Xian parents say government has suppressed findings of side effect damage from kindergarten antivirals

by Michael Woodhead
One of the top Xinhua stories this week is a report from Xian claiming that the local government in the city has suppressed or manipulated the results of health checks on children dosed with antivirals by kindergartens.
The report is a follow up on the shock discovery that two local kindergartens had been routinely dosing children with antiviral medication. The so-called "Yao Er Yuan" [药儿园] scandal (a pun on the Chinese name for kindergarten - You Er Yuan 幼儿园 - replacing one character with that for drug) was supposedly about schools dosing kids with antivirals to prevent them getting colds and to improve their attendance (and performance) at the schools. The practice was strongly condemned by health authorities, with the National Health and Family Planning Commission (NHFPC) issuing a warning that this kind of practice was strictly prohibited, and calling on all local authorities to conduct checks on kindergartens. 
The children attending the kindergartens involved were referred to local hospitals to undergo checks to ensure that there had been no untoward effects from having being exposed to the antivirals. However, some parents are now saying that the checks have been a sham and the results of health checks have either been fabricated or suppressed. One parent quoted by Xinhua is a Mr Zhu, who says that his five year old daughter had suffered from renal impairment and haematuria from the antivirals, but this had not been picked up by the official hospital checks. He took his daughter to another hospital for a check up and they found significant kidney damage, but this was not reported by the official hospital. Further investigation by Xinhua reporters found that there were several hundred children whose tests showed that had experienced adverse health effects from the antivirals, but the official government figure was just 65. Further investigation revealed other anomalies. Many of the tests results were identical, suggesting they were not genuine but just copies. Discrepancies were also seen in ultrasound scans of children, which experts again said were not genuine. One parent reported that when he took his child for a scan he was given the 'result report' even before she had undergone a scan.
A Xinhua reporter put these claims to the local government in Xian, which responded by saying that the investigation into adverse effects had not been concluded and any figures released were premature. They said the concerns raised by parents and the media would be referred to higher authorities, which would take the feedback as part of its ongoing investigation into the antiviral dosing of kindergarten children.
[Editor's note: it might seem odd that a Chinese government newspaper is highlighting apparent government malpractice ... there may be more than this than meets the eye, or perhaps it is genuine attempt to expose wrongdoing as part of Xi Jingping's campaign against 'formalism' and 'poor working styles'].

Essential medicines for children not available in China

by Michael Woodhead
Essential paediatric medicines such as amoxicillin and salbutamol are often not available in Chinese hospitals or private sector pharmacies, and those that are stocked come with hefty markups, a survey from Shaanxi has found.
When researchers from Xi'an Jiaotong University surveyed a sample of pharmacies and hospital dispensaries to check the availability of 28 common paediatric medicines they found that less than 30% of the drugs on their list were available. The list included basic medicines such as antibiotics, analgesics, antihistamines and vitamins. Drugs that were not available included amoxycillin-clavulanic acid, ibuprofen, morphine and vitamin B6.
Writing in PLOS One, the researchers said this was a concern because when paediatric drugs are not available, doctors   may try adapt adult versions of the drug by using lower doses, which is dangerous. Or if the recommended drug is not available, doctors may substitute a less appropriate drug, they added.
They also found that the paediatric drugs that were available often had huge markup over and above the manufacturers selling price. Amxoycillin, for example, had a manufacturer's price of 6.20 yuan but was sold to the patient for 11 yuan,  a markup of 77%. Salbutamol had a manufacturer's list rice of 13 yuan but sold for 37 yuan to the public. The recommended treatment for chronic asthma,  beclomethasone, cost about 1.6 days’ wages, which made it unaffordable in the public sector hospitals especially as it is needed for ongoing treatment of a chronic condition.
Most of the high markups was due to  public hospital pharmacy profit margins.
The researchers concluded: "We recommend that relevant measures should be taken to enable children to obtain sufficient medicines and effective treatment at affordable prices. The government should adjust the prices of originator brands and lowest-priced generics and improve the efficiency of centralised medicine purchasing systems.
"We recommend urgently that the government should substantially improve public drug procurement and price management, making the procurement system more efficient and the pricing system more scientific, rational and transparent."

