Overview of Xiangxi Tujia and Miao Autonomous Prefecture—Social Undertakings (Part 7)
Section 7 Medical and Health Care. Before the founding of the People's Republic of China, diseases such as malaria, leprosy, smallpox, and cholera spread through the Xiangxi region, leaving people of all ethnic groups in the suffering of poverty and illness. A folk rhyme from that time went: "When the rice in the fields turns yellow, malaria strikes and puts you in bed," and "The first to die has someone to carry the coffin; the later to die has no one to bury them," reflecting how people of all ethnic groups suffered deeply...
This article has been compiled from historical materials in the "Zhangjiajie Tour Guide Network" (33519.com · City Overview section). Some administrative divisions, population, socioeconomic data, and policy information may be outdated and are for reference only; for the latest situation, please refer to official releases by the local government and scenic areas.
Section 7 Medical and Health Care
Before the founding of the People's Republic of China, diseases such as malaria, leprosy, smallpox, and cholera spread throughout the Xiangxi region, and people of all ethnic groups lived in the misery of poverty and illness. At that time, folk rhymes circulated such as: "When the rice in the fields turns yellow, malaria strikes and puts you in bed," and "Those who die first have someone to carry them; those who die later have no one to bury them," reflecting the suffering of all ethnic groups from the ravages of disease.
After the founding of New China, the Party and the government showed great concern for the hardships of all ethnic groups, actively developed medical and health undertakings, and vigorously carried out epidemic prevention and health care work and mass patriotic health campaigns, achieving remarkable results.
I. Basic Situation
In 2005, Xiangxi Autonomous Prefecture had 3,038 medical and health institutions of various types, including 23 medical institutions at or above the county level, 9 disease control institutions, 9 maternal and child health care institutions, 9 health supervision institutions, 216 township health centers, 2,436 village health rooms, 235 individual clinics, 96 infirmaries and health stations, and 5 community service centers. There were 6,187 hospital beds in total, with 23 beds per thousand population. There were 7,009 health technical personnel in total, including 2,455 with assistant (technician) titles, 1,599 attending physicians, 141 associate chief physicians, and 13 chief physicians. The prefecture had 26 health technical personnel, 0.7 practicing physicians, and 0.7 nurses (assistants) per thousand population.
II. Rural Health Undertakings
In 1998, the CPC Xiangxi Autonomous Prefecture Committee and the Prefecture People's Government convened the highest-level and largest-scale prefecture-wide health work conference since the establishment of the prefecture, focusing on studying and arranging the strengthening of rural health work. At the end of the year, the Prefecture Party Committee, the Prefecture People's Government, and the Prefecture Health Bureau, in accordance with the new situation and prominent problems facing rural health work, deployed and launched rural health system reform, greatly stimulating the internal vitality of rural health work and achieving notable results. That year, all 8 counties and cities of the prefecture passed the review and acceptance of the provincial "Primary Health Care" leading group, reaching the lower-limit standards for primary health care work in impoverished areas, and rural primary health care work across the prefecture fully met the standards. From 1999 to 2005, Xiangxi Autonomous Prefecture invested a cumulative total of 167 million yuan in building the rural health service system, carrying out supporting building construction for 99 township health centers, 9 disease control centers, 8 infectious disease wards, 7 county people's hospitals, and 3 traditional Chinese medicine hospitals, completing a construction area of 198,000 square meters; equipping county, city, and township medical and health institutions with 4,293 units of "new six items" of medical and health equipment including X-ray machines, B-ultrasound machines, electrocardiographs, gastric lavage machines, semi-automatic biochemical analyzers, and ECG monitors; and training and cultivating 10,297 person-times of rural health technical personnel. Successively, 2 county-level disease prevention and health care institutions reached the construction standards issued by the ministry, 35 township health centers reached the "First-Class A" standard, and 79 township health centers reached the qualified standard.
