Tuesday, 23 December 2014

Saturday, 20 December 2014

A roundup of the medical news headlines from China

Efforts to establish a primary care system in China are faltering because a lack of qualified doctors entering the specialty, according to the People's Daily.  It says GPs account for about 50% of doctors in western countries but only 5% in China. In addition, few young doctors want to become GPs because of the poor status, lack of career prospects and poor pay. The article says China must increase pay and career prospects for community care doctors if it is to achieve its stated aim of having a gatekeeper system to reduce hospital overcrowding.
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In Sichuan, villagers have petitioned to expel an 8 year old boy because he is HIV positive. Even his own grandfather was among those who signed to get rid of the boy from an un-named village. The villagers said the boy was a 'time bomb' and he should be removed to "protect villagers' health".

The Washington Post has a feature on the new wave of foreign investors  trying to make a buck out of the rapidly changing and deregulating Chinese healthcare system. However, the feature notes that efforts by foreign investors to open hospitals and clinics in China is limited by the lack of medical insurance and the overall shortage of skilled doctors in China.

Chinese ministers are doing the rounds of county-level hospitals, which are the target for the next wave of reforms. The government wants to try stop the decline of county hospitals as patients bypass them and head straight to major city hospitals, which they believe to have more expertise.

One in four patients admitted to rural hospitals in China doesn't need to be there, according to a study from  Tongji Medical University in Wuhan. The study found that 27% of patients at rural hospitals had been admitted inappropriately, with wrongful admission rates as high as 37% for older Chinese. The researchers said the higher reimbursement levels provided in the New Rural Medical Insurance scheme for inpatients than for outpatients encouraged patients to be admitted and treated inappropriately.

Wednesday, 17 December 2014

Baby for sale to pay medical bills | Ambulances misused by non-urgent callers | Avian flu returns more virulent


Rural migrant sells baby to pay medical bills

A rural migrant women from Sichuan has been trying to sell her baby on the street of Fuzhou to raise money to pay medical bills for the baby's father. Police were called when the women displayed a sign saying "Boss fled after industrial accident and we don't have the money for treatment; I'm willing to sell my child to save her father." The woman said she had already paid Y7000 in medical bills for treatment of her husband who had injured himself after falling from a construction site. Some sympathetic passers-by gave the women some money before she was persuaded to end her 'sale.'

Beijing ambulances used for non-urgent cases

Ambulance services in Beijing are overstretched because 80% of cases they transport are non-urgent and do not need to attend the emergency department, a survey has found. Only 20% of the people brought in to hospital by ambulances had life-threatening conditions, according to a report from the Beijing's Health Planning Commission, which found that most of the ambulance patients could be treated in the outpatients department. The commission has suggested that patients are triaged before being taken to hospital as many critically ill patients are left without transport while ambulances are dealing with non-urgent calls.

Avian flu returns more lethal

The severity of H7N9 avian flu in China increased with the "second wave" last winter and the virus may return in an even more virulent and lethal form this winter, researchers have warned. The lethality of the H7N9 virus increased by 48% from the first wave in 2013 to the second wave in 2014, according to Dr Li Feng and colleagues at the Key Laboratory of Surveillance and Early-warning on Infectious Disease at the China CDC, Beijing. In the latter part of the first wave the death rate among hospitalised patients was 17% for young people under 60 and 42% for people over 60. In the second epidemic the death rate was 36% in people under 60 years, and 59% in people aged 60 years or above.
"If another epidemic of human infections with influenza A(H7N9) virus occurs in the winter of 2014/15, proactive control measures on the poultry-human interface may be preferable to reactive measures," the researchers suggested.

Monday, 15 December 2014

Nurses inadequately trained | Child physical abuse common | Coal use causes black lung

Nurses lack adequate training

Only one in seven nurses in China undergoes a three year undergraduate training program, and many lack adequate training, medical educators have complained. In a letter to the Lancet, Liu Fengxia and colleagues at the Fourth Hospital of Hebei Medical University say that they are worried by the fact that most nurses in China not receive standard nursing training. Each year only 30,000 out of 186,000 graduate nurses earned standard bachelor degrees, they noted. Most nurses received only diplomas after brief training. The lack of education and the stressful working conditions mean that poorly trained nurses could make mistakes in patient care - and their lack of training may also be a factor in triggering violence against health staff.
"Nurses are intermediates between doctors and patients. In our practice, we have seen misunderstanding and mistrust between patients and doctors most probably due to of the inadequate training of nurses. A more comprehensive training system for nurses is needed," they write.

Physical punishment of children condemned

China's high rates of physical punishment of children amount to a culturally-accepted high level of child abuse, researchers have said. A major review found that 36% of children in China experienced physical abuse from parents, typically in the form of slapping and spanking for disciplinary reasons. They said the rates of physical punishment in mainland China were significantly higher than in other Asian countries, where the influence of western methods of parenting was stronger. The researchers said physical punishment was "culturally accepted" within Chinese society because the Confucian philosophy of parenting, which endorses parents’ authority and filial piety, is still prevalent in the minds of Chinese parents and children.
"A well-known proverb “gun bang di xia chu xiao zi” (also translated as “spare the rod, spoil the child”) indicates that the filial piety is achieved by strict physical discipline of children," they noted.
They said China's high rates of physical abuse were concerning because of the known associations with poor mental health and harmful behaviors, such as depressive disorders, anxiety disorders, eating disorders, childhood behavioral disorders, suicide attempts, drug use, and risky sexual behaviour.

