Willing to be the "gatekeeper" of rural health
-- More than 95% of the general practitioners in Hainan choose to stay at the grassroots level after the completion of their services
"Ah Gong, you are very dangerous now, you have to go to a higher-level hospital, and if you don't agree, I can only find the police!" In the face of the patient's non-cooperation, Zeng Guangwang, the vice president of the "post-90s" of the Nansheng Town Health Center in Wuzhishan City, was so anxious that he had to move out of the "rescuer".
This is not the first time Zeng Guangwang has encountered such a situation. Is the patient's lack of cooperation due to a lack of understanding of the disease? Or is there a distrust of grassroots doctors?
Whatever the reason, Zeng Guangwang is determined to change this situation.
Since 2010, our province has carried out the work of training general practitioners in rural areas, and outstanding young people like Zeng Guangwang have gone to primary medical positions and become the backbone. According to the preliminary statistics of the Provincial Health Commission, 159 of them have completed their service period (ranging from five to six years) in accordance with the agreement, and more than 95% of them are willing to continue to stay at the grassroots level.
Ankang Hospital of Baoting Li and Miao Autonomous County. Photo by Ma Ke
What made them choose to stay?
What kind of changes have they brought to the grassroots?
01
Realize your ambitions at the grassroots level
What is the Yang Ah Gong who made Zeng Guangwang anxious?
One day in 2023, Ah Gong Yang claimed that he had a sore throat and came to Nansheng Town Health Center for treatment. According to the symptoms, the attending doctor judged that Yang Ah Gong was not an ordinary sore throat, so he found Zeng Guangwang.
After understanding the basic situation, Zeng Guangwang immediately arranged for the patient to do an electrocardiogram and found that there were symptoms of myocardial infarction. After emergency treatment, Zeng Guangwang suggested that he be immediately transferred to a higher-level hospital for inpatient treatment.
"It's okay, I just have a sore throat, where is there such a serious ......" Yang Ah Gong's stubbornness made the situation stalemate for a while. But Zeng Guangwang knew that if he did not treat him in time, the patient's life was likely to be in danger at any time, so in desperation, he could only move out of the method of "finding the police" and urging the other party to go to a higher-level hospital for examination.
Subsequently, the 120 ambulance referred Yang Agong to the Second Provincial People's Hospital and performed interventional surgery.
Now, the recovered Yang Ah Gong is grateful to Zeng Guangwang, and every time he passes by the Nansheng Town Health Center, he has to come to see Zeng Guangwang and say hello and chat with him.
This is a microcosm of the role of rural orientation and training of general practitioners at the grassroots level.
In 2021, Zeng Guangwang, who completed 3 years of regular training at Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, came to Nansheng Town Health Center. When he first arrived, he had surprises and gaps.
The surprise is that after the standardization of primary medical care in Hainan, the primary medical institutions are no longer the "old and broken" and "cases are all handwritten" in his impression, but "the software and hardware are very powerful".
The gap lies in the fact that he focused on medical care when he was in a tertiary hospital in Shanghai, but when he went to the grassroots level, he was more widely managed, and in addition to medical treatment, he also had to be responsible for public health, family doctor contracting, etc., which was not easy to do.
"Once I went into a home physical examination, I found that an uncle's blood pressure was already very high, but my uncle didn't care." Zeng Guangwang said that there are still many patients who come to the health center and ask for infusions, and they will not leave if they do not give infusions.
Facing the reality, Zeng Guangwang was determined to make a change. He learned to communicate in a way that was acceptable to the grassroots people, and slowly changed their concept of medical treatment.
"Uncle, look at the person next door, he didn't take medicine because of high blood pressure, he fell ill a few days ago, and now he is sent to a big hospital for rescue, is it scary? So, you have to take this blood pressure medicine on time! Zeng Guangwang carried out health education like a homely person, and slowly, the people in the neighborhood became more and more recognized by this young man.
Not only that, Zeng Guangwang also brought the technology to other doctors in the township health center through outpatient teaching and case discussion.
Zeng Guangwang, vice president of the Nansheng Town Health Center in Wuzhishan City, conducted an eye examination for her grandmother. Photo by Ma Ke
Today, Nansheng Town Health Center has established a chest pain treatment unit and passed the audit and certification of the Provincial Chest Pain Center, so that chest pain patients can get early identification and emergency rescue at their doorstep.
Li Youfang, the old director of the Nansheng Town Health Center, said that the health center used to have a very low outpatient volume and no inpatient wards. With the arrival of Zeng Guangwang and two other rural general practitioners, the number of inpatient wards and outpatient clinics has increased considerably.
This year, Zeng Guangwang's service agreement expired, and he, who was originally from Haikou, still chose to stay in Wuzhishan. "Compared with the city, I think the township needs us more, and here we can gradually change the health concept of the grassroots people, which is also the meaning of my stay." Zeng Guangwang said with a smile.
02
Truly bring what you have learned to the people
"It's too difficult for grassroots medical institutions to recruit young people!" Ji Shuxia, director of the Sandao Town Health Center in Baoting Li and Miao Autonomous County, often sighs that she has been working at the grassroots level for decades, and she has always been unable to recruit young doctors.
"In the past, it was good to have 2 out of 10 positions, and 2 of them might not be able to stay." Ji Shuxia said that the health center serves a population of about 18,000, and there was no traditional Chinese medicine department before, because there was no good traditional Chinese medicine practitioner at all, so people in the vicinity had to take a 40-minute bus ride to the county traditional Chinese medicine hospital to seek medical treatment.
This situation did not change until the arrival of Fu Meichun.