III. Disease Prevention and Control
In 1953, the Xiangxi Miao Autonomous Region Disease Prevention and Treatment Station was established. In 1959, the Xiangxi Tujia and Miao Autonomous Prefecture Health and Epidemic Prevention Station was formally established, and in 2002 it was renamed the Prefecture Center for Disease Prevention and Control. Township-level disease prevention and health care stations were established in all townships to carry out disease prevention and control work.
Immunization Program. In the 1950s, Xiangxi Autonomous Prefecture provided free cowpox vaccination in both urban and rural areas. In the 1960s, seasonal vaccination against common childhood diseases was carried out with measles vaccine, Japanese encephalitis vaccine, and oral polio vaccine. From the 1970s to the early 1980s, cards were issued and certificates distributed for children under 7 years old, and routine immunization was implemented. In 1987, the prefecture equipped a planned immunization cold chain system, and scientifically administered the "four vaccines" — measles vaccine, BCG vaccine, DPT triple vaccine, and oral polio vaccine — according to immunization procedures. In 2002, hepatitis B vaccine was incorporated into planned immunization management. Between 1993 and 2005, 12 rounds of 24 cycles of large-scale "polio vaccine intensified immunization" or "polio vaccine missed-dose supplementary immunization" activities were organized across the prefecture, with a cumulative total of over 1.9 million doses of oral polio vaccine administered to children aged 0–47 months. Diseases targeted by planned immunization were effectively controlled, with no wild-type poliovirus cases for 4 consecutive years, no diphtheria cases reported for 12 consecutive years, and measles and DPT controlled below ministry-issued standards.
Control of infectious diseases. Smallpox and plague, Class A infectious diseases that seriously endangered people's health, have been eliminated. Due to persistent drinking water disinfection, strengthened food hygiene supervision, and disease surveillance, there were no cholera cases for seven consecutive years from 1999 to 2005. The incidence of epidemic cerebrospinal meningitis dropped from 150.25 per 100,000 in 1967 to 0.15 per 100,000 in 1998. Hemorrhagic fever and leptospirosis have been effectively controlled. The intestinal infectious diseases that troubled people, such as hepatitis, typhoid, and dysentery, have decreased significantly. The overall incidence of infectious diseases steadily declined from 14,660.1 per 100,000 in 1970 to 220 per 100,000 in 2005. In the spring of 2003, after SARS outbreaks occurred in some provinces and cities in China, the prefectural party committee and prefectural government adopted strong measures for mass prevention and mass control, allocated a special fund of 6.15 million yuan, and made every effort to block the invasion of SARS.
Prevention and Treatment of Leprosy and Parasitic Diseases. Leprosy screening and treatment began in the 1950s. By the end of 2005, a cumulative total of 4,159 leprosy cases had been discovered, with an average annual incidence of 2.22 per 10,000. The rates of standardized combined chemotherapy and regular treatment both reached 100%. Parasitic diseases were the most serious threat in Xiangxi Autonomous Prefecture, especially malaria. In 1971, the incidence rate was 547.72 per 10,000. In 1983, comprehensive measures were promoted in high-malaria areas, including preventive medication for the entire population, radical treatment of current cases, radical treatment during the dormant period, and spring anti-relapse treatment. From 1988 to 1990, the prefecture reached the standard of basically eliminating malaria in stages and batches. For filariasis, the population infection rate was 4.25% in 1958–1959. In 1976, comprehensive prevention and treatment measures of diethylcarbamazine mixed with table salt and medication for positive patients were implemented throughout the prefecture. From 1980 to 1985, county by county successively reached the standard of basically eliminating filariasis, and in 1996 the prefecture reached the standard of eliminating filariasis.
Control of Tuberculosis. In the first survey in 1960, the tuberculosis prevalence rate in the prefecture was 3.11%. Starting in 1975, BCG vaccination was administered to children under 15 years old, with a cumulative total of 1,862,764 person-times vaccinated by 1985. In 1984, the Prefecture Tuberculosis Prevention and Treatment Institute was established. Since 1992, the state has implemented a tuberculosis control project, using World Bank loans and matching local government funds to provide free treatment and management for tuberculosis patients, and tuberculosis has been effectively controlled.
