In the past, it was centered on ＂treating diseases＂, but now it is a ＂health guardian＂. The reporter went into the clinic of Mabei Village in Zhongxiang, Hubei Province to see the changes (first-line
General Secretary of the Supreme Leader pointed out: "Accelerate the implementation of the Healthy China Action, carry out the patriotic health campaign in depth, improve the national health promotion policy, innovate the social mobilization mechanism, improve the health education system, strengthen the comprehensive prevention and control of key populations and major diseases, prevent and control major diseases from the source, and realize the transformation from treating diseases as the center to health as the center." "We must promote the construction of county medical communities, improve the basic infrastructure conditions, implement the treatment of rural doctors, and improve the ability of prevention and treatment and health management at the grassroots level."
In the vast rural areas, in order to realize the transformation from treatment-oriented to health-oriented, it is necessary to improve the service ability of rural clinics and rural doctors, so that they can not only prevent and treat diseases, but also manage health. In recent years, all localities have conscientiously implemented the spirit of the important instructions of the Supreme Leader General Secretary, constantly strengthened the infrastructure construction of village clinics, intensified the training of village doctors, and spared no effort to protect the health of villagers. A few days ago, the reporter walked into the clinic of Mabei Village, Chaihu Town, Zhongxiang City, Hubei Province, and visited with village doctor Wang Hongju to observe the process of villagers enjoying public health services and record the changes in rural health undertakings.
— — Editor
Chaihu Town, Zhongxiang City, Hubei Province, is located in Jianghan Plain, on the bank of Hanjiang River — — More than 50 years ago, in order to build Danjiangkou Reservoir, 49,000 people from Xichuan County, Henan Province moved here from the reservoir area.
Since the 18th National Congress of the Communist Party of China, local party committees and governments have paid more attention to the construction of primary health care system, and adopted a series of measures from the aspects of infrastructure improvement, talent team training, service content optimization, and operation mechanism adjustment, so as to continuously improve the rural medical and health service capacity and prevent and control major diseases from the source. Nowadays, every village in Chaihu Town has a clinic, and villagers can enjoy high-quality and convenient public health and medical services at their doorstep.
From "old three samples" to "treasure chest"
In the past, there were only stethoscopes, sphygmomanometers and thermometers, but now there are many kinds of equipment such as blood glucose meter, oximeter and ECG monitor.
Driving from Chaihu Town, taking the road, crossing the river and entering the village road, after a green wheat field, the village committee compound of Mabei Village appeared in front of you.
A few bungalows close to the roadside are Mabei Village Clinic. Documents such as prescription system and public information are hung on the wall, including diagnosis room, treatment room, observation room, public health service room, reference room and pharmacy — — "Five rooms and one room" is fully functional.
Min Fengge, a 63-year-old villager, is infusion, and his right hand is wrapped in a bandage. A few days ago, she accidentally cut a big hole in her right hand at home with a vegetable knife and sewed a needle in Chaihu Town Health Center. I caught a cold again last night and I couldn’t stop coughing. Early the next morning, she came to the village clinic to see a doctor.
Village doctor Wang Hongju took out his "treasure chest" — — The intelligent health service package measures blood pressure, body temperature and blood oxygen saturation for Min Fengge, and listens to her breathing with a stethoscope. "There are rales in the lungs and rough breathing. Initially, it is bronchitis. First, I will prescribe two anti-inflammatory and antiviral drugs for you."
At the same time of infusion, Wang Hongju checked the suture of her right hand, cleaned the wound and changed the dressing, and told her not to touch the water.
There are 603 households with 1356 permanent residents in Mabei Village, with a high proportion of elderly people, many of whom have chronic diseases such as hypertension and diabetes. The villagers’ demand for medical treatment is relatively large.
"I used to have a headache and brain fever. I had to go to the town health center more than 10 kilometers away to see it. People were tired and often had to queue up. In recent years, the medical conditions in the village have improved, and minor illnesses can be optimistic at home with less money. " Min Fengge said with a smile that the village has also opened a medical insurance networking settlement device, and villagers can directly settle and reimburse medical expenses in real time by swiping medical insurance cards.
"This is due to the government’s continuous investment in health care." Wang Hongju, a native of this village, feels deeply about this. When he was a child, his father was a "local doctor" in the village, relying on ancestral plasters and herbs to treat people. Some patients were not at ease and would rather go to the town health center.
Determined to solve the problem of medical treatment for villagers, in 2006, Wang Hongju, who graduated from Henan Nanyang Health School, gave up the opportunity to stay in the city and returned to his hometown to become a village doctor.
"At that time, the office space was my own three tile houses, so I used it to see a doctor ‘ Old three ’ — — Stethoscope, sphygmomanometer, thermometer. " Wang Hongju said, drugs need to go to the pharmacy in the city to purchase.
