Sitting in the doctor's office with her left hand connected to a long transparent plastic tube linked to the drip bag hanging on a pole beside her, Zhao, 58, was happy to be receiving quick service. She was undergoing a treatment for her eye infection.

The small room is part of the Baimi Community Medical Center, a clinic located right across from her apartment building near the northern Second Ring Road in Beijing.

"I prefer it here to the large hospitals. It is so convenient and offers a good service, and the price is fair," Zhao said.

She had gone to two of the city's larger hospital for her eye problem, but she was disappointed with what she saw.

"I hate to see the doctors' cold faces there and I was exhausted from the long queue at the outpatient department," she said.

"It is especially tiring for us, the elderly, when doctors shuffle us between different departments on different floors," she said.

That's why Zhao and some of her neighbors have opted for the small clinic, which is a subsidiary of the Changqiao Medical Center located in the Dongcheng District.

General care, including laboratory tests and disease diagnosis are offered at the clinic. "Here I don't have to run between different departments," said Zhao.

Dr Song Lizhen, a general practioner in her 30s, and her colleagues from the Baimi clinic have undergone rigorous examinations and are up to date on a wide range of medical subjects, including internal medicine, surgery and psychiatry. They spend their morning seeing outpatients who mostly come from the neighborhood.

Changing approach

The introduction of community medical centers, such as the one in Baimi, signals a change in medical care, from passively sitting back waiting for patients to visit to actively stepping into the communities to provide service. Approach to individual treatment has also changed. In the past, Song and her colleagues were only required to tell patients to take their medicine on schedule. Today, health education is becoming increasingly important as physicians encourage their patients to learn how to prevent illness.

Patients visiting these community clinics are mostly elderly people with typical chronic old-age illnesses, such as hypertension, diabetes, coronary heart disease, and respiratory tract diseases.

"In the past, the doctors were only focusing their attention on the disease treatment, but now we try to make the patients feel we are their friends and really care about them so they will open their heart to us," said Dr Li Zhijing, head of the Gulou community medical clinic, a few kilometers away from the Baimi center.

Doctor Li's office has become a place where nearby residents feel welcome to visit frequently. They share with Li their physical and mental problems and even troubles they encounter in their daily life.

Besides seeing patients at the office like their colleagues in regular hospitals do, physicians at community medical clinics also provide on-site services in the community every Tuesday and Thursday.

The physicians have built ties with community committees, which take care of the needs of residents in the communities, to see if residents need services that can be easily provided outside the clinic, such as blood pressure measurement. The committees usually set up a time and place for the special clinic. These on-site clinics help doctors keep up with the residents' ongoing medical conditions, which helps them provide more informed care.

Home visits are also provided for those who have mobility problems. "When they feel ill, they can just give us a phone call," said Dr Song.

Popularity

The popularity of community medical clinics has not been won easily.

At first, they tried to create health records for all the residents in the communities they are servicing. However, they later found their efforts seemed too ambitious without support from the residents.

So as of last year, doctors started focusing their efforts on the management of outpatients and looking after residents with chronic diseases.

Patients who frequently pay visits to the medical centres fall into the "intensive management" category and are required to visit the doctors at least once in a month to ensure quality health- care.

"Some of them come here for prescriptions only, but we can measure their blood pressure and hold a health consultation," explained Dr Li.

Every doctor is required to consult their patients' medical records every month to ensure the patient has had a check-up.

This follow-up and care at different locations in the community has helped local clinics provide better care. "It is mutually beneficial. On one hand, we have served our community and on the other hand, we have made more residents get to know us and those who have been treated at outside clinics and diagnosed with a disease are likely to become our patients," said Dr Song.

Short of hands

Providing good health service to the community is a huge project. "Our current small staff is still incapable of managing all the residents," said Dr Li.

According to Ministry of Health requirements, there should be one medical worker for every 2,000 residents, but most of the medical centers are short of hands if they were to comply with these guidelines.

In the Baimi community, four doctors serve about 17,000 residents.

One important mission for the community clinics is disease prevention and health protection.

However, in their daily work the limited staff have their hands tied with treating incoming patients.

In order to save time contacting residents, the stations have developed good co-operative relations with the community committees, which have undertaken the co-ordination work.

The doctors are invited at an arranged time and place to give lectures on a special subject, such as first aid and chronic diseases.

Despite the bright development prospects for community medical centers, some problems with current healthcare policies have hampered their advantages.

Many doctors and patients expressed their dissatisfaction that the community medical centers are only allowed to prescribe a limited number of drugs.

Some drugs, which are effective in treating common diseases, such as hypertension, diabetes and vascular diseases, can only be prescribed by doctors at the large hospitals.

Hou Chunyu, 73, a retired worker, was receiving intravenous treatments for coronary heart disease. He said he had had to go a long way to the Peking University First Hospital to get the prescription. "Actually, I did not receive any special treatment there," Hou complained.

"The drugs I am using are the common ones. Why can only the large hospitals prescribe them? I don't understand," said Zhao, who shared the same experience with Hou.

Community doctors hope that their community health medical centers will be granted with more power.

"The patients will benefit from that," said Song.

(China Daily December 18, 2003)