Prevention and Treatment of Endemic Diseases. In 1983, the prefecture, counties, and cities all established leading groups for endemic disease prevention and treatment, carried out large-scale baseline surveys of iodine deficiency disorders, and determined that 144 townships across the prefecture were iodine deficiency disorder areas, with 102,800 patients and an average prevalence rate of 6.64%; there were 1,558 cases of cretinism. Comprehensive prevention and treatment measures focusing on the consumption of iodized salt were adopted, and the prevalence rate dropped markedly. By 2000, all 8 counties and cities of the prefecture had successively passed national acceptance, reaching the goal of basically eliminating iodine deficiency disorders.
IV. Health Supervision
In accordance with the Ministry of Health's "Opinions on the Reform of the Health Supervision System," Xiangxi Autonomous Prefecture began implementing health supervision system reform in 2002. In July 2002, the Prefecture Health Bureau established the Prefecture Health Supervision Institute, a fully funded public institution at the deputy division level, with personnel managed as civil servants. The reform of the health supervision system in counties and cities began in 2003 and was fully completed by the end of 2005. A total of 237 staffing positions for health supervision institutions were approved across the prefecture. In order to further improve the health supervision network and effectively strengthen rural township health supervision work, township health supervision offices were established in designated townships, with 410 township health supervisors and 2,436 rural health supervision information officers appointed. The salaries of township health supervisors were included in the full fiscal budget; village-level health supervision information officers received 1,000 yuan per person per year, shared by the prefecture and county/city levels of finance. From 2003 to 2005, the Prefecture Health Bureau held 8 training sessions for health supervisors, training 638 person-times, and for three consecutive years carried out prefecture-wide on-the-job legal study activities for health administrative law enforcement personnel, actively participating in the creation activities for top ten administrative law enforcement units and top ten law enforcement personnel organized by the Prefecture Party Committee and Prefecture People's Government. In 2004, the Prefecture Health Supervision Institute was rated by the office of the provincial leading group for governing the province according to law as a provincial demonstration window unit for handling affairs according to law. Continuous special rectification efforts were carried out in food hygiene, illegal medical practice, cosmetics hygiene, and combating the "two illegal practices," continuously improving the safety of the food consumption chain in Xiangxi Autonomous Prefecture, continuously standardizing the medical service market, and continuously raising the people's sense of safety in seeking medical care and consuming food.
V. Maternal and Child Health Care
Maternal and child health care work in Xiangxi Autonomous Prefecture adhered to the policy of "taking health care as the center and grassroots as the focus." First, it promoted the publicity, implementation, and law enforcement inspection of the "Maternal and Infant Health Care Law," gradually bringing maternal and infant health technical services across the prefecture onto a legal track. Second, it promoted the creation of baby-friendly hospitals and a baby-friendly prefecture. In January 1997, the Provincial Health Department evaluated Xiangxi Autonomous Prefecture's work in creating a "baby-friendly prefecture" and confirmed that it met the standard. Third, it promoted maternal and child health project construction. In 1996, the "1996-2000 Grassroots Health and Maternal and Child Health Project" assisted by the United Nations Children's Fund was implemented in Yongshun, Baojing, and Huayuan Counties. The maternal and child health centers of the three counties built or expanded more than 2,000 square meters of business space, added 73 pieces of medical equipment, and provided project training and clinical further study for grassroots maternal and child health personnel. In 1998, the World Bank loan Health IX Project was launched in Longshan County and Jishou City. In 2000, all eight counties and cities in the prefecture carried out project work to reduce maternal mortality and eliminate the incidence of neonatal tetanus, intensified public publicity, strengthened personnel professional training and business guidance, and vigorously carried out work to bring township health center obstetrics construction up to standard. By 2005, 81 township health centers across the prefecture had met the standard in obstetrics construction, more than 90% of township health centers had resumed inpatient delivery services, the prefecture's hospital delivery rate rose from 41.52% in 1999 to 79.28% in 2005, maternal mortality dropped from 95.72 per 100,000 in 1999 to 58.26 per 100,000 in 2005, and the incidence of neonatal tetanus fell from 1.1‰ in 1999 to 0.2‰ in 2005.
