True Caring and Our Medical Future from the Perspective of the Yugurs People

: Wilhelm Reich once said, "Advanced medical technology alone cannot save patients. Without studying the family and social conditions that cause the disease, and without helping patients eliminate external factors that cause the disease, patients cannot be cured." Famous medical anthropologist Dr. Kebowen also said that the impact of care on patients is enormous. And what I saw and heard in Sunan Autonomous County, Gansu Province confirms this viewpoint: Sunan County also has its own modern hospital, but patients have expressed that the medical experience is not good and are more willing to believe in the physical and mental interaction therapy of Mongolian medicine. Hospitals and the government both believe that they are doing their best to help patients, but in fact, what patients may want is not just technical and policy care, but spiritual comfort.


Introduction
With the advancement of technology, modern medical [1] technology has been highly developed.Compared to ancient times, we now have a large number of advanced medical devices, cutting-edge drugs, the most professional doctors, and a more convenient medical system in medical treatment [2].In theory, the medical experience of modern people should greatly surpass that of the past, but is this really the case?Have we made much progress in the fight against diseases compared to the past?If we only consider it from the perspective of science and technology, the answer is yes.But if it is from the patient's experience, this issue needs to be discussed.In fact, what comes with cutting-edge medical technology is only a greater focus on the disease, rather than on the patients themselves.Many patients have recovered physically, but their hearts are still riddled with wounds.That's why humanistic caring [3] is a very important topic in modern medicine.
The anthropology of caring provides an understanding of the range of behaviors, perceptions, and feelings associated with providing care for another person.Culture, a concept central to anthropology, comprises the implicit and explicit set of assumptions, behavioral guidelines, and interconnected beliefs that are shared by members of a society.Culture shapes both the experience of illness and that of giving care [4], and informs the ways that these roles are perceived by others.Illness behaviors are often linked to social factors, gender norms, ethnic factors, and politics, as well as differences in philosophies, cultures, and in socioeconomic status.[5] 2. The main battlefield on the modern medical search roadhospitals 2.1 Modern medicine

Introduction
Modern medicine, also known as mainstream medicine, is a general term for conventional healthcare based on the "Western model" of evidence-based practice for diagnosing and treating disease.Mainstream medicine assumes that all physiologic and pathological phenomena can be explained in concrete terms, and "best practice" is the end result of a stream of objective analyses which begin with nonhuman model systems, evolve through blinded studies and statistical analysis of those results, and end with guidelines to which doctors adhere to achieve optimal patient outcomes.[6]

The Thinking Mode of Doctors in Modern Medicine
Doctors under the modern medical system are people who have undergone modern medical education and training.They were instilled with rationality, rigor, objectivity, and the pursuit of scientific thinking from a young age, and grew up learning mathematics and scientific knowledge.Therefore, naturally, in their thinking system, doctors are people who use their scientific knowledge to save lives and heal wounds.Unlike the mysterious wizards of the past Middle Ages, doctors should advocate science and seek truth from facts in order to combat diseases.

The process of seeking medical treatment in modern medicine
In the modern medical system, when a patient goes to the hospital for treatment after falling ill, doctors often assist in the examination of modern medical equipment such as drawing blood and taking photos according to their condition requirements, and then provide further rehabilitation suggestions such as medication and injections based on the examination results.Due to the large size of modern hospitals, the number of doctors is often much smaller than the number of patients waiting for treatment.Therefore, during this process, patients also need to register and wait in line.As doctors receive a large number of patients every day, they do not care too much for each patient, often following the hospital's procedures.Even to exaggerate, rather than being treated by doctors, it is more like both doctors and patients completing their respective tasks -one is responsible for using scientific knowledge learned to combat diseases, and the other is responsible for cooperating with the other to implement the process.[7]

Introduction to Sunan County Hospital Background
The Sunan County People's Hospital, which we conducted interviews and research on, was founded in 1953 and is the only secondary comprehensive hospital in the county that integrates medical treatment, first aid, teaching, rehabilitation, and preventive health care.The hospital covers an area of 16400 square meters, with 129 beds and 14 primary clinical departments, 13 medical technology departments, and 10 functional departments.There are currently 123 employees.The annual outpatient volume is over 50000 people, with over 2600 patients admitted and over 600 surgical cases.In 2019, it passed the "Second Class A" hospital evaluation.[8-10]

