The author of this article: Tun Tun
In mid-April, Kiryu (pseudonym), a resident physician of a hospital in Puxi, Shanghai, saw a message for help on the mutual aid website:
A patient who lives in Changning, Shanghai asked for help online. Affected by the epidemic lockdown, he was unable to go to the original hospital. The patient urgently needs the antitumor drug exemestane tablet, which has been discontinued.
Kiryu checked the drug inventory in his hospital and asked several classmates working in the hospital about exemestane tablets.
“No textbook taught me how to find medicine for a patient in isolation at home.”
In Shanghai, many doctors like Kiryu spontaneously became volunteers. They were active in hospital posts and online platforms, groping and holding up one by one that no one could see in hidden corners. helper.
How many people could we help if we were all in the hospital?
On March 30, Hua Rongqi, a third-year student at the University of International Business and Economics, created the “Shanghai Medical Emergency Assistance” online document to collect information on various assistance from Shanghai citizens. The document organizes solutions to common problems such as dispensing, hemodialysis, chemotherapy, and maternal and childbirth, and also summarizes the supply and insurance channels for oxygen cylinders, ostomy bags, and psychological assistance. The volunteers behind the online documentation call themselves “Shanghai Keepers.”
“Shanghai Medical Emergency” Online Document Homepage
Xiao Lei (pseudonym), a clinical medicine student from a university in Shanghai, saw this document in the circle of friends that night. She quickly signed up and became one of the earliest core initiators. As early as mid-March, Xiaolei’s school entered quasi-closed-loop management, and Xiaolei, who was still in the department rotation, was forced to suspend all clinical work. “Seeing that the teachers in my hospital are all on the front line, as medical students, we also want to help a little.”
At the same time, Internet person Liu Sitan created “We Come to Help You Shanghai Anti-epidemic Mutual Aid Website”. Liu Sitan came up with the idea of creating a mutual aid platform when he was volunteering in the community, hoping to have a window where he could pay attention to the elderly living alone. On April 24, the mutual aid website also launched an English version.
“We’ll Help You Shanghai Anti-epidemic Mutual Aid Website” English version homepage
The founders left this sentence on the website, “The Western Han Dynasty has a country, its name is Daohou, Yingche Jiasui, Baode Yanghe”. Liu Sitan said, “This is a place where a group of people who love to give and help get together.”
Tongyu met founder Liu Sitan while volunteering in the same community. “I was moving things at the time, and Liu Si talked about it and said that he had created such a platform for help, and asked me if I wanted to join.”
During the epidemic, Kiryu’s hospital took turns to schedule shifts, often closing the loop for a week and taking a week off. In Kiryu’s university class group, some students expressed emotion, “We have so many doctors, if all of us are working, how many people can we help?”
Kiryu said, “Afterwards, I thought, since there is no way to do some work in the clinical front line, can we help more people to solve their medical needs through this platform. “
With the forwarding of mutual aid documents and mutual aid websites, many medical students and doctors contacted one after another, hoping to join. “Some people are in hospital positions, some are in Fangcang shelter hospitals, and some are doctors in designated hospitals. Although they are busy, everyone spares no effort to help solve the problem,” Kiryu said.
At the beginning of the establishment of the website, like all volunteers, after collecting the information of the seekers on the platform, they verified and communicated by phone, and helped the other party to contact the neighborhood committee, hospital, takeaway and other channels. , try various ways to solve the problem of the seeker.
On April 10, Pu Qing (pseudonym) joined the Daohou team. Prior to this, Pu Qing collected information on the elderly in need of help in Pudong New Area through his personal account, but he found that his personal strength was still limited, and he quickly joined “Daohou” after seeing that the platform was recruiting.
As a hospital administrator, Puqing discovered soon after joining the team that the existing operating mechanism would create problems as the number and demand of volunteers increased. “On the one hand, the volunteers are very enthusiastic, and everyone goes to help, but it is possible that a seeker will receive repeated calls from different volunteers; On the other hand, the volunteers’ professions, abilities, and resources are all different. Yes, it is necessary to divide the work, and make full use of the talents of each volunteer due to the excellent job setting and post-fixing.”
That night, the core members of Puqing and “Daohou” held a meeting for about two hours, proposing to standardize the process, set up groups according to the information for help, and need professional doctors to participate. Kirito, who has a professional background, became the head of the medical team. “There are currently about 20 volunteer doctors with practicing certificates, basically in the range from hospitalization to attending treatment”.
Similarly, the “Shanghai Keeper” team has gradually figured out a path in the process of volunteering. The medical team increased from 2 people to more than 30 people, and Xiaolei became the person in charge.
In order to process help information more efficiently, these online mutual aid platforms have formed a relatively standardized process:
First, volunteers will collect information from the platform and contact the seeker for verification. During this process, some volunteer doctors help to classify the needs from a professional perspective and judge the degree of criticality;
Subsequently, these different needs are distributed to different groups such as drug purchase, chemotherapy, hemodialysis, medical treatment, etc., and the volunteers in the group will provide help or guidance to the seekers in a targeted manner;
In addition, some volunteers will continue to make return visits to care about the situation of the seekers and continue to optimize the help process.
