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An old Chinese saying goes: "Keep an army for 1,000 days to use it for an hour."
However, the ongoing battle against SARS (severe acute respiratory syndrome) has only a small "regular army" for treating infectious diseases. As a result, many medical workers from other departments have marched to the front. While their heroism has won admiration from the public, both medical workers and the community are rethinking their ideas on infectious respiratory diseases.
Dangers of Complacency
Many Chinese do not consider infectious respiratory diseases, such as colds and flu, serious.
It's common for them to continue their daily work when they run a fever. Instead of being told to stay at home, they often win praise from their colleagues and their bosses.
Only the elderly, in their 70s and above, are afraid of a cold or flu in case it develops into pneumonia.
"For the Chinese, the flu is not considered deadly, so they are not afraid of it," said Doctor Zhou Ping'an, director of the departments of internal medicine and respiratory diseases at Dongfang Hospital, attached to the Capital University of Chinese Medicine in Beijing.
The Chinese medical profession has not taken infectious respiratory diseases seriously either.
"In the past two decades, common infectious diseases have almost disappeared in China, thanks to vaccinations and natural immunity in the population," said Zhou. "Doctors in the infectious diseases department seldom have patients."
Urban people believe hepatitis is their main communicable disease threat.
According to Zhou, questions were raised about whether Beijing needed several hospitals specializing in infectious diseases. The specialist hospitals include You'an and Ditan hospitals, caring mainly for hepatitis patients, the 309 army hospital, the Beijing Chest Hospital northwest of the Summer Palace, and the Tuberculosis Research Institute in Tongzhou District.
The same question was asked of doctors working in respiratory departments, which also have few patients. Previously, the doctors mainly dealt with colds, accounting for most cases, plus flu, cough, tracheitis and asthma, Zhou noted.
But despite the flu epidemics in Europe and the Americas in 2000, which infected millions and filled hospitals there, China has remained relatively free of the flu in the past three years.
The common cold, or even the flu, rarely causes alarm among the public or medical workers, even when several students or co-workers sneeze or cough in classes or the workplace.
Meng Yu, a consultant working in a Beijing-based educational centre, said she viewed the flu as a minor ailment before the SARS epidemic.
She recalled that she had a high fever once that failed to respond to medication. "I believed that I could fight it by myself," she said. "I told myself that it was nothing but a cold, not something serious."
From the government down to medical workers, few were alert to the potential threat of infectious respiratory diseases.
Surprise Attack
The onslaught of SARS caught the Chinese medical world unprepared.
"Early on, medical workers simply didn't have a good understanding of infection control, like wearing masks and protective garments," said Zhou. "As a result, a great many were infected."
With more medical workers contracting SARS, an invisible fear spread, panicking some staff and affecting their immune systems, making them more vulnerable to infection.
Ignorance about infectious respiratory diseases also led to misinformation. Some medical workers later argued that SARS spread across the country partly because of communication problems within the health system.
The SARS epidemic started as early as November in South China's Guangdong Province.
"Why did doctors in Beijing not draw lessons from their Guangdong counterparts at the beginning?" asked Cai Boqiang, director of the department of respiratory diseases at Peking Union Medical College Hospital.
Cai attributed the initial carelessness of medical workers in Beijing to two pieces of misleading information.
At the very beginning, the mysterious contagious disease was named feidian (atypical pneumonia) by Guangdong doctors.
Medically speaking, this term is inaccurate as atypical pneumonia consists of a wide range of well-known diseases, like chlamydia pneumonia, mycoplasma pneumonia and viral pneumonia.
Many clinic doctors didn't believe that atypical pneumonia could be that serious and therefore were slow to respond, Cai said.
The World Health Organization described the illness as severe acute respiratory syndrome, which is more accurate.
At that time, "we all believed that it was some kind of chlamydia pneumonia, for we never had contacted with SARS patients," recalled Cai. "However, later, the epidemic there turned serious. So we then decided it could not be chlamydia infection based on their analysis as well as the judgement of our own chlamydia experts."
Later, when the experts from the China Centres for Disease Control and Prevention announced they had located the chlamydia-like agent believed to be the primary culprit behind SARS, Cai and his colleagues expressed their doubts.
"It is not just an academic issue, but one that affects protection measures and clinical treatment," explained Cai.
In mid-March, Cai and his counterparts learnt first-hand how dangerous the infection could be. His hospital was one of the first in Beijing to receive SARS patients.
"We were the first to wear masks at work," Cai said. "I took part in the diagnosis of the first SARS patient in our hospital. At that time, I was armed to teeth, for I had no direct knowledge of the disease."
The relatively good protection measures adopted by Peking Union Medical College Hospital at the beginning of the SARS outbreak led to far fewer infections among medical workers there.
Forgotten Plague
"Respiratory diseases are among the biggest enemies of human health, and the prevalence of SARS further illustrates that," said Cai.
Respiratory diseases -- such as pneumonia, chronic obstructive disease of the lung, pulmonary tuberculosis, and lung cancer -- are the main killers in China's countryside and the third biggest cause of death in the cities, noted Cai.
However, in the past few years, respiratory diseases have not got the attention they deserve from both the Ministry of Health and Peking Union Medical College Hospital, according to Cai.
His department did not have enough staff or medical equipment such as respirators -- shortages that were aggravated by the SARS epidemic.
"The key is money," noted Cai.
Hospital authorities focused instead on cardiovascular diseases -- from which they make far more money than respiratory diseases.
"We are the poor, even in the department of internal medicine," said Cai. "Even the tables and chairs in our offices are old and shabby."
According to Cai, nearly all the departments of internal medicine in his hospital are designated as key medical research projects. But the departments of respiratory diseases and infectious diseases have missed out.
Consequently, new graduates from medical college all seek work in the "important" departments, resulting in the long run in "respiratory failure," Cai said.
Health Care System Inadequate
Hospitals are not the only institutions to blame for their pursuit for profit, Cai said.
In the past few years, the reform of the medical and health care system has highlighted the concept of "cost accounting."
This concept should be reviewed, as the SARS crisis showed that the health care network should first of all serve the people, instead of running like a company for profits, Cai argued.
In fact, the epidemic crisis has sounded alarm bells about past health care system reform.
"Infectious diseases can affect human beings at any time, and it is necessary to take preventative measures and set up respiratory infectious disease department properly in comprehensive hospitals," suggested Zhou Ping'an.
The public has also rethought its attitudes about colds or flu-like respiratory diseases, especially in SARS-affected areas. Many people went from early panic over the virus to coming to terms with the disease and have begun to adopt a different view of respiratory complaints.
"I never thought that pneumonia was difficult to treat, so I will pay more attention to my personal hygiene," said Zhang Yin, a senior from Guangdong University of Foreign Studies. She said she would consult a doctor first if she develops SARS-like symptoms in the future.
SARS has also changed Meng Yu's attitude about flu.
Now each time Meng recalls her former "brave" behaviour, she feels a little scared.
"If that happened again, I would definitely go to see the doctor," she said. "Through the SARS epidemic, I've learned to take better care of myself."
(China Daily May 29, 2003)
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