Editor/Shi Aihua
Guangzhou Huangpu District Community Health Service Center ____
December 7, the State Council Joint Prevention and Control Mechanism issued the "new ten articles" and the "hierarchical diagnosis and treatment work program", clear Asymptomatic infected people and light cases with home isolation conditions are generally taken home isolation measures. Among them, vaccination, mapping of key populations, classification and management, as well as triage work, is now undertaken by primary medical institutions.
Under the new policy, some cities where the number of infected people is at a high level have also seen a new round of challenges for their primary community healthcare organizations.
As of Dec. 10, 349 community health centers in Beijing were open to receive patients with fever; the Tianjin Municipal Health Commission recommended that home treatment personnel preferred community health centers for medical treatment, and 264 community health centers and health centers under its jurisdiction, all of which opened fever clinics. Shanghai, Guangzhou, Shenzhen and other cities have also introduced similar policies.
A number of community doctors mentioned in interviews that most of the antigen-positive infected people will be panicked in the early stages of the disease, making the phone calls to community hospitals frequently "busted". Yuexiu District, Guangzhou City, a community doctor said, he is not only responsible for the task of "chasing the sun", but also undertake vaccination, special patient monitoring work, "sometimes feel that a person split into three people are not enough."
In the face of new changes, community doctors are also trying various ways to deal with these "emergencies", a community doctor in the antigen-positive infected people's consulting phone bluntly said: "infected don't worry about it, should eat and eat"; in the To help the urgent need for medical cases docking hospitals in the case of failure, community hospitals to take the initiative, directly drive the patient to the nearest designated hospitals.
December 8, a community health center in Huangpu District for inhalation vaccination
"The first thing I felt was the panic of the residents"
"Hello, my family members self-test antigen, just measured seems to be positive, may I ask what to do now? "
December 8, more than 11 p.m., "the new ten" released the next day, Huangpu District, Guangzhou City, Xiagang Street Community Health Service Center, Dr. Deng Tian has lost count of how many antigen self-testing positive residents received a day of phone calls. Most of these callers are asymptomatic or mildly ill.
He told the callers that if they showed symptoms such as fever and sore throat, they should come directly to the community hospital to register and see the doctors, who would prescribe the right medicine, "If there are no symptoms, it's just like the usual, work work work, rest rest rest, eat eat eat."
Square cabin hospitals have been canceled one after another, so that the pressure of the new crown treatment transferred to the grass-roots community hospitals, "after the adjustment of the policy, the pressure of our grass-roots work is getting bigger and bigger," said Deng Tian, he felt the first problem is that residents are more panicked, and his cell phone 24 hours a day to receive a call from antigen-positive residents. Even if there are no symptoms, people want to seek help from the community hospital, most of the callers asked for a single tube of nucleic acid, always want to prove that they are still "negative".
The panic that Deng Tian felt during the many calls for advice was far greater than the symptoms of the infection itself, and he even advised the callers not to test the antigen. In the face of residents callers, he will sometimes use the vernacular to persuade: "Do not go every day to test the antigen, this virus is now nothing pathogenic, it does not matter if you are infected, do you hear me?"
The situation that Dr. Deng Tian encountered in the Xiagang Street community in Huangpu District is happening in Guangzhou's Yuexiu District as well.
Dr. Huang Xiang, of the Beijing Street Health Service Station in Yuexiu District, said that residents now test themselves for antigens at home, and that positive results do not need to be reported to the community, and that even if they do, they can no longer afford to manage them, "It's just too much."
Dr. Huang Xiang said, some antigen self-test positive residents asked for a home test of nucleic acid, he can only them backward, and now the list of antigen-positive people have been lined up table row several pages. And the service station even nucleic acid test positive patients can not serve over, the entire Beijing street living more than 30,000 residents, a day tested positive nucleic acid more than 50 people, more than 200 people since December.
