The National Health Commission mentioned in a notice released on Dec. 26 that it would give full play to the role of county, township and village healthcare networks, do a good job of surveying the health of key populations, strengthen the allocation of medical resources, and equip them with enough medicines for the treatment of respiratory illnesses, as well as auxiliary therapeutic equipment, such as oxygen generators. A sound mechanism has been established for city-level and above general hospitals and county-level hospitals to help each other. It has also smoothed the referral mechanism between the city and county levels, enhanced the capacity of rural areas to treat serious illnesses, and provided medical care for high-risk groups such as the elderly and patients with chronic basic diseases in rural areas.
With the arrival of the Spring Festival homecoming tide, some grassroots medical staff have begun to worry about whether the health care system in rural areas can take on more pressure.
On Dec. 26, three grassroots medical workers in Shaanxi, Hebei and Anhui spoke with China News Weekly about the current state of epidemic prevention in rural areas.
Their experiences may shed some light on the upcoming epidemic peak in other rural areas.
The following is from the mouths of the village doctors.
Yang Chun, a village doctor in Weankou Township, Xixiang County, Hanzhong City, Shaanxi Province
"The medicine that's left will last for three more days."
Since about Dec. 20, more people have been visiting the doctor.
At its peak, there must have been hundreds of people a day, especially from 10 a.m. to 3 or 4 p.m., when the infirmary was full of people.
Most of the people's symptoms are fever, sore throat, cough, body aches, and some have difficulty swallowing and eating, and for those who are weak, in addition to symptomatic medication, they also need to be put on an IV drip to replenish their energy.
Our village has a resident population of about 4,000, of which nearly 800 are elderly, and with only two village doctors in total***, the pressure is great. When I'm too busy, I have to ask my family to help, but they don't know anything about medicine, so they can only help out a little.
The biggest problem in the countryside is the lack of medicine. Before the epidemic policy change, there were basically no people in the health center except for the elderly with underlying diseases who came for daily boiled medicines and IVs, and I didn't think about stocking up on medicines.
The director of the town health center sent a message a few days after the implementation of the "new ten" policy, reminding us to stock up on medicines to cope with the next outbreak, and that it would be best if we could buy a three- to six-month supply. But there was no money for that, and when I went to place my order on Dec. 12, I couldn't get much medicine left.
Over at the pharmaceutical company, you can only purchase about 1,000 dollars worth of medicines at a time, and you can only get a few sporadic boxes of medicines like those for clearing heat and reducing fever for the Xinguan epidemic, which is not enough at all.
Not being able to get in the medicines, we can only restrict the villagers from buying them. Some people have asked me to prepare the demand for medicine, I basically refused. For those who come to us with symptoms, we split up the boxes and sell them, prescribing up to three days' worth of medication per person.
Even with this saving, it's still not enough, like the antipyretic Anacin, which I had three big bottles of before, totaling a few thousand tablets, but now I'm selling at least 400 to 500 tablets a day, and I don't have much left.
There are not enough tablets to go around, so we use Chinese herbs and boil the packets according to the county hospital's formula for treating new crowns. Each person with two pairs, plus a little Western medicine, can also relieve the symptoms, basically drink two or three days to get better.
The trouble is that since December 26th, the Chinese herbal medicines have also started to run out, and the medicine packets can't be boiled.
Two of my village doctor classmates are experimenting on themselves to try to see if they can reduce their fever through acupuncture because of the shortage of medicine.
In addition to the lack of medicine, villagers' general medical knowledge is limited. Many people have symptoms and will not seek medical attention at first, some people have medicines but don't know how to take them, and some elderly people have problems in the middle of the night and carry on until morning when the situation may become serious. So on a daily basis, I still need to do some science for them, including how to use medicine, how to physically cool down the temperature and so on.
If there is an emergency, such as a pregnant woman or an elderly person with a serious underlying disease who is burning too much, I try to let go to their higher level hospitals for treatment, just for fear of delaying the time.
Fortunately, most of the infected people in the village are still young and middle-aged, and there are not many elderly people. But when the Spring Festival returns in a while, young people working abroad will come back one after another, especially the elderly, may be at greater risk, by then, the county hospital, the city hospital pressure will be even greater.
I roughly calculated that the medicine left at the moment won't last more than a week, or at most three days. Only a small amount of medicine can be brought in for those two days as well.
Not only the village dispensaries, but also the health centers in the town and the hospitals in the county do not have a good stock of medicines. There are also counterparts from the county hospital who buy medicine from me and bring it back for their relatives.
This is my biggest worry, if there is no medicine and the number of infections among the elderly with underlying diseases continues to increase, the next will be very troublesome.
In the past few days, the Health Bureau has also been counting the medicines in various clinics and health centers, but the lack of medicines has not yet been resolved, and it is hoped that the medicines can be made available as soon as possible.
Li Liang, a village doctor in Fangzhai township, Handan city, Hebei province
"We stocked up on medicine before the peak of infection, but we don't have enough staff."
The peak of infection in the rural areas of this side of Handan is in the week before and after Dec. 15th.
My clinic didn't run out of medicine during this period. Because before the peak of the epidemic, the Health Bureau issued a notice to prepare drugs, and I had already prepared almost all of them by that time, and then a few days later, I drove to the pharmaceutical company by myself, and got lucky and got some more drugs. Although there is no ibuprofen, but like paracetamol, analgin injection, I have all of them here, as well as clearing the heat and detoxification of Qingkailing, ribavirin injection, although they are not special drugs, but all of them are also effective.
Because we stock up on medicines in advance, the prices don't fluctuate too much. We have a few pharmacies here, in addition to the clinic, and the villagers are well aware of the prices of common medicines.
