Action of poverty alleviation doctors： from common diseases to rare diseases, ＂no one can be less＂

　　editorial comment/noteHe walked into wumeng mountain from Beijing Grand Hospital, the capital. Together with his colleagues and local doctors, he did his part to improve the local medical service ability and relieve patients’ pain, so that a single spark could start a prairie fire. Strive for a new era, and take responsibility for poverty alleviation. CCTV focused on the front line of health poverty alleviation, followed Yin Jian, a neurologist at Beijing Hospital, to Dafang County, Bijie City, Guizhou Province, and told the story of "poverty alleviation" in the depths of the mountains.

　　Dr. Yin Jian (second from the left in the back row) is making rounds in the ward.

　　Cctv newsDafang County, Guizhou Province is located in wumeng mountain, southwest China, at an altitude of 1,600 meters. Here, mountains are connected with mountains and water is connected with water, which is magnificent and is the hinterland of Yunnan-Guizhou Plateau. It’s cold in winter, and you can’t see the sun for more than 20 days. It’s rainy and wet, and the ground is muddy. This is somewhat unsuitable for a northerner born and raised like Yin Jian. At the end of 2018, as the backbone of the neurology department of Beijing Hospital, Dr. Yin Jian was sent to Dafang County People’s Hospital of Guizhou Province as the temporary vice president for half a year by the the State Council Poverty Alleviation Office to carry out professional and technical precision poverty alleviation work. He admitted that his initial concept of Dafang County and even Guizhou was very vague. When he set foot on that land, he was deeply attracted by the beautiful local scenery. Xi Huan, Dean of National Geriatrics Center; Chen Tong and Pan Qi, deputy directors of the Medical Department of Beijing Hospital, attached great importance to the national poverty alleviation program. Before leaving, they specially instructed Beijing Hospital to be the national geriatric center and the core hospital of the national difficult disease diagnosis and treatment capacity improvement project, and fully supported the generous poverty alleviation project.

　　Although Dafang County is a national poverty-stricken county, it has a rich history and culture. It is located at the junction of Han nationality, Miao nationality and Yi nationality, with 33.2% ethnic minorities. The population is scattered and the degree of urbanization is low. However, due to its high fertility rate, the population reaches one million, and most of them are young people, this small town is full of vitality.

　　Dafang County is located in a remote area with poor infrastructure and conditions, and the expressway to Guiyang, the provincial capital, was completed in 2016. Only two slow trains reach the provincial capital every day. The local people have limited health knowledge and insufficient health awareness. It is very common that minor illness depends on forbearance, serious illness depends on fate, and chronic illness depends on remedies and inertia, relying on the help of the government and superiors. These problems are really in front of Yin Jian, and they have also become the driving force behind his work.

　　Advancing by groping, promoting the construction of stroke center in local hospital

　　Yin Jian learned from Dafang County Health and Health Commission that the county is a high-fluorine area and a high-prevalence area of tuberculosis. The diet is high in salt, alcoholism and smoking are common. The typical disease spectrum of developing countries in transition is high in metabolic syndrome, hypertension, coronary heart disease and stroke, and the incidence of malignant tumors is rising. At the same time, the high incidence of infectious diseases represented by tuberculosis in this area is still a social problem that needs great attention.

　　However, the training of local health personnel is seriously inadequate. In 2018, there were only 51 lectures and trainings by experts outside the county; 174 person-times of advanced medical care. After many visits and repeated communication with local medical staff, Yin Jian found that stroke is a frequently-occurring disease in the local area. If Dafang County Hospital joins the construction of "Brain Prevention Committee-Stroke Center" promoted by Guizhou Provincial Health and Wellness Committee, it will greatly promote the prevention and control of stroke. Yin Jian immediately communicated this idea with Wu Guangming, Dean of Dafang County People’s Hospital, and Comrade Li Jian, head of Dafang County Health and Wellness Committee, and everyone hit it off. And actively contact with director Liu Zhen, who was sent by Beijing Hospital to the People’s Hospital of Guizhou Province, vice president Chu Lan of the Affiliated Hospital of Guizhou Medical University, director Xu Ping and director Xu Zucai of the Affiliated Hospital of Zunyi Medical University, and director Luo Yong of the Department of Neurology of Zunyi First People’s Hospital; Professor Kuang Shixiang from the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine sought professional and organizational training in Stroke Center.

