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Improving community-based primary medical services to protect the health of China’s aging population

Community doctors are very important in the early prevention and treatment of common diseases in the elderly such as atrial fibrillation and cataracts.
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Anxiang County Traditional Chinese Medicine Hospital organizes activities in the countryside.

To the elderly in Tuanjie, a remote village in the northern edge of Hunan Province, it's considered a big event in the community whenever the County Hospital of Traditional Chinese Medicine holds disease education and free consultations. On this day, the village cadres and the doctors in the village clinic would go door-to-door to send out notices, inviting the elderly to gather at the village clinic.

Luo Zan, Chief of Publicity and Expansion Department of Anxiang County Hospital of Traditional Chinese Medicine, remembers a 92-year-old patient with severe vision loss who was not aware that he had cataract for nearly two years. After the doctor's explanation, his family took him to the County Hospital of Traditional Chinese Medicine to undergo cataract surgery. In that free clinic consultation, there were eight other cataract patients from Tuanjie village, just like him. They had also learned about their own cataract conditions and received surgical treatment at the hospital and regained their clear vision.

"Village doctors are usually the first point of contact for most patients, aged 70 and above. By improving the knowledge and awareness of village doctors, patients will have a higher chance of early diagnosis and treatment," says Luo Zan.

With an aging population, strengthening the diagnosis and treatment capabilities of grassroots medical institutions and medical workers, and promoting the prevention and treatment of common diseases of the elderly, is important to promote healthy aging. This is the goal of the “Community Health Worker (CHW) Capacity Building for Elderly Common Disease in China" project initiated in 2021 by the China Primary Health Care Foundation and supported by the Johnson & Johnson Foundation.

Promoting preventive care by making healthcare more accessible

Most of Luo Zan’s patients are aged 70 to 90. They generally suffer from coronary heart disease, stroke, cataract, COPD and other diseases. However, due to lack of disease knowledge, the elderly usually come to the hospital for treatment only when their conditions have reached critical stages.

"If these elderly people can get a timely diagnosis in the rural hospital, they can come to the county hospital for treatment earlier, reducing their financial and physical burden," Luo Zan adds.

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Zhang Yansong conducts health education for elderly residents in the community.

Zhang Yansong is a general practitioner at the Beijing Baizhifang Community Health Service Center. More than 90% of the residents in her community hospital are elderly. On outpatient days, she sees more than 70 patients on average daily, not only to deal with the diagnosis and treatment of various common diseases, but also working on the prevention and healthcare of residents. Zhang participated in a public welfare project for capacity building in the prevention and treatment of common elderly diseases in the community, where three clinical experts conducted professional training on common diseases of the elderly such as atrial fibrillation and cataracts.

For Zhang Yansong, inviting the clinical experts was very beneficial in improving the general knowledge of doctors. As community doctors are converted from internists, they were only trained to handle the responsibilities of general practitioners. These community doctors often lack knowledge in disease fields such as ophthalmology and cardiology. However, through professional training, she has gained a deeper understanding of the diagnosis of these related diseases, which will help her achieve timely diagnosis and early treatment when facing elderly patients in the community.

"In the past, I thought that problems such as cataracts and atrial fibrillation should be solved by specialists, and general practitioners only need to manage patients such as hypertension and diabetes. But in fact, the early prevention of these common diseases of the elderly is also one of the responsibilities of community doctors,” Zhang Yansong shares.

Zhang Yansong recalls receiving an elderly patient who came to the center for treatment due to palpitations and discomfort. Zhang Yansong diagnosed him with paroxysmal atrial fibrillation and immediately contacted and referred the patient to a tertiary hospital via fast channels where radiofrequency ablation was performed. Due to accurate diagnosis and timely treatment, the patient recovered and was discharged from the hospital within a week.

Helping healthy aging

According to the latest data from the National Bureau of Statistics, in 2022, there were nearly 980,000 grassroots medical and health institutions across the country, including 34,000 township health centers, 36,000 community health service stations and 321,000 outpatient clinics. There are a total of 588,000 village clinics, an increase of 2,210 compared to the previous year. These clinics were widely spread over streets, communities, towns and villages. According to a recent survey, 90% of families can reach the nearest medical point within 15 minutes.

The development of public welfare projects for the prevention and treatment of common elderly diseases in the community has injected new power into the promotion of healthy aging. It is reported that since the launch of the public welfare project, more than 80,000 community health workers have been trained in the prevention and treatment of atrial fibrillation and cataract diseases through a combination of online and offline forms, and more than 1.86 million people have benefited.

With the continuous promotion of the project, the concept of early diagnosis and early treatment of common elderly diseases has been popularized in more grassroots, and more grassroots medical workers have gathered to protect the health of the people around them.

"Today, Anxiang County Hospital of Traditional Chinese Medicine adheres to the concept of 'not treating the disease only when it happens, but treating the disease before it.' The concept has gradually become popular in rural areas," Luo Zan says.

For Zhang Yansong, being a community doctor is her constant choice, "During close contact with ordinary people, they are willing to share about their family affairs or their own illness to us, and I am also happy to be their companion. I will help these patients with my heart, so that they can be healthy, not only to lengthen their lifespans, but also increase the quality of their lives. This not only makes patients happier, but it allows me to also realize my true-life value."

This article was translated and adapted, with permission, from the piece "China Doctors' Day: The first line of defense in the battle to protect aging health," originally published by China News Weekly on the Weixin social media platform on August 19. The original article in Chinese is here.