The rural doctor of Yunnan-Guizhou Sichuan survives the current situation is investigated The empty room of shell village is of common occurrence
The structure wears out and runs off greatly " Leave no successor " Technology poor reporter know, restrict the intersection of business income and meagre, the intersection of endowment insurance and the intersection of person who lack and factor while surveying and studying in Yunnan, Guizhou, Sichuan, the senilization day by day of the local rural structure of doctor's team, the young rural doctor runs off seriously, fall into the awkwardness of leaving no successor. At present, even " empty shell " has appeared in some administrative villages Clinic (station) ,It is unable to meet the local villager's demand for public health and basic medical care. The cadres and masses at the basic level call upon, if does not take measures in the steady rural doctor's team in time, optimize the structure of team, " bottom of the network " of the tertiary hygiene service network Will meet " People walk in the net and break " . The out-of-balance reporter of aging psychology of the structure knows while surveying and studying to cannot help but change one's profession in medicine of young village, at the outlying village hygiene station where some traffic inconvenient, economic conditions are bad, because the business income is meagre, the funds of the government are subsidized uncompletely, the personal livelihood is difficult to maintain, many rural doctors cannot help but change one's profession, it is serious to cause the brain drain. At present, stand fast at the rural doctor post, are mostly the old comrade above the age of 50. Come into Sichuan and reach the county at the hygiene station of monarch's dam village, two rural doctors' big photo heaves in sight: Liu Zhou and Liu GuangSheng. Liu Zhou is a head of the hygiene station, 53 years old this year, it is more than 20 years to work as rural doctors. He points to Liu GuangSheng's photo and says: "Two children of his are studying, mortgage of the house also wants more than 1000 yuan each month. The income of medicine of village is too low, he just left the clinic last month, went to Guangdong to work as a temporary labourer. I getting older, go out, work as a temporary labourer too. " Popular science Liu Lan, division chief of place of the department of public health of Kweichow Province says, rural veterinarian, the government will subsidize 250 yuan every month, much village medicine sighs with deep feeling, it is still not so good as handling livestock's disease handling somebody's disease. It is low to ensure, but the medical organization of higher level proposes the high requirement to respects such as their education, working qualification, service ability, work load,etc.. So, a lot a bit younger rural doctors, would all like to go out and work as a temporary labourer. "Medicine of village comes from peasants, they can do accounts most, work as a temporary labourer in the coastal area there is 2000 yuan every month at least. " In Yunnan Province, it is very serious to run off the phenomenon too. Field, county of Funing, fluffy the intersection of town and the intersection of wood and tall and erect the intersection of country and rich doctor Liu, clinic of village, say: "The price rise now, our monthly income is less than 1000 yuan on average, can only support oneself, a lot of people are unwilling to work as the rural doctor. " Fluffy the introduction in full bloom of the king of Deputy Secretary of Party Committee in the town according to the field, the former clinic village of bowl factory cures Yang Ming's good fortune, the application of submitting the resignation in March of this year, 4- 6 rural doctors resign every year to fluffy the town in the field. With a large number of loss of the young rural doctor, the senilization day by day of the rural structure of doctor's team, and the professional pride of the team begins to drop by a wide margin. "Twenty or thirty years ago, medicine of village is all intellectuals in the village like teacher working at a school run by the local people, all ' half a public person ', the social status is higher. " The department of public health of Sichuan Province defends Zhou Jun, vice section chief of place and says agriculturally, " during these years, the income of medicine of village has dropped, the undertaking is turned into making a living, professional pride is certainly in a greatly reduced state compared with what it used to be. " The remote post nobody shows any interest in " The empty shell village of empty medicine " The reporter of common occurrence finds, with the original rural doctor's senilization day by day while surveying and studying, new force because treatment bad and terms arduous so unwilling that the intersection of village and hygiene get, cause the rural doctor's team in the basic unit to leave no successor, some " blank villages of medicine of village " Appear repeatedly. The village of the intersection of Kweichow Province and Xifeng county 9 is only 32 kilometers from town to county town, there are clinics of 22 villages in all at present. As early as 2008 ago, after going out to work as a temporary labourer in several pieces of medicine of remote village clinic village, there are clinics of 5 villages in the whole township there are apparatus, house but not have a rural doctor, become " empty room of shell village " . 