　　In order to ensure the solid landing of the stroke center, with the approval of the hospital, Yin Jian overcame difficulties and extended counterpart assistance for three months. Hard work pays off. In May, 2019, Dafang County People’s Stroke Center was approved by the National Health and Wellness Commission and became the first batch of county-level "Demonstration Stroke Prevention Centers" in Guizhou. It was officially awarded in the National Convention Center, and the county government departments coordinated the municipal departments to make city guide signs.

　　Yin Jian talked about the completion of the stroke center, which was both exciting and gratifying. He said: "This is the result of the precise help of the leaders of Beijing Hospital and the strong support of many related personnel." He hopes that the stroke center can benefit the people on this side, and it can be regarded as doing his bit.

　　Realizing the Breakthrough from 0 to 1 for Difficult and Rare Diseases with Professional Skills

　　As a neurologist engaged in the research and clinical treatment of difficult and rare diseases, Dr. Yin Jian wanted to use his medical knowledge to do something practical for the local people. Before leaving, he specially consulted many senior experts in the hospital, and everyone said that he would open all the resources of Beijing Hospital to complete the task of counterpart assistance. On the occasion of leaving Beijing, Yin Jian decided to take this as another important starting point for this professional poverty alleviation.

　　After several rounds of rounds in the hospital, Yin Jian found that the patients in Dafang County’s local neurology department were mainly cerebrovascular diseases, but there were many problems of unclear diagnosis of difficult and rare diseases. Difficult and rare diseases in the nervous system were one of Yin Jian’s main areas of attack. He wanted to give play to his expertise in this respect, so he pioneered the joint provincial hospitals (Affiliated Hospital of Guizhou Medical University, People’s Hospital of Guizhou Province, Affiliated Hospital of Zunyi Medical University initiated and founded the "Consultation Center for Difficult Diseases in the Department of Neurology of Guizhou Province", which created a fixed learning and communication platform for neurologists in Dafang County Hospital. Doctors from Dafang County People’s Hospital participated and studied for free as grassroots units. This is the first batch of only county-level hospitals in Guizhou Province to participate in the consultation center.

　　There are many poor patients in Guizhou. Yin Jian also took advantage of the domestic first-class experimental diagnosis platform for neuroimmune diseases built by Professor Xu Xianhao and Professor Zhang Hua in the Department of Neurology of Beijing Hospital, and took the initiative to take out his own research funds to test biological samples for local patients in Guizhou free of charge. He said: "During my six months of poverty alleviation in Guizhou, wang hong, a technician in the laboratory, has tested hundreds of serum and cerebrospinal fluid of patients in Guizhou, and at least dozens of myasthenia gravis patients have been screened and diagnosed (three of them are even rarer, accounting for only about 4% of all myasthenia gravis patients with Musk antibody positive, all of which are long-term undiagnosed patients with the longest course of 12 years) and four cases are NMOSD (neuromyelitis pedigree disease).

　　On the platform of consultation center, under the remote guidance of six doctors, including Director Chen Haibo, Deputy Director Gong Tao and Director Li Shuhua, from the Department of Neurology of Beijing Hospital, one case of very rare intranuclear inclusion body disease (NIID) and one case of CLIPPERS (chronic lymphocytic inflammation with pons-cerebellar peripheral enhancement syndrome) were diagnosed, which were unanimously praised by local patients and colleagues.

　　Four unusual cases

　　Speaking of difficult and rare cases of nervous system, Yin Jian mentioned an 84-year-old man who was diagnosed with neuromyelitis optica spectrum disease. At first, the old man went to the ophthalmology department because he couldn’t see one eye. The doctor suspected that it was neuromyelitis optica spectrum disease. Later, the ophthalmologist recommended him to go to the neurology department for further examination. However, due to the extremely low incidence of this disease, only about 10/100,000, the local hospital dared not make a diagnosis. The deputy director of the congratulatory message of Guizhou Medical University mentioned this case in the consultation center for difficult diseases. After discussion and exchange, it was decided to send the sample to Beijing Hospital for testing. Finally, the specific AQP4 antibody was captured by CBA immunofluorescence technique in Beijing Hospital, and it was diagnosed as NMOSD (neuromyelitis pedigree disease). Due to the timely diagnosis, the old man’s eyes have now recovered. This is the elderly patient with the highest onset reported in domestic literature.

