Surgical Treatment of Iatrogenic Low Variety Anal Stenosis with Diamond Flap Anoplasty – A Prospective Study

Background: Anal stenosis results from loss of anoderm with subsequent fibrosis and scarring of underlying tissue. The condition represents a technical challenge in terms of surgical management. It is a serious complication of anorectal surgery, most commonly seen after surgical haemorrhoidectomy. However, stenosis can also occur after perianal circumferential burn due to application of herbal medicine by village doctors. Objective: This study was conducted to see the outcome of diamond-flap anoplasty for the treatment of moderate to severe anal stenosis. Patients and interventions: Unilateral diamond flaps anoplasty was performed for moderate to severe anal stenosis. Final anal calibre of 25 to 26 mm was targeted. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis severity, postoperative complications and the time of return to work were recorded. Results: From July 2012 to January 2017, 18 patients (12 males, 67% and 6 female patients, 33%) with a mean age of 34 years (range, 25-52) were treated. 15 of the patients had a history of previous haemorrhoidectomy and 3 had circumferential perianal chemical burn due to application of herbal medicine by village doctors. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24- 26), and 25 ± 1 mm (range, 23-27). The clinical success rate was 98.9%. No severe postoperative complications were observed. Conclusion: Diamond-flap anoplasty is a highly successful method for the treatment of anal stenosis caused by previous haemorrhoidectomy and perianal circumferential chemical burn by herbal medicine. J Shaheed Suhrawardy Med Coll 2020; 12(2): 67-71

Chekhov as a writer and as a doctor

In his short autobiography, Anton Pavlovich wrote that after a great number of years, although he could not remember what exactly had prompted him at one time to choose the profession of a doctor and enter the medical faculty of the university, he knew for sure that subsequently he never regretted his choice. In his letters, he even wrote that he considered literature to be his wife, while medicine was his mistress, and when he got tired of one, he turned his gaze to the other. «Perhaps this is immoral to some extent,» he wrote, «but I never get bored. Why not chase two hares if there were hounds!» Chekhov began his medical practice in the Zvenigorod district of the Moscow province. He was lucky to have as his mentor an outstanding physician P. A. Arkhangelsky, whose fame as a practicing therapist was so great that young doctors from almost all over the country came to him to gain experience. The eminent doctor was very pleased with the success of the talented young man, and even left him solely for the entire hospital as a practicing doctor. Such activity helped Chekhov not only gain invaluable medical experience, but also formed the basis of many of his works, such as «The Runaway», «Village Doctors», «On Official Duty». Anton Chekhov devoted the first half of the day to receiving patients, and in the afternoon, he took part in autopsies, acted as a medical expert, and consulted especially difficult and controversial cases of diseases.

Outsiders in the Village

A shortage of women doctors in Rajasthan’s rural government sector has left sizeable gaps in the provision of women’s healthcare. This chapter explores how, in their narratives, women doctors position themselves as outsiders in the village, unable to create successful careers and lives in rural spaces. Medical graduates considering a rural career must contend with the hierarchy of medical prestige that places cities above villages and the timescale that frames villages as ‘backwards’ spaces. In doctors’ narratives of the village, doctors used the village as code for low educational and class status—and by separating themselves from the geographical space of the village, they also put metaphorical distance between themselves and their subaltern Other. Women doctors’ reluctance to occupy rural space illuminates the ways that class, space, and gender overlap to shape the practice of healthcare, with impacts felt far beyond the careers of doctors.

The influence of personality, alexithymia and work engagement on burnout among village doctors in China: a cross-sectional study

