sinh thuc phim chi biin sin tgi thj xi Lai Chiu nim 2005 - 2006, Chuyin di lit nghipp Chuyin khoa cip I.
Dgi hgc Y khoa Thii Nguyin, tr 46
5 Hd Thj Anh Ddo, Phgm Thanh Yin. Nguyin Khdnh Trdm vd CS (2000). Mdt si cdng trinh nghiin cuv vi dinh duung, an toin thgc phim. Nxb Y hgc. Hi Ndi.
6 Hd Thj Anh Ddo, Phgm Thanh Y i n , Nguyin Vdn
Lan, Nguyin Lan Phuang vd CS (2003). Tinh trgng vp sinh cua mdt sd logi thOc in cd nguy co d nhiim cao trin thi tnrdng Hi Npi nim 2003. Ky yiu hpi nghi khoa hgc vi ATVSTP - Cue ATVSTP nim 2005, tr. 214 - 219.
7. Hd Thj Anh Ddo, Phgm Thanh Tiln (2004). Thgc trgng an toin thuc phim d Vipt Nam. NXB Y hpc, Hd Ndi.
THIJC TRANG NHU cAu CH&M SdC SllTC KHOE N H A N D A N , BO D Q I VA MdT SO YEU TO ANH H O ^ G DEN CONG TAC DAM BAO Y T£ TAI CAC XA DAO THUdC OjA B A N Q U A N KHU 7 VA Q U A N KHU 9
T6M TAT
Nghiin cuu thuc trgng tinh hinh bio dim y ti tgi cic xi dio thudc dja bin quin khu 7 vi quin khu 9 eho thiy nhu ciu khim ehCra binh cua nhin din vi luc luvng vu tmng ngiy cing ting, edng tic vin chuyin bpnh nhin, cap cuv. tim kiim cuv ngn trin biin gip nhliu khd khin. Do xa dit liin. khoing cich giQ'a cic dio tir 1- 200 km Ty Ip hp nghio vi cpn nghio cao (10
•16.6%) Ngudn nhin lgc y li tgi 19 xi dio cdn thiiu, ch! cd 11/19 xiAhi trin ed bie sy; 16/19 xi cd y s9 sin nhi hope hp sinh tmng hgc, 40/90 thdn ip cd nhin viin y ti. Tmng, thiil bi khim bpnh edn thiiu, xuing cip nhanh do dd im vi dp mpn khdng khi eao. Cdng tic vp sinh phdng djch cdn nhliu yiu kim, cudc sdng eia ngw din vdi nhiiu thdi quen khdng tit anh hwdng din sue khoi ciJa ngwdi din dio li nhung thich thirc Idn dii vdi nginh Y ti tmng cdng tic dam bio y ti tgi khu vyc niy.
Tif khda: Ngudn nhin lgc, kit hgp quin din y, bio dam y te, xa dao.
SUMMARY
Study on current status of ensuring healthcare service In the island communes of military zone 7 and military zone 9 shows that: the demands on medical examination and tmatment of people and army forces am inemasing, the patient tmnsportation, emergency, seamh and rescue on the sea am difficult Due to far fmm inland, the distance between the islands fmm 1-200 km The rate of poor and near poor is high (10-16 6%) Health human msources in 19 island communes is lacking. There are doctors in 11/19 communes/towns, obstetric-pediatric assistant doctors or 2** degme midwives in 16/19 communes, health wori<ers in 40/90 villages. Equipment rapidly degrades by the high moistum and salinity In the air. That epidemic prevention work is still weak, the lives of fishermen with many bad habits affect the health of the islanders am major challenges to the health sector in health ensuranee in this area.
Keywords: Human resource, combination between army medical service and civil medical service, health ensuranee, island communes
DAT V A N Dfe
Tgi d c xd ddo thudc dja bdn Qudn khu 7 vd Qudn khu 9 d nhilu y l u t i anh hydng Idn den sire khde con ngydi vd hogt ding y t l . Cdc dao thudng nim d e h xa dat lien, diin tieh nhd, ddn so khdng ddng nhyng d vj tri xung yeu ve mgt quoc phdng - an ninh vd d t i m
PHAM Lg TUA'N, N G U Y I N CdNG SINH - Bp Yte L £ V A N B A O - Hgc vipn Quin y quan trpng v l kinh l l - xd h i i ciia cdc dja phyang. Ddi sing ngydi ddn trin ddo d n nhilu khd khdn, ty l i h i nghio d n eao, trinh d i ddn tri khdng ding diu, diiu ki$n sinh hogt ciia ngydi d i n r l l khd khdn. nhy thiiu nguin diin, nguin nydc s g d , dieu ki$n giao luu vdn hod cdn hgn chi...Khi hdu, Ihdi tilt khIc nghi$l, giao thing khing thudn Ipi, djch binh cd nguy ca xuat hi$n vd phdt triln. Cing tde tim kilm, ciru ngn, d p ciru vd v i n chuyin ngydi bj thyang, bj b§nh v l tuyin sau gdp rlit nhiiu k h i khdn vd t i n kdm nhat Id vdo miia mya bdo. Mdi khde, nhu d u chdm sdc su'c khoe nhdn dan vd lye lypng qudn d i i trdn dja bdn ngdy d n g cao trong khi chua phdt huy m i t d e h hi§u qua d c nguon lye hi$n ed eiia d ngdnh Y t l nhdn ddn vd nganh Qudn y
VI the, viic nghiin euu thye trgng nhu d u d d m sdc sire khoe eua nhdn ddn, lye lypng qudn d i i vd d e yiu t i anh hudng d i n d n g tde bao dam y te trin d e dao Id h i t sire d n thiet trong giai dogn hiin nay.
