Editor/Shi Aihua
Guangzhou Huangpu District Community Health Service Center
On February 7th, 65438, the State Council Joint Prevention and Control Mechanism issued "Ten Articles of New China" and "Work Plan of Graded Diagnosis and Treatment", making it clear that asymptomatic infected persons and mild cases with home isolation conditions generally take home isolation measures. Among them, vaccination, mapping of key populations, classified management and triage have been undertaken by primary medical institutions.
Under the New Deal, in some cities with a high number of infected people, grass-roots community medical institutions are also facing a new round of challenges.
As of 65438+February, 10, there were 349 community health service centers in Beijing open to patients with fever; Tianjin Health and Health Commission recommended community health service center as the first choice for home therapists. All 264 community health service centers and hospitals in this area have fever clinics. Shanghai, Guangzhou, Shenzhen and other cities have also introduced similar policies.
Many community doctors mentioned in the interview that most antigen-infected people will have panic in the early stage, which makes the telephones of community hospitals "explode" frequently. A community doctor in Yuexiu District of Guangzhou said that he is not only responsible for the task of "chasing the sun", but also undertakes vaccination and monitoring of special patients. "Sometimes I feel that it is not enough for one person to split into three people."
Facing the new changes, community doctors are also trying various methods to deal with these "emergencies". When answering the consultation call of antigen-positive infected people, a community doctor bluntly said: "Don't worry about infection, just eat it"; In the case of unsuccessful docking with the hospital to help the patients in urgent need of medical treatment, the community hospital took the initiative to drive the patients directly to the nearest designated hospital.
On February 8, 65438, a community health service center in Huangpu District carried out inhalation vaccination.
"The first thing I felt was the panic of the residents."
"Hello, my family checked the antigen. It seems to be positive just now. What should I do now? "
11On the evening of February 8, the day after the release of "Ten Articles of New China", Dr. Deng Tian from Xiagang Street Community Health Service Center in Huangpu District, Guangzhou, had received numerous calls from residents with positive antigen self-test within one day. Most of these callers are asymptomatic or mild patients.
He told the caller that if he had symptoms such as fever and sore throat, he would go directly to the community hospital and the doctor would prescribe the right medicine. "If there are no symptoms, he should work, rest and eat as usual."
The cancellation of Fangcang Hospital shifted the treatment pressure of new coronary pneumonia to primary community hospitals. "After the policy adjustment, the pressure on our grassroots work is getting bigger and bigger," Deng Tian said. The first problem he felt was that the residents were more afraid. His mobile phone receives calls from antigen-positive residents 24 hours a day. Even if there are no symptoms, everyone wants to ask the community hospital for help. Most phone calls are about single-tube nucleic acid, always trying to prove that they are "negative".
In many consultation calls, Deng Tian felt a sense of panic far greater than the infection symptoms of Omicron infected people themselves. He even persuaded the residents who called not to test the antigen at will. In the face of calls from residents, he sometimes persuades in plain Chinese: "Don't test antigens every day. This virus is no longer pathogenic. It doesn't matter if you are infected. Do you understand? "
The experience of Dr. Deng Tian from Xiagang Street Community in Huangpu District also happened in Yuexiu District, Guangzhou.
Huang Xiang, a doctor at Beijing Street Health Service Station in Yuexiu District, said that now residents are testing antigens at home, and there is no need to report positive results to the community. Even if they did, they couldn't manage them. "Too many."
Dr. Huang Xiang said that some residents with positive self-test antigens asked for home nucleic acid testing, and he had to put it back. Now the list of antigen-positive people has been lined up for several pages. The service station can't even serve patients with positive nucleic acid test. There are more than 30,000 residents living in the streets of Beijing, and more than 50 people are positive for nucleic acid every day, and more than 200 people have been tested since 65438+February.
