Research of the hygiene state of poor county of a country

Research of the hygiene state of poor county of a country
Sichuan Province Chengdu first associate professor of treatment of the People's Hospital Chen YanHua
" the doctor, I see the disease at 5 yuan "
Since 2006, I have the honor to participate in ten thousand doctors of Ministry of Public Health and support the rural hygiene project twice, go to Xide county of Yi Autonomous Prefecture of Liangshan of Sichuan Province to work. Poverty alleviation, county of Xide, do person in charge, introduce this county countryside poor peasant have 31786 people (the intersection of per person and annual net income absolutely until 625 yuan following) ,Low-income the intersection of peasant and 25543 people ' The annual net income of per person is in 625- 1000 yuan) ,Total 57329 people, accounts for 38.39% of the agricultural population, the overwhelming majority is the masses of Yi, they are or higher than the absolute poverty line under the absolute poverty line slightly, the adequate food and clothing have not been solved yet.
The patient of Yi that treated in the daily clinic of the county hospital, conditions are generally all relatively critical, and very poor. Some treats the unlikely disease in hospital in the city in time, such as acute upper airway infection, may tow into serious disease too in the countryside of Xide county, after erupting pneumonia simultaneously, have to be in hospital. Very rare disease in some cities is not rarely seen in Xide county, such as dysentery, measles, scarlet fever, typhoid fever,etc.. Child and even adult are malnutritive and very common.
Because is economical and in a difficult position, locals will not go to see doctor when appears while less than symptom of jeopardizing the lifing. Generally they " Hit and hang the needle " (infusion) Regard as and fall ill and not have sick line of demarcation. Appear uncomfortable, most people hard to resist, until resist, can reach hospital diagnose the illness. So according to counting, the proportion of number of times that different kinds of diseases go to a doctor is: Wound account for 1.83% in the two week, chronic disease account for 30.46% in the half a year, account for 67.71% in hospital in the first year. Peasants' ill rate is 24.25% (should be interpreted as the rate of suffering from serious disease) ,25.24% of the patients have not gone to a doctor because of financial difficulties.
Prop up medicine in Xide, it is very important to take up a job as a doctor and go through long, knowledge is much, medical ethics is good. Open examine, in patient that go to a doctor include, woman, the intersection of child and all department. Some go to school in books, take up a job as a doctor the intersection of disease and card that has not see 20 more than year, such as typhoid fever, paratyphoid fever, malaria; Some infectious diseases, such as acute jaundice hepatitis, new pulmonary tuberculosis; Some value the disease, such as snail fever, liver cirrhosis ascites, cancer of various later period,etc., it is a main disease contacted every day. Because of the local poverty, so most patients just seek medical advice while having heavy condition. It speaks with Sichuan to be here every day " Take an exam of craftsmanship " .
It all have little money only that most patients in Xide come to go to a doctor, some patients of Yi say once entering the consulting room: "Doctor, I see the disease at 5 yuan. " Yi on some high mountains, the primitive idea that batered originally has also kept some more or less, they will propose for the doctor: " see the disease of a chicken " . This does not want you to accept his chicken, that sell the chicken on the nearby market first, the money sees the doctor and spends the maximum that can be accepted today. In this way, you must consider trying hard to use it by the side, reducing the flavor number of medicine while prescribing; Try hard to cure the disease with the lowest priced medicine. Do not basically consider in the city how much medicine the price is, ability several times rotates in the brain more to start to write or draw on the prescription here soon. Could turn on various to check, required the doctor to mainly use traditional " hoped to smell and asked and cut " here in the hospital originally To judge the condition. And these must also guarantee to diagnose accuracy and curative effect positively, because Yi's compatriot thinks you are the expert coming down on the province. Meet disease have money register patient that get it filled again, oneself foot a bill pay first for them situation of expense very common too. The doctor can not bear and let those even set out on the first day after walking mountain path of several 5 kilometers absolutely, diagnose you that is wrapped up in outdoors " Examine tiles " Roll up the patient in a night and return empty.
Once in hospital, the expenses are different to bear for most peasants of Yi. Hospitalization cost of patient spend in at the county level and above medical organization mainly, wound go to a doctor each time expense of person reach 1332 yuan in go to a doctor by at the county level and above medical unit in the half a year, it is 4.33 times that of unit expenses of medical treatment under county and county; The number of patient that the medical organization at the county level and above is in hospital accounts for 24.9% in hospital the number of people, but the hospitalization cost used accounts for all 84.1% of the expenses in hospital, the average expenses reach 6087.63 yuan time, is close to and in hospital in the medical organization at county level 10 times of the expenses.
The intersection of Yi and president of hospital, county of Xide, the salad Kazakhstan say don't: " peasant it has disease to be serious disease, county quite a lot hospital can not cure, get up ,Have to reach to hospital and province of Liangshan state. We hospital, already until expenses it controls to be here 800- 1200 yuan each time in hospital, or can not afford to give. Money have, treat, can't stop, park, cause deaths soon, the intersection of I and the difficult president! "
The person in charge that the county poverty alleviation is done says: "Have an appointment in 20% of the peasants the intersection of person and financial difficulties, fall ill medicine blow. Fall ill workforce of is it or not main to die family aloning,in anti-poverty register of me can one of families more. Some people even if by sell off pig and ox, lend the money, diagnose the illness, the result is not fine. There is every year of person in 5%- 6% of the peasants because the average expenses of once reach 3- 4 times of the per capita net income in hospital in the hospital at the county level and above, either it is that ' return to to cause due to illness poorly due to illness, have got back to my register again. "
He says: "Doctor Chen, you do not know how difficultly it will want a family to shake off poverty. Once fall ill, finish. "
Like Xide county, Liangshan other 10 country of state make poor county exist this kind " poor to exceed disease, the worse the poorer " Vicious circle,it is it is main for reason since it hinder the that development of different regions.
