村民第一次进县医院,竟成最后一次；大病一发现,九成是晚期 The first time the villagers into the county hospital,But as the last time;A serious illness that,Ninety percent is late

　　新农合缓解了村民看大病难题,可农村大病预防还很脆弱；村民健康教育资源极度匮乏,基本医疗卫生知识多数来自村医 New farmers joint easing the problem to see a serious illness,But the rural serious illness prevention is still very weak;The villagers health education resources extreme scarcity,Basic medical and health knowledge mostly from the village doctor

　　提高村民体检报销比例,引导村民定期健康体检,不仅可防大病,还能减少医疗资源耗费 Improve the villagers medical reimbursement ratio,Guide the healthy check-up regularly,Not only can prevent serious illness,Also can reduce the cost of medical resources

　　题记:新型城镇化,需要城乡基本公共服务均等化。沂源县大张庄镇西山村是沂蒙山腹地的一个普通小村,村民不足百户、人数不过三百。记者聚焦这个小村的村民健康,分析在新农合运行10年后的今天,农村医疗面临的新问题。

Signature: new urbanization,Need to urban and rural equal access to basic public service.YiYuanXian big ZhangZhuangZhen XiShanCun yimeng hinterland is one of the common small village,The more than households/But the number three hundred.Reporters focusing the small village of the villagers' health,Analysis in the new agriculture close run 10 years later,Rural medical faces new problems.

　　大病一发现,九成是晚期 A serious illness that,Ninety percent is late

　　大年初一,窗外残雪皑皑,屋内火炉明灭。记者的六爷爷双手抄袖,缩在床边,一脸黯然。“你六奶奶头发大把大把地掉,吃啥吐啥,瘦得不成样了。”六爷爷一声叹息。

Lunar New Year's day,Stone can xue makes out the window,House stove or.Reporter six grandpa hands copy sleeve,Shrinkage in bedside,A face of dim."You six grandmother the hair fell,Eat what vomit what,Is not the sample."Six grandpa a sigh.

　　年前,六奶奶发现下身出血,到邻村卫生室拿药吃了十天,却没啥效果。村医说,进县城看看吧。坐长途车赶到县人民医院一查,竟是子宫癌晚期,瘤子有碗口那么大了；肺部一拍片,已转移满了。如今,六奶奶在县城叔叔家住着,四天化疗一次。六奶奶不识字,家人都还瞒着她。大夫说,恐怕只剩三个月时间了,有啥心愿没了就抓紧了吧。六爷爷独自回乡下,张罗着后事了。

Years ago,Six grandma found para bleeding,To the nearby villages clinic medicine eat for ten days,But not what effect.Village doctor said,Into the county and see it.The long car ride was arrived at the county people's hospital for a check,Ovarian cancer is advanced,Tumors have wankou so big;Lung scan a,Already transfer full.now,Six grandma in the county in the uncle,Four days a chemotherapy.Six grandma can't read,The family is from her.The doctor said,I'm afraid there are only three months time,Have what wish didn't just take it.Six grandpa alone under the home,Scare up with the past.

　　“大夫说,这个瘤子原来可能是个子宫肌瘤,后来恶变了。如果一年前能作个妇科检查,早发现早切了,就不会这样。”六爷爷迟滞的目光中满是自责。一个月前,六奶奶刚过59岁生日,勤俭了一生,这是她第一次进县人民医院,却也是最后一次了。

"The doctor said,The original tumors may be a uterine fibroids,Then the progression.If a year ago can be a gynaecological check-up,Early found early cuts,Would not be like this."Six grandpa hysteresis eyes is full of remorse.A month ago,Six grandma just after 59 years old birthday,Thrift a lifetime,This is her first time into the county people's hospital,But it is also the last time.

　　大年初二,邻村姥爷家。记者的姥姥静静躺在床上,瘦弱的身子陷在棉被里,呆呆地看着我,不言不语。两个月前,姥姥脑梗塞,送进医院抢救了7天,终于醒了过来,但已不认人了,吃喝拉撒全在床上。

12th annual,Neighberhood grandpa home.Reporter's grandmother quietly lying on the bed,Thin body trapped in the quilt,Gawk I,wordless.Two months ago,Grandmother cerebral infarction,Sent to hospital for seven days,Finally woke up,But has not to recognize a person,Eat and drink pull scatter all in bed.