Dr. Deng Tian also said that at present, most of the efforts of community hospitals are still focused on "nucleic acid-positive" infected people. In Guangzhou, community health service station health care workers to the nucleic acid positive households to stick door magnet, at the same time to send "love package", which has Lianhua Qingdian, Xiaochaihu granules and other traditional Chinese medicine and a few tablets of antipyretic medicine, in the positive home isolation of the sixth day, the health service station health care will be home to pick nucleic acid, if it is a negative nucleic acid, and immediately lifted the quarantine.
During the period when the nucleic acid-positive infected people are homebound, Dr. Deng Tian and his colleagues are responsible for the medical needs of these patients at home, "We are going from one battlefield to another, and for us, this battlefield is much more stressful."
"On the first visit, we do a health check to see if he has any potential risks." Dr. Deng Tian said he records the age of each member of the family, whether they have any underlying diseases or mental illnesses at every house he visits, "and we also send a copy of the medical guidelines so that they have a scientific understanding of the disease." There is even a commissioner in charge of mental illness in the health station where Dr. Huang Xiang serves. Once a mental patient develops an illness or has a need to seek medical prescriptions, Dr. Huang will contact the Health Bureau at the same time, and someone from the Health Bureau will send a special car to a psychiatric hospital for treatment.
Community hospitals for nucleic acid-positive people at home to prepare the love package
"120 is still very difficult to call"
For the general positive home patients, fever and other symptoms, the community doctors will recommend home first take fever-reducing medication, the real community doctors are nervous about some of the The situation of the "special people" to seek medical treatment.
Guangzhou Haizhu District, Jianghai Street Health Service Station, Dr. Du Juan, specifically responsible for the jurisdiction of the positive home personnel in the "special populations", according to her, in the streets of Jianghai, including the elderly, children, pregnant women and the need to do dialysis of the positive "special people!
According to her, in Jianghai Street, including the elderly, children, pregnant women and positive "special people" who need to do dialysis, adding up to about 300 people.
In accordance with the degree of urgency, Dr. Du Juan to three days once a day to a frequency of home visits to these special patients, busy times a day to the door of a dozen households, these patients appeared life-threatening symptoms, such as coronary artery disease, cerebrovascular disease, sudden vomiting, coma Du Juan's duty is to them in a timely manner to resuscitate and assist the patient's family members to call 120, the situation is serious, the community hospitals will contact the Health Commission to open a green channel for medical treatment.
One morning at the end of November, about 6:30 or so, Du Juan received a phone call that a positive old man fainted on the road, "I'm still quite worried when I go," this is the first time Du Juan close contact with the positive patients, before that, she was originally responsible for only the basic work of the community health care security, no need to work with the positive infected people face to face.
"I suspect that the old man is just dehydrated," Du Juan arrived at the scene, immediately gave the old man measured blood pressure, blood sugar, indicators show normal, she began to give the old man an injection, and with a hanger hanging up a bag of saline, the old man replenishment of some fluids, and slowly, the patient is much better.
At the same time, Du Juan's colleagues began to call the 120, but hit the past has been occupied, Du Juan and his colleagues in the patient has been waiting until 8 o'clock, the 120 ambulance arrived. "It was especially hard to call."
At 8:30 a.m. that morning, Du Juan received another call: "Someone else has fainted." At the time, the only first-aid kit in the community was in her possession, and hospital leaders urgently found someone to pick her up on an electric bike and rush together to the resident's home to save her life.
It was a 4-year-old girl with a disability and positive nucleic acid. Du Juan gave her blood pressure, blood sugar, data are okay, just people are not very conscious. Du Juan said, he was on the scene to save treatment at the same time, the community's leaders have been calling the Health Commission to help contact hospitals that can be attended, but because the little girl's medical history is not yet clear, it is difficult to coordinate the right hospital.
"She was living on the third floor, or a pretty small, chubby little girl," Du said, adding that because of the lack of manpower involved in the transfer, police also arrived with a stretcher, "and the four of us carried her outside together."
At that time, Du gave the girl injections and fluids, and after injecting a bag of saline, the girl still did not turn around. Because there was never any coordination with the right hospital, the community hospital leader took the initiative and drove directly for 20 minutes to take her to the nearest New Guan designated hospital, the Southern Medical University Hospital of Integrative Medicine.