“Shanghai Keepers” partial grouping
Image source: provided by Xiaolei
Many volunteer doctors still have their own jobs in the hospital and can only handle information for help in their spare time. The mutual aid platform does not have rigid scheduling rules for doctor volunteers. More often, it adopts the method of “dispatching orders”. Doctors who are free can reply to messages or claim tasks in the group. Although everyone has different schedules, workgroups are always guaranteed to have someone online.
At present, the online mutual aid document of “Shanghai Keeper” has accumulated more than 2,000 help messages, an average of hundreds of messages per day. Xiaolei told Lilac Garden, “Judging from the number of people in our group chat, it may actually be far more than 2,000 people.”
“Shanghai Keepers” help data statistics
Similarly, more than 6,500 help messages have been numbered on “We’ll Help You Shanghai Anti-epidemic Mutual Aid Website”.
“Daohou” accumulated help data
The addition of the doctor makes the search for medicine flow in the medical circle
Of all the help, buying medicine seems to be the biggest need.
Affected by the logistics under the lockdown in Shanghai, many patients asked for help, and insulin that needed cold chain transportation could not be purchased. Xiaolei and other volunteers of the “Shanghai Keeper” contacted Guoda Pharmacy and Fahrenheit Pharmacy successively to inquire about the purchase and delivery of medicines. A regional leader of Neptune Star found Kiryu, hoping to join the “Daohou” volunteer team to help check the drug inventory of Neptune’s various stores.
Through multi-channel contact, the volunteer team of “Shanghai Keepers” also obtained the detailed information of Guoda Pharmacy’s directly operated and franchised pharmacies in the city, including the location of the store, the name of the pharmacy, whether it is open or not. , left-behind staff and personal telephone numbers. Xiaolei said, “We called these pharmacies one by one and asked if there was any medicine.”
Guoda Pharmacy store information obtained by “Shanghai Keeper”
Image source: provided by Xiaolei
Compared with non-medical volunteers, doctors have more resources and channels, and can provide more efficient guidance and help when solving the problem of buying medicines.
Patients who needed exemestane tablets at the beginning of the article were already in a state of discontinuation when they asked for help, and the designated hospital for the patient’s own serious illness medical insurance closed outpatient clinics due to the epidemic. Kiryu told Lilac Garden, “Anti-tumor drugs can only be prescribed in the outpatient department of the hospital. After seeing this request for help, I first checked the stock situation of my hospital nearby.” Kiryu’s hospital only has the imported drug Arnoxin, and cannot use the serious illness medical insurance. It is difficult for patients to bear the high cost of imported drugs at their own expense.
Kiryu asked several college classmates again, but some hospitals, although they have medicines, stipulate that they cannot provide them to newly diagnosed patients. After some inquiries, a classmate from a hospital in Puxi told Kiryu that their hospital had the domestic drug Sulai, which could be dispensed in the outpatient clinic. After getting the news, the patient applied to the neighborhood committee to go out and successfully got the medicine.
Pu Qing recalled receiving a request from a girl whose family needed dopasizine tablets. “My first reaction was to reassure her. I felt reassurance was very important when I was working in outpatient clinics. Many people asking for help were actually anxious because they didn’t get feedback.“
Puqing sent some Internet hospital links to the helper, asking her to consult a doctor first. At the same time, Puqing also contacted his friends in JD.com and asked JD.com Pharmacy’s “drug registration level”.Taiwan” whether the drug can be delivered. “I have been encouraging her. I said that we will find a way to find it together, and we will definitely be able to buy medicine.”
Through various information channels provided by Puqing, the seeker finally bought Dopasizin tablets through Meituan. Afterwards, the seeker told Puqing that he had failed many times before, and that without Puqing’s persistence and encouragement, he might not have persisted for two more hours this time.
The chat history of the helper and Puqing
Image source: Provided by Puqing
Puqing’s own job is related to Internet hospitals. After receiving a lot of requests for help in buying medicines, he discussed with Kiryu and proposed that the dispensing process needs to be systematically sorted out. At present, the “Daohou” platform has compiled a detailed process for dispensing medicines and seeing a doctor. Non-medical volunteers can also guide patients step by step according to the manual. “My job is to sort out the process and help children and their families seek medical treatment in a better and safer way. I will also share my work experience in the outpatient and emergency department with Kiryu, and we will collect some new ways to connect with the helpers.”< /p>
The process of dispensing and medical treatment organized by “Daohou”
Image source: provided by Kiryu
In addition to seeking medicine, another part of the demand comes from seeking medical treatment. Although Shanghai has already announced the hospital’s medical treatment information through major platforms such as Shanghai Publishing and Bidding, the dynamics of the epidemic situation changes all the time, and the information is too large and messy, and it may not be synchronized or disclosed in time. The addition of doctors effectively fills this information gap.
