China's pediatrician shortage to worsen with two child policy

by MICHAEL WOODHEAD

In Guilin's main children's hospital this New Year there were only three doctors on call to cover more than 30 beds for children - and a long waiting list - around the clock. Last year there were seven doctors but four have resigned.

Doctors at the hospital say there is a vicious circle - as more paediatricians resign, the pressure on the remaining doctors gets worse, and the speciality becomes even less attractive to other medical graduates. Speaking to local media, paediatricians say there problem is an increasing one for the whole of China. Paediatrics is an unpopular branch of medicine that finds few takers.

One of the reasons is the low income compared to other branches of medicine - paediatricians don't get the opportunity to make extra bonuses or commissions from surgical operations, prescribing drugs or providing medical devices.

Secondly there is the intolerable pressure from pushy parents of Little Emperors. Children with only minor illness are brought in by neurotic parents who demand attention and excessive or inappropriate treatment for their child. Doctors working with children say their parents and grandparents can be obnoxious - expecting immediate treatment and instant miracles for their spoiled child. This often leads to abuse, disputes, complaints and legal action between doctors and families.

Thirdly, paediatricians also struggle with what they call the "dumb patient" problem - unlike adults, children cannot explain their problem well, and therefore doctors need much greater clinical skills to be able to diagnose their illness.

The low income, high pressure and lack of respect means that paediatricians get little satisfaction from their work. Not surprisingly, many vote with their feet and leave.

The lack of child specialists means that the remaining doctors face 12 hour shifts every day - and have to work as many as 10 night shifts a month. Paediatricians are already exhausted and demoralised  - and they expect the situation to become even worse as two child regulations come into effect in 2016.

Doctors warn that abortion is being used as a regular contraception method by many Chinese women

translated by Michael Woodhead
Private clinics are encouraging women to use abortion as a regular method of contraception, doctors in Guangxi have warned.
Some women are having as many as six abortions and putting themselves at risk of infertility and other complications because abortion is promoted by commercial clinics and hospitals as quick and risk-free method of managing unwanted pregnancy, according to an article in Straits Economic Online.
Dr Li Jingjing, deputy head of the obstetrics and gynaecology department at the Liuzhou Workers Hospital said she had seen women who had as many as 12 abortions because of ignorance about family planning methods and misinformation about abortion circulated by some clinics.
She said some women resorted to abortion because they had unwarranted fears about using oral contraceptives, believing they had harmful side effects. Other women without children said it was too early to consider tubal ligation and their husbands were unwilling to use condoms. Dr Li cited the recent example of a 28-year-old women who had already had six abortions and despite feeling it was 'not quite normal' had little idea of the harms it caused.
Dr Li said there were many such "ignorant and fearless" women and the number of repeat abortions was high, although there were no official statistics available. With 17 years experience in obstetrics and gynaecology, Dr Li said she found younger women were more and more indifferent to the use of abortion and some of them fell into the habit of using it a a regular method of contraception.
One of the reasons was the widespread advertising of "quick and painless abortion" services by private clinics and some hospitals. The adverts for these clinics, which promised "One sleep and it's all fixed - zero harm" were a kind of malpractice, said Dr Li.
A reporter visited several hospitals in Liuzhou and found that abortion was offered for 500-2000 yuan and promised to be painless and convenient. Some even offered '10 minute' procedures for abortion in early pregnancy. Hospital websites also featured prominent advertisements inviting women to have abortions, the reporter found. Hospital figures showed that 85% were first time abortion, 10% were second time and 4% were third abortions. This information confirmed that the abortion situation was 'chaotic', the reporter concluded.

China medical news for Sunday 2 February

Cosmetic procedures a high risk for hepatitis C
Chinese people are more likely to contract hepatitis C from a cosmetic and beauty treatments than from medical procedures or blood transfusion, a study from Jilin shows.
Researchers found that hepatitis C rates had increased rapidly in Yanbian, Jilin, more than doubling from  2007 to 2011. Unexpectedly, they found that cosmetic treatments conferred the higest risk - almost five fold higher than control groups. Having someone esle in the family with HCV was also a high risk for infection, presumably through sexual transmission between spouses, the researchers said. Writing in PLOS One, the researchers for the Capital Medical University, Beijing, said cosmetic treatments had become popular in recent years and there was a risk of viral infection with procedures that broke the skin such as shaving and ear piercing.