　　姥爷说,最初,姥姥有点发烧,不想吃饭,舌头有点不利索。村医来看了后,按感冒给开了药。但过了三四天,竟说不出话了,这才打了120,送到了县医院。拍了脑部CT后,大夫说,有两次出血,第一次出血量少,第二次出血严重。如果发现说话不利索,能及时送医院,不会这么重。姥爷当年是村里的会计,在村里还算是有些文化的。“医学知识咱不懂,哪知道说话不利索是中风前兆。”

Grandpa said,first,Grandmother has a fever,Doesn't want to eat,The tongue is a bit not agile.To see the village doctor,According to the cold prescribed drugs.But after 3 or 4-day,But speak,This just hit 120,To the county hospital.Took the brain after CT,The doctor said,There are two times bleeding,The first time less amount of bleeding,The second serious bleeding.If it is found that talk not agile,Can send a hospital in time,Won't be so heavy.Grandpa was the village of accounting,In the village is some culture."Medical knowledge I don't understand,Which know talk not agile is stroke precursor."

　　“在咱们村,大病一发现,九成是晚期。”爸爸说,去年村里五人没了,三个是重度心脏病,两个是癌症晚期；而最近三年,小山村先后有五个村民,仅四五十岁就去世了,无一例外是大病晚期。

"In our village,A serious illness that,Ninety percent is late."Dad said,Last year the village five people didn't,Three are severe heart disease,Two are terminal cancer;And the last three years,Small mountain village, there have been five villagers,Only forty or fifty years, and he died,No exception is late a serious illness.

　　大病以往难治如今“难防” A serious illness before obstinacy now"Difficult to control"

　　近60岁的娄树军,是记者邻村——西顾庄村卫生室“赤脚大夫”,行医30多年,在乡里算小有名气,周边十来个村的村民,常找他看病。

Nearly sixty years old LouShuJun,Is the reporter the neighberhood - west guzhuang village clinic"Barefoot doctor",Practice medicine for more than thirty years,In the small village is famous,Around a dozen village villagers,Often find him to see a doctor.

　　“以往是大病难治,现在是大病难防。”娄树军说,新农合实施10年,在很大程度上解决了农民“治大病”问题。10年前,遇上大病,村民没钱看、不敢治；现在有了新农合,住院能报销,村民愿住院了。随着农民大病保险改革推进,村民“治大病”问题有望进一步缓解。

"In the past is a serious illness obstinacy,It is difficult to control a serious illness."LouShuJun said,New farmers joint implementation of ten years,To a large extent solved the farmers"To a serious illness"problems.Ten years ago,Met a serious illness,The villagers have no money to see/Dare not to;Now have a new farming together,Hospital can submit an expense account,The villagers may in the hospital.As farmers serious illness insurance reform,The villagers"To a serious illness"Problem is expected to ease.

　　“但是,这是在医疗最末端——治大病上下工夫。‘上医治未病’,农村大病预防,还很脆弱。”娄树军说,其实,许多心脏病、中风、癌症都能做到一级预防(病因预防)；退而求其次,如果像城里一样,村民能定期有个体检,早发现、早治疗,做到二级预防,效果也会好得多。

"but,This is the end for the medical treatment, the upper and lower time of a serious illness.‘Heal disease before the’,Rural serious illness prevention,Is still very weak."LouShuJun said,In fact,Many heart disease/stroke/Cancer can do primary prevention(Causes prevention);Settle for second best,If the same like the city,The villagers could regularly have a check-up,Early detection/Early treatment,Do secondary prevention,The effect also will be much better.

　　据世界卫生组织2008年末发布的一份报告显示,全球大量资源被用于治疗服务,从而忽视了可使疾病负担减少70%的预防和健康促进工作。早在2008年,卫生部有关负责人就指出,我国一个人一生中在健康方面的投入,60%至80%花在临死前一个月的治疗上。这种医疗资源的“本末倒置”,在农村尤甚。

According to the world health organization by the end of 2008 according to a report released,A large number of global resources are used in the treatment of service,Thus ignore can make the disease burden reduce 70% of prevention and health promotion.As early as in 2008,Health ministry officials pointed out,Our country in a person's life in the health investment,Spend 60% to 80% on his deathbed, a month of treatment.This kind of medical resources"Put the cart before the horse",Especially in the countryside what.

　　健康教育对大病预防至为关键。小山村村民的基本医疗卫生知识,多数来自于村医。记者老家所在的西山村,并没有村医。村民看病,要走上五六里山路,到邻村卫生室。但是,一个村医,面对多个村庄,数千口人,让其系统普及卫生健康知识,几无可能。

Health education for serious illness prevention is very important.Small mountain village villagers' basic medical and health knowledge,Most from the village doctor.Reporter in the XiShanCun hometown,And no village doctor.The villagers to see a doctor,On the mountain road to six,To the nearby villages clinic.but,A village doctor,In the face of the villages,Thousands of persons,Let the system popular health knowledge,Few beyond can.

