The development of pediatrics in the west is related to the most basic equality of life. It allows children born in relatively underdeveloped areas and developed areas to have the same chance of safe birth and healthy growth as much as possible, and not to die or leave a disability due to insufficient conditions.
"There was no breathing, my heart rate was weak, my hands and feet were paralyzed." Li Chunlian said.
She still remembers a 31-week premature baby who was admitted to the neonatal department in early 2021. "The family has no hope." "I can't save it." At that time, the hospital scored him only 1 out of 10.
Rescue, all-out rescue. Li Chunlian and several other doctors began intubating and ventilating. Three days later, the child, who had been "sentenced to death," was relieved. However, he began to have a fever again, and his mother gave birth to him 3 days after the membrane rupture prematurely, and the infection was too severe, causing sepsis.
The hospital did not treat sepsis much, and immediately opened a remote consultation. Since 2016, Guizhou has established a province-wide telemedicine service platform and the largest telemedicine private network in China. "Experts say meropenem (antibiotics, suitable for infections caused by specific bacteria), but we don't have them here."
Remote consultation specialists and hospitals recommend that children be transferred or use the "cephalosporin III" plus other drugs available in the hospital, but at some risk. In the end, the family did not transfer to the hospital, stayed in Li Chunlian's department for 28 days, and was successfully discharged. Later, the child went to the higher hospital for re-examination and found no major problems.
Li Chunlian's unit is a county hospital in Tongren City, Guizhou Province. The county has a population of less than 400,000, and it was lifted out of poverty in 2019.
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In April this year, Li Chunlian won a place and went to Shanghai Children's Medical Center to receive a three-month "Academician +" Western Pediatrician Training Course. This is a training course for pediatricians in western China, co-funded by the Humanitarian Aid Fund for Medical Workers of ByteDance and Xiaohe Health, and has training bases such as Shanghai Children's Medical Center, Children's Hospital Affiliated to Fudan University, and Beijing Children's Hospital.
Western Pediatrician Training Course
During the training class, Li Chunlian met 20 pediatricians who were also from the western region. Some of them are attending physicians in municipal hospitals, and some, like Li Chunlian, are grassroots pediatricians who have been practicing for many years. There are also a number of doctors and lecturers at Shanghai Children's Medical Center.
A bridge over a chasm
During the three months of the course, the biggest shock was to narrow the gaps that were immediately visible. "In Shanghai hospitals, there are special people in charge of ventilators in the wards," Li Chunlian said, while in the county hospital where she is located, a series of operations such as diagnosis and ventilator access are concentrated on one person.
In Shanghai, as soon as the child is found to be in critical condition, surgery can be performed immediately. "Not a minute is wasted." Li Chunlian recalled her feelings in the training class.
The county is different, many complex or surgical diseases can not be treated by the hospital, and it takes two or three hours to turn to other hospitals. "Missing out on surgery may leave you with regrets." Compared with Shanghai Children's Medical Center, there are too many childhood diseases that cannot be cured in the western small town hospital where Li Chunlian is located. Referrals, cumbersome and layer-by-layer referrals, are the helpless choices they often make.
Taking intestinal perforation in newborns as an example, if this disease is treated in time, the survival rate is high, otherwise it will quickly endanger life. In Shanghai, children often have to change floors for surgery, from neonatology to pediatric surgery. Because the departments of large hospitals are complete and the team is stronger, the problem can be solved in one stop. In the county where Li Chunlian is located, the hospital is not equipped with pediatric surgery, and it takes 4-5 hours to drive to the provincial capital to do surgery.
Newborn transport is called the relay of love. Sun Xiangyang said that the referral of children from other hospitals to his hospital takes half an hour in the near and 4 hours in the distance. The longest time it takes for the child to be transferred to a higher-level hospital.
The problem is universal, and there are inherent deficiencies in the development of pediatrics in the west, not just in hardware gaps. In 2015, the survey of pediatricians in Guizhou Province showed that there were 1572 pediatric practitioners and practicing assistant physicians in the province, and there were only 0.32 pediatricians per 1,000 children, lower than the national average (0.53 per 1,000 children at the beginning of 2016 and 0.63 in 2019). Compared with the eastern hospital, the western pediatric hospital is short of personnel and lacks a perfect team configuration.
The gap means that common pediatric diseases may delay the development of severe diseases, and severe diseases may lose the opportunity to treat them. Zhang Liping from the Department of Pediatric Critical Care Medicine of a hospital in Bijie City participated in the "Academician +" Western Pediatrician Training Course funded by bybyDance Medical Fund in the same period. Here, she saw another world of pediatric critical illness.
She sees the various operational details commonly used by PICU (Pediatric Intensive Care Unit). In Bijie, which has a registered population of nearly 10 million, children with blood tumors occasionally appear, but Zhang Liping is rarely able to treat them. The hospital will arrange for children suspected of having hematological tumors to be admitted to the intensive care department, but the department can only transfuse blood, and cannot perform puncture, hemodialysis, and transplantation for children. Eventually, the confirmed child can only be referred upwards.