9 village town presidents of health clinics in towns and townships Gong Yongs tell reporters, the hospital has been all the time for medicine of village of recruiting of these clinics of 5 villages, as have medical the intersection of special secondary school and education, " recruit the intersection of village and medicine, must have the intersection of qualification and terms, doctor of assistant, newly " of national regulation standard of recruiting This requirement is carried and does not dare to carry. However, because the village clinic is located in remotely, there is little population, the business income is not high, nobody shows any interest in all the time. In April of this year, the hospital employed to medicine of two villages at last. "They both do not apply for a job voluntarily in this, one is to come to the commune hospital to apply to run the clinic, can't reach the condition; Another one is that the commune hospital in the town attacks the black clinic and practises medicine in the course illegally, a guy of illegal practice of medicine running into it. We have done much ideological work, they agree to look on as medicine of village. There are no persons yet so far in other 3 clinics. " The rural hygiene Zhou Jun, vice section chief of management office of department of public health in Sichuan Province says, though the whole province is advancing standardized construction in a more cost-effective manner, but meagre because of the rural doctor's income, in poor mountain area, minority area, " are there rooms unmanned" The phenomenon still exists. The reporter finds when Sichuan Yi Autonomous Prefecture of Liangshan Xide county, Zhaojue county and other places interview, some village clinics are set up in the sun-dried mud brick rooms of peasant households, medicine of village will not see the doctor, can only launch some medical treatment and health care work, most village have the intersection of village and clinic or " have the intersection of room and nobody " . The grandson, managing Vice County Magistrate of Zhaojue county says " the old doctor can not stay, it is even more difficult than to step on it to employ the young rural doctor even more in history. Qualified for assistant medical practitioner, hear, want, get rural commune hospital, come, come on, want the medical organization to the health clinics in towns and townships to work. " In addition, some rural doctors with relatively better technology, often enter the health clinics in towns and townships and work through the examination, this causes too " The empty room of shell village " Appearance. For example the intersection of pond and township, county of Hezhang, 3 the intersection of village and medicine admit to the health clinics in towns and townships last year, lead to the fact vacancy appears in the clinic of 3 villages, has not found the suitable person all the time so far. The academic ability collective " Aphasia " Technology " short leg " Know when remedying a reporter to survey and study urgently, because of attracting outstanding talents, the low, professional level of the education is limited, become a characteristic of rural structure of doctor's team too. What a engineering level of promoting them, have already become a key influencing the present rural function of doctor's team to give play to. Fluffy a king in full bloom of Deputy Secretary of Party Committee in the town to tell reporters in the field of Funing county that has ever worked as medicine of village, he has not always participated in training systematically from the high hygiene of Funing county duty after graduation from class, those knowledge studied by experience and before that all. In one year, participate in the professional training of a few days once in a while, often read the notification files of the health bureau. Congratulate and open and say bravely, the training of medicine of village now of Ministry of Health is not fixed in dragon's medicine of every village of deer of township of nest of deer of Kweichow Province, need to issue the index to come to commune hospital in the township and assign according to the training project that higher authorities appoint. "In the past three years, I participated in two training of practical technical training, practical technology popularization of Chinese medicine of clinical medicine, train place in county town, each two days such as training, the training method, in order to invite the old doctor or show CDs live, recommend some to direct against common pathology Practical technique,and correlated with theory knowledge. " He Kai brave,etc. for village medicine think generally? Shell bank source Qun lower Piao last ���� lackeys of � Rong Guo �� hoarse Bi consult midges sauced rectify to visit prostitutes to wait upon Guo cut off from emperor send the Chen Xian imperial families of Piao last �� trip after standing erect to chaff after colluding Piao Lead by Tong sole �� on � last ship if you can't cut out, is the Piao low to block heavy curtain inlay Hou cherry �ѧ� Tao of servant 1 lung lower mus of emperor Jia cut after shining to �Ҭ����� often after waving by �� bridges joyouses boundless and indistinct �ë� K �� wall � one of my darling Liang �� is fat and poor Piao lead the intersection of apple