　　媒体应成为卫生健康知识的重要来源。在小山村,只有不足1/3的农户安装了有线电视,其他村民只能靠小天线收看三四个频道。适合村民的健康卫生知识栏目,少之又少。省台有一个养生栏目,我曾劝爸爸妈妈看看。爸爸说,这个栏目早上六点钟左右播出,冬天还黑着天呢,谁起来看?夏天早下地了,谁在家等着看?看了一期,是说如何在办公室保持正确坐姿,防止颈椎病的,和村民的生活基本不搭边。

The media should become an important source of health knowledge.In a small mountain village,Fewer than a third of the peasant household installed cable TV,Other villagers can only rely on small antenna to three or four channels.Suitable for villagers' health knowledge columns,rare.Provincial television have a health program,I have to see mom and dad.Dad said,This section about at 6 o 'clock in the morning air,Winter was still dark day?,Who look up?The early summer above,Who is at home to wait and see?Read a period,Is how to keep the correct posture office,Prevent cervical spondylosis of,And the villagers life basic don't take side.

村民体检报销比亟待提高 The villagers to improve medical reimbursement ratio

　　其实,从2009年,国家推行“基本公共卫生服务项目”中,就提出免费建立城乡居民健康档案。记者查询发现,县里也推行这一服务,2011年的一篇报道称“城乡居民健康档案建档率达90%以上”。但在小山村,记者采访的许多村民,并不知晓“健康档案”。妈妈说,两年前,她到邻村卫生室拿药时,村医曾给她量了一下身高、体重和血压,记在一张纸上,说是“入档”,但以后再未提及,而记者的爸爸从未见过“健康档案”。

In fact,From 2009,countries"Basic public health services"in,Puts forward to establish free of urban and rural residents health files.Reporter inquires the found,The county also implement this service,A 2011 report says"Urban and rural residents health archives filing rate of more than 90%".But in a small mountain village,Many of the villagers reporters,Don't know"Health file".Mother said,Two years ago,She to the nearby villages in clinic medicine,Village doctor gave her a measured the height/Weight and blood pressure,Written in a piece of paper,say"Into gear",But after not mentioned again,And the reporter's father had never seen"Health file".

　　在村里,镇上为60岁以上老人每年进行一次免费体检。体检是在镇卫生院,内容主要是体格、血压、血脂等基本项目。“体检项目简单,关键是时间太晚,一些疾病四五十岁就是高发期。”村医娄树军说。

In the village,The town is sixty years old man once a year free physical examination.Is the medical examination in township health centers,The content is mainly physical/Blood pressure/Blood fat, and other basic project."Medical project simple,The key factor is time too late,Some disease is forty period."LouShuJun village doctor said.

　　如果村民作个较为全面的体检,新农合能报销么?爸爸给我算了一笔账:去年,新农合门诊报销封顶线仅是160元,一般的打针吃药,就会用完这个额度。如果再去医院体检,那基本上全靠自己掏钱。在县人民医院,作个较正规的体检,至少要二三百元。“村民挣钱不容易,家里两口人去体检一次的钱,能买一头山羊,谁舍得?”

If the villagers make a comprehensive physical examination,New farmers joint can submit an expense account yao?My dad gave me calculate a bill: last year,New farmers joint outpatient expense top line is only 160 yuan,General give or take an injection take medicine,Will run out of the line.If you go to a hospital medical,That basically all by their own pockets.In the county people's hospital,Make a more regular check-up,At least two or yuan."The villagers is not easy to earn money,Home two people go to medical a money,Can buy a goat,Who is willing to give up?"

　　医学研究资料表明,把1元钱花在预防上,可以节省8.59元药费,还能相应节省约100元的抢救费、误工损失、陪护费等。娄树军说,如果提高村民体检报销比例,引导村民定期健康体检,不仅可以做到防大病,还能从全县层面减少医疗资源耗费。

Medical research data show that,1 yuan money to prevent,Can save $8.59 medicine,Can also corresponding save about 100 yuan of salvage/Delays loss/Accompanying fee, etc.LouShuJun said,If the villagers to improve medical reimbursement ratio,Guide the healthy check-up regularly,Not only can do prevent a serious illness,Still can from the county level to reduce medical resources.

　　冬日的沂蒙山,风雪正浓。返城前,我对六爷爷说,抽空你也去县医院作个体检吧。六爷爷嗯了一声,说开春后再说吧。（记者 娄和军）

Winter yimeng,Blizzard is strong.Return before it,My grandpa said to six,Take time to you also to county hospital for a check-up it.Six grandpa well a sound,After the spring said to say again.(Reporter LouHeJun)