"Recently, we are applying for funds from the National Health Commission for the promotion of cancer pain care in Ganzi Tibetan Autonomous Prefecture." The first word Jia Yuming talked about after sitting down is cancer pain care. "Once you have the funds: meetings, training, drug use standards for the cancer pain care, service sites for the cancer pain care in 18 counties of Ganzi Prefecture, the introduction of morphine ... Jia Yuming has a clear plan for the next step. "The first local model site of cancer pain control in the Tibet area, jointly approved by the Health Commission of Yibin and Ganzi, has been set up in Yajiang County, Ganzi Prefecture. The standardization of Yajiang experience could make a big difference in Gangzi Prefecture if Health Commission calls the dispatching doctors and local doctors to implement it together."
The Silent Majority
According to the new edition of China Cancer Report 2019, malignant tumor (cancer) has become one of the major public health issues that seriously threaten the health of Chinese people. On average, more than 10,000 people are diagnosed with cancer every day, and 7.5 people are told of getting this disease every minute. It was accompanied by 61.6% incidence of cancer pain, of which 50% of the pain levels are moderate to severe, and 30% are unbearable severe pain.
At present, the five-year relative survival rate of malignant tumors in China is about 10% higher than that of a decade ago, reaching 40.5%, but pain is still an important cause of death for cancer patients.
Fighting on the front line of tumor treatment, Jia Yuming, director of the Department of Oncology at West China Hospital of Sichuan University and Yibin Hospital, has a deep understanding of how torturous cancer pain could be.
"After my graduation from Chongqing Medical University in 1984, I was enrolled into The Second People's Hospital of Yibin and joined the Oncology Department in 1989. I could hear clearly of the painful groans of cancer patients at night in the ward of the Oncology Department. This is also a kind of torture for patients' families, for no one wants to see their beloved ones suffer so much."
The development of science and technology undoubtedly has a huge impact on the treatment of cancer. The improvement of survival rate year by year gives the public enough confidence to conquer malignant tumors. But the attention and treatment on the pain of malignant tumors seems to be locked in the patient's clenched teeth.
Yu Juan, a young female teacher at Fudan University, described the feeling of cancer pain in her posthumous book Incomplete in This Life: "At that time, osteoclasts were already densely packed in the body, and the body could not be touched. Once touched, I would pass out. The pain was not from the bone piercing, but from the cancer cells eating away at the bone in every minute. I didn't cry, not because I was strong-minded, but too painful to cry. I could only hold the breath with all my strength, and if distracted a little, I would pass out with pain."
China launched the campaign of "Model Ward of Standardized Treatment of Cancer Pain" in 2011. In 2016, National Health and Family Planning Commission and National Administration of Traditional Chinese Medicine jointly issued Notice on Strengthening the Management of Standardized Cancer Diagnosis and Treatment, in which it emphasizes once again the promotion of "Model Ward of Standardized Treatment for Cancer Pain". But as early as decades ago, Jia Yuming had started to pay attention to the cancer pain when he was studying at Chongqing Medical University.
"I read the book Cancer and Me in a small bookstore while in the college. Weng Guangan, author of the book, was a doctor, but unfortunately got cancer later. This book records his pains after suffering from cancer, which shocked me greatly." Weng's real and complex feelings imprinted deeply in the mind of Jia Yuming, who felt lost as a medical student then. It helped Jia Yuming to choose to become an oncologist and committed to the promotion of cancer pain care.
"There are only a few cancers that can be cured, but most of the cancer pain can be controlled." Jia Yuming's most profound case was an elderly couple with cancer. The husband got cancer in his eighties, and by targeted therapy and morphine, he lived to be nearly ninety years old now. During that period, his wife got cancer, and her condition was controlled in the same way. Jia Yuming posted a picture of the old couple lying together hand in hand in his Wechat Moments.
"Now they can live a normal life, and even go out for travel between sessions of the treatment. Their quality of life improved significantly. I joked that they could live up to a hundred years old. The fear of cancer for many is not the disease itself, but the unbearable pain the disease brings. Once the pain is controlled, the burden of patients will not be so heavy, and the improvement of life quality helps the treatment of the disease as well. "Jia Yuming said.
However, the promotion effect of cancer pain care is far from satisfaction. Jia Yuming wrote an article Thirty-Eight Fen, The Shame of China Oncologists in which it indicates that, China ranks 59 on the list of developing countries of average morphine usage. China's annual morphine dosage is 38 cents per capita, while Yibin is only 26 cents, which is lower than the national average. The morphine consumption in the United States for 300 million people is 100 times that of 1.3 billion people in China.
"There is an analogy that the modernization of a city can be measured on the lipstick sales. Likewise, a country's management of cancer pain can be measured on the usage of morphine. We are far behind on that."
For such a gap, Jia Yuming believes that it is related to patient's prejudice against morphine and strict control of morphine in the medical system.
