would have 90 percent of their medical fees covered by health insurance, and the rest can be sponsored by the government if they could not afford it, Tashi Nyima says.


    It has been two years since the system started running there. Local medical workers are divided into groups, usually comprising a licensed general practitioner, a nurse and two village health workers. Each group of family physicians serves a single village as a complement to the regular medical work they do.


    The family physicians, on call to make house visits around the clock, have built a highly reliable health safety net for rural dwellers.


    Rheumatism, hypertension and heart diseases are some of the common diseases in the plateau region with relatively cold weather, says Wugyan Tsering, 41, a local doctor.


    He often visits patients in the countryside at night, even having to wait for an infusion to be completed before returning immediately to start his work in the township's health center the next day.


    It was not until last year that local doctors could have a regular day off every week, he says, earlier only having been able to have a day off after completing a night shift.


    They also help to update the villagers' health files, arrange referrals to larger city hospitals for severely ill patients they are unable to treat, and help them handle health insurance procedures, says Tashi Nyima, whose team of four family physicians has been assigned 645 villagers to look after this year.


    They have been providing free health checks for the villagers for about 10 years, Amei says.


    It takes time for the doctors to learn that they need to carry out their duties in accordance to the bioclocks and life habits of the villagers, and to give feedback in time. With doctors' diagnosis, the villagers would be more willing to take doctors' advice, like taking less oil and salt.


    And it also takes time for the villagers to understand the importance of healthcare and preventing the diseases by developing healthy living habits, Amei says.


    Villagers now know a lot more about chronic diseases thanks to health lectures given by the family physicians that include dietary guidance, training on how to measure one's own blood pressure and blood glucose at home, and that will eventually provide advice on what to do in emergencies.


    When Xu stayed in the township he visited a patient living in the mountains who had rectal cancer and who had undergone eight rounds of chemotherapy.


    Rural people usually lack awareness of how they can take care of themselves, Xu says, and the cancer patient had hematochezia, an early symptom, for a long time, but had failed to take it seriously.


    It is important to have more general practitioners in the countryside, making regular house calls and doing health checks on villagers, he says.


    "In rural areas we need to attach a lot more importance to preventing diseases."


    After the free clinic day in Tuoding township, Amei followed the Beijing-based medical experts to other neighboring townships.


    She stayed with the general practitioners and cardiologists for two days, learning how to better control hypertension and how to decide whether to let diabetes patients use insulin or take medicine, problems that have long preoccupied her.


    The techniques she learned in those two days were down-to-earth and easy to put into practice, she said. However, she regretted that the experts came with little medical equipment and could not diagnose all the patients and put all of their skills to good use.


    Xu and Amei say it is crucial that rural doctors be armed with practical medical skills rather than being taught a lot of theory, and in that regard hand-on demonstrations are of great use.


    Wugyan Tsering says a high-end electrocardiograph has been idle since experts organized by the Chinahearts Organizing Committee handed it over to them five years ago. The reason? The instruction manual that came with the equipment is in English only, and the doctors still do not know how to operate it.


    Local doctors were busy helping villagers register with doctors, and interpreting between the experts and the villagers for the whole day, so the opportunity was missed to dust off the electrocardiograph and to provide some guidance on how to use it.


    Most people from Tuoding township speak Tibetan, the ethnic Lisu language and local dialects rather than Mandarin.


    Wugyan Tsering says he received more than 100 phone calls from villagers the night of the free clinic day, asking whether there would be another free clinic event over the following days.

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