The special system of Sunan County Hospital Background
Unlike hospitals in major cities in China, Sunan County Hospital still retains the medical system before China's reform and opening up -all financial revenue is handed over to the government, which then pays salaries to hospital public officials, and the hospital's personnel allocation is also arranged by the government.According to the dean, "This special system greatly reduces the workload of hospital staff, but also brings some drawbacks, such as the low work enthusiasm of doctors in Sunan County Hospital."Because it is completely monitored and deployed by the government, Sunan County Hospital often needs to accept inspection and supervision from upper government personnel, and often the hospital has to undergo some mandatory training, which leads to a shortage of doctors in the departments that should treat patients.[11][12] In addition to being fully supervised by the government, which often leads to doctors being busy with work outside of medical affairs, the fact that Sunan County Hospital is located in a small county town also leads to a shortage of doctors.The doctors trained under modern Chinese education are often among the most outstanding and hardworking in their academic performance.They have undergone multiple levels of selection and endured a long period of study to become doctors, so they naturally aspire to tertiary hospitals in big cities -with good conditions and high salaries.Small hospitals like Sunan County Hospital generally do not have young doctors willing to come.In addition, due to the small scale and low level of hospitals, even local residents of Sunan County are more inclined to seek medical treatment in nearby large city hospitals, especially in situations such as giving birth or undergoing major surgeries, while those who seek medical treatment in Sunan County hospitals are generally for daily illnesses.Therefore, Sunan County hospitals also tend to recruit general practitioners instead of doctors who are particularly proficient in a certain field, as this can meet the needs of patients with the minimum number of doctors.

Descriptions of patients and doctors from the Hospital's view
The dean of Sunan County Hospital is generally confident in the development of the hospital.He said, "Although the doctors in our hospital are not experts in a certain department, they are very versatile and can see any disease.Our hospital's equipment is also relatively advanced and the conditions are still very good.Nowadays, young people like to give birth to children in big cities, but the older generation still sees doctors in our hospital.Isn't it because our doctors are versatile and our hospital is convenient?"

Overview of Medical Insurance Policies in Sunan County
For Sunan County, the process and scope of government reimbursement of medical expenses are roughly as follows: Employers and employees are required to register at the insurance registration window in the service hall of the medical insurance center.According to the notification of the medical insurance center's audit results, the employer designates the handler to collect the registration form from the medical insurance center.The employer will fill out and stamp the registration form and basic information of insured personnel on a floppy disk, and establish personal insurance records.After being verified and stamped by the employer, the insured personnel roster will be sent to the medical insurance center for proofreading and revision, and a medical insurance card will be produced.At the same time, the medical insurance card production cost will be paid.[13] The maximum payment limit for basic medical insurance for urban and rural residents in ordinary outpatient clinics is 100 yuan per person per year.
Urban and rural residents who participate in insurance are admitted to designated medical institutions in the city, and the minimum payment standard for primary medical institutions is 150 yuan; The minimum payment standard for secondary medical institutions is 600 yuan; The minimum payment standard for tertiary medical institutions is 1200.[14][15] The annual maximum payment limit for basic medical insurance hospitalization for urban and rural residents has been increased from 50000 yuan to 80000 yuan.
The reimbursement proportion of drug expenses within the policy scope for outpatient drug security patients with hypertension and diabetes in urban and rural residents was adjusted to be 70% of the reimbursement proportion of ordinary outpatient services.[16]

Promotion of medical insurance policies in Sunan County
Compared to residents of first tier big cities, the cultural level of residents in Sunan County is not high, and their ideological concepts are more traditional.Moreover, due to the relatively backward local living standards, they lack sufficient understanding of the latest policy situation.The government of Sunan County has specifically increased its efforts to promote medical insurance policies among the public in response to the local situation.In addition, due to the large number of elderly people living in Sunan County, the government has specially increased the reimbursement amount and scope year by year to ensure that common and local characteristic diseases such as asthma and rheumatoid arthritis are taken into account as much as possible.
However, there are still some issues with the local medical insurance policy.Firstly, the low awareness rate of reimbursement policies is still very serious.Local residents often feel confused when faced with complex and cumbersome reimbursement rules and processes, and due to frequent changes in reimbursement policies, it is difficult for local residents to keep up with the latest policy changes.Secondly, although the government has gradually increased the scope of reimbursement and tried to reduce the medical burden on the people's lives, there are still many voices hoping that the government can continue to expand the scope of reimbursement for drugs and increase the amount of reimbursement.After all, for the elderly people in Sunan, whose children work in big cities and only receive a monthly pension, the cost of illness is really too high.