Mye tiiu eiia de tdi:
1- Dinh gii thuc trgng nhu ciu chim sdc sue khde nhin din, luc Iwgng quin dpi trin mpt sd dao thupc ^a bin Quin khu 7 vi Quin khu 9.
2- Phin tich mpt sd yiu ti inh hwdng din cdng tic bio dim y ti tgi cic xi dio thupc dja bin Quin khu 7 vi Quin khu 9.
Kit qud nghiin ci>u ciia de tai la ca sd xay dyng mi hinh t i chire hogt dOng KHQDY tgi cac xd dao, huyin dao phii hpp vdi dilu kipn thyc te hipn nay, nhdm ndng eao chit lypng d n g tdc chdm sdc va bao vg syc khoe nhin ddn, lye lypng qudn ddi tren cde tuyen dao thuie dja bdn Qudn khu 7 vd Qudn khu 9.
D 6 | T[f(?tiG VA PHU-aNG PHAP NGHIEN Cl/U 1. D l i t u v n g , dja d i l m vd thdi gian nghien ciru:
1.1. Doi tirgng nghiin cwu:
D l i typng nghiin eiru id hogt ding KHQDY vd d c y l u t l Snh hydng d i n cing tdc bao dam y t i eua y t i tuyin xd vd iyc lypng qudn y tren dja ban.
1.2. Dja diim nghiin ciru:
Nghiin eiru dupe tien hdnh tren todn bp 19 xd dao thuie dja bdn Qudn khu 7 vd Quan khu 9.
1.3. Thdn gian nghiin cd-u: Thdng 6/2010 den thdng 6/2011.
2. T h i l t k l nghidn cu-u: Thiet k l nghien d u Id mi Xi d l ngang k i t hpp h l i cuu.
3. Ky thu^t thu thgp thdng tin:
3.1. Hoi ci/u so lipu:
Thu thdp s i liiu v l cac ffieu kign t y nhien, kinh t l xa
Y HOC THirc HANH ( 8 1 0 ) - s d 3/2012
hii vd y le d i i vdi cdng tac KHQDY chdm sdc sire khde nhan dan va b i dpi tgi cdc xd dao thudc dia bdn Qudn khu 7 vd Qudn khu 9
3.2. Quan sit tr^c tiep:
Sir dyng Phieu khao sat dan vj qudn y trong 5 ndm (2005-2009)
3.3. Phdng van sau:
- Phdng v l n todn bp d n bO, nhdn vign cua 16 trgm y te xa, 4-5 cdn bp nhdn vi6n y t i a moi PKDKKV. Sd iLrpng doi typng trd Idi phong v l n : 92 ngydi.
- Tien hdnh phdng van dya vdo b i cdu hdi ed nhiiu npi dung, trong do ed cac yeu t i anh hudng din cdng tae eham sde sue khde nhdn ddn vd b i dpi vd trong ddp irng vdi ede llnh huong khan d p ,
KtT QUA NGHIEN Cl>U vA B A N LUAN 1. Nhu cdu cham sdc sire khoe nhdn ddn vd Iyc lupng quan dpi
1.1. Tinh hinh mac bpnh cua nhin dan:
Tinh binh qudn trong 5 ndm (2005-2009), s l lypt kham bgnh/trgm d Phu Quic Id cao nhlt vdi 2,931, thip nhat d Phu Quy vdi 2.014 lu-pl.
S i lupt din kham binh tgi cde trgm y t l xd d huy§n Phil Quy ed xu hydng giam di rd rit, Tinh binh qudn, moi trgm khdm khoang 2,000 ngudi/ndm nhung khing dong diu,
• Vdi cic PKDKKV: tgi An Thdi (Phii Quie), s i lupt khdm bgnh ndm 2005 Id 14.876 lypt, tdng dan qua d e nam vd len den 25.591 lypi vao nam 2009, trung binh Id 19.572 lupt/ndm, tgi Hdn Tre (Kien Hai), so lupt kham benh lang lu-ang irng tif 3.776 len 8,574 lupl, tmng binh Id 8 172 lypt/ndm, tgi Lgi San (Kidn Hai), s i lypt kham bgnh tang r i rgt han, tir 4.705 len 15.328 lypt, trung binh Id 11.536 lyp't/nam.
' Tgi huypn Cdn Dao:
Sd lypt khdm bgnh hdng ndm d Trung tam y t l quan dan y Cdn Dao dao dpng tir 12.000 d i n 14.000 lypi vd chu yeu la kham BHYT (11.000-13.000 lupl). So lupt cap cuu hdng nam khoang 20-30 lupl So binh nhdn chuyin vign binh quan khoang 20 ngydi/nam.
Ve ea d u binh d a ngu'di ddn den khdm bgnh 45- 50% la bgnh dydng hd hap, phoi, phe quan; 9-14% Id bgnh dydng tieu hda; 11-15% Id nhu'ng tjgnh tim m g d ; 2-3% Id cac bgnh phu khoa; 7-15% Id tai ngn, thu'ang tich,
1.2. Tmh hinh mac bpnh cua Iyc Iwgmg quan dpi:
Do lye lupng Hai quan Viing 5 ddng nhat ndn so lypi kham bdnh nhieu han so vdi Iyc Iu'png bp dpi dja phyang ciia ede tinh Ty Ig qudn nhdn mae bgnh phdi dieu tn npi Iru d d c bgnh xa. dpi dieu tn chi chiem 15- 20% s i khdm.