VI. Medical Administration
Hospitals at all levels across the prefecture took graded management and upgrading to standards as an opportunity, and their pace of development accelerated. On the basis of meeting the "Grade II Class A" standard, the Prefecture People's Hospital further expanded its extension, newly acquired more than 300 mu of land in the Qianzhou New Area, and planned to build a completely new Grade III general hospital. In 2005, the Prefecture People's Hospital had a building area of 57,200 square meters, 21 clinical departments, and 18 medical technology departments. It invested 33.8 million yuan to purchase more than 400 units/sets of equipment, including a 1250mA large C-arm angiography machine, a Siemens large spiral CT, an open magnetic resonance imaging scanner, a medical electron linear accelerator, and a head gamma knife, and carried out a number of highly difficult surgeries such as severed limb (wrist) replantation, giant acoustic neuroma resection, brainstem tumor resection, and mitral and aortic valve replacement. In 1997, upon review by the Provincial Health Department, the hospital was rated as a Grade III Class B hospital. People's hospitals in all counties and cities strengthened the construction of emergency rooms and supply rooms to meet standards, increased technology introduction and development, and improved overall technical strength. In 1997 and 1998, upon prefecture review and provincial spot checks, the People's Hospitals of Jishou City and Baojing, Huayuan, and Yongshun Counties were successively rated as Grade II Class A hospitals. Medical quality and medical safety management were vigorously strengthened. Medical units at all levels signed medical quality and medical safety responsibility statements level by level according to administrative subordination, and formulated and improved accountability systems. The Prefecture Health Bureau persisted in carrying out no fewer than two medical quality and medical safety inspection activities each year. It organized and carried out hospital management year activities centered on patients and with improving medical quality as the core. Hospitals at and above the county level generally publicly announced service commitments and carried out professional conduct evaluations, further improving social supervision and self-supervision and promoting professional conduct development. The "Blood Donation Law" was conscientiously implemented, and voluntary blood donation activities by citizens were organized. From 1988 to 2005, 31,755 person-times participated in voluntary blood donation across the prefecture, with voluntary blood donation volume reaching 8,989,250 milliliters. A 1,475-square-meter business building for the Prefecture Central Blood Station was built, improving blood collection and supply conditions. Blood quality was effectively guaranteed, meeting the needs of clinical blood use. Regular and surprise medical administration law enforcement inspection activities were organized, illegal medical practice was banned, nonstandard medical practice behavior was corrected in a timely manner, and medical market management was gradually standardized. Unified qualification examinations for licensed physicians were organized. From 1999 to early 2006, more than 7,500 person-times applied for the examination across the prefecture, and 7,300 people obtained licensed physician or licensed assistant physician qualifications.
VII. Medical Science and Education
Adhering to the guiding ideology that "science and technology are the primary productive forces," talent training and scientific and technological development were placed in a very important position. The Prefecture Health Bureau, the Prefecture People's Hospital, Huayuan County People's Hospital, and Yongshun County People's Hospital added science and education sections, gradually forming a work situation with "leadership in charge, target tasks, funding input, and supervision and guidance." Across the prefecture, 20 provincial-level academic leaders, 50 prefecture-level academic leaders, and 100 reserve talents were identified, implementing the "251" talent training project. All medical and health units set up talent training funds and, according to business development needs, carried out on-the-job training and full-time further study for personnel. From 1996 to 2005, all levels across the prefecture held a total of 507 short-term professional training classes of various types, training 19,965 person-times. The broad ranks of medical and health technical personnel consciously updated their knowledge to meet the needs of medical science and technology and health development. Seventy percent of medical, pharmaceutical, nursing, and technical personnel made full use of medical education networks approved and recognized by the Ministry of Health and the State Administration of Traditional Chinese Medicine, such as Satellite Health Science and Technology, Haoyisheng, and the 21st Century Traditional Chinese Medicine Online Education Center, to study new theories, new knowledge, new technologies, and new methods, laying a solid foundation for responding to public health emergencies. Medical and pharmaceutical society organizations at all levels were established and improved, and society activities were carried out regularly, diversely, and at a high level, promoting the improvement of medical and pharmaceutical academic standards across the prefecture. The structure of medical education was adjusted, and Jishou Health School merged with Jishou University, officially hanging the "Jishou University School of Medicine" sign in September 2000.