How do people from the Medical Insurance Bureau view the development of hospitals
We interviewed personnel working at the medical insurance bureau.The deputy director of the Medical Insurance Bureau said, "The information rate about medical insurance policies is indeed an unsolvable issue.We have done a lot of publicity work, including forwarding WeChat Moments, posting notices, and so on.However, when it comes to reimbursement, there are still many people who are unclear about the process and regulations... Residents are unable to receive reimbursement payments in a timely manner, and we are also very worried."Another deputy director also added, "This issue is like filling out a college entrance examination application.If it weren't for having children and going to college, no one would be willing to pay attention to such complex policy changes.If it weren't for family illness, no one would be willing to study these tedious reimbursement processes." In addition to issues related to reimbursement policies, the two deputy directors of the medical insurance bureau also discussed their views on Sunan County Hospital: There are many obstacles to the development of small hospitals in rural and county areas, because the economic development of Sunan County is too backward, and young people are unwilling to stay and want to work in first tier cities outside.As a result, the hospital does not have enough patients to support its operation, and the level of doctors becomes increasingly poor without exercise, which further leads to no one being willing to see doctors in Sunan County hospitals.

The Story of Lack of Caring --high incidence and causes of local diseases
When it comes to the characteristic diseases in the Sunan region, we have to mention bronchial asthma.Bronchial asthma is a heterogeneous disease characterized by chronic inflammation of the airways involving multiple cells and cellular components.This chronic inflammation is associated with airway hyper-responsiveness, typically resulting in widespread and variable reversible expiratory airflow limitations, leading to recurrent symptoms such as wheezing, shortness of breath, chest tightness, and/or coughing, with varying intensity over time.It often occurs and worsens at night and/or in the morning, and most patients can alleviate it on their own or through treatment.[17][18] Although bronchial asthma is a common disease worldwide, its incidence rate in Gansu Province (Sunan County) is significantly higher than that in other regions of China.It is speculated that this may be related to the local climate.There are often sandstorms in the local winter, and there are many small particles in the air that are harmful to the human body.In addition, Gansu Province (Sunan County) belongs to a high-altitude area and has relatively high requirements for human cardiovascular function.In addition to the above two points, there is also a very heartbreaking reason.Sunan County has a large grassland, and the local herders mainly rely on grazing for a living.The work of herding is very boring, leading to a large number of herders indulging in smoking to alleviate loneliness.The poet we interviewed, Teacher He, can smoke a full 6 packs of cigarettes a day at most.Such lifestyle habits also inevitably lead to lung damage.[19]