Ve ca d u bgnh, chii yeu la d e bgnh dydng hd hap tren (viem mui hpng, d m eiim...), mgt mdi. Ngodi ra d n mdt s6 binh khde nhy long ly, vidm p h i quan, vidm dg day, vidm ddy than kinh...
1.3. Tinh hinh djch bpnh:
' Cl huypn Phu Quy:
Trong giai dogn 2005-2009, tgi huygn Phu Quy khdng xay ra djch bgnh nao. M i l so bgnh truyen nhiem nhy ciim A, sit ret. sot xuat huyet, lieu chay chi xult
•li^n rai rde.
' Cf huypn Phu Quoc:
Bang 1. Tinh hinh djch bpnh d huyin Phu Quic (2005-2009)
Chl s i S6 vy djch Sd ngu'di mdc
Sfi tir vonq
N3m 2005
1 98 0
2006 0 0 0
2007 4 758
2 2008
1 95 1
2009 1 18 0 Djch binh d Phii Quic trong giai dogn 2005-2009 xay ra vdi 2 logi bgnh Id ciim (3 vy) vd s i t xult huylt (4 vy). Xd thudng xuyen xay ra djch binh nhit d Phii Quoc la xd Gdnh Ddu (3 vy trong 5 ndm) Cd 4 vy djch sot xuit huyit d Dyang Ddng, Gdnh D^u, Hdm Ninh, Hdn Tham diu vdo ndm 2007 vdi 758 ngu'di mSc vd trong dd ed2 l y vong.
B§nh sit xult huylt e i ty \p mIe cao d ede xd/lh|
trln. Du-ang Ddng, An Thdi, Gdnh Dau, Hdm Ninh, Hdn Tham.
' Cf dc xi dio cdn Igi:
Djch binh trong giai dogn 2005-2009 chl xay ra d 2 xa (An San vd Lgi San). Cdc logi bdnh cd djch Id eiim (2 vy, vdo cdc ndm 2005-2006) vd s i t xuat huyit (3 vy, vdo ndm 2007 vd 2009) B$nh sit rdt vln ein nhung so m i c rat it, nhilu ndm khdng cd binh nhan sot rdt
Do dde diem v i d|a ly, ddn s l tren d c dao il, Igi phan b i m$t dp thya. Ca sd hg tang kmh t i - xd h i i edn chua phdt triin, ddi sing nhdn ddn edn nhieu khd khan;
trinh d i ddn tri thap, ddi sing vdn hda tinh thin cin hgn ehl M|t dp ehudt gian, muii, ruoi eao. Vln de vg sinh mdi trydng, giai quyit d c chat thai sinh hogt chua d bign phdp hiiu qua, nguy ea i nhiem mdi trying tren ede dao Id hipn hO'u, nguy ca biing phdt cac djch bgnh dudng tieu hia, hd hap, truyen nhiem la rat eao. Do vgy d n g tdc tuyen truyen v i sinh phdng bpnh d n du-pc cac d p cac ngdnh quan tam vd ed biin phap hipu qua de khong ed djch binh biing phdt vd ldy lan.
1.4. Tinh hinh cap cd-u, c&u hp ciru ngn tgi khu vwc:
Cdng tdc ket hpp qudn ddn y d vung biin-dao, Iyc lypng hai quan va quan y Hai quan cd vj tri rat quan trpng. Cde to phau thugt ciia Hai quan tren dao phoi hpp vdi ede dpi phiu thugt ea dpng tren tdu eiia qudn y Hai quan da tgo thdnh mgng lu'di cuu chu'a lidn hodn tren bien theo tu-ng khu vyd. T i chirc cuu hp nhy tren dd tgo ea sd cho viic cuu hp, ciru ngn tren biln ngay d n g l i t han. Ndm 1991, khi xay ra vy tai ngn do nhd gidn dau khi 1, to cyy vdt tiep cgn ngn nhdn d i u tien mat 35 gid;
nam 1992 d p eiru ngn nhdn ehim tdu thdi gian tiep d n dau tien d n 25 gid, nam 1995, thdi gian tim kilm tiep cgn ngn nhdn dau lidn do chim tdu cdn 3,5 gid... Mgng lu'di quan ddn y cac dao xa bd dd ciru chira va cuu song hdng ngdn ngydi tren ddo vd bien, ciru sing nhieu ngu'di trong cde vy bao l i e tren biln, trong cac vy ehim tdu vd trii dgt...
Trong mua mua bdo, mpi hogt dpng tren bien deu bj hgn che, nhilu dpi ddiig to bat ngd trin biln gdy nhieu rui ro, thdm hpa cho ngudi vd cac phyang tiin hogt ding trdn biln. Cing tdc tiep t l y te, ciru hp, ciPU ngn va vgn ehuyin ngydi bj thyang, bj binh tir bien, dao vdo dat liin gdp rat nhieu khd khdn, nhilu khi khing thyc hipn dypc. Cd nhilu trydng hpp d p cwu. dde biit la d p eiru ngogi khoa, khdng d dieu kign can thipp phau thugt, phai vgn chuyen vao bd t i n rat nhieu thdi gian, de dpa din tinh mgng bpnh nhdn. Mgt khdc, trang thiet bj d p ciru trin tdu, thuyin r i t sa sdi hoac khing e i ; d c thuyin viin, dge bipt Id ngy ddn khing du'pc huan luygn
Y HOC THUC HANH (810) - S6 3/2012
dly dli v l y t l , ky thuit cii'u hd, ciru ngn, trong qud trinh tham gia tim kilm, ciru h i , eiru ngn r i t khd khdn, nhiiu khi tim kiem, vdt dupe nhyng khdng ciru dypc.
