In a hillside village in the Chinese province of Anhui, the villagers of the Huangjian Township were waving goodbye to Dr. Xu Xiaochan from their doorsteps. Before the doctor left in her distinguishable medical car, the villagers gave her flowers in gratitude for her assistance as she concluded her mission in the village.
Xu Xiaochan is a doctor from the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine. Dr. Xu had recently completed her two-year service in the Huangjian Township, Xiuning County, Huangshan City in eastern China’s Anhui Province.
Zhang Jianming, like his wife Xu, is a doctor from the Second Affiliated Hospital of Anhui Medical University, though specializes in western medicines. While he was assigned to Xujia Village, Xu was assigned to Qingxi village.
Xu and her husband Zhang both applied to the Anhui government-led “Stationing One Hundred Doctors in Villages” campaign to alleviate poverty by improving public health. The campaign had selected 113 doctors from tertiary hospitals to provide medical and health services in the rural areas of the province. The couple, having both been accepted to participate in the initiative, were assigned to two villages in close proximity within the Huangjian Township of Xiuning County.
The Huangjian Township is located at the juncture of the Anhui and Zhejiang provinces. The area was among the last of the mountainous townships in Anhui Province to receive access to highways, electricity, and telephones. With an average altitude of 820 meters, high mountains, and dangerous roads, the township is daunted by poor transportation and is shrouded in clouds and fog all year round. There is a saying that says “Clouds drift in Huangjian”.
Every morning, Xu and Zhang would arrive at their respective village clinics to take on the responsibility of providing medical care and public health services for more than 1,400 local people.
When Dr. Xu first began her service in Qingxi village, she would visit the local households and create health files to provide a clear understanding of the villagers’ health conditions. She screened out any villagers who might be seriously ill and accordingly advised them to go to the hospital for timely treatment. Dr. Xu found that the local villagers’ preference for pickled foods was a high-risk factor for diseases such as high blood pressure. In an effort to promote public health through better nutrition, she suggested that the villagers eat more light foods and begin using preventative drugs. However, the villagers did not initially accept her suggestions, asking “If we don’t eat salty food, how can we have the strength to work in the fields?” and “If the medicine is so expensive, then who could afford it?”
To spread awareness of public health among the villagers and begin building trust in her medical practice, Dr. Xu encouraged everyone to take their blood pressures in the village clinic. She found that more than 140 of the about 600 residents in the village had high blood pressure and remarked, “That number was too high and very abnormal. Since then, whenever I found villagers with high blood pressure, I would repeatedly tell them to have a reasonable diet and take medicine on time.”
Following the instructions and advice given by Dr. Xu, the villagers gradually began to change their eating habits, while the drop in the price of antihypertensive drugs allowed more villagers to take otherwise inaccessible medicines. The village began to see experience a notable improvement in public health patterns, largely as a result of Dr. Xu’s proactive approach to medical treatment. “After two years of efforts, now villagers with high blood pressure can basically eat a reasonable diet and take medicine on time. I feel quite happy,” Xu said.
Dr. Xu and Dr. Zhang may practice different areas of medicine, but they work together for the benefit of their patients. “We complement each other. I am relatively better at Western medicine and she often asks me to have consultations, whereas she is good at Chinese medicine and helps patients in our village who need acupuncture,” said Zhang. He recalled an experience where an elderly man had come down with rashes all over his body and had a body temperature of 40°C. After giving him a check, Zhang found an insect bite scab in the patient’s groin. “Based on the previous blood routine examination result, I think the syndrome of fever and thrombocytopenia is caused by a tick bite. In severe cases, it may be life-threatening,” he said.
It became apparent that the senior villager had been bitten by a tick when he was working on the mountain during the plum rain season in southern Anhui. Therefore, Zhang suggested that he go to the Huangshan City People’s Hospital to get inpatient treatment in the Infectious Disease Department. After the patient was hospitalized, a doctor there said, “With some further delay until the platelets decrease to a certain level, it might cause major organ bleeding and threaten his life at any time.”
About 10km away from the village clinic where Xu worked there is a village called Zhoujiayuan. The village officially has a population of more than 200 people, though the number of people who actually live there is only around 60 or 70, with most of whom being old or disabled. To make it easier for the residents to see a doctor, Dr. Xu made a sign reading “mobile clinic” and drove to the village every Wednesday and Friday afternoon to give medical and health services. Since her car is the only one with a “Wan (another name of Anhui) A” license plate in the whole township, everyone became familiar with her vehicle. While Xu was driving on the road, some people would flag her down to receive simple treatments or some medicine. After arriving at Zhoujiayuan, Xu would park her car in the center of the village, put up the “mobile clinic” sign on the top of her car and begin performing medical services.
