Snake bites in China: the medical consequences

by Michael Woodhead
Living in Australia, I am naturally extremely wary of snakes, given that this continent has many of the world's most venomous and aggressive varieties - often living in your back yard. Aussies know that if you get bitten by a snake you need to use pressure immobilisation and get help - quick. But what about China? What are the chances of being bitten by a snake and how dangerous are they?
A new report of snake bites from  Hainan gives some idea of what might happen. In a review of more than 1000 cases of snake bites, Dr Shuang Jiebo and colleagues from the 425 PLA Hospital in Sanya, found that the vast majority were caused by pit vipers (46% - aka Trimeresurus stejnegeri) or cobras (40%). Most of the bites occurred in summer (April-Sept) in young males, typically farmers or fishermen, and the bites were mostly on the legs or arms. According to the article the pit viper venom contains a potent haemotoxin, but is not usually fatal:
"The wound usually feels extremely painful, as if it had been branded with a hot iron, and the pain does not subside until about 24 hours after being bitten. Within a few minutes of being bitten, the surrounding flesh dies and turns black, highlighting the puncture wounds. The wound site quickly swells, and the skin and muscle become black due to necrosis."
The Hainan doctors found that most of the wound sites of pit viper bite victims showed swelling, and the skin and muscle became black due to necrosis. In contrast, the cobra venoms are mainly neurotoxic, hemotoxic and cardiotoxic. "The cobra bite is extremely painful and the swelling appears immediately. Other symptoms may include drowsiness, nausea, vomiting, abdominal pain, mental alertness and respiratory failure. "
In their review, about a third of snake bites caused mild envenomation, and only 11% resulted in severe envenomation, which meant a longer hospital stay - often a week or more. Only 1% of patients died, and these tended to be due to bites by sea snakes or King Cobras.
Treatment outcomes were better when patients received prompt treatment - and the researchers also claimed that "Sheyao" traditional medicine was a good remedy for snake bites. This is said to contain  toad skin, centipede, and 'humifuse euphorbia' herb as well as paris polyphylla.
"Prevention, pre-hospital management (first aid) and the importance of the early transfer to the hospital should be emphasized," they concluded. 

Private health is the centrepiece of health reforms in China

A few news items from this week:

Medical tourism project for Hainan

Hainan province is building what it claims to  China's first special zone for medical travel, to try attract elderly people in search of  a cheap and clean place to spend their retirement.
The Boao Lecheng International Medical Travel Zone covers an area of about 20 square km and the provincial government will create preferential policies to attract overseas medical institutions including lower taxes for imported medical instruments and medicines. Medical tourism has been backed by China's health minister, Li Bin, who said  it "will make Chinese medical institutions take steps to adapt to international demand, so that the overall standard of medical service will be enhanced."

Private hospitals given preferential treatment

To encourage private hospitals, the government is to allow them to charge whatever prices they want and also force health insurance providers to cover treatment in private as well as public hospitals. New measures announced by the National Health and Family Planning Commission include relaxing price controls covering non-public hospital services. The decree also states that all private hospitals should be included in the country's public medical insurance schemes - so long as they reach the basic  standard for 'designated' hospitals -  and government departments should implement the same reimbursement policy for both public and private hospitals. Privately-owned hospitals have welcomed the measures, especially the decision to treat all hospitals equally regarding the reimbursement of patients' medical costs.

Foreign private doctors shown favourably on TV

Chinese TV is giving positive publicity to the handful of foreign doctors working in private clinics in China. In a programme this week CNTV says foreign doctors are "flowing" into China and helping to meet the needs of China's healthcare industry.
"Alongside providing advanced treatment for patients who can afford it ... they can contribute with their knowledge and experience, in Chinese hospitals." the programme stated.

Another doctor killed by patient

A doctor has been killed in Jiangsu reportedly by a 45-year-old male patient who was angry about the outcome of a circumcision procedure. Dr Shan Erhui was stabbed to death in the lounge of a hospital in Fengxian county on Tuesday. The suspect, Wang Fangli,  underwent circumcision in the hospital on March 30 and had antibiotic treatment afterwards, and was said to be dissatisfied with the treatment outcome and the medical expenses.

Volunteers sought to protect doctors from violence

Beijing hopes to recruit 1500 "Guardian Angel" volunteers to act as intermediaries between doctors and patients, defusing disagreements and smoothing over tensions, according to Xinhua. The plan seeks to use students and patients who will serve a one-year 'guardian' term in 21 hospitals in the capital.
“Patients will understand doctors better after talking with our volunteers,” said Feng Guosheng, head of the Beijing Municipal Administration of Hospital.