Dr. Deng Tian also mentioned that most of the energy of community hospitals is still on "nucleic acid positive" infected people. In Guangzhou, the medical staff of the community health service station put a door magnet on the residents with positive nucleic acid, and at the same time sent a "love bag" containing traditional Chinese medicines such as Lianhua Qingwen and Xiaochaihu granules and several antipyretics. On the sixth day of home isolation, the medical staff of the health service station will come to collect nucleic acid. If the nucleic acid is negative, the isolation will be lifted immediately.
Dr. Deng Tian and his colleagues will be responsible for the medical needs of these patients during their stay at home. "We have moved from one battlefield to another. For us, this battlefield is more stressful."
"The first time we come to the door, we will do a health check to see if he has any potential risks." Dr. Deng Tian said that every time he went to a family, he would record the age of each family member, whether he had a basic disease or a mental illness. "We also need to send a medical guide to let them have a scientific understanding of this disease." In the health station where doctors in Huang Xiang serve, there is even an expert in charge of mental illness. Once a mental patient falls ill or needs medical treatment or prescription, Dr. Huang Xiang will also contact the Health and Health Bureau, who will send him to a mental hospital for treatment.
Love package prepared by community hospital for nucleic acid positive family members
"120 is still very difficult to play"
For general positive patients with fever and other symptoms at home, community doctors will suggest taking antipyretics at home first. What really makes community doctors nervous is that some "special people" seek medical treatment.
Dr. Du Fu from Jianghai Street Health Service Station in Haizhu District, Guangzhou, is responsible for the "special population" among the positive family members in the jurisdiction. According to her introduction, Jianghai Street includes the elderly, children, pregnant women and positive "special people" who need dialysis, adding up to about 300 people.
According to the degree of priority, Dr. Du Fu's visits to these special patients range from once every three days to once a day. When he is busy, he visits more than a dozen a day. When these patients have life-threatening symptoms, such as coronary heart disease, cerebrovascular disease, sudden vomiting and so on, Du Juan's duty is to rescue them in time and help their families to call 120. If it is serious, the community hospital will contact the Health and Health Commission to open the green medical Passage.
165438+1One morning at the end of October, at about 6: 30, Du Fu received a phone call saying that a positive old man fainted on the road. "I was quite worried when I went." This is Du Fu's first close contact with positive patients. Prior to this, she was only responsible for the basic work of community medical security and did not need to face positive infected people.
"I suspect that the old man is dehydrated." After Du Fu arrived at the scene, he immediately measured the blood pressure and blood sugar for the elderly. After all the indicators showed normal, she began to give injections to the elderly, and hung a bag of salt water on a hanger to replenish some liquid for the elderly. Slowly, the patient is much better.
At the same time, Du Juan's colleagues started to dial 120, but the line was always busy. Du Juan and his colleagues waited around the patient until after 8 o'clock, and 120 ambulance arrived. It's hard to make a phone call.
At 8: 30 that morning, Du Fu received another call: "Someone fainted again". At that time, the only first aid kit in the community was in her hand, and the hospital leaders urgently asked someone to ride an electric car to pick her up and rushed to the residents' homes for treatment.
It's a 4-year-old girl with disability and positive nucleic acid. Du Fu measured her blood pressure and blood sugar, and the data were good, but people's consciousness was not clear. Du Juan said that when he was being treated at the scene, community leaders kept calling the Health and Health Commission and asked them to help contact the hospital where he could see a doctor. However, due to the unclear medical history of the little girl, it is difficult to coordinate with the appropriate hospital.
"She lives on the third floor and is still a chubby little girl," Du Fu said. Because there were not enough people involved in the transshipment, the police also came with stretchers. "The four of us carried her outside together."
At that time, Du Fu gave the girl an injection and infusion. After injecting a bag of normal saline, the girl still didn't get better. Because she couldn't coordinate with a suitable hospital, the leaders of the community hospital took the lead and drove directly for 20 minutes, and sent her to the nearest designated hospital in COVID-19, the Hospital of Integrated Traditional Chinese and Western Medicine of Southern Medical University.