Coal use leads to black lung

China's high use of coal for fuel has led to high rates of pneumoconiosis and "black lung", researchers say. In a Dow Jones report, clinicians said pneumoconiosis was common in mining workers and other coal-related industries, especially as workplace safety rules were often ignored in China. masks could help prevent pneumoconiosis but were often not provided to workers, they noted. The number of people diagnosed with pneumoconiosis has risen sevenfold from 2005 to 2013 to about 750,000, at an average pace of 35% annually, according to official data. And while treatment is available, it is often unaffordable for many low paid workers, labour activists note.

Sunday, 14 December 2014

Zhejiang hospital runs out of money, can't pay for medicines

by Michael Woodhead
A hospital near Taizhou in Zhejiang is "crying poor" saying that increasing patient burden and rising prices means it does not have enough money to buy essential drugs. The Xianju county hospital has out up a notice on its public LED screen asking for "understanding" because it is no longer able to provide medical supplies such as blood plasma. 

The hospital authorities said their outlays exceeded their income and they no longer had funds to buy drugs and other medical supplies. The director of the hospital, Chen Xiaojun, told Xinhua that the hospital was more than 15 million yuan in debt because the New Rural Medical Insurance Scheme did not cover all the expenses incurred by patients and the insurer was refusing to release further funds. The local health department was also refusing to provide further funding, and the unpaid bills of 11 million yuan meant that pharmaceutical companies were no longer willing to supply drugs to the hospital.

The shortage of drugs was most acute for the high cost drugs for conditions such as bronchitis and anaesthetics and other drugs needed to cover surgery, he said. This meant that operations at the hospital also had to be curtailed. Medical staff said patients were being advised to find another hospital if they had a serious disease, and medical staff were also complaining that their wages had not been paid for some months.

The hospital authorities blamed the 'bankruptcy' on three factors: they said the government reimbursement levels for had been set in 2008 and had not kept up with rising costs or increasing patient numbers. Secondly, the price of drugs had also increased substantially, leaving hospitals out of pockets, especially with new zero markup policies. And most importantly, the rural medical insurance scheme expanded the reimbursement to patients for inpatient costs from 40% to 80% of fees, which meant many patients now wanted to stay as inpatients for longer, driving up costs.

A spokesman for the Xianju country government said the relevant departments were now having a 'crisis meeting' to solve the problems that had led to the  lack of funding at the hotel. However a spokesman said the Xianju hospital was not the only hospital facing the problems of rising costs and falling income, and the problem had to be tackled on a wider basis by changing the reimbursement system and charges, he said.

The local government also criticised the hospital for making public announcements about its poor financial state and lack of medications, as this would lead to public panic and loss of faith, he said.

Sunday, 7 December 2014

Infusion superstition condemned | Hukou medical reform | Heavy metals found in wheat

Doctors condemn superstitious belief in infusions

A life-threatening incident of allergy to an infusion has lead a Shanghai doctor to criticise parents and grandparents for insisting their children have unnecessary infusions to treat minor illnesses with fever. A 12-year old boy with fever treated at the Ruijin Hospital  nearly died after having a massive allergic reaction to an infusion he was being given for a fever. The boy recovered thanks to the rapid response of medical staff, but doctors said they faced huge pressure from parents to give infusions when they were not needed. Doctors said parents had an almost superstitious belief in infusions and insisted on them to help their children get better quicker so they would have more time to study.

Hukou reform will give rural migrants healthcare rights

Millions of rural migrants may get access to affordable healthcare as China modifies its household registration (hukou) system to give more right to the floating population. In a major shift in policy, reforms to the residence permit system will grant migrants the same access as urban residents to  public services  such as medical treatment  for their children. The plan, which has been released for consultation by by the Legislative Affairs Office of the State Council, would allow migrant workers who stay in a city for half a year with a stable job and residence may apply for the residence permits.

Wheat near Yellow River contains heavy metals

People living near the Yellow River are being poisoned by eating crops containing high levels of heavy metals absorbed from irrigation water drawn from the river, a study shows. Wheat grown in areas around Baotou irrigated by Yellow River water showed high levels of mercury, lead and selenium, researchers from the Inner Mongolia University of Science and Technology showed. Crops also contained high levels of copper, zinc and manganese, they found.