and �� assuare ��� sigh Mie throb with fear, admire Shang of Zhyuan musical sound Qun pay �� the third constellations contrary to �� to be poor The low car Piao leads the apple ��! Fragrant plant the intersection of Chen and the intersection of warbler and head of Piao entangle what �� dust joyous Piao it will be person who take off �� Pian's yellow Se ��'s tip center of ����'s moth It macerate if you can't escape from by �ѧ�, Piao be entangled to strong in to be smashed in error Ji �� Ke �� rhizome of chuanxiong rose noon for the �� s after lasting Jia to circles of �� Jias apt in order to bragging for the moths after lasting �� by Yu! ? Because in addition, are short of money, some province and city are not high to the enthusiasm of personnel training, also influence the quality of the rural doctor's team to promote directly. For example, the provincial finance in personnel training of the rural hygiene has been put into all the time it is zero in recent years in Kweichow Province, all rely on the national project, such as " the second cancer is sifted and checked " , " report of judging and information of coming down with infectious disease " Wait for country's special training project. And the adjacent province, invest 3 million yuan of Damien every year in Yunnan Province. Operate unstandardly and abuse the medical hidden danger of antibiotic and stress that obtains employment and has operating unstandardly, problem of stressing etc. of abusing antibiotic, medical hidden danger to the rural doctor, Yunnan, Guizhou, the intersection of Sichuan and three province launch a pilot project, advance rural hygiene serve, manage integratively, some areas have already made the preliminary effect. But because country and provincial health organ lack the implementation instruction of pertinence, the basic unit moves forward " Integrate " , the a bit high problem of providing and delivering smoothly etc. of insufficient, basic medicine price of motive force still exists puzzledly more in management. Operate improper medical ethics and lose reporter Fan and visit finding, the village clinic of Sichuan poverty-stricken area of Yunnan-Guizhou, practise medicine unstandardly, abuse antibiotic, haphazard infusion, hold in various degree " The great prescription " Wait for the question, a great deal of hidden dangers of infecting etc. that bury malpractice and disease. In the clinic of a village of river township of prestige county dual of the market of Zhaotong of Yunnan Province, set up the injection room, medicines room in the dark red brick house of three rooms of light respectively, but the aseptic operation of the injection room performs practically no function. Medical apparatuses such as the swab, alcohol, tweezers, scissors,etc. are put on three medical trays, a cobweb is just here " The aseptic district " Above, did not put several having garbage bin covered up at all on the ground nearby. And this kind of situation, more general in the rural clinic of a lot of that the reporter visited. Meanwhile, except clinic medical environment of village being bad, furthermore made people worry about, the mostly rural doctors that the reporter interviews are while treating patients, do not wear gauze mask, glove to contact with the patient directly, does not have any safeguard procedures, once the job infection takes place, the clinic may infect the source as twice. Medicine of many villages interviewed says, though the health bureau often sends the file and tells forbidden drug and apt allergic medicines, but the doctor of the rural health station abuses the phenomenon of antibiotic and remains incessant after repeated prohibition. A originally ordinary one catch a cold, take some common cold drug how often be better too, for being with instant effect making profits more, will give patient draw two penicillin, the intersection of three generations and medicine directly a few rural doctor. Grassroots' unreasonable using the medicine habit, has caused the abuse of antibiotic indirectly too. Kweichow Province Hezhang county flat for the intersection of mountain and village to cure bright red, say a lot of villager come on, diagnose the illness now bravely, demand to become effective fast, itching to have one injection on these should do the trick, think " expensive medicine " at the same time " good medicine " ,Demand, type better than penicillin antibiotic one after another, so as not to farm work of delaying, delay the condition " we advise the invalid words, can only write a prescription according to patient's demand " . Some areas " Integrate " The effect shows the reporter and interviews to know for the first time, the unlawful practice of practising medicine and presenting in the course to the rural doctor, three provinces in Yunnan-Guizhou Sichuan have been already villages and towns in some areas, the organization launches the village and integrates and manages the pilot project, in the charge of health clinics in towns and townships, respect of examining to the administration, business, medical instrument, financial affairs and performance of the clinic of every village etc. pays and standardizes management, have made some preliminary effects. The flat mountain area of Hezhang county of Bijie Prefecture of Kweichow Province begins to try to integrate and manage in the village from 2008. It is flat for president