Infusion madness: patients in Nanchang hospitals consuming gallons of IV antibiotics

by Michael Woodhead
Health experts in Nanchang, Jiangxi have admitted that their city's hospitals are some of the worst offenders in China when it comes to the practice of allowing patients to unnecessary IV infusions. 
In a country where the average person consumes eight bottles of IV infusion fluid per year, Nanchang is above the national average. Dr Yuan Zhaokang, head of the Nanchang University department of public health, says 90% of people are not aware of the risks and harms of IV infusions and yet between 60-70% of people in outpatient departments are given them. Of these patients, 75% don't need the infusions and could be given oral medicines instead. Dr Yuan says China's rate of IV antibiotic use is10 times higher than the international average, meaning that most intravenous antibiotics given in China are unnecessary.
In theory, the public are told that they should not have an injection when an oral medicine will suffice, but in practice in China this order has been turned on its head, Dr Yuan says.
A Sichuan emergency medicine director, Dr Zhen Tao says he opposes routine use of IV drips for people with colds, but it is hard to change the public mindset.
"People believe that IV infusions are more effective and work faster than oral medicine - but they are wrong," he says. Given a choice, patients always demand "infusion first", and few are aware that this directly contradicts the WHO advice for "never give an IV infusion when an IM injection will suffice, and never given an injection when oral medicine will be sufficient".
While this message is slowly getting across to more educated adults, the situation for children is getting worse, says Dr Zhen. Whenever the weather gets cold or the season changes, the hospital's infusion room is crowded with children who have colds who are attached to IV infusion bottles.
A common cold is a minor viral illness - so why do all Chinese insist on having unnecessary antibiotics by intravenous infusion? Dr Zhen says one reason is the pressure from parents with 'inflexible' thinking and attitudes. Another reason is that hospitals make money from infusions.
"Families want a quick cure-all and hospitals want a quick profit. When these two factors come together the result is bad medicine," says Dr Zhen.
The craze for children to have infusions especially worries Dr Zhen because he says it can weaken their health. Antibiotics not only kill pathogens, they also kill the 'good' bacteria that children need for developing an immune system and digestive health, he says. This is especially so for children who have repeated infusions, which become a vicious circle, where more treatments are requested because the child gets sicker and more prone to infections.
As well as increasing antibiotic resistance, IV infusions of antibiotics often cause many other serious health problems, including life-threatening anaphylaxis and other allergic reactions, phlebitis and injection site reactions, circulatory overload and heart failure as well as pyrexia (high fever), Dr Zhen warns.
The only people who really need IV infusions are those who have swallowing disorders, gastric malabsorption problems and the acutely  critically ill patient, he said.

Jiangxi woman is first human to die from H10N8 flu

by Gillian Wong
Chinese authorities said Wednesday that a 73-year-old Chinese woman died after being infected with a bird flu strain that had sickened a human for the first time, a development that the World Health Organization called “worrisome.”
China’s Center for Disease Control and Prevention confirmed the woman in the city of Nanchang had been infected by the H10N8 bird flu virus, a strain that had not previously been found in people, the Jiangxi province health department said on its website.
This is the second new bird flu strain to emerge in humans this year in China. In late March, the H7N9 bird flu virus broke out, infecting 140 people and killing 45, almost all of them on the mainland. The outbreak was controlled after the country closed many of its live animal markets — scientists had assumed the virus was infecting people through exposure to live birds.
Timothy O’Leary, spokesman for the World Health Organization’s regional office in Manila, said WHO officials were working closely with Chinese authorities to better understand the new virus. He said though its source remains unknown, birds are known to carry it and it would not be surprising if another human case was detected.

A rural doctor's views on China's health reforms

Fengcheng Yuandu Clinic, a hospital in Yuandu township, Jiangxi province, is responsible for the health of 50,000 local residents and has gradually become a medical center serving surrounding areas in recent years.
Hospital Director Zou Huihua said he puts great effort into improving the quality of medical teams and the service of the hospital.
Ensuring the healthcare in townships like Yuandu and rural China is very important, Dr Zou said.
The Chinese government approved a series of proposals to improve the healthcare system in townships and villages during the most recent session of the CPC Central Committee congress held in November.
As an experienced doctor at the grassroots level for nearly 20 years, Zou believes what he has been doing is indeed meaningful.
"There are a lot of doctors in big cities," Zou said. "But in townships and villages they need people like me."

Cold blooded doctor comment angers relatives of dead Jiangxi woman

by Amy Li
The family of a 35-year-old woman who died giving birth last month is accusing a Jiangxi hospital of malpractice, and is considering launching a third-party investigation into the matter, Chinese media reported.
But what infuriated many Chinese bloggers more than the dispute over patient Li Xiaoyang’s death was what many called a “cold-blooded” comment from the doctor who operated on Li, Guangren hospital president Zhang Ning.
In an interview with Southern Metropolis Daily this week in Wuren county, Zhang allegedly said, “A hospital is the place where people die.”