Background In China, as the “gatekeepers”of rural residents’ health, the primary-level village doctors, play a very crucial role in ensuring and serving the health level of rural residents. However, the burnout of village doctors is gravely threatening the stability of rural primary medical system step by step. This study systematically evaluated the effects of personality, work engagement and alexithymia on burnout of village doctors, and further measured and assessed the mediating effect of alexithymia and work engagement in the association between personality and burnout. Methods The subjects were 2684 village doctors in Jining, Shandong Province, China, from May to June 2019. Sociodemographic characteristics, alexithymia, personality, work engagement and job burnout were quantitated by self-completed questionnaire and measured by Likert 5–7 scale. One-way ANOVA, Person correlation analysis, and Structural Equation Modelling (SEM) were used for statistical analysis and mediating effect evaluation. Results 2693 questionnaires were collected in total, of which 2684 were valid, with an effective rate of 96.2%. 65.2% of village doctors were diagnosed with burnout, and 54.3% showed moderate to severe emotional exhaustion, 61.6% showed moderate to severe low sense of personal achievement, and 33.9% showed moderate to severe depersonalization burnout. Personality had a direct positive effect on work engagement (β = 0.50, p < 0.001), a direct negative effect on alexithymia (β = − 0.52, p < 0.001) and burnout (β = − 0.50, p < 0.001) respectively. Work engagement had a direct negative effect on burnout (β = − 0.10, p < 0.001), while alexithymia had a direct positive effect on burnout (β = 0.16, p < 0.001). In the path between personality and burnout, both work engagement 95%CI:(− 0.17)–(− 0.08), and alexithymia 95%CI:(− 0.36)–(− 0.09), have significant mediating effects. These results strongly confirm that personality, alexithymia, and work engagement are early and powerful predicators of burnout. Conclusion According to the results, medical administrators should pay attention to the personality characteristics of village doctors in vocational training, practice selection and job assignment, encourage village doctors to reflect on their own personality actively, and to reduce job burnout by obtaining necessary social support, constructing reasonable achievable career expectations, improving time management ability, and participating in psychological counselling programs.

Livelihood Patterns and Socio-economic Conditions of the Fishermen of Kharingcha Baor at Chaugachha Upazilla in Jashore District, Bangladesh

A field study was carried out to investigate the livelihood patterns the socio-economic conditions of the small-scale traditional fishermen of Kharingcha baor at Chaugachha upazilla in Jashore, Bangladesh. The survey was conducted on 100 peoples from 70 families of the fishermen in the study area. It was found from the study that 94% fishermen were comprising of males, while 6% were of females. Among them, the majority was Hindus (88%) and the minority was Muslims (12%). During the suvey, the proportion of semi paka houses were documented to be 88%, while kancha were 12%, and all the families had electricity facilities. It was found that 20% of fishermen had no education, 6% had passed SSC-HSC examinations, 14% had passed 6-10 classes and 24% had passed 1-5 classes. It revealed that 84% of fishermen were married and 16% were unmarried. Throughout the study, 33% of the fishermen were found to be dependent on village doctors, 40% on upazilla hospital and 27% on MBBS doctors. Several types of local boats and dingi nouka as well as nets such as tana jal (surrounding net), set bagnet, khapla jal (cast net), thela jal (push net) etc. were used for the harvesting of different fish species (Labeo rohita, Catla catla, Cyprinus carpio, Cirrhinus mrigala, Heteropneustes fossilis, Channa striatus, C. punctatus etc.). Averagely, 35-80 kg fish per day was caught by a group of fishermen using a boat. The majority of the fishers sold their harvested fishes upon the fulfillment of their demands. The monthly mean income of fishermen was around BDT. 5,000-15,000 in the baor area. Among the fishermen, 56% of them were observed to lend money from money lenders and 44% from the NGOs for their fishing-related activities and livelihoods. It revealed from the present findings that the traditional fishermen of Kharingcha baor require more technical, organizational and institutional helps for the improvement of their socioeconomic condition and sustainable livelihood.

Influential Factors of Burnout among Village Doctors in China: A Cross-Sectional Study

(1) Background: The heavy workload and understaffed personnel of village doctors is a challenge to the rural healthcare system in China. Previous studies have documented the predictors of doctors’ burnout; however, little attention has been paid to village doctors. This study aims to investigate the prevalence and influential factors of burnout among village doctors. (2) Methods: Data was collected by a self-administered questionnaire from 1248 village doctors who had worked at rural clinics for more than a year. Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) with three dimensions—emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). A logistic regression model was applied to estimate the influential factors of burnout. (3) Results: The prevalence of overall burnout was 23.6%. Being male (OR = 0.58, 95%CI: 0.41–0.82), poor health status (OR = 0.80, 95%CI: 0.67–0.94), low income (OR = 0.62, 95%CI: 0.40–0.95), and a poor doctor–patient relationship (OR = 0.57, 95%CI: 0.48–0.67) were significantly related to burnout. Conclusion: Burnout is prevalent among Chinese village doctors. Policies such as increasing village doctors’ income and investing more resources in rural healthcare system should be carried out to mitigate and prevent burnout.