Violence in healthcare take a strange turn: nurse beaten by intern for questioning his advice

Healthcare staff in China have become inured to the threat of violence from disgruntled patients and their relatives, but this week a nurse has been subject to a violent beating from an unexpected quarter - an intern in her own department.
The nurse called Li Mei (pseudonym) says she still can't make sense of what happened, but she believes it was because she expressed doubt about the medical advice provided by a new intern in her department called Dr Du Mou.
A Shaanxi newspaper reports that the nurse was working in the internal medicine department of the Railway Hospital at Lueyang, Shaanxi alongside a male intern.
The nurse gave an interview to a journalist while she was lying in bed with an obvious red welt across her swollen face. She said the young male doctor had punched her repeatedly in the face, chest and stomach and also kicked her. She said it was because she had reminded him that his medical advice for one seriously ill patient was incorrect.
"As soon as I finished speaking he hit and kicked me. I was just stunned and dizzy and left with ringing in my ears," she said.
The nurse said she was now so sick she was unable to breastfeed her one year old child.
The local police station said they had sent officers to attend the incident, but when they arrived and ascertained what had happened, they were told by hospital management that this was an internal hospital disciplinary matter and they need not get involved. The head of the department confirmed to the reporter that an incident did take place but he refused permission for media to speak to the intern involved, who was still on duty.
The hospital director said the hospital managers said they were taking the incident very seriously and treating the injured nurse as best they could. An investigation would look closely into the events and would handle the matter gravely. The intern who hit the nurse was a recent graduate from medical school who had not yet passed his one year probation period. The intern said the nurse had sworn at him and cursed his family and he had impulsively struck out and hit her just once. The manager said interns did not have prescribing rights or the authority to give medical advice without supervision form a qualified doctor. He understood the two parties gave very different versions of the incident and the hospital was now investigating.

Shaanxi obstetrician on trial for selling six babies to human traffickers

Zhang Shuxia, an obstetrician who allegedly sold new born children to human traffickers, is on trial at the Intermediate People's Court in Weinan City in northwest China's Shaanxi Province.
Zhang is charged with selling six children between November 2011 and July 2013 with one of them dying during the commission of the offence. Zhang allegedly gained tens of thousands of yuan from the trafficking.
On July 16, 2013, Dong Shanshan, a local resident in Shaanxi Province's Fuping County gave birth to a baby boy at the Fuping Maternal and Child Health Care Hospital. Zhang, who was deputy director of the hospital's maternity department, told her and her husband Lai Guofeng that the child suffered from syphilis and hepatitis B transmitted from the mother and would not survive.
Zhang did not let the couple see their baby but said he had already been taken away.
Lai questioned the doctor's diagnosis and took his wife to another county hospital for syphilis and hepatitis B tests the following day. Two days later, the test results showed his wife was free of both diseases.
On July 20, Lai contacted police who investigated and found the baby in central China's Henan Province 20 days after he was born.

Who will replace the ageing village doctors who work hard for a pittance?

Believing that their situation will one day improve, village doctors are working tirelessly to better the health conditions of rural areas.
Shi Huaiqing is one of this group of about one million village doctors. 

Shi, 52, hails from the village of Shijiagelao in Luochuan county, near the city of Yan'an in Shaanxi Province. He has been a doctor for 35 years and has been responsible ever since for the village's 268 households. 

The job does involve some risks, considering the increasing number of disputes between doctors and patients in recent years.


"We're afraid of potential risks. Often, I am nervous about taking on a patient even if I am confident I can cure them," Shi said, adding that this definitely has increased the economic burden on villagers since they often have to travel far to town or county hospitals.  