Wednesday, 3 December 2014

Beijing doctor explains on Youku about bribes and commissions

by Michael Woodhead
A video is circulating on Youku of a man purporting to be a former surgeon at a Beijing hospital, explaining how the red envelope bribe and commission system works in China. 
The erstwhile doctor, claimed to be  Li Rui of the Beijing Aerospace Institute Hospital Urology department. He said that during his time working in surgery, doctors would make huge commissions by charging patients exhorbitant sums for ancillary items such as a 1500 yuan gauze pad to stop bleeding, on which they earned a 30% fee. He said surgeons performed many simple operations such as removing appendix in 10 minutes and then adding lots of expenses to the bills. Dr Li said it was best to work in procedural specialties such as orthopaedics, surgery and obstetrics where there were more opportunities to perform operations and use expensive medical supplies and devices. The man was purportedly giving a presentation at the well-known New Orient academy  in Beijing, although the institute denied any knowledge of his working there. In a statement the Beijing Aerospace Institute Hospital denied the man's claims, describing them as baseless and slanderous. The hospital said there had been a Dr Li working at the hospital but he had been absent for six months and thus his contract was terminated. The hospital said the man's statements on video lacked credibility, citing as an example that there was no way a surgeon could do an appendix removal in 10 minutes, even with the most modern equipment.
However, the video has been widely circulated on Chinese social media sites, drawing comments on the greed and corruption of doctors and the profit-seeking nature of public hospitals.

Tuesday, 2 December 2014

Diabetes in China: the numbers are staggering

by Michael Woodhead

The Lancet Diabetes & Endocrinology journal is this month running a series of articles focusing n type 2 diabetes in China.  

The numbers make for grim reading: more than 12% of Chinese are reported to have diabetes (100 million people) according to US criteria (although there is some dispute over whether these  criteria may result in overestimates).  Because of the lack of awareness and lack of adequate screening and intervention programs, many of the Chinese with diabetes are undiagnosed, untreated, or uncontrolled. 

The articles say that Chinese people are especially prone to type 2 diabetes at relatively low levels of overweight, and Chinese people are more susceptible to [insulin producing] beta cell failure and deficits in insulin production. The blame, unsurprisingly, is put on China's rapid development and shift to lifestyle factors such as eating an unhealthy diet and doing less exercise. 

A second article says that there are also problems with provision of prevention and treatment programs for diabetes in China. As well, there is little research on the best forms of drug therapy for Chinese people with diabetes. Newer [and more expensive] anti-diabetes agents such as the gliptins seem ideal, but they are not currently accessible or widely used by most doctors.

The articles conclude by saying that any solution to the diabetes epidemic in China must be based on multiple strategies: there needs to be healthcare reform to make diabetes prevention and treatment more widely available through primary care and through initiatives such as diabetes nurses. There are need to be major preventive health campaigns to promote healthier eating and activity, to reduce the risk factors for diabetes in China. The articles also note that health reforms are needed to provide adequate health insurance cover and reimbursement for treatment of diabetes patients in China

Monday, 1 December 2014

China's best case scenario for an Ebola outbreak: 3000 deaths

by Michael Woodhead

With more than 600,000 annual passenger arrivals from Africa and a poor to non-existent public health infrastructure in most parts of the country, China faces  a very real risk of an Ebola outbreak. That the verdict of infectious disease specialists who have modelled what will happen if a person with Ebola lands in China and is not detected immediately.

Dr Chen Tianmu and colleagues from the Changsha Center for Disease Control and Prevention have used data from previous Ebola outbreaks overseas and also from outbreaks of dengue and HIV viruses in China to model the likely spread of the infection before it can be brought under control. They modelled several different scenarios based on different levels of infectivity of the virus and different levels of detection and containment.

They based their calculation on the fact that there were 524,900 African visitors and 112,966 Chinese returning from Africa each year in China. Based on current distribution of Ebola Virus Disease and the rates of carriage in Africa, they estimated that 0.04%–0.16% of these arriving passengers in China (255–1021 people) may carry Ebola. Even if an optimistic assumption is made that only 1% of them slip through the entry-exit inspection and only 1% of these are not picked up by further reporting and monitoring follow ups, this would still mean 3-10 Ebola virus carriers could be at large in China.

The researchers noted that China lacks a primary care system and most sick patients go direct to hospitals that are overcrowded and where Ebola patients might spread the virus to others. China also has limited public health reporting and surveillance systems for much of the country, and it would therefor be possible that cases of Ebola virus could be misdiagnosed and slip though the net until the patient became symptomatic and infectious.

The researchers then calculated that the likely impact of such 'index cases' spreading the Ebola infection to others would be outbreaks of Ebola in China affecting between 6000-10,000 people. With a likely fatality rate of around 50% this would mean a severe mortality burden for China, they wrote.

Writing in Travel Medicine and Infectious Diseases, they said the lack of Ebola testing facilities in China and poor infection control practices would further encourage the spread of the infection, they predicted. Other factors, such as the lack of quality control on blood transfusions (as seen with outbreaks of HIV and hepatitis) would also increase the risk of spreading Ebola in China, they warned.

"Even if a good surveillance and monitoring system is implemented at immigration, an effective and efficient local medical response system involving primary health care providers and awareness of the general public is necessary to minimise the risk of an Ebola Virus outbreak due to other unknown sources," they suggested.