Rationale and Design of a Cluster Randomized Trial of a Village Doctor-Led Intervention on Hypertension Control in China

Background In China, hypertension prevalence is high and increasing while the control rate is low, especially in rural areas. Traditionally, village doctors play an important role in infectious disease control and delivering essential health services to rural residents. We aim to test the effectiveness of a village doctor-led multifaceted intervention compared to usual care on blood pressure (BP) control and cardiovascular disease (CVD) among rural residents with hypertension in China. Methods In the China Rural Hypertension Control Project (CRHCP), a cluster randomized trial, 163 villages were randomly assigned to the village doctor-led intervention and 163 villages to control. A total of 33,995 individuals aged ≥40 years with an untreated BP ≥140/90 mmHg or treated BP ≥130/80 mmHg or with an untreated BP ≥130/80 mmHg and a history of clinical CVD were recruited into the study. The village doctor-led multifaceted intervention is designed to overcome barriers at the healthcare system, provider, patient, and community levels. Village doctors receive training on standard BP measurement, protocol-based hypertension treatment, and health coaching. They also receive technical support and supervision from hypertension specialists/primary care physicians and performance-based financial incentives. Study participants receive health coaching on home BP monitoring, lifestyle changes, and adherence to medications. The primary outcome is BP control (&lt;130/80 mmHg) at 18 months in phase 1 and CVD events over 36 months in phase 2. Conclusions The CRHCP will provide critically important data on the effectiveness, implementation, and sustainability of a hypertension control strategy in rural China for reducing the BP-related CVD burden. Clinical trials registration ClinicalTrials.gov identifier NCT03527719

Livelihood status of Sundarbans dependent people at Shymnagar Upazila of Satkhira, Bangladesh

Azad AK, Pitol MNS, Rakkibu MG. 2020. Livelihood status of Sundarbans dependent people at Shymnagar Upazila of Satkhira, Bangladesh. Asian J For 5: 28-35. The study aims to know the livelihood status and dependency on Sundarbans at Shymnagar Upazila in the Satkhira district. A questionnaire survey was carried from 130 respondents in three unions. Most of the respondents (65%) were middle-aged (30-50 years old) and 22% of them were female and 78% were male. Among them about 51% were illiterate, 24% had primary education, while 25% had secondary education. About 72% of respondents were fully dependent and 21% were partially dependent on Sundarbans for their livelihood. Only 37% of people in these areas had their shrimp farm (gher). The respondents collected fuelwood (92%), aquatic resources (80%), small timber (54%), honey (27%), goran (Ceriops decandra) (8%), and golpata (Nypa fruticans) (6%) from Sundarbans. Only 63% of respondents had their livestock like cows (2%), poultry (68%), and goats (30%), whereas 84% of respondents were involved with different NGOs. Among the respondents, 70% had the access to disaster warnings, whereas only 24% had shelter facilities. Only 28% of respondents had access to drinking water from deep tube-well and 33% from ponds. About 50% of respondents did not get better medical treatment and were dependent on village doctors and only 8% of respondents received treatment from Government hospitals. It was alarming to know that about 91% of respondents did not know co-management in Sundarbans. Most of the people living here were not satisfied with their present occupations and about 98% of them were eager to start a new occupation. Only 11% of respondents got benefitted from government Vulnerable Group Feeding / Vulnerable Group Development support.

The Effect of Wechat-Based Training on Improving the Village Doctors’ Knowledge of Tuberculosis Management: A Pre-And-Post Intervention Study from China

Background: In China, village doctors played a crucial role in TB cases referral and management. The current study aimed to evaluate the effect of WeChat-based training program on improving the village doctors’ knowledge on TB management.Methods: A One-year WeChat-based training was conducted by means of releasing original contents (in forms of text, poster, video or cartoon), through WeChat subscription account (WeChat SA) once a week. Pre-and post-training offline tests were hold using the same self-administered questionnaire to evaluate the training effect.Results: A total of 467 village doctor were included in the study. During the training, sixty original articles were posted through WeChat SA. With respect to the two tests, the median score increased from 50 (40.0-60.0) to 60 (53.0-70.0) (p<0.001) after training. The median scores were always higher after training no matter what kind of article contents and forms. In addition, the effectiveness of such training was found to be influenced by gender and education level.Conclusions: Our results indicated that WeChat-based training could partly improve the knowledge of village doctors on TB management. It is worthy to explore more effective new media-based training methods that might promote TB control work in rural China.