The Shanghai Children's Medical Center, where the training is located, specializes in the treatment of childhood leukemia, with a cure rate of 80%.
At the beginning of the training, Zhang Liping encountered too many problems, so that many places did not understand too much. With the deepening of the training, she saw for the first time the diseases and professional technologies that she had never seen before, and gradually understood the standardized process of diagnosing and treating such diseases, learned advanced treatment plans, and even filled in details such as nursing documents and scales.
There was a "class representative" in the training class- Sun Xiangyang from a hospital in Liupanshui City, and Zhang Liping would ask him questions he didn't understand. He worked in neonatology for 11 years, as an attending physician, and won many national awards. The department is also one of the higher levels in the local area.
Since 2014, he has repeatedly gone to Shanghai Fudan University Children's Hospital and other well-known pediatric hospitals for further study, like ants moving, and "moving" the advanced experience of various diseases back to Liupanshui little by little.
Sun Xiangyang is treating respiratory distress syndrome in preterm infants
For example, neonatal congenital heart disease is a short board in Guizhou and even the entire western pediatric hospital, and fine circulation management is required before surgery. "From the discovery of complications, judging the timing of surgery to specific operations," Sun Xiangyang said, before the cognition was relatively rough, there will be many blind spots, and he established a system in training. For example, neonatal lung disease, etc., will not be cardiac ultrasound, intracranial B ultrasound, Sun Xiangyang will chase the doctor mentors to ask, learn, and then promote to their own departments.
Even if he continues to learn so much knowledge and experience, Sun Xiangyang participated in the "Academician +" western pediatrician training this time, or always felt the gap between the pediatric level in the east and west.
"At that time, I felt that our neonatology department was lagging behind, 10 to 15 years behind Shanghai and Beijing." For example, liupanshui's success in treating premature babies weighing less than 1 kilogram is still a proud deed of doctors, but Shanghai was able to treat such newborns 10 to 15 years ago.
Bridging the divide requires the help of more western pediatrician training programs such as this.
A window and a door to life
The effect of further education and training on different doctors is different, and each has its own gains. In the mouths of many participating doctors, the training opened a window. Outside the window is the theory and practice of hard-core pediatric intensive care options and so on by more advanced pediatricians.
Zhang Liping knows that due to the degree of development, the programs and processes she witnessed and felt were difficult to migrate to Bijie for a while, but she knew more about blood tumors. In the future, when encountering relevant cases, she can at least make a quicker judgment and point out the way out.
Li Chunlian said that during her trip to Shanghai, she "saw instruments and diseases that I didn't know before, learned standardized operations, and saw real gaps." Her department has been improving its ability to cope with complex diseases, saving children time and money on hospital transfers. When she returned from this training, she deeply felt, "In a serious, emergency situation, how important it is to have a strong team." ”
In contrast, Sun Xiangyang attended the training course with a clearer purpose. He followed the chief physician for consultation and study, and was also happy to answer questions to the "classmates" of the same period. The doctor's mentor was too busy, so he poured himself on his own, and when he encountered something he didn't understand, he concentrated on seeking help. In this way, he absorbed more "Shanghai experience" that was meaningful to Liupanshui.
The Western PediatricIan Training Program, supported by the ByteDance Medical Fund, has been running for 5 years. Sun Xiangyang explored a path of "field further education - internal reform" in the process of continuously participating in training. His hospital belongs to a specialized hospital, multidisciplinary auxiliary departments are insufficient, the hospital has no surgery for a long time, and congenital heart diseases and digestive diseases that require surgery can only be transferred. Now, the hospital has begun to prepare for its own pediatric surgery.
There is a problem that Sun Xiangyang's own hospital is improving, "the overall survival rate of critically ill children in the entire Liupanshui area is still low." Why? Asphyxia occurs in newborns, and untimely resuscitation will lead to brain and many vital organ damage. The resuscitation technology of other hospitals in Liupanshui is generally not in place, and even if he is referred to his department, the baby's condition is mostly very poor when he comes to the hospital, and the survival rate is low. Even if the rescue is successful, the cost and disability rate will rise significantly.
In order to solve this problem, Sun Xiangyang was admitted to the provincial neonatal resuscitation training teacher, and participated in the national related training and examination, and the simulation training of a hospital in Shanghai. Back in Liupanshui, in 2018, he recruited doctors for the first time to carry out a four-month neonatal resuscitation simulation training, and the success rate of neonatal resuscitation in the whole region began to improve.
Sun Xiangyang is training in neonatal resuscitation techniques
The development of pediatrics in the West is about the most basic equality. Projects such as the training of pediatricians in the west have a greater role in improving the level of key doctors like Sun Xiangyang, and then driving the improvement of the overall regional counterpart level. The relevant person in charge of ByteDance said that the company will support 4 western pediatrician training courses every year in the next 3 years, and try to tilt to more relatively underdeveloped areas.
For such a training class, Sun Xiangyang, who has participated in many times, commented: "Let children born in relatively underdeveloped areas have more opportunities for safe birth and healthy growth." ”
( At the request of the interviewee, the characters in the text are pseudonyms )
Text / Zhang Shiji