Nurses inadequately trained | Child physical abuse common | Coal use causes black lung

Nurses lack adequate training

Only one in seven nurses in China undergoes a three year undergraduate training program, and many lack adequate training, medical educators have complained. In a letter to the Lancet, Liu Fengxia and colleagues at the Fourth Hospital of Hebei Medical University say that they are worried by the fact that most nurses in China not receive standard nursing training. Each year only 30,000 out of 186,000 graduate nurses earned standard bachelor degrees, they noted. Most nurses received only diplomas after brief training. The lack of education and the stressful working conditions mean that poorly trained nurses could make mistakes in patient care - and their lack of training may also be a factor in triggering violence against health staff.
"Nurses are intermediates between doctors and patients. In our practice, we have seen misunderstanding and mistrust between patients and doctors most probably due to of the inadequate training of nurses. A more comprehensive training system for nurses is needed," they write.

Physical punishment of children condemned

China's high rates of physical punishment of children amount to a culturally-accepted high level of child abuse, researchers have said. A major review found that 36% of children in China experienced physical abuse from parents, typically in the form of slapping and spanking for disciplinary reasons. They said the rates of physical punishment in mainland China were significantly higher than in other Asian countries, where the influence of western methods of parenting was stronger. The researchers said physical punishment was "culturally accepted" within Chinese society because the Confucian philosophy of parenting, which endorses parents’ authority and filial piety, is still prevalent in the minds of Chinese parents and children.
"A well-known proverb “gun bang di xia chu xiao zi” (also translated as “spare the rod, spoil the child”) indicates that the filial piety is achieved by strict physical discipline of children," they noted.
They said China's high rates of physical abuse were concerning because of the known associations with poor mental health and harmful behaviors, such as depressive disorders, anxiety disorders, eating disorders, childhood behavioral disorders, suicide attempts, drug use, and risky sexual behaviour.

Coal use leads to black lung

China's high use of coal for fuel has led to high rates of pneumoconiosis and "black lung", researchers say. In a Dow Jones report, clinicians said pneumoconiosis was common in mining workers and other coal-related industries, especially as workplace safety rules were often ignored in China. masks could help prevent pneumoconiosis but were often not provided to workers, they noted. The number of people diagnosed with pneumoconiosis has risen sevenfold from 2005 to 2013 to about 750,000, at an average pace of 35% annually, according to official data. And while treatment is available, it is often unaffordable for many low paid workers, labour activists note.

Downton Abbey? No, Beijing: domestic servants have fake health ceritficates, risk passing on infections to kids

by Michael Woodhead
For a newspaper that is supposed to be upholding the spirit of socialism, the Beijing Daily is sounding uncannily like the bourgeois Daily Mail these days. 
In today's issue there is a lengthy feature dedicated to investigating the question of whether domestic staff can be trusted when it comes to health and hygiene. More specifically, the paper has an in-depth report on the bona fides of the health certificates that nannnies, cleaners and other domestic ayi-style servants present to their employers as evidence of their suitability for working in the household. The Beijing Daily reports the case of a female obstetrician, Zhao Li, who spent months and more than 10,000 yuan looking for a suitable nanny for her 2-year old daughter. When she found the right nanny, she was assured by the domestic staffing agency that the woman was of good character and had a health inspection certificate. However, being a meticulous medical mother, Zhao Li was concerned about the possible risks to her daughter's health and decided to double check the nanny's health status by having her undergo a health checkup at her own hospital. She was shocked to discover that the young nanny was hepatitis B positive and also had a fungal skin infection. "My daughter could have been exposed to many infectious diseases. These health certificates they present are worthless," she told the paper.
When reporters from the Beijing Daily inquired further they found that  nannies and other domestic staff are not required by law to have the state-monitored health checks that are required by other employment sectors such as hotel and food preparation staff - and yet they do much the same work. Domestic staff are certified by the employment agencies, which have a vested financial interest in showing that their 'workers' are in excellent condition. The health checks for domestic staff are done by private clinics and there is no supervision of their standards or identity checks - it was reported that some would-be employees sent a healthy 'impersonator' in to have their tests done for them. A spokesman for a reputable public hospital (the PLA 302 Hospital) that has  a clinic for employment health certification said that many domestic servants were migrant workers and often had been exposed to many infectious diseases. As well as hepatitis they frequently detected diseases such as tuberculosis, measles, intestinal and skin diseases. Females they tested sometimes had vaginal thrush and other sexually transmitted diseases (STDs), the spokesman said.
A doctor at the hospital said domestic servants might pass on viral, bacterial and fungal disease to household members via washing facilities, eating utensils and if they were in contact with the bathroom. The Beijing Daily report concludes that it is an anomaly that domestic helpers are not covered by regulations related to employment health checks. They advise that anyone employing a nanny or domestic cleaner/cook should have them checked for a wide range of diseases including respiratory infections (eg tuberculosis), STIs, intestinal diseases (eg amoebic dysentery), hepatitis, skin diseases and also have up to date vaccinations for childhood infections.