Exhausted to Seek Caring in Modern Medicine --The treatment process and difficulties encountered by patients through modern medical
For bronchial asthma, modern medicine generally adopts the methods of administering hormones and inhaling oxygen to solve it.
Glucocorticoids are currently the most effective anti-inflammatory drugs in the treatment of asthma, but the exact mechanism of action in the treatment of asthma is not fully understood.Its main effects include inhibiting the metabolism of arachidonic acid and reducing the synthesis of leukotrienes and prostaglandins; It also promotes the contraction of small blood vessels, increasing the tightness of their endothelium, and reducing vascular leakage; It inhibits the directed movement of inflammatory cells, activating and enhancing respiratory smooth muscle β's reactivity of receptors; It prevents cytokine production, inhibiting histamine decarboxylase and reducing the formation of histamine; It increases the number of PGE receptors, inhibiting the synthesis of acidic mucopolysaccharides in bronchial glands and reducing the release of plasma plasminogen activator and the secretion of elastase and collagenase.[19] Oxygen inhalation is used to correct hypoxia, increase arterial oxygen partial pressure and saturation levels, promote metabolism, and is one of the important methods for assisting in the treatment of various diseases.
The poet He we interviewed is a severe patient with bronchial asthma.He initially went to modern hospitals like many patients, hoping to be cured through modern medical methods such as medication and oxygen inhalation.
He said, "Every time an asthma attack occurs, I feel like I don't have enough breath, my heart is particularly uncomfortable, I have heart failure, and I can't walk.Then I have to go to the hospital to get oxygen, and my family can't help it.Because it often started suddenly and I didn't have time to go to the hospital, the doctor gave me a cardiotonic injection and gave me nitroglycerin......I remember one time I fell directly to the ground, feeling too late for a 120 dose, and finally took nitroglycerin directly." "The doctor knew that I used to graze on the grassland and had to write extensively, which made me addicted to smoking.So he called on me to quit smoking.But quitting smoking has led to a decline in my physical fitness and frequent colds." But the condition worsened time and time again, coupled with the lack of success in seeking medical treatment, Poet He had to travel between major cities, visiting many famous doctors and hospitals, and also trying various methods.
"Because of this disease, I have visited tertiary hospitals in Beijing, Lanzhou, and Hainan, and the doctors have said that it can only be controlled and cannot be cured.They prescribed me many medications, but none of them worked…… Later, I went to the hospital in Zhangye and prescribed a medicine called Hao Huisan, which was added with hormones.After taking this medicine, I slept well that night and breathed smoothly.But after cutting off this medicine, none of the other drugs worked……Oxygen inhalation also cannot be prolonged, as it can lead to dependency." "I still want to live!I don't want to die!"After pursuing modern scientific medical methods without success, Poet He turned to Mongolian medicine, particularly using the physical and mental interaction therapy in Mongolian medicine.
Mongolian medicine is a summary of the Mongolian people's long-term experience in fighting against diseases, and gradually formed by absorbing the experience of traditional Chinese medicine and Tibetan medicine.Mongolian medicine has multiple diagnostic and therapeutic methods.Mongolian medicine is similar to traditional Chinese medicine in that it is mainly composed of herbs and is made from the powder of various herbs.Traditional Chinese medicine is commonly used for treating diseases, and methods such as diet therapy, braising therapy, poultice therapy, sebotherapy, skin therapy, hot spring therapy, acupuncture and bloodletting therapy, and massage therapy are summarized.[20] The full name of Mongolian medicine interactive psychotherapy is "Mongolian medicine psychosomatic medicine overall health interactive therapy", which is a new medical model established based on the theory of Mongolian medicine psychosomatic medicine combined with modern psychological knowledge and technology.[21] Interactive psychotherapy takes psychotherapy as its main axis, assisted by health preservation therapy and drug therapy.In addition to treating physical and psychological diseases, the ultimate goal of interactive psychotherapy is to promote the beauty of human nature and create a perfect state of physical, mental, and moral health.This interactive model fundamentally changes the "single line" and "symptomatic" models of Western psychotherapy, adopting a "multi-dimensional" and "comprehensive conditioning" model, changing the monotonous and passive situation in general psychotherapy.By creating a positive, vivid, relaxed, happy, natural, harmonious, friendly, and warm treatment atmosphere, the treatment activities become more flexible and natural More active and dynamic.[22] Poet He said: "At the beginning, I felt that Mongolian medicine was useless, but the effect has been significant since the second time.We listen to classes every day, which has a hypnotic effect.Then, we do health exercises every morning and evening.The main thing is to massage acupoints and take deep breaths, which promote sleep.Once sleep is good, the immune system improves, and the disease naturally improves.In addition, Mongolian medicine pays attention to mood regulation, and should 'not be angry, not angry with others, and have no temper'." "Additionally, because the sanatorium where I visited Mongolian medicine is located in Hainan, where the altitude is low and the climate is warm and humid all year round.After going there, I didn't wear a mask and didn't feel any discomfort.I felt like the symptoms naturally disappeared, and I didn't have a single episode."

Patient's views on medical insurance policies
For medical insurance, He claims that the current medical insurance system is still quite satisfactory to patients.The procedures have become much easier than before, and there is no need for cumbersome documents such as invoices to prove it.You can directly submit the copies to the medical insurance bureau, report them first, and then approve them.Because bronchial asthma is a chronic disease, reimbursement accounts for a large proportion, and patients only need to pay around 800 yuan themselves.And now you can claim reimbursement with your medical insurance card, directly based on the amount of money spent on medical treatment, which is very convenient.

Conclusion
From doctors, government officials, and patients, three different perspectives on the medical and medical insurance issues in Sunan County reflect different positions and backgrounds, and people's perspectives on the problem are different.If we want to better help patients recover, doctors and the government should not only ensure the medical process and scientific technology, but also shift their perspectives and provide more spiritual care to patients.Patients should also seek the most suitable one for themselves.