"The public's perception of morphine is still in the Opium Combustion in Humen and morphine addiction, and the strict control of morphine in the medical system makes it more difficult for doctors to prescribe the morphine."
The resistance of cancer pain care in big cities and areas with convenient transportation is still there, so the promotion of cancer pain care in remote areas with limited transportation and setting up model site of cancer pain care is far more difficult than anyone can imagine.
Jia Yuming never gives up.
Jia Yuming always remembers his research experience at Hengjiang Town of Yibin County, close to Yunnan Province. Local medical staff told him that once there is a cancer patient in the village, all the neighbors lived nearby would move away. They would only move back when the patient died, because the painful groans of the patient makes it impossible for people around to live a normal life.
Jia Yuming and his team developed the standard of local model site for cancer pain control. It requires lectures by Grade III hospital experts, as well as doctors from township hospitals and "barefoot doctors" from villages to participate in the three level cancer pain control system, i.e. Grade III hospital-Grade II A hospital-hospital at town and village level. Grade III hospitals are responsible for difficult and intractable pain treatment, while township and village doctors are responsible for the patients referral and side effects treatment of morphine-like drugs. Township hospitals with the right to prescribe narcotic drugs may use morphine for pain relief. County hospitals now play the main role in cancer pain control, and later on the role could be shifted to the township hosptials.
"Patients with treatment needs can go to Grade III hospitals, and palliative patients who need pain relief can get morphine to guarantee their life quality without having to go far. This is a great convenience for many patients in inaccessible areas."
Struggling with prejudice, Jia Yuming devoted himself for ten years to the promotion of cancer pain care in his thirty years doctor career. With the support of Health Commission, he promoted cancer pain control to local medical institutions in counties and towns. 15 Grade II hospitals were approved as the local model sites for cancer pain control. Later on, it covers 26 hospitals in Cuiping District of Yinbin city, further reaching down to the Grade I hospitals in townships. Yajiang Country established the first local model site for the standardized treatment of cancer pain control in the Tibetan area, which is a start in the former revolutionary base areas, areas inhabited by ethnic groups, remote border areas and poverty-stricken areas.
Countless People behind One Person
Jia Yuming's prefix name in Wechat is "work is a hobby," and his profile photo was taken at a China Lions Club philanthropic program. In addition to the title "Director of Oncology Department in West China Hospital of Sichuan University and Yibin Hospital", Jia Yuming is also a member of China Lions Club. He joined the Lions Club for the simple purpose of getting more people involved in volunteer work of hospitals.
His Wechat Moments is filled with contents related to the treatment of cancer and cancer pain along the timeline. The computer in his backpack contains numerous PPT courses on cancer and cancer pain treatment. Once opening up any of these PPTs for lectures, he can talk for quite a long time using the humorous and down to earth language style. This is a skill he learned communicating with patients in his year-round lecture tours in his spare time.
"Few people are willing to listen to the professional terminology and therapies. When we go to Yajiang County of Gangzi Prefecture to do the training of cancer pain treatment, we don't have a big audiences there. If you rigidly convey professional terms to them, no work could be done there. "
The "we" mentioned by Jia Yuming, besides his own department members, also includes grass-roots "volunteers" for promoting the cancer pain care.
Deng Yan, a village doctor, met Jia Yuming at the NPC deputy's meeting with Health and Family Planning Commission of Cuiping District. Jia Yuming invited her to keep an eye on cancer pain care after learning that she had study experience in Yibin Health School and work experience in Junlian County Hospital. Deng Yan had the experience of being fussed at by patient's family and bitten by a dog when promoting the cancer pain care in Caiba Township. She persuaded patients to get morphine in the hospital and, knowing it was not available in hospitals around, Deng Yan drove the patient to a central hospital with morphine availability and followed up all the way until the it was delivered to the patient. In the past few years, 18 patients received the assistance from Deng Yan. Besides that, she passed the exam of Level Three counselor, the only one in her local area.
Ju Jiazhen, who set up the local model site of cancer pain control in Junlian County, established another model site at Zhongzang Hospital of Yajiang County. With the support of Yang Gang, the hospital director, she led the hospital staff to introduce the oral morphine-like drugs, morphine sustained-release tablets in particular. The effect of one tablet could last 12 hours and the drug can be prescribed for 15 days at a time. It saves quite a few hours walking for Tibetan people for narcotic drug prescription or dolantin which can only last for two hours.
Jia Yuming compared the promotion of cancer pain care to "Wechat Business": The role of an individual is not enough, "agents" are very necessary and their re-promotion is very important."
There was a time when Jia Yuming traveled by car to Yajiang County. Going through a tunnel, he saw the dotted lights in it. Sighing with emotion, he said: "It is very hard to promote cancer pain care in Yajiang County than to dig through the Erlangshan Tunnel. But once you see the beautiful scenery along the way, all the pains and difficulties are no longer that heavy. After all, it is a meritorious good deed." Perhaps, the cancer prevention should start with cancer pain care in the sparsely populated and relatively back-warded Tibetan area.
