Sun Lien has a lot to learn, but this kind of endemic disease and chronic disease with hidden onset generally does not belong to the scope of emergency learning and treatment.

"You have to take advantage of the fact that you are young and have a good brain, learn a little more, and memorize a little more. Director Huang Wenhui patted Sun Lien's back, because of the height difference, it was a little difficult to pat his shoulder. "Dean Song has said that you will be the one who will go to the diagnostic center to carry the burden in the future. While you can still learn now, you need to learn more. ”

Emergency physicians don't need to learn much about chronic and endemic diseases, but diagnosticians do. For a doctor who specializes in diagnosis, learning as much as possible can not only make his work easier, but also grasp the patient's condition as soon as possible - many chronic diseases can become extremely dangerous if they occur in the same patient with other diseases.

If Sun Lien wants to be qualified for a position as a "diagnostician" in the future, long-term and comprehensive self-learning is very important.

"Okay, hurry up and get to work, there are still half the villagers waiting to see a doctor. Director Huang just "praised" Sun Lien, and then urged him to act quickly, "You go to the village committee first, and I'll come over immediately." ”

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"Fluorosis?" Dr. Pascal and Brune sat on a bench next to the village council, smoking pipes in their hands. If he didn't look at the building behind the two of them, which is very "modern Chinese countryside", he would think that he saw a small village in Western Europe. After the two learned of Sun Lien and Director Huang's diagnosis, the two Americans first glanced at each other, and then began to sigh together, "Why didn't we think of it!"

Fluorosis is not a "endemic disease" endemic to China, it actually exists in many countries and regions. There are epidemics of fluorosis in the United States, the United Kingdom, France and other places. However, the main cause of their disease is the excessive fluoride contained in groundwater, which can lead to poisoning. After the widespread availability of tap water, most of the fluorosis disappeared, at least in developed countries.

The main pathopathy of coal-fired fluorosis is briquettes made from fluorine-laden soil in open stoves, and fluoride-containing fumes contaminate food and air. Tea-drinking fluorosis is caused by drinking a large amount of brick tea and side tea made from old leaves and tea stems. And these two channels of poisoning are not widespread abroad. Drinking water fluorosis, on the other hand, has an obvious symptom that cannot be ignored - dental fluorosis. Because of the natural "stability" of the drinking water source in the place of residence, patients with drinking water fluorosis will almost certainly consume large amounts of fluoride-rich water from infancy to adolescence. This fluoride is deposited in their teeth and forms a different but same cause of dental fluorosis.

But the situation in Guojia Village is noticeably different, as the water they drink contains high levels of fluoride, but it is below the "need to be careful" level. Because the total amount is insufficient, even with the fluoride loess mixed with pulverized coal and burned, the villagers' overall fluoride intake is still not enough to cause fluorosis. It is precisely because of this that in the past census, the local disease control personnel did not include Guojia Village in the list of "water improvement and fluoride reduction".

But that doesn't mean the villagers of Guojia are safe – they are actually on the verge of fluorosis. And the widespread consumption of brick tea and milk tea, which was restarted more than ten years ago, became the last straw that broke the camel's back.

Brick tea is a "brick" pressed out of ordinary tea after fermentation, and due to its unique flavor, there is no obvious difference between the taste of ordinary young leaf buds after fermentation and the taste of old leaf tea stems. Even in the color and brewing resistance of the tea soup, it is inferior to the old leaf tea stem. Therefore, many tea manufacturers will deliberately choose old leaves and tea stems with lower commercial value to make brick tea.

Occasional consumption of the tea brewed from this tea will not cause any harm to the human body. However, if you drink it for a long time and cook it in a "boiling" rather than "soaking" way, a large amount of fluorine will be precipitated from the tea, and it will work with coal burning and drinking water to cause fluorosis.

Thanks to the fact that it is common for tea to be mixed with raw goat's milk when drinking tea in Guojia Village, although this is also dangerous in various senses, after all, it prevents a large part of the villagers from drinking such milk tea on a daily basis. This is also a blessing in disguise.

What is a little frustrating is that there is no good treatment for skeletal fluorosis and dental fluorosis caused by fluorosis, whether it is a roving medical team or a tertiary hospital. The human body has a strong ability to excrete fluoride, and after stopping the excessive intake of fluoride, the patient's body is often able to excrete excess fluoride from the body on its own. But the damage already caused by fluorosis can't be corrected – skeletal fluorosis and dental fluorosis are both permanent damage. There is no cure for them, and these injuries can only be repaired by various means.

The free clinic in the afternoon went smoothly. An interim diagnostic team consisting of Dr. Sun Lien and Dr. Pascal and Dr. Brunn completed medical services for 23 ordinary villagers. Fortunately, none of these patients had fluorosis. Even other underlying diseases are rare – most of the villagers who need treatment come in the morning. In the afternoon, the medical services were mainly publicity and counseling - such as high blood pressure or diabetes and whether it could be cured by cold vegetables.

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"I thought you weren't coming back today. At seven o'clock in the evening, Sun Lien and two tired American experts appeared at the door of their villa. The three of them each carried a bucket of ten catties of raw goat's milk. The smell of milk is mixed with the smell of sheep's body, as if the simple herdsmen of the pastoral area have come to the city to visit distant relatives they have not seen for many years.

Wang Caifeng was preparing for the evening barbecue with Isabella at the door. In addition to the regular barbecue grills, they also specially invited the security guards and employees who stayed at the company to participate, and by the way, they set aside six open spaces for real bonfires.

Yes, a traditional bonfire that is placed directly on the ground and surrounded by refractory bricks. Although there is no fixed idea in China that roasting by a campfire is equivalent to a country vacation, it is always pleasant for everyone to get together in the cold night, roast and eat meat over the fire.

In order to enjoy the bonfire healthily and safely, Wang Caifeng also specially bought a batch of high-quality fruit firewood, according to the relevant laws, the burning of firewood is prohibited in Changning City, but the carton factory is not in the no-burn zone.

Of course, the efficiency and heat of firewood burning cannot be compared to charcoal, but a group of people gathered around a charcoal bonfire, listening to the crackling sound, chatting and drinking, the comfort of charcoal can never be compared. Sun Lien and the others came back just in time, just in time for the bonfire party to begin.

"Goat milk?" Hearing that Sun Lien and others came back with goat milk, Wang Caifeng was a little troubled. She has also drunk goat's milk, and she really can't get used to the smell of goat. And how to store these thirty catties of raw goat milk is a problem - after all, it is a gift from people to thank Xiaosun, and it is not good to throw it away like this. Wang Caifeng, a capable housewife, was in trouble for a while.

"Or else...... Let's make cheese. Isabella thought for a moment and made a suggestion, as a first-generation French immigrant who was relatively familiar with goat's milk. "I can make some dessert tonight......" she looked at a tired Pascal and smiled, "Stephen, you're here to help me." ”

Dr. Pascal glanced at his wife, then sighed helplessly, and then he turned to Sun Lien and said, "What am I talking about? These goat's milk should be given to other doctors!"