2. Mpt sd y l u t l dnh h y d n g d i n c i n g tdc bdo dam y td tgi cdc xa ddo t h u i e dja bdn Qudn khu 7 vd Qudn khu 9.
2.1. Diiu kipn tu^nhi^n:
2 1.1. Dpc diim vi diiu kipn dja ly vi giao thdng vpn tii inh hwdng din cdng tic bio dim y ti tgi cic xi dio:
' Dpc diim vi dja 1^: Cde huy§n ddo bao gim nhilu hdn ddo d e h xa nhau tir vdi trdm m i t d i n hdng trdm km Di§n tich cdc ddo khodng tir 1 km^ - Vdi trdm km, ldn nhlt Id ddo Phil Quie (593,1km'), khodng d e h giO'a cdc dao d i n dIt liin tir 1km d i n hdng trdm km, xa nhlt Id Cdn Ddo (deh Thdnh p h i vOng Tdu khodng 200km)
• Giao thdng vpn lii: Giao thing nii liin cdc xd ddo ehu y l u bing du'dng biln, thdi gian di tir dIt liin din d c ddo m i l khodng 1-10 gid, tuy nhiin ehi di Igi dupe khi gid dydi d p 5. Do vdy eing tdc d p ciru, vdn chuyin ngydi b$nh vd h i trp eho nhau v l y t l chii y i u bing phyang tiin tdu, thuyin ndn r i t khd khdn, dde biit Id miia mua bdo.
Hi$n tgi khu vyc ndy cd 2 dydng hdng khing nli vdi dIt liin: Tuyin thdnh p h i H i Chi Minh - Cdn Ddo vdi 2 ehuyin bay/ngdy, Cf Phu Quic cd sdn bay Duong Ddng dang khai thdc 2 chuyin/ngdy tuyin Rgeh Gid - Phii Quic vd 4 chuyln/ngdy tuyen thdnh p h i H i Chi Minh - Phil Quie. Mpt s i xd d sdn bay dd ehlln cho phdp mdy bay tn,re thdng hg ednh An Thdi, Gdnh Diu, T h i Chdu.
Day la dgc diem thudn Ipi eho viic vdn ehuyin ngydi bj thuang bj binh vypt tuyen khi cd yeu d u .
2 1 2. Dpc diim vi khi hiu, thdi tiit inh hwdng din cdng tic bio dim y ti tgi cic xa dio-
Nhin d u n g , khi hgu tgi khu vyc bien dao thuie dja bdn Quan khu 7 va Quan khu 9 theo c h l dd gid miia vdi hai miia rd rit: mCia mua va mua khd.
Miia mua keo dai tir thang 5 - thdng 11, dgc diem khi hdu Id ndng, am, khdng I n djnh. Day Id mua phdt trien ciia cac logi cdn trunq trung gian truyin binh nhu:
Sot ret, sot xuat huyin, sot md..vi vdy d n chii ^ phdng bpnh cac bpnh truyen nhiem trong thdi gian ndy. Trong miia mua cung thu'dng xay ra mya ddng, bdo, lie xody d n chii 9' d l phdng tai ngn Idt thuyin vd lyt l i i do mya ung kdo ddi gdy thiil hgi v l ngudi, trang bj, Ihuie men eiia d e ca sd y t l . Cdng tdc cii'u hd, cdu ngn trgn biln het sire khd khdn, d n du-pc sy quan ldm cua cde d p , eac ngdnh. Ngodi ra, v l miia mu'a bdo thudng cd cdc tdu thuyin d a ngy ddn ddnh b i t hai san trong khu vyc neo ddu trdnh bdo, v'\pc bao dam y t i eho so ngy ddn ndy eOng Id mit v l n d l c i n ddt ra d i i vdi y t l dja phuang, vi cdc d i i tupng ndy thydng ICr nai khdc d i n nen khd quan ly v l s l lupng d l i tupng phye vy vd djch bgnh cd the du-pc mang d i n tir nai khdc.
Lupng mua trong viing nhilu, khoang 2.000- 2.500mm/ndm. H i thdng ddo ldn cd sdng suii ehay thudng xuydn, luu vyc cdc suii trdn dao d i u n h i , d i d i e Idn, vi vdy kha ndng tgo d c b i n chda nude Id hgn ehl, mya rai xuing dao thudng thodt nhanh xuing ede ting Idp dydi sdu vd phln ldn Id chay ra bien. V i miia mua d n chii y hay xdy ra 10 quit rat nguy hilm, ein b i tri d c ca sd y t l e d d xa ddng ehay cua d e eon suii.
Miia khi bit diu tO' thdng 11 den thdng 4 nam sau, vdi dgc dilm khi hdu ndng, khd vd khdng I n djnh, giao thing
mCia ndy tuang d i i thudn Ipi nhung v l miia ndy rirng edy njng Id, d tranh vdng ra, sing suii cgn kigl, thieu nude ngpt vd thydng xult hiin d e djch b$nh v l dydng tiiu hda, binh ngodi da do nguin nyde bj i nhilm, d n &\ii y vp sinh nguin nude, dn uing hpp vp sinh.