　　There is also a local grandmother in Dafang County, who is nearly seventy years old. Her tongue has shrunk and she has been transferred to many hospitals in the province. She has been diagnosed with amyotrophic lateral sclerosis (ASL), and her family and I have basically given up treatment, so she can’t eat and swallow, comb her hair and brush her teeth. However, after carefully observing her EMG, Yin Jian found that it did not meet the EMG characteristics of patients with gradual freezing. Her serum was sent to the neuroimmunology laboratory of Beijing Hospital, and the antibody against multiple gangliosides was found to be positive by using the latest BOLT immunoassay in China. Later, it was diagnosed as a rare Lewis summer syndrome. Follow-up treatment is not very smooth. Yin Jian said that because the local people’s health awareness is not strong, once they encounter rare and difficult diseases, especially when they are old, they often choose to give up treatment. The old lady did not cooperate with lumbar puncture at first, and with the persuasion and efforts of doctors, the old lady accepted the examination and completed the diagnosis. After immunotherapy, I have recovered very well now, and I can wash my face, brush my teeth and eat independently.

　　During Yin Jian’s stay in Guizhou, a patient with severe subarachnoid hemorrhage was transferred to the Affiliated Hospital of Guizhou Medical University. However, the location of the aneurysm is special, and the blood supply of the parent artery is complicated, so the symptoms of the patients who failed the first operation in the local hospital continue to deteriorate. Yin Jian urgently asked Wang Lijun, chief physician of neurosurgery department of Peking Hospital, the National Geriatrics Center, to consult, and flew to Guizhou at the request of the local hospital. In Guizhou, the world’s thinnest floating guide wire was used for the first time to successfully embolize this complicated posterior circulation aneurysm, which successfully saved the patient’s life. It shows the strength of endovascular treatment of neurosurgery in Beijing Hospital.

　　There are many local families who are poor because of illness. During the period of helping in Guizhou, a local helping cadre found Yin Jian, saying that the child of the family he helped was only four years old this year, with drooping eyelids and fixed eyeballs. Previously, the provincial hospital diagnosed myasthenia gravis and said that the symptoms were more serious. Because the family was poor and could not afford the follow-up treatment, the boy’s father decided to give up and let it develop, but the child’s mother insisted on treatment. The local conditions are limited, so it is impossible to do electromyography examination. Yin Jian wants to give the child a set of standard formal tests first, and bring the child’s serum samples back to Beijing Hospital during the Spring Festival, so that Mr. wang hong can use the latest international double antigen immune competition inhibition enzyme-labeled immunoassay for further detection of acetylcholine receptor antibodies and Musk antibodies, and finally it is diagnosed as ocular myasthenia gravis. However, during the test, it was found that the antibody titer in the little boy’s body was not too high, and it was not too serious to be cured. Generally, it would not affect the child’s learning and life expectancy. The child’s mother was very happy after hearing the news. As a parent, Yin Jian understands this kind of mood very well, and has also formed "WeChat friends" with the mother and son, so that they can come to Beijing for follow-up regularly and make a systematic examination and long-term follow-up plan for their children.

　　Yin Jian recalled the days when he helped in Dafang County and said, "I didn’t do anything special, but in my opinion, I did something with goals: one was to promote the construction of Dafang County Stroke Center; The other is the breakthrough in the realization of local difficult and rare diseases from thinking about trying to diagnosis. I have also become friends with some patients and local doctors and formed a pair. They will come to me if they need help, and I will do my best. "

　　Although I haven’t been in Dafang County, Guizhou Province for a long time, I read deep feelings from Yin Jian’s words in the interview. "Our generosity is really beautiful, and we are located in a foggy area. Driving on the road has a feeling of" walking on clouds ".It is like a fairyland. If there is an opportunity, we must go and have a look! Here you can see the magnificence of China’s mountains and rivers and the determination and efforts of the party and the country to declare war on poverty. You will feel the greatness of China and the hope of China! "