Salaries are low, which is why so few young doctors choose this path as a career. Shi is worried that no one is willing to take his position, including his son.

Shi receives 10,000 yuan ($1,605) a year in subsidies, which is much better than the situation years ago when he and Zhang barely earned 60 yuan a month. But despite this improvement, it is still far from enough. "In some mountainous areas, the subsidies are reasonable to encourage village doctors to keep working but in my county it's difficult," said Shi.


Luochuan county is well-known for its apples that sell internationally. This has allowed local farmers to boost their income, with flash cars appearing around the villages. This has meant that the subsidies for village doctors have paled in comparison to the yearly income of local families. 

If it weren't for Shi and Zhang's wives making extra money working on their apple farms, the two doctors would have trouble supporting their families.

Village doctors have been deemed as heroes fighting on the very frontline of the country's vast healthcare system. However, for decades, they have been officially considered as farmers, with practicing medicine only a part-time job - they are not on the public-owned hospitals' pay rolls and they are not covered by the pension system like other doctors working in the city hospitals.

When healthcare reform was carried out in recent years, which brought greater benefits to rural residents, these doctors seemed to be left behind. Mass petitions by village doctors were reported in many areas across the country, calling for greater respect and equal welfare with urban counterparts. 

When village doctors were invited to meet Li Keqiang in January this year, one made his concerns very clear, namely a lack of training opportunities, inadequate facilities, great risk, low income and no pension.

In truth, the authorities have been trying to address these problems in recent years.

"They made just several hundred yuan a month. If they were treated the same way as village teachers (many included in government pay roll), many problems would have been solved," said Minister of Health Chen Zhu at the annual session of the National People's Congress in 2009 (NPC). 

According to a report by the China News Service on January 25, the Ministry of Health said pilot programs for village doctors under contract will be carried out in some areas, and special subsidies will be provided while a pension system will be established. 


Zhang often drives his car to visit villagers, to make sure they take their injections on time or to carry out physical examinations.

The director of the town's hospital once joked to Zhang that even though his petrol costs aren't covered, he still uses his car for the job, recalled Zhang.

As far as he's concerned, the job requires enthusiasm and patience, but it's all worth it because it places him right at the center of the country's healthcare system, straddling both towns and villages.

These sub-divisions were meant to ensure that common ailments would be handled at the village level, with patients only visiting larger hospitals for more serious problems. 

Zhang graduated from a clinic school in Yan'an after studying three years there. He has been a village doctor since 2000. "Within these years, I've learned a lot but I still need to keep learning to be a qualified doctor," he said.

 Zhang can cure some common diseases such as colds and stomach bugs, but he cooperates with the local town hospital to promote the practice of State-run programs.


Urging villagers to have free medical examinations is a challenge. "Villagers usually value farm work more than their health," he said, adding that it's normal for him to turn to elderly people's children for help to persuade their parents to go to the hospital.

Working hard also takes a toll on doctors' relationships with their families. For Shi, some of his relatives think he does not care about family, as he is often late for relatives' weddings or funerals due to so much of his time being taken up with receiving patients.




Shi's colleague, Shi Shihong who worked in a nearby village, died at the age of 80 before the Spring Festival. His wish was also to improve the condition of retired village doctors.

Gu Linhai, a village doctor who had worked for over 40 years, has been living with cerebral palsy for a decade. Now he only gets 160 yuan a year as a pension, according to Shi. 