2.2. Diiu kipn kinh ti - xi hpi:
* Phin logi kinh ti hP:
Bdng 2. PhSn logi kinh t i h i gia dinh eiia dja [jhygng .(2009) Don vj tinh: %
TT Khu vyc Ngh6o Huygn Phil Quy
Huygn Phu Quic
Cdcx9 ddo khdc
can ngh6o
55,1 _ 6 ^
Huy$n
can Bdo I 0,0 I 2,6 j 50,4 ' j 30,2 | 16,1 . a Phil Quy khing cd sy ehinh lich ldn v l kinh t l h i gia dinh giO'a d e xd. Trong khi dd, d Phii Quic, ty 1$ h i nghio vd d n nghdo cao d xd Hdn Tham (16,7%), Duang Ta (11,2%). O d c xd d n Igi, Tidn Hai d ty l i h i nghdo vd cdn nghio eao nhlt (10,0%).
Kinh t i h i gia dinh d trdn d c xd dao d i i y l u logi trung binh, ty l i h i nghio thip, h i d " nghio tyang dii eao. Tuy nhiin, t^n chit y dpc dilm Id ddn s i phln Idn d ven biln vd sing bing nghi di biln, tdi san Idn nhlt cua hp Id tdu thuyin vd phuang t i i n ddnh bit d nen rat d l nghdo hda do tai ngn ehim tdu.
* Nhi d, edng trinh vp sinh:
Nhilu dja phu'ang cd ty Ig nhd tgm cao nhy: Tho Chdu (92,0%), Gdnh D i u (70,0%), Lgi San (47,0%), H i n Tham (42,0%), huygn Cdn Dao (30,0%). Ty Ig khdng cd h i xi eao nhu': Bai Tham (75,0%), Hdn Tham (56,0%), Tidn Hai (50,0%), Lgi San (50,0%).
Phln Idn d e dao nhat la d e dao nhd chu-a d ho xi hpp vp sinh, ede hd gia dinh ngu ddn thydng d sat ven biln hodc trdn thuyin vd d n g trinh v i sinh tgm, d c chit thai thai tnj-c t i l p xuing biln n i n rat i nhilm khu vyc g i n bd. Ngodi ra, h l u h i t sing trong nhd tgm sdt biln, d d t hpp, d i am eao, nydc ngpt thieu ndn de phdt sinh b$nh dudng tidu hda vd da liiu.
* Ngudn dipn vi phuung tipn nghe nhin:
Nguin diin ehii y i u d khu vyc nghien d u diing mdy phdt nfen tinh trgng thilu di§n Id thirdng xuydn. Tj l | h i gia dinh khing d diin eao d m i t s l xa nhu: Ciia Cgn (29,0%), Hdm Ninh (29,0%), Cira Duang (20,0%), San Hai (15,0%).
Phu'ang ti$n nghe nhin chii y l u Id ti vi vd radio. Ddy Id phyang t i i n r i t thudn Ipi d l ndng eao dan tri trong cing tdc vp sinh phdng bpnh vd tir bd d c phong tyc tgp qydn Igc hdu d l t i l p c#n vdi d c ea sd y te trong vipc khdm chu'a binh eua nhdn dan.
* Mpt sd thdi quen cd anh hwdng khdng tdt din sue khde vi y ti:
- Chua cd ^ thirc xdy dyng h i xi hp gia dinh hpp vg sinh.
- Uing nyde khdng dun sdi, ngCi khdng mIe mdn.
- An thuy hai san tyai sing, goi.
- Chat thdi ciia d c ca sd san xult, che biln thiiy hai san ehya qua xir ly, chat thai sinh hogt cua nhd dan xa thang ra bien.
Y HOC THtfC HANH (810) - s 6 3/2012
- Chdn tha ring gia siic.
Vi vgy, <^ng tdc tuydn tryyin phing ching djch bgnh d n du'pe tiin hdnh thu'dng xuydn vd d n dupe sy quan tdm CLia eac t l chirc xa h i i d l thay doi hdnh vi, lii sing CLia nhan ddn khu vyc nay.
2.3. Carsd vpt chat vi nhin /(/c y ti cua khu v{rc:
2.3.1. Casdvpt chit:
' Ca sd hg ting cua trgm y ti xi:
Co sd hg ting d a cdc trgm y t l xa cy bdn dam bdo v l diin tich xdy dyng, s i phdng Idm vi$c, tuy nhiin ty' Id nhd c4p 4 d n cao d Phii Quy, Phii Quic. C i 02 PKDKKV mdi dirpc xdy dyng chuan (Hdn Tre vd Lgi San).
* Trang thiit bi y te cho cic xi:
Hau hit d c trgm y te xd dupe trang bj d c thilt bj khdm bpnh dan gian, b i dyng ey KHHGD, bdn san khoa, b i dyng cy dd de, giudng lyu bdnh nhdn theo qui i^nh. Cac trang bj d " ldm sdng, ehIn dodn hinh anh hlu hit khing cd, chi cd mdy sidu dm (4/19) logi trlng den dan gian. Die bipt nhilu ca sd thilu thiiu trang bj sa ehe, bao qudn thuie Ding y (3/19) vd trang bj khdm chuydn khoa Tai - Mui - Hpng (8/19), chuydn khoa Rdng Hdm Mgt (5/19) tgi d c xa dao.