The county hospital is still too far from the national goal
Go back Chengdu, entangled with whom the heavy mood of me have greatly, releive in will it be will it be the end September 2007, this is because of January of 2007, Xide county shuts one of the pilot counties newly and agriculturally as 4 of Liangshan state. The intersection of Xide and county have in all, join, shut peasant 122603 people, account for, all should join 82.1% to equal to number. Have already felt from the prominent increase of my daily out patient, " shut newly and agriculturally " Contributing. The situation tried for 5 months is counted, Xide county joins the visit patient that shut, clinic and proportion in hospital are since rising to 50.7% - 49.3% at 32.79% - 67.21% of 2005, the clinic person has exceeded persons for the first time for many years and is in hospital; In 2,105,000 expenses that 3314 persons in hospital happen, state aid is 832,200, " it is poor to cause due to illness " to reduce to a great extent , " it is poor to return to due to illness" Probability. In addition according to the intersection of Xide and actual conditions of county, shut medical fee of pregnant and parturient women equal to and " lower, disappear " while being agricultural while being new joining 100% of project is compensated. The actual compensation proportion over 5 months is 39.54%.
The apparatus of the county hospital is defending VI project, province in recent years " The poverty alleviation of hygiene " , " ability construction of the hygiene of strengthening the ethnic mimority area " , " lower, disappear " , " treasury bond " Wait for project support to leave, acquire more than 3600 pieces of medical equipment and apparatus. But contrast comes with the goal " the service system construction of the rural hygiene is with the development plan ", disparity is still very great.
The commune hospital can not afford the expenses of surfing Internet of 100 yuan per month
I have reached the commune hospitals of some townships of Xide in the investigation. In recent years, supported by anti-poverty projects of various countries, 24 health clinics in towns and townships got more than 1700 sets of medical equipment and apparatus(one) ,But contrast according to the goal of " planning ", only a few apparatuses such as the refrigerator reach the quantity required, apparatus on it is most either quantity disparity large or equipment quantity as " 0" . It is insufficient to compare the apparatus, another difficulty lacks talents. The commune hospitals of 5 centres have X-ray machine which a country allocates, electrocardiograph, Ultrasonography B to diagnose the appearance, have person to operate qualification use temporarily under state that meet an urgent need just ' Lack medical image professional personnel) ,Can't fully contribute. Larger difficulty is lacking the funds. Before trying newly and agriculturally jointly, there are only 1- 2 patients each day in the general health clinics in towns and townships, there is no a patient to seek medical advice all day sometimes. Average prescription have only 3- 4, impatient few. Average every day 36 clinic persons of commune hospital of 5 centres, average prescription of 6.3 yuan persons of clinic, it is not enough to remedy difference parts of the salaries to workers by medical incomes. System management of pregnant and parturient women at ordinary times, children's health care system management, rural midwife's training, children plan job funds such as immunity to pay from every commune hospital meagre medical income. Clerical cost at least, water and electricity expenses must be paid. It is managed, even become the problem to keep running well that most township commune hospitals are in debt, the intersection of clinic and quantity and drop, in state that wither gradually in hospital rate.
Know the difficulty of the commune hospital in the township, why do I understand in the commune hospitals in the township of 5 centres and the computer that equips of straight newspaper of public health event happen suddenly as infectious disease in the western region in what has been seen, because unable to pay and surf the Net support expenses are unable to surf the Net. Regard network as person of a part of life as to these of ours, network fee of 100 yuan needn't basically be considered each month, but this expenses, the unable commitments at all of health clinics in towns and townships of Xide county.
The village clinic is two square meters
In the investigation in Yi village of the high mountain, I understand the village clinic as health care network network bottom of the rural tertiary hygiene too. What is called village clinic, generally there is a corner in one's own home in medicine of village, there are several bottles of simple medicines. Congratulate waves of the intersection of Lip river and one village of township, cure family, a dirty desk, there are odd medicine bottles to cover with dust above, the propaganda materials of a pile of epidemic prevention, perhaps it is those village clinics of two square meters on statistical data of Xide.
There are clinics of 176 villages in Xide county, cover 170 natural villages in the whole county. 25 can launch prevention and health care and basic medical care. These 25 clinic medicines varieties, more than 20 kinds, worth 1000- 1500 yuan, it accounts for 10% of total population to serve population, mainly distributed in the mountain of the crown, two river mouths and a district and mountain area to have an elevation of 2500 meters the following. There are clinics of 15 villages that can launch limited prevention and health care and treatment slight injury and small disease. Medicines variety, within 20, worth 100- 500 yuan, serve population, account for total 15% of population, distribute in 5 slices of 2500 meter following mountain area of district mainly. The clinic of other 136 villages can only launch the extremely limited prevention and health care, there are no medicines and medical equipment, about 75% of the population has no most basic medical organization to offer medical treatment service, is mainly distributed in the high and cold mountain area in 5 districts.
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