Pneumoconiois: China's neglected occupational disease

by Michael Woodhead
Delegates at the National Peoples Congress have called for a compensation fund to be set up for China's leading cause of occupational disease - dust-induced pneumoconiosis. 
Many people were moved recently by the high-profile case of a young Henan man who suffered from the disabling condition, and he was lucky in winning media attention for his case, and securing 30,000 yuan to pay for his treatment costs. However, representatives say that for the vast majority of patients with pneumoconiosis in China there is no such happy ending. Despite being the leading occupational disease, most of the patients are migrant workers, of whom as many as 600,000 are thought to have penumoconiosis. Since most migrant workers are on low wages, few can afford treatment and the disease progresses to the point where they suffer a slow and painful death. For some patients the pain and disability are so much that they commit suicide.
A few local governments have set up schemes to help pay for the treatment of pneumoconiosis, but most patients live in impoverished rural areas where funds are not available for treatment.
At the NPC, one delegate who is the head of the Changsha Hospital, Dr He Binsheng proposed a simple policy that would help end many of the problems with pneumoconiosis patients once and for all. DR He said the answer was to set up a pneumoconiosis treatment fund and also a dust-disease inspection board to supervise high risk industries and prevent further cases from happening. The fund would help pay for the treatment of patients and also provide some social support for their families. Governments could co-operate to set up regional pneumoconiosis treatment and rehab centres for those who are rendered unable to work through pneumoconiosis disability, he said.
Dr He was supported by a Hunan deputy, who said compensation should come from a workplace injury compensation scheme.

Medical news in China's media

HIV is one of several conditions newly listed as occupational diseases for police and  medical workers, meaning that those who develop the illness will be eligible for work-related injury insurance reimbursement. Other new conditions covered are leukasmus, blast exposure hearing damage, and ocular burns (such as to the cornea, lens of the eye or retina) caused by laser light and frostbite, according to Women of China.

The city of Lanzhou in Gansu has adopted tough new anti-smoking measures in public places. New legislation specifies "non-smoking" indoor areas, including medical institutions, schools, government office buildings, public dining places, and public transport carriers. Smokers, face fines from 50 to 200 yuan, according to the Peoples Daily.

Police in Henan broke up a fake medicine production ring that placed fake-drug ads on the radio and the internet and used bogus medical experts to talk with patients.According to CRI the fake drug operation had earned the fraudsters 300 million yuan

And in the China Daily, psychiatrists are reported to be looking at links between China's terrible smog problems and mental health. Clinicians say studies are needed on the negative impact of smoggy days on anxiety and depression due to lack of sunlight and production of the hormone melatonin.

Ministry of Health revises list of occupational diseases

The Ministry of Health (MOH) on Tuesday began soliciting public opinions on its revised list of ailments considered occupational diseases.
The catalogue of diseases occurring as a result of work and which may therefore be given special consideration under insurance has been newly amended to include AIDS contracted by medical staff through exposure at work.
The revised regulation includes 130 kinds of occupational diseases and adds 17 work-related illnesses to the list. However, chlordimeform toxicosis has been removed from the list as manufacture and use of the chemical that causes it has been prohibited, according to the MOH.
The amendment also classifies occupational diseases into 10 categories, which specifies work-related lung diseases and other respiratory illnesses as one major category.
Of the newly added ailments, five are related to lung diseases caused by metal powder, erionite, double chlorine methyl ether and other materials.
For lack of necessary protection, pneumoconiosis is a major occupational disease in China, especially among miners.
Statistics from Daaiqingchen.org (eliminating pneumoconiosis with love), a charitable foundation established to help treat migrant workers who have developed the disease, show that about 6 million rural Chinese are affected by the disease.
Source: CRI

New laws will help Chinese with occupational disease

In 2009, factory worker Zhang Haichao made headlines when he voluntarily underwent open-chest surgery to prove that he had contracted pneumoconiosis, also known as "black lung disease."
Although multiple private doctors had already diagnosed the fatal disease through x-rays, Zhang could not collect workplace injury compensation because a government hospital had refused to corroborate the diagnoses. Suspecting corruption between his employer and the hospital, Zhang opted for an operation to physically reveal the dust resting in his lungs.
Now, a draft law in China is seeking to make it easier for workers like Zhang to prove that they were injured while on the job.
Specifically, the draft law titled "Diagnosis and Identification of Occupational Disease" says that if no evidence exists negating the possibility of a hazardous workplace affecting a worker's health, then the case automatically qualifies as an instance of occupational disease.
Moreover, organizations responsible for formally diagnosing occupational disease—such as local hospitals—may not refuse a patients' request for an examination, the draft law holds.
According to a 2009 Ministry of Health report, 200 million workers in China work in hazardous workplaces, but 37.8 percent do not receive any compensation. Yu Wenlan, a health expert at the Chinese Center for Disease Control and Prevention, told the China Daily in 2010 that only 10 percent of employees receive regular occupational health services such as free check-ups.
The draft law will require employers to submit a large amount of documentation to the government, including records about each workers' occupational history and the work site's risk factors. Workers may appeal to the State Administration of Work Safety to conduct an investigation if they think their company's paperwork is not in order.
When workers disagree with the diagnosis given by hospitals approved by provincial health bureaus, they may apply to local health departments for another examination, under the draft law. If they still disagree with the local health department, then they may appeal to provincial health departments.
Hospitals that provide false diagnoses after taking bribes are punishable for up to 50,000 in fines, and may lose their occupational disease diagnosis certification, the draft legislation says.
In addition to the pending law, the Chinese government also began requesting comments and suggestions to draft legislation on "China's Law on the Prevention and Treatment of Occupational Diseases."
In the end, Zhang's open-chest surgery allowed him to collect 600,000 yuan in compensation, prompting 13 other workers to opt for the procedure. It was a rare success in a country where black lung disease caused by the inhalation of dust comprises the vast majority of reported occupational disease cases.
The ailment costs China 8 billion yuan in healthcare fees every year, and between 1949 and 2009 has affected 653,000 people, out of the total 720,000 occupational disease cases reported.
146,500 Chinese have died as a direct result of Black Lung Disease, said Tang Chun, an occupational disease expert with the All-China Federation of Trade Unions, to the China Daily in 2010.
Source: Caixin