'Thudc thiit yiu:
Mit so nhdm thuie h l u nhy c^ du d d e trgm y t i xa/PKDKKV d Phii Quoc: giam dau, hg sit; khdng sinh uing; thuoc dudng tidu hia. Trgm y t l xS Hdm Ninh thilu nhdm thuie dudng tieu hda; thilu thuie phye vy cho khdm chOta bpnh BHYT d 3 trgm (Hdm Ninh, Duang Ta, Cira Cgn). Trgm y t l xd Hdm Ninh, Cira Cgn vd PKDKKV An Thdi deu cd bdc si nhirng Igi khing d dii djch tmyen.
Cf trgm y t l cdc xa ddo khde d du mdt so nhdm thuie thdng thydng: giam dau. hg sot; khdng sinh uing;
thuoc dudng tieu hda, thuoc dung cho kham chu'a bgnh BHYT. PKDKKV Lgi San cdn thilu d j d tnjyen, khang sinh tiem, nhdm thule tim mgch, thin kinh; trgm y te xa San Hai thilu nhdm thuoc diiu trj bpnh ngodi da.
2.3 2. Tinh hinh nhan lgc y ti.
Trong so 3 trgm y t l xa d Phii Quy, cd 2 trgm d bde sT va 1 trgm khing d bac s7. 100% d c trgm deu d YS da khoa.
So lypng nhdn vien cua trgm y te d c xd diu dgt mii'C quy anh t i i thilu d a Bp Y te Id it nhlt 5 ngudi.
Tuy nhien, do khoi iu'png d n g vipc cua y t l xa nhieu, ndn cdn b i , nhdn vidn y te phdi kidm nhipm nhiiu vipc.
Trong s i 8 trgm y te xa d Phu Quoc (trtr PKDKKV An Thdi cd 20 d n bp nhan vidn, trong dd d 4 bac si), c6 6 trgm cd bdc sT vd 2 trgm khdng cd^ bdc sT (Cua Duong va Hdn Thorn); 100% d c trgm deu cd YS san nhi hogc hp sinh tmng hpe. 100% d c trgm deu d YS da khoa.
Huygn dao Kien Hai d 4 xd dao thi tgi 2 xa dd triln khai phing kham da khoa khu vyc Id Hin Tre vd Lgi San.
- Xa dao Nam du: Bien d l 06 NV: 02 y sy, 03 diiu dy&ng, 01 DSTH.
- Dao An San: Bien d e 07 nhan vien: 03 YSDK, 02 NHSTC, 01 DSTH, 01 dan s i ) . Qudn y d 02 y sy.
- Dao Hdn D i e (xa Tien Hai- Ha Tidn- Kien Giang) hiin d 4 nhan vien y t l : (02 YS, 01 DSTH, 01 y td).
Cdc xa ddo cdn Igi trong khu vyc g i m xS Hdn Ngh§
v^ San Hai thuie huypn Kiin Lyang vd xd Tien Hai thuie thj xa Hd Tien d i u trien khai trgm y te xa vdi Iyc Iwpng 4-6 ngydi.
B a n q 3. D d e d i e m n h d n I y c e i i a t r a m v t i x d TT
1
2
3 Khu v y c Huygn Phil Quy(n=3) - Trvng binh
HuyPn PhCi Q u i c (n=8) - Trung binh Cdc xd dSo khdc (n=5) - TrunQ binh
T6ng s6 CBYT
5,3
6,4
5,4 S i bdc s i
0.7
0.9
0 S i YSBK
2,0
3,6
2,8 SAYS
sSn nhi
0,7
0,4
0,6 HO Sinh
trung hi?c
1,0
0,9
0,8 Tuy nhidn, v i ea ciu trinh dp chuydn mdn thi chu-a ddm bao. T i t d cdc trgm ndy diu ehya d bdc si. Dde biit, trgm y t i xd San Hdi khdng ed y si sdn nhi ho$c hp sinh trung hpc.
• Tgi cic thdn, ip:
- Tgi Phu Qu9, mgng lydi y t i thin I p edn hgn ehl.
mdi dype triin khai d 3/4 thdn cua xa NgO Phyng vd 1/2 thdn cua xd Long Hai.
- Tgi Phil Quoc, mgng lydi y t i thin I p dd dype trien khai d hlu hit d c xd. Ridng 8 dao thuie xd T h i Chdu do diin tieh nhd n^n khdng ed y te thdn ban. Xa Gdnh D i u dja bdn ring, cd I p d d trung tdm xd 15km, dd d 3/3 thdn, I p cd nhan vidn y t l . Trong khi dd, xd Duang Ta cung d dja bdn ring, dan cy phdn bo khdng dong diu nhung mdi cd 1 (to) y t l I p d Suii Ldn.
- Tgi cde x i dao thudc Kien Lu-ang, Kidn Hai vd thj xa Ha Tien, mgng lu-di y t l thin ap dd dupe trien khai d cde xa An San, Lgi San, Nam Du vd Hin Nghg. Tuy nhien, d c xd Hdn Tre, San Hal va Tien Hai chua cd hd thong y t i thdn ap Dieu ndy da cd anh hydng ldn den hogt dpng y t i ciia xd
- Huypn Cdn Dao cd 10 khu ddn eu nhung khdng cd hp thong y t i eCia cde khu dan cu. Vipc thieu hyt Iyc lypng y te d khu dan cy se d anh hydng d i n kit qua thyc hign d e hogt dpng y te, dgc bigt Id thyc hipn cac chuang trinh yte.
