A Tale of Two Cities Supporting Xinjiang

"Dr. Zhou, this plan is too idealistic."

Nuerbahati pushed the rural heart health outreach medical program back to Zhou Yi, who had just returned from advanced studies in Dalian and was still full of the advanced cardiovascular screening models he had seen there.

He ambitiously wanted to replicate this in the pastoral areas of Xinjiang.

"Where is it idealized?"

Zhou Yi pointed to the plan: "Electrocardiogram machines and portable ultrasound machines are now available in miniaturized form. We'll drive down, stay at one location for two days, and then move on after the screening is complete."

Nurbahati sighed, "Dr. Zhou, you've been staying at the city hospital for too long."

He took a map of Xinjiang and spread it out. "Look at Tacheng and Karamay, these farms and regiments don't seem far away, right?"

There's no road here. Or rather, there is a road, but it's a path made by cattle and sheep, and your equipment truck can't get through.

Zhou Yi disagreed: "Then let's get an off-road vehicle!"

"Off-road vehicles can get in, but what about the equipment?"

Nuerbahati tapped on the equipment list in the plan, "The portable ultrasound is relatively portable, but it still weighs thirty kilograms. Add the generator, electrocardiograph, and medicine, and it won't fit in one vehicle. And—"

He emphasized, "How did you find the herdsmen?"

They follow the water plants; today they're in this valley, next month they might be crossing two mountains.

"They have no fixed address and no cell phone signal, how are you going to contact them?"

Zhou Yi was stunned.

In Dalian, free clinics are organized by posting notices in the community, and residents come on time. He really hadn't considered the problem of not being able to find patients.

"What should we do then?"

Heart disease is prevalent in pastoral areas; does that mean we shouldn't screen for it?

"We need to screen, but we have to use our methods."

Nuerbahati's eyes held a calmness unique to old herdsmen. "You have to learn to walk on the grassland before you can think about running."

The team started arguing at their first preparatory meeting.

Zhou Yi insisted on bringing the most advanced equipment, saying, "Early heart disease screening, ultrasound is indispensable!"

What can you hear with just a stethoscope?

The younger doctors on the team supported Zhou Yi: "Yeah, what era are we living in? Still relying on the old three methods?"

But the old nurse, Gulibaha, shook her head: "The ultrasound you're talking about was brought down from the city hospital last time. It broke on the way and took three months to repair."

"For free medical clinics in pastoral areas, the first thing to do is to get acquainted with the equipment."

Nurbahati finally made the decision: "Take them all, but they need to be modified."

Large equipment is disassembled into smaller parts and loaded onto different vehicles.

In case the equipment breaks down, we still need to be able to get things working using a stethoscope, a blood pressure monitor, and our experience.

The task of modifying the equipment fell to the instrument department. The veteran technicians clicked their tongues in disbelief as they looked at those precision instruments.

"Once this ultrasonic probe is disassembled, it may not be able to be reassembled."

"The electrocardiograph machine is a fully encapsulated unit; forcibly disassembling it will damage it."

Zhou Yi spent three days in the workshop, working alongside the masters to figure things out.

Finally, a solution was devised: instead of disassembling the entire machine, it was broken down into several large modules, and a special shockproof box was designed, which was then wrapped with layers of sponge and shock-absorbing material.

"Like Russian nesting dolls, a large box inside a smaller box, with cushioning in each box."

The first expedition was headed to a remote regiment in Tacheng.

The convoy departed at 6:00 AM and was scheduled to arrive at 9:00 AM.

As a result, they encountered a sandstorm halfway there, with visibility dropping to less than five meters.

The guide, Xiao Zhao, remained calm: "This happens often. Drive slowly and follow my tracks."

It took three hours to travel 20 kilometers.

Finally, we arrived at a relatively flat river valley, where thirty or forty herders were already waiting.

But a new problem arose: the generator was too noisy when it started, which affected electrocardiogram and ultrasound examinations.

"Can we do without a generator?" Zhou Yi asked.

"Without a generator, the equipment won't have power," Xiao Ma said helplessly.

An old herdsman walked over and pointed to the solar panels in the distance: "Will those work? We use them to watch TV at night."

That was a simple solar power system used by the herders, with very low power output.

Nurbahati said, "Let's give it a try!"

They only connected one electrocardiograph machine, which was barely powerful enough.

Although it's slow, at least we can get the work done.

The test results surprised Zhou Yi: out of twenty people screened, six had abnormal electrocardiograms!

"This ratio is too high!"

He couldn't believe it. "Is there something wrong with the equipment? Or is it being operated incorrectly?"

Nuerbahati personally re-examined the equipment, his expression grave: "The equipment is fine."

Junior brother, this is the reality in pastoral areas: a high-salt, high-fat diet, cold climate, heavy physical labor, and inconvenient access to medical care, leading to a high incidence of cardiovascular disease.

Suspected patients identified through screening require further ultrasound examinations, but solar power cannot power the ultrasound equipment.

"Go back to the car and do it!"

The I Ching decides: "Use the car battery."

They set up a makeshift inspection room in the back seat of the SUV.

The herders lined up to board the bus, each undergoing a cardiac ultrasound.

The results confirmed the findings of the electrocardiogram: four out of the six people did indeed have organic heart disease, and two of them required immediate treatment.

An ultrasound revealed that a 50-year-old herdsman named Bahiti had an enlarged heart and impaired cardiac function.

"Don't you usually feel anything?" Zhou Yi asked.

Bakhti chuckled, "I just sometimes feel short of breath. I thought it was normal for people to be like this as they get older."

Nuerbahati said seriously, "This is not a problem of old age, it's a heart problem."

You need to take medication and have regular checkups.

"Is the medicine expensive? Do I need to go to the city for the checkup?"

Bahe asked the most practical question.

Just as Zhou Yi was about to explain, Nurbahati stopped him and said in Kazakh, "The medicine is not expensive; we have a basic drug list."

We don't need to keep going to the city for checkups; we'll come again next time.

Bahiti was relieved.

The first day was busy until dark. Eighty-seven people were screened, and eleven patients with heart problems were found.

The team was so exhausted they didn't even have the energy to eat, but they felt a great sense of accomplishment.

However, another problem arose during the meeting before bed.

"Less than a hundred people have come today," Xiao Ma tallied. "At this rate, our goal of screening two thousand people..."

"Can't finish."

Nuerbahati bluntly stated: "The herders are too scattered. Some of them heard about the free clinic and rode for half a day to get there."

We can't afford to wait, and we can't wait indefinitely.

Zhou Yi stared at the map and suddenly asked Xiao Zhao, "How many relatively concentrated settlements are there in this area? Not the nomadic kind?"

Xiao Zhao pointed to several points on the map: "Here, here, and here, there are settlements. Herdsmen gather here more often in winter."

"What about summer?"

"In the summer, the grazing is scattered, but the grazing points are relatively fixed, with about a dozen households at each point."

Zhou Yi had an idea: "We shouldn't be doctors who stay at the clinic, but doctors who make house calls."

The equipment was simplified, only the most essential items were brought, and the teams split into several small groups, each heading to a different grazing point simultaneously.

"There aren't enough devices to go around."

"No ultrasound," Zhou Yi gritted his teeth. "Just bring the electrocardiograph and rapid test strips."

First, we do an initial screening to identify suspicious cases, then we conduct ultrasound scans on those cases.

Nurbahati thought for a moment: "Let's add another mobile screening point, put the ultrasound equipment there, and suspicious patients can ride a horse or take our car there for testing."

After the plan was adjusted, efficiency was greatly improved.