In 2015, Hubei Province issued the "Implementation Plan for Further Strengthening the Construction of Village Clinics and Rural Doctors". By the end of 2017, all village clinics in the province had reached the standards of "public property rights, standardization of construction, standardization of services, informationization of operation and integration of management". By the end of the year, Mabei village clinic was completed and put into use, covering an area of 120 square meters, and was equipped with diagnostic tables, sickbeds, computers, printers and other equipment.
Gastrointestinal drugs, antihypertensive drugs, cold drugs, rheumatism drugs … … On the shelves of the clinic pharmacy in Mabei Village, all kinds of drugs are placed in different categories with rich varieties. "The drugs needed in the clinic can be purchased through the centralized procurement platform for essential drugs in Hubei Province, and the pharmaceutical companies will distribute them uniformly." Wang Hongju said that at present, there are nearly 100 kinds of drugs in the clinic, which is much more than in the past.
Since 2020, Hubei Province has vigorously implemented the short-board project of public health. "Zhongxiang City invested more than 25 million yuan to comprehensively upgrade the software and hardware environment of village clinics." Li Mingxiang, director of Zhongxiang Health Bureau, said that at present, 467 village clinics in the city are equipped with intelligent health service packages, including ID card readers, sphygmomanometers, blood glucose meters, oximeters, ECG monitors and other health testing equipment, which further strengthens the diagnosis and treatment capabilities.
Minor illnesses do not leave the village, and serious illnesses can also be referred in time. Not long ago, Wang Jing, who lives in a group of Mabei Village, got up in the morning and suddenly felt headache and dizziness, and her hands were a little numb. Wang Hongju examined him and found that his tongue was a little crooked. He suspected that it was a cerebral infarction, so he immediately contacted Chaihu Town Health Center and started the referral process.
The 120 ambulance sent Wang Jing to the hospital for CT examination, and the result showed that he had an acute cerebral infarction, and he was quickly transferred to Zhongxiang People’s Hospital. After timely intravenous thrombolysis and hospitalization, Wang Jing gradually recovered, returned home, and was given follow-up rehabilitation treatment by Wang Hongju.
"Two hours after cerebral infarction is ‘ Golden rescue period ’ Fortunately, the referral is timely, otherwise the consequences will be unimaginable. " Wang Hongju said that Zhongxiang City has built a county-level medical community including county hospitals, township hospitals and village clinics. Diseases that cannot be treated by rural doctors can be referred to higher-level hospitals in time to ensure that "serious illnesses are not missed".
From just seeing a doctor to managing health
In the past, the main task was to treat diseases, but now we should always monitor the physical condition of villagers, spread health knowledge and prevent serious diseases.
In the early morning of April 19th, Wang Hongju carried a smart health service package and rode an electric car, and started a day of follow-up. The four villagers who are going to visit today are all the objects he focuses on — — Chronic patients, elderly people, poverty-stricken households, etc.
In the past, Wang Hongju’s daily work was "focusing on treatment", doing some basic diagnosis and treatment for colds, fever and trauma. Today, he has become a "health guardian", undertaking various public health services, spreading health knowledge for villagers and preventing major diseases. Home follow-up is an important work content.
"Uncle Wang, aunt Liu, how are you recently? Did you take medicine on time? " In a small farmhouse in Group 5 of Mabei Village, 74-year-old poverty-stricken household Wang Wu Zhong was busy in the vegetable garden. Hearing Wang Hongju’s voice, he hurried to the door to meet him.
Inside the room, 76-year-old Liu Jianling was sitting in a wheelchair with a smile on her face. "According to your instructions, I took medicine on time and had a light diet every day. Now my blood pressure has dropped and my mental state is much better."
In recent years, Zhongxiang City has implemented the family doctor contract service in depth. The city has set up 524 family doctor teams and 1040 family doctors, and the signing rate of rural poverty-stricken people is 100%. In Mabei Village, key groups such as the elderly over 65, the disabled, the mentally handicapped and the chronically ill have a team of family doctors composed of general practitioners, specialists, public health doctors and rural doctors.
Wang Wu’s two sons are in other places, and there are only the old couple at home. In 2019, Liu Jianling suddenly suffered a stroke and was paralyzed from then on. Because the couple’s health awareness is not strong, their diet is salty, and they often don’t eat on time, Liu Jianling’s health is getting worse and worse, and her blood pressure once soared to 140/220.
As a contracted family doctor, Wang Hongju established an electronic health record for Wang Wu Zhonghe Liu Jianling and visited their home regularly. After each examination, their health information will be uploaded to the background of the information system of the health and health department through the computer at the first time, so that doctors can keep abreast of the changes of patients’ condition at any time.