There are many similar emergencies. There is a patient in Du Juan who needs regular hemodialysis. After completing hemodialysis the day before, he was positive for nucleic acid the next day and began to cough. "Then there may be other complications, and he will be in a coma." After receiving help, Du Fu made an emergency visit to examine the patient and found that the patient was unconscious. Although he was sent to the designated hospital in time, the patient was still in poor condition and entered the ICU.
A community hospital in Guangzhou triage desk _ _ _ _ _ _ _ _
Decentralize primary medical staff
Under the multiple tasks of nucleic acid reexamination, special patient monitoring, vaccination and graded diagnosis and treatment, manpower has become the most direct problem in community hospitals.
"It is not enough for one person to split into three people." Dr Huang Xiang from Beijing Street Health Service Station said. In the grass-roots community health centers in Guangzhou, most of them implement two shifts. 8: 00 p.m. to 6: 00 p.m. and 6: 00 a.m. to 8: 00 a.m. the next morning. It is also common to go to work 24 hours when you are busy.
Dr. Du Fu from Jianghai Street also mentioned that he had not rested for more than 40 days. Du Fu's colleagues said that many patients who came home positive had fever and upper respiratory symptoms, and it was one of the important tasks for health workers to deliver medicines door to door. "A person will probably go to 10 to 20 households during the day. There are antihypertensive drugs and hypoglycemic drugs that need daily use, as well as cold drugs and antipyretics. " According to Du Fu's colleague, there are five people working in the day shift in Jianghai Street Health Center, and more than 10 people need to be given medicine. In addition to this work, another important task of community hospitals is "chasing the sun".
The so-called "chasing the sun" is a positive example in mixed pipe detection. Huang Xiang said that at present, all the nucleic acid tests in the society are mixed-tube tests of ten mixed-tube tests or even twenty mixed-tube tests. "Assuming that there are 20 mixed reports, we will chase these 20 people and implement each person's single-tube nucleic acid." The process of chasing Yang requires a lot of manpower, and there are only 30 people in the Beijing Street Health Service Station. The project of chasing Yang alone will consume more than half of the manpower.
Another task is the focus of Huang Xiang's current work-vaccinating the elderly. Some elderly people who are willing to be vaccinated are unwilling or inconvenient to go downstairs, and the neighborhood Committee will entrust community doctors to come to the door. Recently, Huang Xiang feels that the number of people vaccinated has suddenly increased, and he receives calls from residents asking for vaccination every day. According to Huang Xiang, at present, the vaccination rate of the elderly over 65 in Beijing Street, Yuexiu District has reached 8 1%.
"All kinds of materials are still enough, mainly due to the shortage of manpower, because we have been working continuously for more than 40 days without rest," said Dr. Deng Tian from Xiagang Street Community Health Service Center in Huangpu District. "What is most lacking now is a pediatrician, because the sick family is the most nervous and seeks medical advice, but there are fewer pediatricians in each hospital."
Du Fu felt that at the beginning of the new policy, everyone was still in a stage of adapting to the capital, and it would take some time for the pace to slow down.
A colleague in Du Juan is in charge of answering the phone. Their jurisdiction is responsible for 25,000 residents. The health station has four telephones to answer residents' inquiries. Even so, some residents went directly to the health station because they couldn't get in the phone. "If you sit by the phone, you don't have time to go to the toilet and drink water. Although you have been answering the phone, there are still many people complaining that the phone can't get in. " Du Fu's colleague said that every community hospital is like this.
In fact, measures to reduce the pressure on the community have been going on. Du Juan said that he was originally a doctor in a general hospital in Guangzhou, and he was sent to the grass-roots support on 29 October, 65438. "When he was sent to the community, the hospital proposed three to six weeks."
Du Fu said that there were 10 doctors in the same hospital with her. As far as she knows, she is the fourth batch of medical staff in the hospital. She heard that more doctors would be sent in the future. As for when she can return to her original post, Du Fu is not sure.
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