"Besides, don't talk about traffic problems that can't be solved in a short while, 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 looked a little unhappy. Since he became the person in charge of Guangdong's health and epidemic prevention department, he has been in charge of the province's health and epidemic prevention and eradication.
Theoretically, the jurisdiction is larger than that of his superior Ren in Lingao, but the resources he can obtain are really pitiful for such an arduous and huge task.
Dysentery is very widespread 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 very difficult.
Although it looks ugly, it is not a big problem. After all, the starting point for the Senate to stand is too low. Any progress seen from the outside is a great success.
"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 it does not receive enough 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 in a mess, with pneumonia patients and dysentery patients.
They are all crowded into a tent with burn patients, and the beds are next to each other! Let me tell you, this is the talent shortage caused by the higher-ups' demands to work quickly, and there is chaos and management everywhere. This has nothing to do with you eradicating it, you
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 of content, including "hand hygiene" such as hand washing and hand disinfection by medical staff.
, as large as systematic occupational protection standards for medical personnel and professional isolation wards, all fall within the scope of hospital infection management.
The hospital of the Senate naturally has hospital infection management work, and the frontline health center naturally also has work. 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 a considerable number of them are employed.
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 feels that the overall hygiene awareness of the army cannot be established by a few hygienists 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 his self-proclaimed "killing and eradication" approach.
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 the Guangdong and Guangxi areas where peace has not yet been achieved 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 cannot make the summer here
Become 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 situation is very serious. From the perspective of the natural environment, Guangxi in the late Ming Dynasty is simply a disease source reservoir with all five poisons of "damp and hot diseases and insect pests". In the context of the chaotic times in the late Ming Dynasty, these problems can only become more serious. Public security
During the war, frontline troops often had to hunt down bandits for a long 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 they were already fighting with all their strength,
The martial law system was implemented, but after all, the Senate's control in the quasi-security area was not strong, personnel mobility was high, and combat troops had 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 of the quasi-public security area, the spectrum of infectious diseases, the prevalence of endemic diseases, and
Water quality conditions. In fact, the results are not unexpected. The most important ones are intestinal infectious diseases and malaria. Due to ubiquitous transportation problems, disinfection equipment is not readily available, and there are not enough vaccines.
Lin Motian could only use some rights-based methods, such as drawing on the experience of the People's Liberation Army in the old dimension, and establishing a system of "three strikes, two points, and one custody", that is, "the cooks are assigned to prepare meals, vegetables, and soups."
"Separate water to wash hands, wash dishes, and keep dishes and chopsticks by yourself"; another example is to arrange a unified physical examination for the cooks and re-screen the relevant medical history; or to use a more intensive publicity and education campaign to emphasize the routine disinfection of drinking water and the prohibition of drinking
Raw water, etc., is to prevent the outbreak of intestinal epidemics.
But when the war starts, we often don’t have to worry about so much. Thousands of small troops are scattered across the province to fight, and even the conditions of the garrison in the county are not much better. When carrying out clean-up and patrol missions, food and accommodation are required.
Not to mention the conditions, most of the health and disease prevention measures formulated and issued were empty words. 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.
"Besides, 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 Telegraph reported that bacillary dysentery has also been seen in Guangzhou. The frontline should keep bacterial samples to check drug susceptibility according to the new central regulations 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
A bit unexpectedly, the so-called "drug susceptibility", the full name should be "in vitro antimicrobial susceptibility test", which is a typical testing method in the antibiotic era. To put it simply, when there are many kinds of antibiotics to choose from,
Bacterial samples obtained from the patient's infection focus were cultured in vitro, and different antibiotics were added to observe whether the bacteria were sensitive or resistant to these antibiotics. Obviously, this was not a useful test for the Senate, which almost only had sulfonamides 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 you know.
This is the first time we have done drug sensitivity... Anyway, it was just to execute the order, so I did a drug sensitivity test, and I really discovered new problems this time..."
"What new problem?"
"You also said that you think drug sensitivity is useless, right? Anyway, the only thing that can be used now is sulfa. 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: Sonnetsella and Schiffnerii. The ones used to determine drug susceptibility were all Schiffner's disease. What do you think the resistance rate is? 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 sulfonamides and oxytetracycline. Sulfonamides are the main antibiotics that have pioneered the war between humans and bacteria for tens of millions of years. Although they have passed the test of time, they are still used in the old dimension.
Being gradually marginalized, this situation is not unreasonable. Sulfonamides are usually considered to have only bacteriostatic effect but no bactericidal effect, and a very serious drug resistance problem has formed in the old plane. The purity of sulfonamides produced by the Senate is limited
, and there is no trimethoprim as a synergist, so everyone knows that the drug resistance problem will come sooner or later, and bacillary dysentery is also one of the first choice indications for sulfa drugs, and the dosage is large. This time, drug resistance is
It was not unexpected that the bacterium was found in Shigella dysenteriae.
But no one thought 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