of mountain area commune hospital Jin Li to say, the masses reflected between every village clinic of the whole township at that time, " we start with standardizing the medicine price, and three respects of unified financial administration that it is normal to enter the medicine channel, unified business in unison if the price of medicines differs greatly, try integrated management " . In implementing specifically, medicines in the flat clinic of 10 villages of mountain area, are bought on behalf and provided and delivered by the commune hospital in the township in unison, clinic medicines enter account and prescription to record and offer to the commune hospital in the township per month, so as to guarantee to enter the medicine channel to unify, attack medicine of village and take the commission behavior, guarantee the quality of medicines at the same time; The commune hospital in the township organizes medicine of village to concentrate on and train per month, begin with simplest unified prescription form and case form to train, comment on each prescription medicines situation each other. Meanwhile, it is flat for the intersection of mountain area and every the intersection of village and clinic to need the intersection of prescription and form of last month, charge, register copy, shut the intersection of clinic and expense account evidence while being agricultural while being new will it be 1 every month, and including making a diagnosis, the business incomes of fee and medicines fee send to the health clinics in towns and townships and compile a register in unison, turn over every village the income to deduct and buy the profit after the fund of medicines on behalf, return medicine to the village as the remuneration according to 85%. Jin Li says, other 15% of the profits are retained a percentage of the total profits for the enterprise's own use in unison to manage by the health clinics in towns and townships, for the development of the public service of one grade of hygiene of the whole village, for example the apparatus changes, maintains etc. in the house, ensure the expense expenditure to be open and clear. In Chengdu Xinjin county, the locality pursues the countryside " family doctor " The system, set up the health file for villagers, the rural doctor mainly offers public services such as the prevention and health care,etc. to villager. The clinic of 40 villages participating in integrated management of the rural hygiene, the assets are all the financial input of the county, to the rural doctor's standard of 5 yuan for each person every year, provide for them subsidizing according to serving people. Meanwhile, utilize the information-based means, strengthen the supervision of the rural doctor. System lacks the county where the basic unit advances motive force to be fewer than integrated management of some pilot projects, medical organization of the township on the top floor, and the person in charge of village clinic reflects, because the country has not issued detailed and concrete operation implementation suggestion to the integrated management of village at present, basic unit, to implement integrated range and intensity of management, difficult to grasp, health clinics in towns and townships manage, increase work load but can't obtain actual income from it integratively, and the difficult problem exists in the strick precaution of medical risk and division of accident responsibility, lead to the fact it is comparatively difficult for this job to promote in the basic unit, need give from the system design of the upper strata clearly. First, it is guided in detail that the country is scarce, integrated management moves forward puzzledly more. President of Hezhang county of Kweichow Province commune hospital of pond township Li Yan says, Will the village clinic be implemented in the integrated management of village " Two lines of revenue and expenditure " , village cure how about release remuneration, how deal with integrated work load, increase sharply under the this line of situation that question define health clinics in towns and townships " want we how come on, promote, integrate health clinics in towns and townships? " Second, the village clinic is badly paid, the basic unit popularizes" integrates " Motive force is insufficient. The commune hospital of township of nest of deer of Kweichow Province Guiyang Xifeng county is in implementing integrated management, take over all incomes of medicine of village, and then release the remuneration according to the standard of 800 yuan for each person. President of township of deer's nest commune hospital Ban ChaoKai says, are badly paid the clinic business of the village, the clinic of 13 villages of the whole township all include in managing integratively, the income which the commune hospital took over from the village clinic, well below the remuneration that is released for medicine of village, " the commune hospital should all lose money, so the finance does not raise the village to cure the remuneration, it is unable to bring benefit to the health clinics in towns and townships to manage integratively, natural motive force is insufficient " . Third, the role of commune hospital is awkward, malpractice responsibility is divided into a difficult problem. Zhou Jun says, because most village clinics are the rural doctor's private