3 trillion yuan invested and doctors still underpaid

The financial journal Caixin has a feature on how doctors in China still have low incomes despite the 3 trillion invested in the health system by the government. The article says that unless reforms are introduced, medical workers will continue to be paid a pittance -  especially in small town and rural hospitals. It quotes a health ministry spokesman as saying that medical reforms will fail if the "key issue" of doctors' incomes is not solved. The government says it needs to fix the problem of low pay and doctors incomes being linked to prescribing of drugs. It aims to do this by allowing doctors to work in private clinics and to charge higher fees.

Public not happy with expensive private clinics

The Chinese government may see private clinics as the way of the future, but few ordinary citizens in Shanghai can afford their fees. There has been strong criticism of a new private hospital in Shanghai that charges patients up to 1,200 yuan to see a doctor, when it costs just 50 yuan to see a doctor in a public hospital. The opening of Shanghai International Medical Center (SIMC) is being criticised as a symbol of the move to cater only to the well-off in a society.

Hainan hospital pays doctors based on patient feedback

by Michael Woodhead
At the Renmin Hospital in Hainan's Baoting district, doctors dare not displease the patient because their pay depends on having 'satisfied customers'.  Their pay is linked to ratings given by patients on a 24-item service questionnaire. Items reviewed include the bedside manner of doctors, nurses being on duty and available in the clinic and the standard of cleanliness on the ward etc.
In the admin block of the hospital these appraisal forms are in a huge pile, and divided into 26 clinical departments.
The idea came from a partnership with a Shandong hospital whose staff wanted to think of a way to improve service quality. They come up with the idea of having anonymous questionnaires filled in by all patients. The results of the forms are compiled for each department o a monthly basis, giving administrators a clearer idea of areas where service is rated as good fair or unsatisfactory.
Last year the surgical department, for exampe, scored 100% for its service levels, thus ensuring that staff got all 100% of their bonus pay. The paeiatrics department scored 94%, meaning that staff lost 6% of their pay.
Before the scheme, some staff were fairly lukewarm in the way they welcomed and dealt with pateints. Now they are much more careful and give more attention, in the knowledge that their income depends on giving a good impression, a hospital manager says.
Staff are now seen to be smiling and take the initiative, and they speak to pateints more to explain things, he says.
This new system encourages staff to make improvements and has revolutionised the staff approach to patients. In this way, for example, the satisfaction levels in one child clinic increased from 78% to 98% in just over a year.
Source: Haikou News

Hainan to set up foreign medical zone

China's southernmost island of Hainan Province will set up a "special zone," where overseas medical institutions will enjoy preferential business policies for boosting medical tourism, a senior official said Wednesday.
The Boao Lecheng International Medical Travel Zone will be located along the east coast of the island and near the town of Boao, where the Boao Forum for Asia has been held annually since 2001, said Hainan governor Jiang Dingzhi.
Jiang said medical travels, already popular in some Asian countries like Singapore and India, combine travels with leisure and health care, and are likely to boom in China thanks to the rising living standards of people.
The zone, already approved by the State Council on Feb. 28, will enjoy preferential policies that are seen nowhere else, the governor said.
Foreign medical institutions will be allowed to set up business within the zone, while medical joint ventures will not be subject to a share ceiling, a limitation upon overseas medical business in China, Jiang said.
Lower taxes will be granted to imported medical instruments and medicines in the zone, and frontier medical programs like stem cell research will be allowed, Jiang said.
"It is the only travel zone of its kind in the country and I am confident that it will be a success," Jiang, a deputy to the National People's Congress, the top legislature, told reporters on the sidelines of the parliamentary session.
The tropical island province, with its sun, sea and sand, is striving to build itself into an internationally famed travel destination.
According to the provincial statistics bureau, visitors to the island exceeded 33 million in 2012, with travel revenues hitting 37.9 billion yuan (6 billion U.S. dollars).
Jiang, however, noted that travel business on the island is more traditional, hence the need for modern travel modes of technological and cultural attraction.
Covering an area of 200 square kilometers, the zone will be built with an investment up to 100 billion yuan. "It is a huge program," he said.
Jiang said there is no detailed timetable for the program, but he hoped the zone will be operational within two or three years. "The construction of the medical travel zone has already started," he added.
Source: People's Daily