'Ytetwnhin:
Hp thong y, dype tu nhan d tgi khu vyc bien dao chu-a thyc sy phat trien So lypng cdc ea sd hanh nghe y ty nhdn, du-pc tu nhdn it. chat lupng chya cao vd sy khdc biit ldn giiia eac xd. Quy m i hdnh nghe cdn nhd vdi s i lupng nhdn vien 1-3 ngu'di/ca sd. D i i vdi hdnh nghe du-pe tu nhan, ehu y l u Id d e quay thuoc tu- nhdn nhd, do d c dupe sT trung hpc dirng ten.
' Lye Iwgng quan y:
- Tgi huypn dao Phu Qu^:
Binh vidn QDY Phu Quy t l ehire theo md hinh BVDK tuyin huypn vdi tong s i d n b i nhan vien Id 48 ngudi. Qudn y hipn chi d 10 ngudi, trong d i c i 2 bde si (&S 1 bdc sT chuydn khoa 1 ngogi) d t h i trien khai 1 kip trung phiu thugt, vdi kha ndng phau thudt ehu y l u Id logi 2 vd logi 3. Trung binh mdi ndm phau thugt du-pe 100-110 ca.
- Tgi huyPn dio Phu Qudc:
4 xd/thj trln d Iyc lypng qudn y vdi trinh dp cao nhlt Id bdc sT, d e xa d n lgi, Iyc Iu'png qudn y trdn ^ a bdn chi ed trinh dp y td.
- Dpi dilu trj 78/Vung E Hai quan: d 60 ngudi (9 bde sT); d kha ndng thu dung 80 bpnh nhdn.
- Bpnh xd qudn y dao Tho Chu. cd 10 ngudi (3 bdc st), d the triln khai 1 kip tmng phau.
- Bpnh xd BCHQS huyin Phii Quie: Bien d e 15 d n
Y HOC THl/C HANH (810) - S6 3/2012
bp nhan vien chuydn mdn y, dupe (2 bdc sT), cd t h i triln khai 1 kip trung phiu vd XN mdu, nude tiiu (thudng quy).
- Cf huypn dio Cdn Dio:
Trung tdm y t l qudn ddn y huyin C i n Ddo: ed 50 can b i CNV, Ddn y: 46, Qudn y: 04; trong dd cd 6 bdc sy (ddn y: 4, qudn y: 2), 1 d y p e s9 dgi hpe.
- Tgi cic xi dio thudc huyin Kiin Luung, Kiin Hii vi thi xi Hi Tiin:
Cd 2/7 xd khdng ed lye lypng qudn y trdn dja bdn.
Cde xd ddo chya cd bdc sy, ehii y l u Id y s^ vd dilu dudng vidn.
Cdng tde kit hpp qudn ddn y dype phdt huy e i hiiu qua trong CSSK nhdn ddn vd lye lypng vQ trang trin cde ddo. Lye lupng qudn y ddng vai t r i quan trpng b i n cgnh y t i dja phyang trong eing tdc bdo ddm y t i khu vyc biln ddo vi d cdc ddo, nhlt Id ddo n h i ehf ed Iyc lypng qudn y Hai qudn vd Bidn phdng ndn cdng tdc d p ciPU dilu tri, ciru h i , cuu ngn trin biln eho nhdn ddn vd ngy ddn khu vyc ndy do qudn y bdo ddm, nhlt Id trong dilu ki$n thdi tilt x l u .
K S T LUAN
- Nhu cau khdm ehO'a binh eiia nhdn ddn tgi d e trgm y t l xd/PKDKKV ngdy d n g eao: s i lypt d i n khdm binh d xu hudng tdng; nhiiu xS, huy$n trong khu vyc nghidn ciru vln lu-u hdnh b$nh s i t rdt, s i t md, Idng ly;
djch b$nh Idn nhlt Id djch sit xult huylt.
• Dilu kiin ty nhiin, kinh t i xd h i i ea bdn d n nhilu khd khdn eho viie dam bdo y t l , hlu h i t cde ddo d xa dIt liin, khi hdu khie nghi§t, giao thing di lgi khd khdn.
Phln ldn d e xd dao khdng t h i vdn ehuyin b^nh nhdn v l tuyin sau khi thdi tilt xau. Cing tac vp sinh phdng binh cdn nhieu hgn che, nhilu thdi quen anh hu-dng x l u den mdi tru'dng, sdc khoi d a ngydi ddn chua dupe khdc phyc.
- Hg thong mgng ludi y t l : PKDKKV, trgm y t l , y t l thdn I p ca ban phii khip d d c dao Idn; d n g tdc bdo dam y te cho ngu' ddn song d d c ddo nhd, xa d I t liin vd ngu dan danh ca tren bien ggp rit nhilu khd khdn, Cdng tac tim kilm, cuu h i , cuu ngn, d p cu-u vd vgn chuyin tren biln ehua dap dng dupe yeu d u
- Ngudn nhan Iyc y t l , trang thiet bj y te, thuoc dam bao
cho d e trgm y t l , PKDKKV ca bdn d n thilu anh hudng din khd ndng md ring phgm vi eiru d & a khi d n thilt
- Cing tde k i t hpp qudn ddn y ddng vai t r i quan trpng trong eing tde bao ddm y t l khu vye biln dao.