The fever-reducing medicines in our clinic are basically not board medicines but the kind of paracetamol that comes in a bottle of 1,000 tablets, and the purchase price is just a few tens of dollars, so it's enough for one person to share a few tablets. So a person's visit to the doctor, two or three days of medicine is only eight or nine or ten dollars.
If there is a new crown of symptoms, is the need for paracetamol plus some antiviral, cough and phlegm tablets, or then add some vitamin C, the blue root and so on on the line.
But the conditions in the health center are still limited, and after not doing the nucleic acid test, we don't have antigen kits or oximeters for critical care monitoring, so we can only prescribe drugs based on the symptoms.
There are also some people who either have a high fever that won't go away, or whose symptoms don't resolve after a few days, and those who are in poorer health, so they need to be given injections and some nutrient fluids.
While there is no shortage of medicine, there is a particular shortage of manpower. Our village has a population of more than 1,200, with a resident population of more than 700, but in addition to the villagers of this village, many villagers will come to me after the surrounding village health center runs out of medicine.
The peak of infection came especially suddenly this time. In rural areas, basically one person shows symptoms and soon infects a whole area. On the biggest day, more than 130 people came to the health center, and in addition to those infected with the new crown, there were also some elderly people with chronic illnesses who came to see the doctor, and the line was so long that it reached the door.
It was very cold, and many people were crying out for fever, sore throats, and body aches, so I couldn't cope on my own.
After dealing with the patients who came to the health center, I also had to visit villagers at home, some of whom had fevers so severe that they couldn't get out of bed, and some of whom were elderly people who already had mobility problems.
When the peak season began, I myself was hit. I had just sent the patients away at 10 p.m. the first night, and then at 3 a.m. someone came knocking on the door, saying that their family had a fever of 40 degrees and they couldn't get it up on their own. At 7:00 a.m., the line at the door started again, and I was busy until 2:00 p.m. I had to work until 2:00 p.m. My throat was so dry that it smoked, and I was a little dizzy when I stood up, and I've never been so tired in all my years of practice.
Fortunately, during the peak period, there were no elderly people with severe post-infection or aggravated basic illnesses on my side, probably because the medical conditions here are better than those in the remote mountainous areas and there has been no shortage of medicines.
In addition, in the past, our village infirmary and health center established health records for the elderly over 65 years old, and I know very well here who has chronic and basic illnesses in the village. After the emergence of the epidemic, I also regularly call over to ask to see if there is a fever, or if there is any difficulty in seeing a doctor. If there is an emergency, an ambulance will be contacted in a hurry for referral.
Now that the peak season has basically passed here, and the higher authorities have activated an emergency supply mechanism, more medicines are beginning to be tilted towards the grassroots rural areas, the shortage of medicines in the surrounding villages and towns is gradually easing.
Zheng Fu Ren, a village doctor in Guanghua Village, Qimen County, Huangshan City, Anhui Province
"The elderly who are not infected should not go out first."
I am 74 years old this year and a cancer patient, who had colorectal cancer surgery the year before and has been undergoing chemotherapy since then, and was re-examined this year, and the cancer cells have spread to the lungs.
Our village, Guanghua, is located in the mountains of southern Anhui province, with seven village groups and a resident population of more than 800 people, about one-third of whom are elderly people and children.
I'm not in good health, so I don't go to the health center at the village hall, and instead I see villagers at home. I can't go door-to-door with people who are lying in their own beds, unable to move around, when they are sick.
In the last week, I have seen a sudden increase in the number of people coming to my house, especially in the last two days, when I ran out of fever-reducing medicines. I contacted the drug company and they said they were looking for the medicine and would contact me when they got it.
A few days ago, some caring people helped us collect medicines online and mailed us antipyretics and cold medicine.
On Dec. 27, I received a box of cold and flu granules, a box of acetaminophen, and a large handful of masks, which were distributed to infected villagers, a family's worth, and far from enough.
After I was hit, my family soon became infected, too, and were all lying in bed coughing. They were able to lend a hand, but now there was nothing I could do but hang on to myself.
I am the only doctor in the village, which is 30 kilometers from the county seat and 100 kilometers from the city, and many old people are counting on me, so I can't lie down.
After the abolition of nucleic acid, because there is no antigen, I have no way to accurately determine, the people who come to the new crown patients, or the winter flu, or the common cold, can only be based on the experience of symptomatic treatment, flexible.
I open the door at 7:00 a.m. every day, and I'm busy until 7:00 or 8:00 p.m. Recently, I've had about 20 people a day come to my home to see the doctor, and most of them are taking medicine. If you can take it orally, you don't need an injection, and the medicines you are prescribed are mainly analgesic, antipyretic, and antiviral.
There are also some people who come to me to buy spare medicines for fear that when they get sick, I will run out of medicines and it will be inconvenient for them to go to the county town. But I'm so short of medicine right now that I can't sell it to him in this situation. What if there are elderly people or people with serious symptoms who need medicine afterward? I need to save some for them.
Without medication, I can only tell them that if the symptoms are mild, they should carry on for a while, and if they have a fever and headache, they should take medication if they feel they can't carry on. If you can't, you should go to the hospital in the county.
Many of the medical staff at our county hospital have been infected and have to rest at home, and they are also very nervous.
Most of the old people in the village who are in their eighties or nineties and are particularly old have not yet been infected. But they are already in poor health, so if they do suddenly become infected, the situation could be more serious and the treatment more troublesome.
So I've repeatedly urged those who haven't yet been infected to stay home and minimize contact with outsiders to avoid serious illnesses as much as possible.
Author: Wang Chunxiao