Infant mortality, baby friendly hospitals and a possible case of 'rice field back'.

After breakfast in the hotel we all met in the lobby. All the ladies of the group wore beautiful fresh flower headbands and photographs were duly taken. We then set of either on bicycles or in buggy cars to tour the local community. Those of us who cycled quickly learnt the rules of the road which can be described as organised chaos. However, at no stage did we feel threatened. 

The county hospital 

The first stop was at the local County Hospital. Here, we were shown around by a recently qualified Dr Liao. Dr Liao explained to us that she had recently been working in the Accident & Emergency Department but now is working on the general wards. She gets no paid holiday expect for public holidays.

We discussed what happened about medical indemnity. She implied that if a complication/complaint occurred this would be investigated by a higher authority. If a financial pay-out was required the doctor may have to pay a percentage him or herself. 

Infant mortality 

Infant mortality was a problem in China and this has been seriously addressed. Hospital deliveries are encouraged and once a hospital has achieved an acceptable infant mortality rate it is given a 'baby friendly hospital' accreditation. At the hospital the system was a mixture of Traditional Chinese Medicine and western medicine. Gatekeeper nurses were evident at the front of the hospital. 

 One of the major problems in the Accident & Emergency Department is poisoning. This appears to be due to the fact that pesticides used by the farmers are put into poorly labelled bottles and are then drunk inappropriately. 

A Traditional Chinese Medicine pharmacy was clearly evident and the patients received their products to be taken home.

The structure of care appears to be the following:

* The first level is a village health visitor which has some similarity to the GP. 

* There is then a township centre hospital which is perhaps similar to a community hospital.

* This is followed by a County Hospital. If the County Hospital is unable to provide the care that is required the patient moves to a City Hospital and finally to a Provincial Hospital. This is in some way very similar to the structure level in the United Kingdom.

The Accident &  Emergency Department appeared to be very functional. Again, the system is run like a business and financial awareness of both patients and doctors is important. The cost of treatment is clearly indicated early on and the patientís freedom to choose a doctor is clearly evident. The Accident & Emergency Department uses mainly western methods whilst the Outpatient Department is clearly a mixture of both. 

At the County Hospital a rebuilding programme had started and the Accident & Emergency Department was 2 years old. In the Accident & Emergency Department outpatient intravenous therapy was being provided.  This is usually antibiotics.

The hospital provides its own ambulance service but no air ambulance to the local community. 

Following the visit to the County Hospital we toured the surrounding countryside. We saw rice fields, lotus crops and water buffalo.  The water buffalo are only used for 2 weeks a year to plant the rice but this is an essential requirement for this product.

Barefoot doctors and curving spines

What was evident were elderly men and women with severe kyphoscoliosis. Whether this is due to years bending over in the rice fields, osteoporosis or a combination of both is unclear.   

On the way back to the hotel we visited a health worker. Health workers used to be called barefoot doctors and the name arose from the academics who were sent to the countryside during the cultural revolution to be re-educated. The village health workerís surgery was part of her house. Although GPs do not exist this would be the nearest equivalent that we found. 

In the surgery the walls were adorned with information posters about TB and family planning. Again, this was a private service although some insurance scheme was in place. Farmers paid 50 Yuan a month (about £1) into the kitty and the government provided 550 Yuan per farmer.  This pot was then administered by the village health worker to cover the cost of hospital care. The village health worker had a pharmacy of western and Traditional Chinese Medicine was able to offer intravenous infusions.

Following this we cycled through the countryside and back through the busy city to finish this most interesting tour.  Lunch was in a restaurant in the town and we ate outside. A delightful street vendor came along selling handmade flutes. A rendition of  'Auld Lang Syne' allowed the group to hold hands and sing in the usual way - much to the amusement of the locals. 

After some shopping, we gathered in the hotel lobby for the bus back to Guilin.