Atherosclerosis defined in stroke
Intracranial atherosclerosis (ICAS) is the most common vascular lesion in patients with cerebrovascular disease in China, a study  has shown. Researchers at the Tiantan Hospital in Beijing assessed 2864 consecutive patients who experienced an acute cerebral ischemia and found the prevalence of ICAS was 47%. Patients with ICAS had more severe stroke at admission and stayed longer in hospitals compared with those without intracranial stenosis. According to the study in Stroke, after 12 months, recurrent stroke occurred in 3.3% of patients with no stenosis, in 3.8% for those with 50% to 69% stenosis, in 5.2% for those with 70% to 99% stenosis, and in 7.3% for those with total occlusion.

STI risk high for men who visit prostitutes
Men who have unprotected sex with prostitutes are at high risk of HIV and syphilis, Guangxi research has shown. A study of more than 100 men who visited prostitutes found a high rate of unprotected sex (84%). The overall prevalence of HIV, hepatitis C and syphilis was 1.9%, 1.0% and 18.4%, respectively, according to the study published in Sexually Transmitted Infections.

Parasite problems on the Tibetan plateau
Worm parasites are an endemic problem for Tibetans, especially nomadic herders, a study has found.
Echinococcosis affects more than 380,000 people on the Tibet-Qinghai plateua, is spread by dogs and cattle, and is often picked up from drinking groundwater, according to a study by Chinese researchers. Those most at risk include the old and female in particular. Writing in Infectious Diseases of Poverty, the researchers said control of the parasites should focus on deworming both owned and stray dogs and health education activities n Tibetan language.

Bad news for medical device companies in China

by Damjan Denoble
“Taking kickbacks has become a de facto rule in China’s grassroots health centres.”
On Tuesday, Xinhua attributed the above quote to Wang Rusheng, deputy director of a prefecture-level city in the Southern province of Guangxi, within an article devoted to highlighting a tide of corruption allegations involving medical device sales and rural health officials.
Medical device companies, watch out. If you are affiliated with a medical device company in any way this should cause for concern, given both that Xinhua, the official news agency of the PRC, is doing the reporting, and the GSK and related scandals have cast a light on foreign healthcare companies.

Upgrade of rural health system breeds corruption

The upgrade of China's rural medical system is breeding corruption among heads of medical institutions in the country's remote areas.
Between 2009 and August of this year, the presidents of six rural health centers were prosecuted by the local procuratorate for taking kickbacks in the coastal city of Fangchenggang in south China's Guangxi Zhuang autonomous region, making it the biggest commercial bribery case in the city's medical system.
According to procuratorate documents, the suspects received kickbacks from pharmaceutical sales representatives worth 934,800 yuan ($152,496) when purchasing medical equipment such as Color B ultrasound machines in Fangchenggang, home to ten rural health centers.
The case was just one more in a series of similar cases in a corruption quagmire that has trapped several public officers working for the country's rural medical system.
In 2012, six health center deans in Guangxi's Luocheng county, a poverty-stricken county under the jurisdiction of Hechi city, were busted for accepting commissions while buying expensive medical equipment between 2008 and 2011.
Official documents show that the sales agents provided kickbacks to the centers' heads ranging from 10 percent to a staggering 25 percent in an attempt to increase sales.

In Guangxi, 60% of villagers infected with liver flukes

Liver flukes and minute intestinal flukes are endemic in some parts of Guangxi

by Michael Woodhead
A study of villagers in rural Guangxi province near Nanning has found that around 60% of them are infected with fish-borne trematodiasis, manifesting as liver flukes or intestinal flukes.
The liver flukes caused by Clonorchis sinensis appear to be endemic in the region and can cause chronic diseases and are a neglected public health issue in the area, say parasitologists who carried out a study in six rural villages in southern Guangxi.
Their analysis of faecal samples from more than 700 local residents found an overall egg positive rate of 60% (428/718) for C. sinensis and minute intestinal flukes. In some villages the rates were as high as 70%, and cases of heavy fluke infection were seen in up to 18% of villagers.
The researchers say the rates are higher than previously seen and reflect the endemic nature of the liver flukes in the area. The prevalence of C. sinensis infection was found to be 0.4% in a nationwide survey in China between 1988 and 1992, they note.
The infections come from infected fish int he area say researchers form Korea working in conjunction with scientists from the Guangxi Center for Disease Prevention and Control, Nanning. 
Source: Korean Journal of Parasitology