investment, it is peasants that the village cures the identity, so the health clinics in towns and townships can not talk about the hard in management at all, there is only professional guidance. In addition, once the medical dispute takes place in the village clinic, even define in rules and regulations the village clinic undertake the medical risk by oneself, but is regarded as the direct management organization of the village clinic, in masses' eyes, the health clinics in towns and townships must be responsible. Basic medicine difficult to ensure rural doctor bring new anxiety in the integrated management of village, it is the key content of unifying clinic medical instrument management of the village to pursue the basic medicine system. Reporter know basic medicine implement, because basic medicine price on the high side providing and delivering loopholing, leading to the fact, giving medicining in time and handing over medicine to be the whole, more complaints store to this in to lead to the fact health clinics in towns and townships and village clinic, is unfavorable to unifying management of medicines and implementation of national basic medicine system. The price of basic medicine is a bit high, some medicines even exceed the past retail price. President of Hezhang county of Kweichow Province commune hospital of pond township Li Yan says, the similar medicines which the similar producer produced, price difference is too large before and after entering the basic medicine catalogue, in conformity with lotion of dragon's haemorrhoids such as the commonly used horse, implemented the basic medicine system in the past, retail prices were about 6 yuans, and after implementing the basic medicine system, reach 13.9 yuan with the medicines price of the dosage, has doubled. It says, the basic medicine passes the state fixed price to shut to director Ding YuanHua newly and agriculturally in Bijie Prefecture, province grade call for bid price that confirm, until medicines that development and reform committee stipulate sell highest price, compare, reduce to some extent really in the past overall price in unison, but compared with real price of medicines, basic unit generally reflect prices are a bit high, " specific medicines price with the type, even excessively more high than the past retail price " . The basic medicine is not provided and delivered in time, cause the rural health organ to face " lack medicines " Difficult problem. Many persons in charge of health clinics in towns and townships and medicine of village reflect, in the present basic medicine catalogue, many medicines provide and deliver difficult problems. Li Yan says, it is not complete that local medicines often chosen in the commune hospital provide and deliver the company because of medicines, unable to provide and deliver, and other area provide and deliver company out of the intersection of we and the intersection of amount of purchase and little, consideration high, without profit of freight charges, therefore refuse to deliver goods, " such as the compound licorice root slice, local medicines provide and deliver the companies to all reveal that is out of stock within the past one months, and other medicines provide and deliver Company to be also unwilling to hand over, this makes us have a headache very much " . Task badly paid with high risk to ensure the intersection of difference and rural doctor bear at the basic level important task that public health serve again. In recent years, the governments at all levels have increased the input into hardware of the village clinic, have strengthened training and management of the rural doctor, having raised the rural doctor's subsidy standard, the rural tertiary hygiene service network is complete gradually. But the reporter knows while surveying and studying in Yunnan, Guizhou, Sichuan, " bottom of the network " of the rural hygiene of poverty-stricken area Still is firm, the intersection of village and medicine face income to be weak medical treatment with high risk supporting parents, having problem of ensuring etc. still. The income is meagre, do public work eating the own meal Rural the intersection of doctor and source of revenue including medicines make a diagnosis income, public health serve equal to take project subsidize and finance subsidize 3 to the village clinic mainly. Relevant in recent years subsidizes the standard to promote to some extent, but a lot of rural doctors should still make a living by engaged in agricultural production, making the odd-job etc.. Yunnan Province the intersection of Fugong and county draw the intersection of horse and the intersection of bottom and the intersection of every village and medicine, pile before the Deng, such jobs as the service, disease preventing and cotrolling, mother and child care and birth control are propagated that the ones that are responsible for 1043 villagers of this village make a diagnosis, give the whole the intersection of village and children make one physical examination soon every 3 months, leave, want one more than week. However, the strenuous task has not brought the generous income to him. The reporter came to family which Deng Qian piled a few days ago, that was 3 bunkhouses built in accordance with the big rock by the highway, the roof has not been sealed firm, will irritate the wind on four sides. Besides a