KI^N NGHj:
1. C i n xdy dyng d l dn phdt triln y t l khu vye biln ddo cho phu hop. Chii y l u Id phdt triln h i thong ca sd y t l tgi c h l , xdy dyng ede trung tdm d p edu biin tgi cde khu vyc trpng dilm ven biin, thdnh ldp d c t l d p cuu ca dOng qudn ddn y, huln luyin eho d e thuyin viSn, ngy ddn ede k? thudt tim kilm, cdu hd cdu ngn vd hii sue d p cdu trdn bien d l ddp dng nhu d u CSSK nhdn ddn vd LLVT khu vyc biln dao.
2 Tdng cydng d n g tde k i t hpp qudn ddn y, ehil trpng phdt triln nguin nhdn Iyc y t l du s i lypng vd bao ddm v l chit lypng eho khu vyc biln ddo nhlt Id chuyin khoa ngogi vd sdn, nhi Tru-dc m i t d n ludn phidn edn b i y t i d i n d n g tde, nhlt Id bde s? ngogi khoa bdo dam dli 1 kip phiu thudt cdu ehda bydc d i u vd mdt phln chuyin khoa, d$c biit Id phiu thudt m l de vd m i ruit thira d p cdu tgt d e dao xa nhy T h i Chu, Nam Du...
3. D l y mgnh hogt ding truyin thdng-gido dye sue khde trong m i t s i llnh vyc: v i sinh mii tradng, phdng ching dich b§nh, d d m sdc sde khde sinh sdn.
4. B I sung trang thiit bj, thule thilt y i u dly dii theo danh myc qui djnh. Nghiin cdu tuli thp, trang bj y t i chuyin dyng eho khu vyc biln, dao d l d k l hogeh dam bao eho phii hpp.
T A I L l f U THAM K H A O
1. Ban qudn ddn y tinh Bd Rja-Vung Tdu (2010), Bio do dinh gii md hinh KHQDY huypn Cdn Dio
2. Ban qudn ddn y tinh Binh Thudn (2010), Bio do kit qui hogt dpng KHQDY giai dogn 2006-2010.
3. Ban qudn ddn y Qudn khu 7 (2011), Dja ly y ti quin sw Quin khu 7.
4. Ban qudn dan y tinh Kiin Giang (2009), Dja ly' y te quin sw tinh Kiin Giang.
5. Bd Y t l (2011), Bio do tdng kit edng tic thwc hipn Dw in Kit hop quin din y giai dogn 2006-2010, djnh hwdng nhipm vu giai dogn 2011-2015.
D A N H G I A KET QUA P H A U THUAT LONGO TRONG DIEU TRI BENH TRi
DAT V A N Dt
Phiu thudt Longo trong dilu trj tri Id d t vdng niim mgc, du'di nidm mgc tryc trdng trln dydng lype 3 cm nhdm kdo bui tn vd niim mgc trye trdng sa trd v l v| tri binh thudng, ding thdi cdt nguin mdu d i n bui tri do Antonio Longo, phiu thudt vidn ngydi V, thyc hiin t d ndm 1993.
Td thdng 4/1998 d i n 8/1998 Amaud vd cing sy [6]
da thyc hidn phiu thudt Longo cho 140 binh nhdn (td do 4 d 40 bpnh nhdn, d i 3 d 97, d i 2 d 2 binh nhin) kit lugn diing mdy an todn, hiiu qua, nhanh, it biln chdng sau mo vd it dau.
Tgi binh viin Vi$t Dde dd d d l tdi nghidn cdu v l dng dyng ky thu§t Longo vdi thdi gian ddnh gid k i t qud xa nhat Id 28 thdng [1], d i tdi so sdnh k i t qua Longo vdi kit qua ciia d c phau thuit d t trT khdc thdi gian khdm Igi xa nhat 12 thdng [2]. Tuy nhiin, ehya d de tai ndo nghien edu vdi k i t qua vd thdi gian xa han.
TRjNH H 6 N G S O N , N G U Y I N T H A N H QUANG Vi v§y, mye d i d d a nghiin d u ndy nhim ddnh gia kit qua cCia phiu thudt Longo vdi thdi gian xa han vdi mit s i d$c dilm Idm sdng ciia d c bgnh nhdn ndy, vdi ky thudt m l theo 8 bude dd dupe chuln hda [8].
D 6 | T U V N G V A PHUONG P H A P N G H I E N CLTU 1. D l i t u v n g : 90 binh nhdn dypc chan dodn tri vd m i theo phyang phdp Longo tgi bgnh vign Vipt Dire do Bs Trjnh Hing San thyc hipn thdi gian t d 21/07/2005 d i n 19/03/2010 vdi d c tieu chuln: bpnh nhdn thupc mpi Ida tuii; binh tiT dd 2 cd biln chyng, dp 3 vd d i 4 d kdm trT t i c mgeh, nirt k§ hgu mdn, polyp hgu mon vd da thda; khing c i dp xe hdu mdn. ro h§u mdn, vidm trye trdng k i m theo. Khing dya vdo nghiin edu d c binh nhdn do d c phiu thudt viin khdc mo.
2. Phuang phdp: tien edu md ta.
3. Cdc c h ! tieu nghien ciru: Cde binh nhdn trong nhim nghien edu dypc chin dodn tryde mo: tiT nii, ngogi d chl djnh phiu thugt Longo. T i t d bpnh nhdn