In view of Liu Jianling’s hypertension, Wang Hongju made a prescription for her, and adjusted the dosage according to each follow-up to remind them to take the medicine on time. At the same time, he assisted Liu Jianling to apply for a chronic disease card, so that she could enjoy the basic medical security policy and reduce medical expenses.
After several years of continuous follow-up and health management in Wang Hongju, Liu Jianling’s blood pressure gradually dropped, and the drugs she took were reduced from the initial three to two. Wang Wu is physically stronger, and he can do some farm work in his 70s.
Prevention is the most economical and effective health strategy. During the usual follow-up, Wang Hongju will provide health education for the villagers. Every quarter, we will also focus on a health science lecture.
At 9 o’clock this morning, more than 20 villagers gathered in the village clinic. As soon as Wang Hongju entered the door, someone asked, "Dr. Wang, what do you want to talk about today?"
"Talk about the prevention and treatment of cardiovascular disease." Wang Hongju smiled and said, "Tell everyone clearly what hypertension is, how to use medicine and what to pay attention to at ordinary times." In the lecture for more than an hour, Wang Hongju spoke carefully and the villagers listened attentively.
"Dr. Wang, my blood pressure has been relatively stable for two or three days. Do I need to continue taking medicine?" In the Q&A session, 75-year-old villager Lu Jincai first asked questions.
"The medicine can’t be stopped casually. We should follow the doctor’s advice and strengthen the dynamic monitoring of blood pressure. If there is fluctuation, we still have to insist on taking the medicine." Wang Hongju replied.
"We older people, like to eat salty, taste heavier. But my blood pressure has been unstable. I don’t know if it has anything to do with this? " The 67-year-old villager Wang Cheng asked again.
"The salty taste is a key factor affecting the stability of blood pressure. In the later stage, we should pay attention to improving our eating habits, focusing on a light diet, which can not only prevent hypertension, but also benefit the prevention of other diseases. " Wang Hongju said.
Due to unhealthy eating habits and other reasons, the incidence of esophageal cancer in Mabei village was once high. Wang Hongju started with promoting health knowledge and persuaded villagers to improve their eating habits and eat less or no pickled products such as sauerkraut. Now the prevalence of esophageal cancer in the village has been greatly reduced.
From not daring to see a doctor to receiving a patient calmly.
In the past, I could only deal with colds, fever and skin injuries, but now I don’t panic in the face of sudden emergencies.
On the afternoon of April 24th, in the conference room on the 5th floor of the administrative building of Chaihu Town Health Center, Yu Peng, the stationmaster of the first aid station of the Health Center, was giving a training course on "Cardiopulmonary Resuscitation+Defibrillation Technology" to 58 village clinic leaders in the town.
Sitting in the front row, Wang Hongju listened carefully to the training content and took notes from time to time. In the actual operation, he took the initiative to raise his hand and came to the stage to practice on the medical dummy model.
"Hands are interlocked or overlapped, and the heel is pressed with the palm, and the pressing frequency is 100&mdash per minute; 120 times "to observe whether the color of facial skin and mucosa of patients has improved" … … Under the guidance of the head nurse, Wang Hongju gradually mastered the correct technique of cardiopulmonary resuscitation.
When he first joined the work, Wang Hongju could only treat colds and fever, skin injuries, etc. When he encountered some complicated and urgent diseases, he could only refer patients urgently because of his hardware conditions and technical level.
Later, Wang Hongju passed the adult college entrance examination and was admitted to the Medical College of Jingchu Institute of Technology. After several years of part-time study, his theoretical knowledge and clinical skills have been greatly improved. Wang Hongju told reporters that he is still studying in the municipal people’s hospital and the town health center. Every month, the town health center will organize experts such as department directors and head nurses to conduct special training for village doctors, covering pre-hospital first aid, medication and treatment of common diseases, etc. Previously, Wang Hongju judged that Wang Jing might be a cerebral infarction through tongue diagnosis, which was learned from the training of town hospitals.
Now, Wang Hongju is not afraid of the villagers’ sudden heart attack. He will give emergency treatment to the patient first — — Check the oxygen saturation first. If there is hypoxia, you can give the patient oxygen, and then prescribe some drugs to treat heart disease, and then refer the patient after the symptoms are relieved to avoid accidents.
The popularization and application of intelligent medical care has also added "professional helpers" to Wang Hongju. Not long ago, Li Shifu from Manan Village next door suddenly felt chest tightness, shortness of breath and back pain, and made a special trip to see Wang Hongju.
Wang Hongju filled in the electronic medical record in the "Intelligent Medical Assistant" system, and just after writing the chief complaint and current medical history, the system automatically made an auxiliary diagnosis of "acute angina pectoris".
