Besides, let alone traffic problems that can't be solved in a short time, just say it's my job to eliminate this problem. What do you think is the most common cause of death in frontline health centers? "
"What is it?"
"Bacillary dysentery accounts for almost one fifth." Fu Liangqi's face looked a little ugly. Since he became the person in charge of the Guangdong Health and Epidemic Prevention Office, he has been in charge of the province's health and epidemic prevention and eradication. In theory, it is much larger than the jurisdiction of his superior Ren in Lingao, but he can get The resources are really poor for such an arduous and huge task.
Dysentery is very common in this time and space, but it is not difficult to prevent. This disease, which is obviously caused by unclean diet, can cause such a high mortality rate, which shows that the work is not done well, which will make his work report ugly - of course, it is not a big problem, after all, the Senate stands on its side The starting point is too low, and any progress will be seen as a great achievement from the outside.
"It shouldn't be." Song Junxing was a little surprised: "Is it because the disinfectant is not enough?"
"Disinfectants have never been used enough. The main reason is the old problem: the implementation is not in place, and our logistics talents are actually in short supply, and because they receive insufficient attention, the situation may be more serious." Fu Liangqi explained , "It is impossible for me to follow each company to supervise their elimination work one by one. I can only convey the spirit and requirements, but it is meaningless if the requirements are too high, because no company can achieve them."
"Don't talk about the company, do you know how bad the infection control in the health center is?" Song Junxing snorted, "Beds are being borrowed everywhere, and the isolation work is messed up. Patients with pneumonia and dysentery Burn patients and patients are all crowded into a tent, with beds next to each other! Let me tell you, this is a talent shortage caused by the higher-ups' demands to work quickly. Chaos management is everywhere. This has nothing to do with you eradicating it. Even if the water is reduced to distilled water, it can’t be stopped.”
The full name of what Song Junxing calls "hospital infection" is "nosocomial infection". As the name suggests, it refers to infections acquired by inpatients in the hospital, including infections that occur during hospitalization and infections acquired in the hospital and occurring after discharge, but not Including infections that have been acquired before admission or are in the incubation period at the time of admission. Hospital infection management is a very important work content in modern hospitals, covering all aspects, ranging from "hand hygiene" of medical staff washing and disinfecting their hands, to systematic occupational protection regulations for medical staff and professional isolation wards. , all belong to the category of hospital sense management.
The hospital of the Senate naturally has hospital infection management work, and the front-line health clinics also have it - although it is placed in the "medical administration" section of the hodgepodge, the medical administration staff are the same as the front-line medical staff, and the personnel employed are: A considerable part of it is the result of surprise training. No matter how much Section Chief Deng boasts that the Provincial and Hong Kong General Hospital is a "world-class hospital," he cannot hide the low level of 99% of the employees there.
And even if these managers can meet the requirements of the old plane, they will not solve all the problems. Fu Liangqi felt that the overall hygiene awareness of the army could not be established by relying on a few hygienists to promote it in one or two years.
Fu Liangqi is not here as a front-line clinician, but to guide the health and epidemic prevention work in the camps and residents. Basically, it is almost the "killing and eradication" that he calls himself.
Fu Liangqi was "fully psychologically prepared" for the health and epidemic prevention situation before coming to Guangdong and Guangxi, but after reading the reports of several previous veterans, he discovered that implementing epidemic prevention work in Guangdong and Guangxi, which has not yet been completely peaceful, will face many difficulties: even if The scope of this kind of work is limited to the army.
Guangdong and Guangxi are located in the subtropics, with a hot and humid climate, dense forests, and complex terrain, which is very suitable for the reproduction of harmful medical insects, animals and microorganisms. Mosquitoes, flies, gnats, snakes, rats, and leeches are everywhere. The Little Ice Age did not make summers here comfortable and hygienic.
Fu Liangqi summarized from the reports from the front line that the disease spectrum in the quasi-security area is mainly malaria, bacillary dysentery, leptospirosis, typhus, scrub typhus, arbovirus diseases, parasitic diseases, and most of them are infections. diseases, and the epidemic is very serious. From the perspective of the natural environment, Guangxi in the late Ming Dynasty was simply a source of all kinds of "damp-heat diseases and insect pests". Against the background of the chaotic times in the late Ming Dynasty, these problems could only become more serious. During the security war, frontline troops often had to hunt down remnants of bandits for a long period of time. Although the fighting intensity was not high, the physical exertion was not small. In addition, the food and clothing costs were not as high as those in the rear, and the resistance of the personnel was significantly reduced. Although the martial law system is being fully implemented, after all, the Senate's control in the quasi-security area is not strong, personnel mobility is high, and combat troops have to frequently enter natural epidemic foci and epidemic areas to fight, making it very difficult to control the source of infection.