Kiryu said, “We are relatively clear about our unit’s prescribing, drug inventory, and what kind of treatment can be carried out. People who are not in the medical industry can update this information. It may not be so timely and accurate. After we get the information and make a summary, we can help more people.”
Kiryu recalled that the number of requests for help was very large when the platform was launched. We started receiving consultations, and services such as pharmacies and distribution have gradually resumed. Kiryu told us that the number of requests for help has dropped to about 20 in recent days.
The “Shanghai Keepers” also saw a downward trend in the number of calls for help. Xiaolei told Lilac Garden, “Since last week, the demand for medicine has been significantly reduced, perhaps because the hospital has opened clinics one after another, or because the medicine can be delivered to the pharmacy in time, and the pharmacy can also be delivered to the patient in time. Now it’s the least help we’ve ever seen, only about a dozen a day.”
Never provide medical services, this is a red line
From collecting help information to connecting with helpers, in this standardized process, one of the important tasks of doctor volunteers is to judge the criticality of the patient from their own professional point of view, so that other Volunteers can follow up in a reasonable order.
Xiao Lei told Lilac Garden that it is also out of this consideration that most of the medical students in the “Shanghai Keeper” medical group are senior students with internship experience, ” To be honest, I have never been to a clinic, so I really have no concept of these things.”
On the one hand, in the massive amount of help information, doctors need to identify patients who are really in critical condition.
Kiryu recalls an impressive call for help. The patient had been taking medication at the time, but his blood sugar remained high. And because the patient is older, the basic condition is not good, and it is also accompanied by vomiting and confusion. “The help message is written about diabetes, but from a professional point of view, we believe that there is a possibility of diabetic ketoacidosis, which is the fundamental difference between outpatient and emergency departments.”
After realizing this, Kiryu immediately called the person who asked for help, and suggested that the person should not wait for other rescue methods, and should immediately apply for emergency medical treatment. After receiving the news, the patient went to the hospital that night. to the hospital. “I think that’s what we doctors are about on this platform, we’re able to identify some special cases and find people who really need help.”
The volunteer doctor of “Shanghai Keeper”, Dr. Shen, the attending physician of the intensive care medicine department of a hospital in Shanghai, has also experienced similar help.
An elderly patient was diagnosed with ANCA-associated vasculitis in early March and required CTX treatment, which was delayed due to the pandemic. Later, the patient’s condition worsened and he was admitted to a secondary hospital. During this period, he developed acute renal failure with severe hyperkalemia, anuria, dyspnea, and serum creatinine >1000. The secondary hospital was unable to perform hemodialysis at that time. “This is a very urgent situation. The patient has acute renal failure, anuria and severe hyperkalemia, and is life-threatening at any time.”
To make matters worse, the patient tested positive for nucleic acid and needed to be transferred to a designated hospital with treatment capabilities, but the beds were quite tight. The patient’s children were not around. After receiving help, the “Shanghai Keeper” team, considering the danger to life, assisted many times in contacting the National Health Commission, CDC, some designated hospitals, the media, etc.Two days later, the patient was properly transferred to a city-level designated hospital for treatment, and the patient’s condition improved after follow-up follow-up. “For these patients whose lives are on the line, I think our help is meaningful.”
Dr. Shen told Lilac Garden, “Because I work in the ICU myself, I am relatively skilled in judging the criticality of the condition. In the help I have handled myself, about 10% It is indeed a critical illness.”
On the other hand, help seekers may not be aware of their true urgency when describing the situation, and the help information may be distorted out of fear and anxiety. Kiryu said, “His descriptions of all those who came for help were certainly urgent, but they might actually be biased. We can’t just rely on their descriptions, but evaluate them professionally.”
Xiao Lei received a request for help a few days ago. The patient reported dizziness, headache, a history of anxiety, and a panic attack and urgently needed medical attention. “We got to know the situation with the helper and found that the description of the other person is not a typical panic attack, and the panic attack usually lasts for a short time, and the helper contacted us for several hours, so we recommended the helper later. Internet hospital.”
However, the responsibilities of the doctor volunteers also stop there. The doctor does not provide any diagnosis and treatment services other than the diagnosis, medical guidance and comfort. Volunteer doctors are more about providing guidance to the seeker, so that the other party has a way to obtain the medical resources he needs.
Kiryu told Lilac Garden, “We are a volunteer platform, not a professional medical institution. Our practice certificate is designated and cannot be used in non-medical institutions or non-designated medical institutions. For the protection of volunteers, we do not recommend volunteers to provide online medical consultation services directly.”
Puqing also said, “We must not provide medical services, this is our red line. This involves legal compliance issues in multi-site practice, we can provide some guidelines, However, patients still need to strictly implement the responsibility system for the first consultation.”
Planning: yuu.
Producer: gyouza, Leu.
Image source: “Shanghai Medical Emergency Help” online document