Hospital Visits

I spent Wednesday, Thursday, and Friday visiting various hospitals in the Tianjin District. The visits were to learn how communicable disease surveillance works so that we can come up with a plan to improve reporting. For a little background, Tianjin is on of four municipalities in China that answers only to the National Government. Tianjin Municipality consists of the city of Tianjin with a population approximately 6 million, and the surrounding rural area, with a population of about 4 million. First we visited a children's hospital in Tianjin City. Another thing you need to understand is that there are very few private doctors. If your child is ill, you take them to the children's hospital for outpatient evaluation. No appointments, just masses of sick children arriving and waiting to be seen. The outpatient department at this hospital sees about 3,000 sick children each day! On Thursday we travelled to a district about 70 km north of Tianjin City. There we visited a county hospital, a traditional medicine hospital, and a township level hospital. Friday we went VERY rural and visited a township hospital (no inpatient or lab services) and rural clinics in a district about 30 km south of Tianjin City. A few things struck me in these visits: 1. The complete lack of documentation. As far as I can tell, other than an occasional outpatient log, no paperwork is filled out unless the patient is admitted to the hospital. 2. There is no standardization to diagnosis. As lab confirmation is rarely performed, the diagnosis is purely clinical. I was amazed that in a rural clinic with no labs the doctor could diagnose shigellosis. Does this just mean dysentary? How does he know it's not campylobacter? 3. The drying food everywhere. Corn and sunflower seeds were laid out on roads everywhere to dry. Imagine a 6 lane road (3 lanes each direction) with 2 lanes on each side covered with drying corn and sunflower seeds. Who owns all this food? How do they pick it all up when it's dry? Just sweep it up with a broom? I watched cars run over the edges, children run through, dogs squat in the middle, flies and spiders crawling through the food. Do they wash it later? Then we went to lunch and everyone started eating sunflower seeds. I have to say that I had a very difficult time eating the sunflower seeds. I certainly didn't use my teeth to crack open the shell!