100天走遍“老人岛”，打通最后一公里的隔阂 | Health Guardian

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In 2005, Gulangyu, an island under the administration of Xiamen, was introduced to tourists as the most beautiful town in China. It gradually became one of the country's most popular resorts.

自2005年起，厦门市辖内的海岛鼓浪屿就被称为中国最美城区，向游客开放。这座小岛逐渐成为热门的度假之地。

After years of development, the island is packed with shops, hotels, pubs and cafes. Young people feel the warmth of the breeze and waves while enjoying the convenience of a modern tourist industry. The voices of local people are, however, overwhelmed by those of the visitors.

经过多年发展，这里的商铺、旅馆和酒吧咖啡店林立。年轻人们一边享受现代旅游业带来的便利，一边感受着和煦海风和温暖浪花的触感。在风景区鼎沸的人声之中，本地住民的生活似乎很少被提及。

On this island of 1.78 square kilometers, "there are about 4,000 households, which means more than 13,000 permanent residents," says Yang Caihong, a doctor in the Gulangyu Branch of The First Affiliated Hospital of Xiamen University. More than 30 percent of the permanent residents are over 60 years old, including some centenarians. 

在这座面积约为1.78平方千米的小岛上，“大概有四千多户居民，常住人口有一万三千多，”杨彩虹说。她是厦门大学附属第一医院鼓浪屿医院的一名医务工作者。她口中的一万三千人，60岁以上的人口超过三成，其中不乏百岁寿星。

There are no vehicles on the island. Though having to walk through the town pleases many tourists and young people, it presents an immediate obstacle for the elderly, not to mention when they fall ill.

小岛上没有代步工具。对游客和年轻人来说，从岛的这头走到那头，是一种闲适的惬意。但对老年人而言，却意味着最直接的出行困难，更别提生病就医。

"When the old people got sick, they'd have to go to Xiamen by ferry, which normally takes more than half the day," Yang said. "Some medical examinations may need at least three round trips. That's too hard for them. I've been living here for 7 years, and I've got relatives here. It's my duty to help them."

“岛上一个老人如果生病了，到厦门去一定要通过渡船，出岛至少要半天。做一个检查至少跑三趟，这对他们来说是非常困难的一件事情。”杨彩虹说，“我在这边住了七年的时间，还有亲人在岛上，所以我责无旁贷，我们应该去帮助他们。”

As a result a pilot healthcare reform  project is underway in Xiamen, under the direction of three doctors. The Gulangyu Branch Hospital has set up a health record for every chronic patient and carries out treatment according to the type and degree of ailments. Each patient is taken care of by a specialist physician, a general practitioner and a health manager. They would keep tracking the patient's medical history.

这就涉及到在厦门进行的试点医改：“三师共管”的分级诊疗制度。鼓浪屿医院为每一位纳入管理的慢性病患者建立健康档案，根据疾病类型和程度进行分级诊疗。每个病人对应有一个专科医师、一个全科医师、一个健康管理师，对病情进行长期跟踪监控。

Due to limited medical resources and transportation, the residents had little trust in the town's medical system.

"They would not open the door and were very distant," said Yang. "They were thinking: what problems can you solve? Would the examinations be accurate really? They were full of distrust. They wouldn't come even though the health checks were free of charge. I was very upset. I doubted myself, but had to adjust my own mindset."

此前，因为长期就医和出行困难，居民对鼓浪屿的医疗体系并没有多少信心：“敲门敲不开，非常冷淡，因为他们觉得：你们能解决我们什么问题？你们做的检查报告到底准不准？各种怀疑就这么扑面而来，体检单免费的，都送到人家手里，都压着不来。” 杨彩虹说，“我也挺郁闷，一度动摇过，一直在调整心态。”

To help change mindsets,  GPs and health managers visited over 4,900 households in more than 100 days.

最后，全科医生和健康管理师花了一百多天，走遍了岛上的四千九百多户人家。

"We collect the information of the patients and label them with red, yellow and green tags. We visit them every week, making sure they get the diagnosis and undergo the treatments. Then we follow the observation and monitor the health education.

“我们收集这些病人的信息，按照红黄绿标分清楚，一周要跟他见一次面，然后把他的诊断明确治疗方案给落实清楚。然后后续的病情观察，血压血糖的监测，都得做到位，还有健康教育的传播。”

Most of the measurements aim to help the elderly who cannot travel far and patients with chronic diseases. They are carried out by the "three doctors" who visit once in a while. Vehicles are deployed for picking up elderly people to take them to the hospital. Gradually, Yang saw the fruits of her endeavors.

这些措施主要帮扶的人群是行动不便的老年人和慢性病患者，大都由三师共管家庭医生入户完成。医院还配备了敬老车，专门供老年人在家和医院之间往返。渐渐地，杨彩虹的工作有了成效。

"An old lady has to stay in bed and take medicine after a stroke. The prescription, however, was only for one week. The son of the couple was not with them. Every time the husband went out, he'd worry that bad things could happen at home. He felt so helpless. After signing the contract with us, he was greatly relieved. The doctors and the health manager would go to his place with medicine. And he would call us with medical issues."

“有个阿伯的老伴中风后长期卧床，长期要吃药，一周只能开一次药。因为儿子不在身边，他每次出门就觉得家里好像要着火，特别无助。我们签约完以后，他觉得太省事了。我们的医生和健管师经常入户去关心他，给他送药，他一有什么问题就打电话。”

Yang and her colleagues are like the barefoot doctors in the old days, going from one household to another. Modern technologies bring more efficiency: data from the blood pressure monitors and glucometers that they set up at the patients' houses would be synchronized with the doctors' phone apps.

杨彩虹和同事们就好像从前的赤脚医生，挨家挨户地上门服务。新技术也帮助他们提高了工作效率。留在居民家中的血压计和血糖仪测出的数据，可以同步传输到医生手机的APP上。

Today, the residents don't have to ferry across the strait for medical services. Patients with chronic diseases and the elderly can be treated at their homes. Gulangyu as "an island of the elderly," is becoming a comfortable place for people to enjoy their twilight years.

现在，岛上的居民不再需要为了药品和医疗服务漂洋过海，慢性病患者和行动不便的老人可以就近得到医治。鼓浪屿这座“老人岛”也许能真正变为一个舒适宜居的养老之地。

Cameraman: Zhang Jinbo

Film editor: Tan Di, Ma Mingyuan

Story written by: Zhu Siqi

English editor: Bertram Niles

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