Rural Health Station Dilemma
David Marshall standing near the Shi Da Xing Qu She Qu Wei Shang Fu Wu Zhan Health Station, Beijing
I recently visited the Da Xing Qu She Qu Wei Shang Fu Wu Zhan Health Station, located some twenty-five kilometers south of central Beijing. My two companions were a pharmaceutical sales representative and an endocrinologist at a prestigious government hospital in central Beijing. The rutted dirt road coursed through a rural landscape of centuries-old housing and fields of rubble. When we arrived, a makeshift market comprised of sawhorse tables heaped with meats, vegetables, and mixed merchandise and oil drums containing fires for warmth sprawled over several vacant lots, just a hundred meters from the health station. Within an hour of our arrival, the market had dismantled and disappeared.
We greeted the health station manager who told us that the station has 8 doctors, 12 nurses, and 12 clinical and clerical workers serving some 6,000 residents. She estimated that 100 patients come to the clinic every day—impressing me as a low utilization for the 20 medical personnel. The chronic diseases affecting the patient population most are diabetes and high blood pressure. I asked her how many diabetes patients the health station served, but she was unable to get her computer to access the data. Currently, the health station staff only monitors its patients’ blood sugar levels. She said that most residents go to the nearby hospital rather than the health station when their blood sugar is out of control or if they have complications from the disease.
She said that the health station’s greatest need was better training for doctors and health workers who, she believed, currently get inadequate education from the government Health Bureau. Also, she said that the Health Bureau provides little money for patient outreach programs and information. The health station has teamed up with the local community center to host activities like exercise and talks about alcohol. A recent diabetes lecture drew a large audience of 80–100 residents.
Afterwards, over lunch, the three of us observed that this health station manager painted a better picture about the effectiveness of her health station than what we saw. The pharma representative knew that this health station dispenses about 20 insulin prescriptions a month–versus the local hospital that dispenses over 5,000 per month. This is a striking difference in numbers of prescriptions. The pharma representative also believed that the doctors, nurses, and workers at this health station had minimal knowledge of diabetes. The endocrinologist speculated that patients, concerned about quality of care, had good reason to avoid the health station and opt to go the extra distance to the hospital.
The endocrinologist then contrasted the care of the health station patients with the care of her patients. Diabetes patients at her hospital ward usually spend between five and seven days in the hospital and up to two weeks if there are complications. Her nurses take advantage of the patients’ enforced captivity to educate them on blood glucose control strategies. The nurses have ready access to top endocrinologists who can update them on what to teach the patients.
At the end of the day, I wondered how to get the patients to trust the care they get at the local health station, how to improve the care these grass-root doctors give them, and how to develop better synergy between the health station and the local hospital. These are important pieces of the health care puzzle I need to figure out.