“I can’t forget the first patient I saw, an old man 21 days after gastric perforation. No one took him down from the mountain, none of the sutures had been removed for 21 days, and the incision’s dressing had not been changed regularly, leading to an infection,” Dr. Xu reported. “Since then, I understand that when I come to the mountain village, I am no longer an emergency department doctor with the assistance of various departments, but a general practitioner who must be able to solve various complex problems independently.”
The iFLYTEK smart medical assistant system on the couple’s mobile phone showed over the course of the past 18 months in the village, they had received more than 10,000 visits and visited more than 5,000 patients. The monthly average number of visits exceeded that of the township health center.
Before returning to Hefei, Dr. Xu (third from left) and Jianming Zhang (second from left) took their daughter Qingyu Zhang to Qingxi Village to visit a patient.
On the second day of the Lunar New Year of 2020, Dr. Xu ‘s family rushed back to Huangjian. Just after entering the house, a villager brought a traditional Chinese rice dish called zongzi, and said, “I thought you were going to celebrate the New Year in Hefei this year. Everyone will be scared if you aren’t there. We know nothing about COVID-19. When you are in the village, we don’t feel as afraid.”
Recalling that sentence, Dr. Xu looked at the bamboo forest outside the window with a melancholy expression.
In the Spring Festival of 2021, the family of three celebrated the Lunar New Year in Huangjian for the first time. On the night of New Year’s Eve, the whole village prepared traditional dishes and danced together throughout the night. During the festivities, Dr. Xu joined the WeChat group in Huangjian Village, and the villagers cheered “Welcome Dr. Xu to our village, we won’t be afraid anymore”.
The valley often reverberated with the couple’s voice calling their daughter to go home for dinner. Qingyu Zhang had grown to be no different from the children in the mountain village. Her skin had tanned since her time in the city and she often ran towards the streams to swim and catch fish with her friends in the mountains. Here, Qingyu Zhang did not attend all kinds of interest classes, training classes and tutorials, but she lived free and happily. Xiaochan Xu said: “It’s completely different from life in the city. My daughter is more free than ever.”
Before being stationed in the village, Jianming Zhang had little contact with his daughter because of his work, though because of the opportunity to work in the countryside their relationship had grown. “My daughter has grown up a lot, becoming more cheerful and sensible, and is able to endure hardships and be more caring. This growth is very precious.” Jianming Zhang said.
What made Xiaochan Xu most grateful was that she trained a student Xinlian Hu during her two-year residency in the village. “I went back. With her here, I feel relieved that the villagers can see a doctor. If you have any questions, you can connect to the consultation, and there are more experts who can provide technical support.” Xiaochan Xu said.
Xiaochan Xu (left) discussed work with village doctor Xinlian Hu in the clinic of Qingxi Village
In the first half of 2020, Huangshan City uniformly recruited village doctors. Xinlian Hu, who practices in an individual clinic in Yiwu City, Zhejiang Province, returned to her hometown of Huangjian and became an authorized village doctor. Later that year, a special document was issued to protect the treatment of first-line village doctors. Now, the backup village doctors are being trained and improving. The Health Vocational and Technical College was established in Xiuning County, Huangshan City in 2019, and 2,000 people enrolled in the first session. These graduates will be the main force of village doctors. In addition to the village doctors training apprentices, a three-year action plan was implemented for village doctors’ training and the village’s medical and health service capacity improvement project of “tens of millions”.
Faced with the warm embraces and flowers from the villagers, Xiaochan Xu couldn’t help but cry. She was concerned for her 89-year-old patient who was suffering from shingles, and another 70-year-old villager who had a skin disease. She repeatedly urged the villagers: “You must remember the health knowledge I have talked about. It is better to prevent diseases than to treat diseases. You must eat a healthy diet and take medicine on time.”
“In the past two years in the village, I have experienced the COVID epidemic, fighting flood, and poverty alleviation… These are very unforgettable. We happened to be here when the villagers needed the doctor most. I think these experiences were a part of my destin,” Xiaochan Xu said. “Everyone we treated were treated as family members. I just said that this time I was ‘away from home’ and I would come back often.”