By 2005, the medical and health front across the prefecture had declared and established 59 research projects, including 19 provincial-level projects and 40 prefecture-level projects; it won 8 provincial and ministerial science and technology progress awards and 32 prefecture science and technology progress awards.
VIII. Patriotic Health and Health Education
The State Council's "Decision on Strengthening Patriotic Health Work," the "Hunan Province Patriotic Health Regulations," and the "Interim Measures for Patriotic Health Management of Xiangxi Autonomous Prefecture" were conscientiously implemented, striving to achieve the work goals of improving the quality of living environment for urban and rural residents, controlling and reducing harmful factors, and lowering disease incidence. First, patriotic health creation work was promoted. A total of 2 provincial-level hygienic county towns, 1 civilized and hygienic town, 220 civilized and hygienic units, and 37 advanced tobacco control units were created. Jishou, Longshan, Luxi, and Fenghuang counties and cities passed inspection and acceptance by the provincial and prefecture patriotic health committees and met the standard of "advanced rodent elimination county (city)," while Jishou City met the standards of "advanced cockroach elimination city" and "advanced mosquito elimination city." Second, starting in 1998, for seven consecutive years, the whole society was organized and mobilized to carry out major health and epidemic prevention actions, achieving the four implementations of leadership teams, activity funding, technical personnel, and work responsibilities, controlling and reducing the spread of infectious disease outbreaks. Third, health education work was promoted. The "900 Million Farmers Health Education Action" was launched. In August 1997, the Hunan Province "900 Million Farmers Health Education Action" on-site work meeting was held in Luxi County, with Chengduoshan Village in Wuxi Town of that county serving as the on-site pilot for the "action." Baojing County was designated as an "action" project county in 1998 and held teacher training classes on "Life Knowledge" and "Interpersonal Communication Skills," training 796 people. Another 10 community health education pilot sites were held across the prefecture. In 2005, in Jishou, Yongshun, Fenghuang, and Huayuan counties and cities, the "National Hundreds of Millions of Farmers Health Promotion Action - Health Face to Face · Rural Journey Activity" was carried out, going deep into rural areas to carry out health education and health services and using various publicity forms to vigorously popularize health knowledge. Fourth, rural water improvement and latrine improvement were carried out well. A total of 57.89 million yuan was invested in water improvement, and 4,990 water improvement projects of various types were built, with 78.87% of the rural population across the prefecture drinking clean and hygienic water. During the "Tenth Five-Year Plan" period, a total of 32.31 million yuan was invested in latrine improvement, 125,800 hygienic latrines were built, the rural hygienic latrine popularization rate reached 25.39%, and the harmless treatment rate of excrement reached 10.27%.
IX. New Rural Cooperative Medical Care
In 2003, Huayuan County was included in Hunan Province's first batch of pilot counties for the new rural cooperative medical care system and officially launched operation on August 1. More than 170,000 farmers in the county participated in the system, with a participation rate of 74.01%. A total of 5.1 million yuan was raised. In the county, 25,681 people received cooperative medical care compensation, with total compensation of 3.456 million yuan. In 2005, more than 180,000 people in the county participated, with a participation rate of 78.25%. That year, 23,552 people in the county received cooperative medical care compensation, with total compensation of 5.373 million yuan. In the second half of 2005, Baojing County and Jishou City were also included in Hunan Province's 2006 pilot counties and cities for the new rural cooperative medical care system. After extensive publicity and mobilization, more than 160,000 farmers in Baojing County and nearly 120,000 farmers in Jishou City participated in cooperative medical care, accounting for 67% and 77.6% of the total agricultural population respectively. On January 1, 2006, rural cooperative medical care in the two counties and cities officially launched operation.