In 2014, Fu Meichun was admitted to Shanghai Hainan Medical University (formerly Hainan Medical College) and chose the Hainan Provincial Rural Order-oriented Free Medical Student Program to study for an undergraduate degree in traditional Chinese medicine. After graduating from university, she went to Qionghai Hospital of Traditional Chinese Medicine for 3 years of standardized residency training. In June 2022, she came to Sandao Town Health Center and became the youngest doctor in the hospital.
"What can I do without TCM?" Fu Meichun said frankly that at first, she felt useless at the grassroots level, which made her see no hope.
But soon, Ji Shuxia supported Fu Meichun to establish a Chinese medicine department in the health center. In October 2022, Fu Meichun devoted herself to the intense preparation for the construction of the TCM department, she listed the development plan of the TCM department, learned the relevant knowledge of medical insurance settlement, the introduction of traditional Chinese medicine, and introduced instruments and equipment such as traditional Chinese medicine, acupuncture, fire cupping, electroacupuncture, and physiotherapy. In February 2023, the Department of Traditional Chinese Medicine of Sandao Town Health Center was officially opened.
"How to buy Chinese medicine? What can I be reimbursed? How much acupuncture materials are purchased so that they are not wasted and sufficient? How to solve the problem that the elderly do not bring enough money to see a doctor? The situation at the grassroots level is more complicated than Fu Meichun imagined, she started everything from scratch and slowly explored.
"In the beginning, there weren't many patients, so we spread the word in a variety of ways." Fu Meichun said that many patients do not know that the town health center can see a traditional Chinese medicine doctor, and there are only two or three patients a day. Later, she led her colleagues to go to the countryside to do free clinics and carry out publicity, and now the TCM department can receive more than 20 patients every day.
"I feel a sense of accomplishment to be able to use what I've learned to solve problems for patients." Fu Meichun said that there was a patient who had left his right limb with weakness after a stroke and was unable to walk on his own. After receiving the consultation, she was treated with acupuncture and traditional Chinese medicine, and after 2 months, the patient was basically able to walk independently.
"I like the grassroots!" Fu Meichun, who wears a ponytail and big eyes, speaks very straightforwardly, "I like to make friends with patients, especially when they see me and call me Dr. Fu with a smile, I always feel warm in my heart." ”
Fu Meichun, a doctor at the Sandao Town Health Center in Baoting Li and Miao Autonomous County, examines the patient. Photo by Ma Ke
Ji Shuxia saw all this, which made her happy and worried. Worryingly, Fu Meichun's service agreement will expire in July next year. "If she chooses not to renew her visa, how will the newly established TCM department be maintained?" Ji Shuxia said.
"There is a stage to show my talents, or is the grassroots more suitable for me." Fu Meichun's words dispelled Ji Shuxia's worries, in fact, this young man had already decided to stay at the grassroots level, not only her, but most of her classmates also chose to stay. Because at the grassroots level, they are "needed" and can really bring what they have learned to the people.
03
The old dean has a successor
In May, Wu Min, the recently retired director of the Xiangshui Town Health Center in Baoting Li and Miao Autonomous County, breathed a sigh of relief. He finally found a suitable successor.
In the context of the great development of medical treatment in Hainan, Xiangshui Town Health Center was also listed as Xiangshui Hospital of Baoting Medical Group. Wu Min took advantage of the development to improve the hardware of the health center. Between the green mountains and green waters, the once dilapidated low-rise bungalows have become clean and tidy buildings, equipped with 5G remote diagnosis and treatment equipment such as ECG, fetal heartbeat, ophthalmology, ultrasound, and even CT machines.
The improvement of hardware makes Wu Min proud, but who will take over has become a problem for him.
"Improving hardware and improving the treatment of grassroots medical personnel are all about keeping young and capable people at the grassroots level, but where can we find suitable young people?" Wu Min's heart disease became more and more serious as his retirement time approached.
At this time, Qiu Guofang, who had completed 3 years of training in the First Affiliated Hospital of Hainan Medical College, came to Xiangshui Town Health Center. It was this young man who later became the "good medicine" that Wu Min praised whenever he met people, and could relieve his heart disease.
"When he first arrived, I didn't have much hope because a doctor had already left. But later, more and more patients told me that this young man was calm, good-tempered, and had good medical skills. Wu Min knew that his successor was coming.
After a year of observation, Wu Min began to train Qiu Guofang as his successor, supporting him to do what he wanted to do, buying the equipment he needed, and encouraging him to participate in various trainings.
Therefore, Qiu Guofang presided over the construction of the chest pain center and the integrated outpatient clinic for chronic diseases in the health center, rebuilding the one-stop service process to facilitate the management of patients.
"The grassroots level is not as good as the tertiary hospital, there are not so many departments subdivided, and at the grassroots level, we must become a miscellaneous family, become a general practitioner, and strive to become the first guardian line of people's health." Qiu Guofang speaks slowly and logically, and it is precisely because of this that people are willing to chat with him and accept his health management advice.
"The more we look at the serious complications of chronic diseases, the more I feel that the responsibility of the 'gatekeepers' of primary health is great." Qiu Guofang said that he may not be able to do difficult surgery to treat diseases and save people like the doctors in big hospitals, but he is willing to let more grassroots people control the disease at the doorstep, and he is willing to continue to stay at the grassroots level.
In May this year, Wu Min retired, and Qiu Guofang was appointed as the vice president of the health center to take charge of the overall work.
Wu Min is still playing his role as a consultant in the health center, and he is happy not only to hand over the baton, but also to have three general practitioners from rural orientation to come to Xiangshui Town Health Center in the future......
With the continuous advancement of the work of training general practitioners in rural areas, we believe that more gratifying stories of "handing over the stick" will continue to be written in the land of Qiongzhou, and the team of grassroots health "gatekeepers" will continue to grow and become younger.
Source: Hainan Daily