Public Health To The Countryside

In order to improve the health quality of urban and rural residents,cultivate their own health management awareness,prevent and control the infectious diseases and chronic diseases,the state began to launch basic public health service projects in 2009,relying on urban and rural primary medical and health institutions.Public health services for hypertension and type 2 diabetes are being rolled out across the country through the health management of chronic patients.However,the initial implementation of the project in Le village not only resulted in a sense of imbalance of village doctors between medical services and public health,but also resulted in the lack of understanding and cooperation of villagers because they value treatment over prevention.After the repeated efforts of the grass-roots medical staffs represented by village doctors,the prevention-oriented health management was gradually accepted by villagers.Based on the village doctor’s complaints and the villagers’ misunderstanding,this paper focuses on the institutional arrangement of public health in the countryside,attempts to carry out ethnographic research on the implementation of the health management project for chronic disease patients in Le village,Western Yunnan,from three aspects:implementation contents,implementation objects and implementers,and reflects on the practice process of public health project’s inadaptability in local society at last.The field study shows that:At the beginning of the projects,it values quantity over quality and causes the huge efforts that village doctors pays in archives rectification process.It not only affects the effective delivery of chronic disease management,but also directly reflects the undesirability of the deviant approach,that is,the system clarifies and simplifies the objectives of chronic disease prevention and treatment into meeting the targets.While actively adjusting themselves to balance the dilemma between individual medical services and public health responsibilities,village doctors have also internalized the meaning of public health in terms of concept and behavior.Villagers show a misunderstanding of the public health project,behind it is the collision of two sets of ideas,one is the traditional medical concept of "centering on healing,emphasizing treatment rather than prevention,and not seeking doctors if there is no disease",the other is the health management concept of "focusing on prevention,prevention before disease onset".Based on the ambiguity and uncertainty of villagers’ understanding of chronic diseases,the medication compliance of patientswith chronic diseases under management is not only a problem of individual’s cultural quality and temperament,but also influences by factors such as disease characteristics,economic burden,family neglect,self-judgment and physical experience,the pragmatic logic of mobilizing modern medical knowledge and local knowledge is demonstrated in the aspect of disease response in the end.As the implementer of the public health program,under the identity of "non-doctor",the public health officer is faced with the lack of initial trust,inadequate management capability and the ache of livelihood,this implies that medical treatment and public health should be combined.Through the investigation of the doctor-patient interaction in the management of chronic diseases,this paper is more convinced that the village doctors of the local acquaintance society is undoubtedly an excellent agent for the public health in the countryside.As a public health intervention projects,the story of the health management of chronic patients in Le village inspires us,the concepts and habits of the people to be implemented should be acquired and understood before it goes to the countryside,a more tolerant and open attitude is still needed for us to face the self-cognition and coping behaviors of patients when they confront the difficulty of chronic diseases,and practice with targeted health interventions,at the same time,the realistic circumstance of the village doctors and the public health officer should be changed and preferential treatment.