Before officially getting involved in Guangdong and Guangxi, Lin Motian once applied for the first batch of subsidies and did some health investigation work with several veterans of the public health department. He roughly understood the health situation, spectrum of infectious diseases, endemic diseases and epidemic situation in the quasi-public security area. Water source water quality conditions. In fact, the results are not unexpected. The most important ones are intestinal infectious diseases and malaria. Due to the ubiquitous transportation capacity problem, killing drugs and equipment are not readily available, and there are not enough vaccines, Lin Motian can only use some rights-based methods, such as drawing on the experience of the People's Liberation Army of the old dimension and creating a The system of "three hits, two points, and one safekeeping" is adopted, that is, "the cooks are assigned to prepare meals, vegetables, and soups, and separate water for washing hands and dishes, and the dishes and chopsticks are kept by themselves." Another example is to arrange a unified inspection for the cooks. or use a more intensive publicity and education campaign to emphasize routine drinking water disinfection and prohibition of drinking raw water, in order to prevent the outbreak of intestinal epidemics.
But when the war starts, we often don’t care about that much. Thousands of small units were scattered throughout the province, and even the conditions of the garrisons in the county towns were not much better. When carrying out clean-up and patrol tasks, the food and accommodation conditions are not to mention, and the health and disease prevention measures formulated and issued are mostly empty letters. Even after the frontline health system was rectified, the situation faced by Fu Liangqi was still the same.
Taking bacillary dysentery, the most unfavorable epidemic situation, as an example. Due to insufficient drugs, it was difficult to treat patients in a timely manner. Not only did casualties occur, but a considerable number of chronic patients also accumulated, becoming a hidden danger of secondary infection of bacillary dysentery in the army. Not to mention the conditions on the way back to the camp, mutual contact and transmission are simply unavoidable. After returning to the camp, only a small number of patients can be isolated, but a large number of patients cannot be isolated, making it easy for reinfection and the spread of the epidemic.
"And Brother Song, there are new tricks in the epidemic recently... Take a look at this first." Fu Qiliang took out a page of documents from his arms.
Song Junxing took it and saw that it was a telegram from the Guangdong Region Health Commission:
1 Brigade Guard: Wujiang News. Bacillary dysentery is also seen scattered in the ear. The front line should follow the central government's new regulations to keep bacterial samples to check drug susceptibility and report in time. Liu, Lin.
"According to the central government's new regulations, keeping bacterial samples to check drug susceptibility... Is it necessary? There are not many antibacterial drugs available now. Even if the drug susceptibility is determined, is there still a choice? It's not the same as using sulfa..." Song Junxing Somewhat surprisingly, the so-called "drug susceptibility" should be called "in vitro antimicrobial susceptibility test", which is a typical testing method in the antibiotic era. To put it simply, when there are many antibiotics to choose from, bacterial samples obtained from the patient's infection focus are cultured in vitro, and different antibiotics are added to observe whether the bacteria are sensitive or resistant to these antibiotics. Obviously, this was not a useful check for the Senate where almost only sulfonamides were available.
"I sent a telegram to Guangdong before to report the situation of bacillary dysentery here." Fu Qiliang received the telegram and said, "Now it seems that bacillary dysentery has also appeared in Guangzhou, but it is just scattered. But I called back specifically to let him know. This is the first time we have done drug sensitivity... Anyway, it was an order, so I did a drug sensitivity test, and I really discovered new problems..."
"What new problem?"
"You also said that you think drug sensitivity is useless, right? Anyway, the only thing that can be used now is sulfonamide. It is for this reason that so far we have basically not conducted drug sensitivity tests on any kind of bacteria." Fu Qiliang's expression became more and more solemn, "The dysentery strains I received were of two groups: Sonnei and Schiffnerii. The ones used to determine drug susceptibility were all Schiffner's. What do you guess is the resistance rate? The average is 20%! The highest can To 74%!”
"So high!" Song Junxing, who didn't take it seriously at first, was shocked when he heard this number.
The only antibiotics currently widely used in the Senate are sulfa and oxytetracycline. Mainly sulfonamides - this antibacterial drug that pioneered the war between humans and bacteria for thousands of years. Although it has passed the test of time, it has been gradually marginalized in the old dimension. This situation is not unreasonable. of. Sulfonamides are generally considered to have only bacteriostatic effects but no bactericidal effects, and a very serious drug resistance problem has developed in the old realm. The purity of the sulfonamides produced by the Senate is limited, and there is no synergist with trimethoprim. Therefore, everyone knows that the problem of drug resistance will come sooner or later. Moreover, bacillary dysentery is also one of the preferred indications for sulfonamides. Dosage It is very large, and it is not unexpected that drug-resistant bacteria were found in Shigella dysenteriae this time.
But no one expected that this day would come so early.
Although the proportion of drug-resistant strains currently emerging is not high, it is a very bad sign. When drugs are already insufficient, the emergence of drug-resistant strains will undoubtedly make the dysentery epidemic even worse.
------------------------------------------
Next update: Volume 7 - Guangzhou Governance Chapter 438
(End of chapter)