Combined with the description of the patient’s symptoms, Wang Hongju thought that this diagnosis was more likely, and immediately gave the patient indomethacin sublingually. After half an hour, Li Shifu’s pain symptoms eased, and Wang Hongju referred him to Chaihu Town Health Center for further examination and treatment. After five days of in-hospital observation, Li Shifu has recovered now.
Since August 2020, Hubei Provincial Health and Health Commission has carried out strategic cooperation with scientific and technological enterprises to promote the application of artificial intelligence-assisted diagnosis and treatment at the grassroots level. Zhongxiang is one of the six pilot cities (districts).
“‘ Intellectual medical assistant ’ Not only can it quickly make auxiliary diagnosis according to symptoms, but it also has the function of synchronous access to electronic medical records, radiological images and other data to help village doctors understand the patient’s medical records, examination results, past medical history, etc. in other places, so as to make a better diagnosis. " Wang Yang, head of the grassroots health unit of Zhongxiang Health and Health Bureau, said that the "intelligent medical assistant" system has achieved full coverage of village clinics.
From single income to multi-channel guarantee
In the past, income depended on drug addition, but now we get various subsidies by virtue of diagnosis and treatment technology and health services.
Behind the improvement of medical and health service level, the income security of rural doctors is also constantly improving. Wang Hongju told reporters that after the reform of the national basic drug system, the income structure of village doctors changed from drug addition to government subsidies. "In the past, it was generally 7%— At a rate of 15%, the drug is sold at a higher price, and the monthly income is about 1,500 yuan. " After the reform, drugs were sold at the cost price, but through multi-channel guarantee, Wang Hongju’s income not only did not decrease, but increased significantly.
In recent years, policies such as subsidies for basic public health services, subsidies for the national essential drug system, general medical expenses, subsidies for basic operating expenses of village clinics, and fixed subsidies for on-the-job practicing village doctors have been implemented one after another to jointly protect the income of village doctors.
"In 2009, the subsidy for basic public health services for village doctors was 6 yuan/person-time, and now it has been raised to 32 yuan/person-time, and the per capita general medical expenses have also increased from 5 yuan to 8 yuan." Wang Hongju said that in addition, the national basic drug subsidy standard for village clinics was raised from 8 yuan to 10 yuan, and the operating expenses of village clinics were raised from 3,650 yuan to 5,000 yuan per year. For village doctors who have been practicing on the job for three years, the government also provides a fixed subsidy of 1,200 yuan each year for purchasing social endowment insurance to ensure their retirement life. Today, Wang Hongju earns more than 4,000 yuan a month, and with the year-end bonus, the annual income can reach 60,000 yuan.
However, it is not easy for village doctors to get all these subsidies. "In addition to the quota project, other subsidy projects are adopted ‘ Prepayment first, then settlement ’ In the way of payment, 70% will be pre-allocated at the beginning of the year. After the year-end performance appraisal, the remaining funds will be allocated according to the assessment results. " Wang Yang introduced.
The assessment of Mabei village clinic is the responsibility of Chaihu Town Health Center. In 2015, Zhongxiang City initiated the reform of the management mode of "the county manages the town and the town hires the village" to realize the integrated management of people, finance and materials in village clinics by township hospitals.
Liu Zhigang, president of Chaihu Town Health Center, said that every year, the health center should organize four assessments of the village clinics in the town, and through consulting the ledger and follow-up records, on-site inspection of medical safety, telephone call-back visits to residents and patients, household verification, etc., we can deeply understand the work of village doctors and whether all tasks are in place. "The assessment items for village doctors include 55 items in 14 categories, including health records, health education, vaccination, maternal management, health management of the elderly, management of patients with hypertension, and satisfaction of the masses." Liu Zhigang said.
Not only the treatment is guaranteed, but also the career development of village doctors has more channels to rise. In 2019, the Hubei Provincial Department of Human Resources and Social Security and the Provincial Health and Health Commission jointly issued relevant opinions, appropriately relaxing the qualifications and papers for the participants in rural primary health centers, and clarifying that primary health professionals and technicians can also participate in the evaluation of senior titles. Up to now, 55 rural doctors in Zhongxiang have obtained senior titles. At the same time, through the smooth two-way flow mechanism of grassroots talents, in recent years, 75 village doctors in Zhongxiang City have been selected to work in higher-level units such as township hospitals.
More and more policy inclinations have made village doctors more motivated. A few years ago, another village doctor came to Mabei village clinic and became Wang Hongju’s right-hand partner.
"Now more patients come to the clinic to see a doctor than before, and even go to school in other towns and come back to the village to see a doctor." Wang Hongju said: "A minor illness will not leave the village, and a serious illness will not be missed" is becoming a reality.