There are many other similar emergencies, Du Juan's district has a patient who needs to do regular hemodialysis, in the case of the previous day has finished hemodialysis, the next day the nucleic acid measured positive, and began to cough, "and then may be triggered by some other complications, his whole person fell into a coma." Du received a call for help, emergency door to door to this patient check, found that the patient is no longer conscious, although timely sent to the sentinel hospital, but in the end, this patient is still in bad condition, and into the ICU.
The triage desk of a community hospital in Guangzhou ___________
Downloaded grass-roots health care workers
In the review of nucleic acid, special patient monitoring, vaccination, and hierarchical diagnosis and treatment of multiple tasks, manpower has become the most immediate problem for community hospitals.
"It's not enough to split one person into three." Dr. Huang Xiang of the Beijing Street Health Service Station in Guangzhou said. Most grassroots community health clinics in Guangzhou operate two shifts: one from 8 to 6 p.m. and one from 6 to 8 a.m. the next morning, and it's not uncommon for them to be busy 24 hours a day.
Dr. Du Juan of Jianghai Street also mentioned that he had not rested for more than 40 consecutive days. Du's colleagues said many of the positive home patients have fever as well as upper respiratory symptoms, and going door-to-door to give them medication is one of the important tasks of the health center staff. "During the day, one person probably goes to anywhere from 10 to 20 households. There are those who need antihypertensive and hypoglycemic medicines for daily use, as well as those who need cold and fever medicines." According to Du's colleagues, there are five people on the day shift at the Jianghai Street Health Center who need to deliver medicines to more than a dozen people. In addition to this work, another heavy workload in community hospitals is "chasing the sun".
The so-called "chasing the sun" is to screen out positive cases in mixed-tube tests. Huang Xiang said, now the social surface of the nucleic acid test are ten mixed one or even twenty mixed one mixed tube test, "assuming that there is a 20 mixed one reported, we have to chase the 20 people, the implementation of each person's single tube of nucleic acid." The process of chasing the sun needs to invest a lot of manpower, but Huang Xiang's Beijing street health service station only 30 people, just "chasing the sun" this project will take more than half of the manpower.
Another task is Huang Xiang's main focus at this stage -- giving vaccines to the elderly. Some of the elderly people who are willing to take the vaccine are unwilling or inconvenient to go downstairs, the neighborhood committee will entrust the community doctor to come to the door. Huang Xiang recently felt that the vaccination people suddenly become more, every day to receive calls from residents to take the initiative to ask for vaccination. According to Huang Xiang, the current vaccination rate of elderly people over 65 years old in Beijing Street, Yuexiu District, Guangzhou City, has reached 81%.
"All kinds of supplies are still enough, mainly manpower is not enough, because we have been working for more than 40 consecutive days without rest," said Dr. Deng Tian of the community health service center in Xiagang Street, Huangpu District, "Now the most lack of pediatricians, because children are sick family members are the most nervous, and asked to for medical treatment, but every hospital has fewer pediatricians."
Du feels that at the beginning of the new policy, everyone is still in a stage of adapting to all of them, and it will take some time for the pace to calm down.
One of Du Juan's colleagues is responsible for answering the phone, and their district is responsible for 25,000 residents, and the health station has four telephones used to answer residents' inquiries, even so, there are still residents who go straight to the health station because they can't get through to the phone, "If you're sitting by the phone, you don't have time to go to the bathroom or get a drink of water, and even though you're answering the phone all the time, there's still a lot of people complain that the calls don't come in." It's like that at every community hospital, Du's coworkers say.
In fact, measures to ease pressure on the community have been ongoing. Du Juan said she was originally a doctor at a general hospital in Guangzhou City before she was sent to the grassroots to support them on Oct. 29, "and when she was sent down to the community, the hospital offered three to six weeks."
Du said, with her hospital in the same batch sent to the grass-roots level of 10 doctors, as far as she knows, she has been the fourth batch of hospital medical staff, she heard that the back to be added to send, as for when they can return to their original positions, Du is not sure.
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