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10 тема англ
10 тема англ
Under conditions of medical reforms in Russia, medical students should know how to
organize rural public health and workers’ training.
The main task of rural public health is the complete satisfaction of the villagers` necessities
with the highly qualified health care.
Health care to rural population in Russia is founded on the same organizational principals
like to urban one:
unity of medical and preventive arrangements;
guarantee of free health care;
continuity of health care (out-patient and in-patient);
district-territorial principle of service;
specialization and integration of the health care;
special attention to social important groups of population (children, women,
working population).
But there are differences between rural and urban areas which are determined with the
whole series of the factors:
Social-economic conditions;
Specific agricultural labor and living conditions in the countryside;
Transportation and road condition within the rural area, etc.;
Settling nature and service radius of the villagers;
Medico-demographic peculiarities;
Sex and age structure peculiarities;
Degree of the demographic density;
Morbidity and invalidity state;
Way of life;
Natural conditions;
Development of the infrastructures in the whole and separately of health facilities.
These factors leave traces on the medical aid nature (its volume and quality) for
villagers and demand the special organizational forms and work methods from public health
bodies.
So, the settling nature, the small compactness, the remoteness of the villages from each
other, the distance of the nearest medico-preventive establishment render the significant
influence on the medico-preventive aid availability and make for the low level of the
morbidity( in according with the visits).
The significant part of the village pensioners live alone and need in the care.
The number of chronic diseases increased.
It`s very difficult to provide the qualitative dispensary observation in the countryside.
The insufficient availability of the secondary and tertiary medico-preventive aid, the
inopportune diagnostic and treatment and in- regular dispensary observation promotes the high
level of invalidity.
The specific character of agriculture labor makes for the necessity of moveable medical
help forms.
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The main peculiarity of the medical help organizing to rural population is the stage
character.
STAGES OF HEALTH CARE RENDERING
TO RURAL POPULATION:
I stage – rural medical division:
Premedical care
Primary medical care: therapeutic, pediatric, surgical, obstetric and gynecological,
stomatological.
II stage – rayon medical establishments (municipal level):
specialized medical care
Primary care to rayon city citizens and nearby villages.
III stages – oblast (kray, okrug, and republic) medical establishments (level of subject
of Russian Federation):
Narrow-specialized care.
I STAGE
PRIMARY CARE
RURAL MEDICAL DIVISION
Divisional Feldsher and Ambulatory Centre of
hospital obstetric post general practice
Diagnostic and treatment of patients with the most spreading diseases (till recovery or
complete compensation);
Treatment after receiving other kinds of aid;
Patients’ need of special reference;
To carry out preventive arrangements;
Dispensary observation of patients with goals before nosologic diagnostics and medical-
social prophylaxis;
Rendering urgent and emergency aid.
The rural medical division (RMD) is a primary medical section in the establishments`
system providing health care to rural population. RMD consists of:
Divisional hospital (inpatient department) including
Feldsher and obstetric post (premedical care) and
Ambulatory (outpatient clinic) (outpatient care) or
Centre of general practice.
Tasks of RMD:
1) rendering of medico-preventive aid to population;
2) anti epidemical work;
3) protection of mother and children health (nursing pregnant women, delivering child
when normal pregnancy, dynamic observation of children and juveniles);
4) sanitary inspectors of the territory, economic objects, educational establishments;
5) analysis of population health;
6) hygienic education of population.
Ch ie f d o c to r
X-ro o m a n d
Clinical F u n c tio n a l
P h y s io - u ltra s o n ic
laboratory th e ra p y ro o m
d ia g n o s tic
d ia g n o s tic
ro o m
ro o m
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FOP: functions
1) premedical care (about 60%);
2) carrying-out doctor’s prescriptions;
3) children and pregnant women nursing;
4) dispensary observation;
5) measures to increase infant and maternity death rate;
6) sanitary-hygienic education of population.
AMBULATORY (like independent facility) is like a small urban polyclinic with the
similar structure and functions. They provide:
early detection of diseases and risk factors;
timely patients` treatment in an outpatient clinic and at home;
selection of persons who needs dispensary observation, their timely examination,
treatment and rehabilitation;
organizing emergency aid;
temporal disability examination;
dispensary observation of women and children;
realizing consultations in doctor`s assistant and obstetric points;
sanitary and anti epidemic measures;
referral for advice to district medical establishments;
Patient referral for medico-social examination in case of the stable disability.
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AMBULATORY: staff
Therapeutist
Pediatrician
or family doctor
Stomatologist
Obstetrician-gynecologist
AMBULATORY: structure
Rooms of doctors (therapeutist, pediatrician, stomatologist, obstetrician-gynecologist)
Physiotherapy room
Clinical laboratory
X - room
Registry
Functional diagnostics room.
II STAGE
II STAGE
SPECIALIZED CARE
Rayon medical establishments
(Municipal level)
Central rayon hospital
Rayon (city) hospital
Pediatric rayon (city) hospital
Maternity hospital
Woman consultation
Rayon (city) dispensaries
Rayon (city) medical centers
Emergency station
Blood transfusion station
The main medico-preventive establishment of the second stage is a central rayon hospital
(CRH). The CDH is the centre of qualified and specialized medical care. Simultaneously it`s the
administration body and the centre of organizational-methodical and operative management with
all health establishments in rayon.
CRH: STRUCTURE
Administration;
Economical section;
Inpatient ( specialized) departments (7-8 profiles minimum):
- Therapeutic
- Surgical
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- Pediatric
- Obstetric
- Gynecological
- Neurological
- Infectious
- Traumatological and other.
Outpatient (polyclinic) department (15-17 specialists) with medico-diagnostic rooms and
laboratories;
subsidiary structural subdivisions:
- medical archive;
- informational-analytical subdivision;
- pathologic-anatomical department;
- emergency and urgent care departments;
- additional diagnostic departments.
III STAGE
Narrow-specialized medical care
Oblast (kray, okrug and republic) medical establishments
(level of subject of Russian Federation)
Oblast (kray, okrug and republic) hospitals
Oblast (kray, okrug and republic) Pediatric hospitals
Oblast (kray, okrug and republic) Maternity hospital
Dispensaries (oblast, kray, okrug and republic)
Specialized centers (oblast, kray, okrug and republic)
Blood transfusion stations (oblast, kray, okrug and republic)
Hospitals of veterans of wars (oblast, kray, okrug and republic)
Basic establishment of third stage is oblast (kray, okrug and republic) hospital. These
health facilities are scientific-organizational, methodical and educative centers of rural public
health in the subjects of RF. They provide narrow- specialized care to rural population.
Basic tasks of oblast (kray) hospital:
1) narrow-specialized inpatient and consultative outpatient care;
2) emergency and planned consultative care;
3) introduction of advanced diagnostic methods and treatment in medical practice;
4) improvement of medical staff professional skill;
5) analysis of work of all health facilities in the subject of RF;
6) improvement of quality of medical care to population in the subject of RF;
7) research work.
Inpatient departments:
- Reception unit
- Therapeutic departments
- Surgical departments
- Operative unit
Medical-diagnostic subdivisions:
- Laboratory
- Diagnostic centre
- Physiotherapeutic department
- Morgue.