Shi said his living conditions are much better than those of his colleagues who work in remote areas of the countryside, and therefore he has no excuse to give up his job, despite accepting conditions too forbidding for most.
Source: Global Times

Chinese doctors prescribe antibiotics instead of rehydration treatments for diarrhoea

Most patients with diarrhoea were given inappropriate antibiotics when they should have received oral rehydration solution

by Michael Woodhead
In Chinese hospitals, patients presenting with diarrhoea are given inappropriate antibiotics and IV infusions rather than the simple oral rehydration therapies recommended in 'best practice' guidelines, and mismanagement  is much worse in rural areas, a study has found.
Researchers from the Department of Infectious Diseases at Peking University First Hospital assessed adherence by tertiary hospital physicians to national guidelines and World Gastroenterology Organization guidelines for the management of acute diarrhea in adults. The findings suggest nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.
Their survey was carried out among physicians and 800 patients in 20 hospitals in Beijing and Shaanxi. Data were collected for 800 patients.
The researchers found that 31% of patients with diarrhoea self-medicated before visiting the clinic, most commonly with antibiotics. The mean interval between the onset of acute
diarrhoea and going to a specialist hospital diarrhea clinic was 2.4 days.
In hospital, routine stool examinations were ordered for 70% of patients, vibrio cholera stool culture for 57%, and non-vibrio bacteria stool culture for only 11%.
Only 62% of patients received the recommended fluid and electrolyte therapy and only 28% received oral rehydration solution. In contrast, 33% of patients were given IV fluids even though only 14% needed it.
Antibiotics were the most common drugs (61%) used and the most common antibiotics were fluoroquinolones, followed by aminoglycosides. In total 51% of patients received irrational antibiotic treatment (unnecessary for 48%; indicated but not prescribed for 3%).
Poor adherence to best practice guidelines was more common in Shaanxi compared with Beijing -  fewer individuals received oral rehydration (8% vs 49% respectively) and more received intravenous fluids (46% vs 21%, respectively). More of the patients in Shaanxi province were given antibiotics (65% vs 57%, respectively), and more received IV antibiotics than Beijing (49% vs 27%).
The researchers conclude: "tertiary hospital physicians in China do not adhere well to [international] guidelines or to national guidelines for the management of acute diarrhea. These findings suggest that nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.
Source: BMC Public Health

Family Planning authority criticised for ordering female staff to have four pregnancy tests a year

The local family planning authority in Shangluo, Shaanxi Province, has told women working at government affiliated institutions they are obliged to take a pregnancy test four times a year.
The Shangluo Population and Family Planning Commission, Shaanxi Province, increased the number of pregnancy tests for urban government staff from two to four in August.
It also ordered women who already have a child to be fitted with an intrauterine device. The commission's policies were widely criticized by Web users after they were made public Saturday.
The local commission told the Beijing News that more frequent pregnancy tests will allow it to identify government staffers who are pregnant and order abortions at an early stage if the woman is not qualified to bear a child.
"The local commissions have to take certain measures in order to meet their family planning quota," Liang Zhongtang, a former expert with the National Population and Family Planning Commission and a researcher at the Shanghai Academy of Social Sciences, told the Global Times.
Although the law does not specify frequency, requests of women to take pregnancy tests in smaller cities or villages are very common, said Laing.
The Shangluo commission said the pregnancy tests were obligatory and those who refuse to take the test could be punished.
Source: Beijing News

Shaanxi 'nail house' hospital attacked by thugs over demolition dispute

A hired mob caused damage to the hospital and attacked people

Twelve suspects involved in vandalism attacks at a hospital in northwest China's Shaanxi Province have been arrested yesterday, according to local police.
A group of masked men had been smashing the Century Hospital in Xianyang, Shaanxi Province in northwest China three times from September 13 to October 7. Many medical facilities were destroyed.
"We have lost almost 100 thousand yuan (around US$13,000) just in terms of property," said Wang Dongjun, vice president of the hospital. "Three staff on duty were also injured."
Wang said the hospital was smashed because it didn't agree with the demolition conditions provided by the property developers.
"We invested over 20 million yuan into construction of this hospital, but the developer only plans to compensate 1.4 million yuan for demolition."
Zhao Zhengyong, head of Shaanxi province pledged to examine the issue in October. Apart from the 12 arrested, the local police are after those at large at this moment.
Source: Sina