small television, there are only several bed bed clothes and several pieces of shabby furniture in the room. "Several years ago, the government subsidized 126 yuan per month, because of undertaking the propaganda work of birth control last year, subsidize, improve get 300 more than, make a diagnosis 3 or 4 one hundred of fee, only enough for whole family's reluctant life too. " Deng has piled and cannot help but said ago. This is only a epitome of the rural doctor's income of Yunnan-Guizhou Sichuan. Reporter's investigation finds, besides rural doctor that some medical technology is good, monthly incomes of rural doctors of three provinces of Yunnan-Guizhou Sichuan are mostly between 500 yuan and 800 yuan, some rural doctor's incomes are even lower than 500 yuan. "We are eating the own meal, doing publicking work. " It is flat for village villager's the Li 's to say after working as nine mountain range townships in the rural doctor's Sichuan for 41 years a thousand years, "teacher working at a school run by the local people, agricultural science and technology person, persons who list in the countryside ' six successively of livestock's veterinarian person ', accept government subsidize, but we can only by meagre to charge and support the family. It is not as good as the mud bricklayer to do medicine of village, originally wanted to resign last year, but thought of those villagers, horizontal lower heart! " The medical dispute, force medicine of a village leave As a rural doctor, should grasp rural common diseases, endemic diseases, as to general disease, can diagnose and suit the remedy to the case correctly; As to the comparatively critical patient, can diagnose tentatively, take the first aid measure correctly, and adopt the appropriate way to change the place of examination in time. However, restrict because of curing all sorts of objective factors such as skill level, medical condition, traffic communication, masses' cognition, rural medical disputes and malpractices take place high in recent years, the rural doctor is light and sustains economic losses, heavy and goes bankrupt. "As medicine of village is most afraid of meeting the medical dispute. " Every village of the water tide of pond township of Hezhang county of Kweichow Province cures me and remembers still having a lingering fear of last time refinedly. "That is that a person of penicillin presents the false and negative boy, finishes the skin and gives him infusion after trying, has never expected that the allergic response has appeared in half an hour, shock. Fortunately it is apt to deal with, the boy parents do not have Investigate but this make me eat nothing kind meal. If really present the accident, I can not be explanatory really. Only sustain economic losses, then must go bankrupt. " Commune hospital president's palace of village Town of Kweichow Province Xifeng county nine? It strain it take on last �� barium Tao ���� Yun so carry 3 squid frame rake pipits yellow stir according to greedy to wish � Quns unreal Ji of �� 1 table not to be lasted barium that pavilion of ancient wine vessel made of horn O inner feeling Shens outspokens Mei � is contrary to �� badly The string is stired according to wishing �� Chen �� in a difficult position to stir and cut open the deer to try quail Wei � greedily to engrave on gold or silver ��, Qiong of milk, comb the intersection of �� and gray the intersection of �� and the intersection of Qun and the intersection of reef and �� silk ���ҩ� The Jing Yu refined Xie �� wood � of the small clam �� octogenarian �� rapid government? Reporter investigation find environment bad having auxiliary monitoring device reason because of the intersection of professional ability and bad, operation, the rural doctor's operation risk is really high. The reporter has collected the prescription that some village medicine opens in the interview, find after the medical expert examine, a lot of really exist, initiate the medical risk easily. Has not always raised, the livelihood becomes the secret worry in the future Reporter find except that income meagre and medical treatment have a big risk, whom rural doctor afraid most to very raise survey and study. The Luo 's of medicine of every village of going straight said before the long township that the 42 -year-old Xifeng county of Kweichow Province flowed, it is calculated that retired with 60 years old, he still can practise medicine for 18 years. Join now to assuare newly and agriculturally, can only receive the pension of 110 yuan each month. "Depend on money this, even to have a meal is enough, retired to support parents, perplex thing that we have a headache most. The village cures the treatment low and ensuring little, though I carry on parent's cause, will not allow my son to look on as medicine of village again in the future, would rather let him go out, work as a temporary labourer than better as medicine of village too. " "The rural doctor's problem of supporting parents the reason why delays solving, it is still the identity question after all. " Zhou Jun says, after new China is established, the vast rural shortage of medical services and medicines, so many regular doctors handle peasant's disease, the method at that time was trained half agricultural, half and is cured " Barefoot doctor " . The rural doctor has made indelible historical contribution in order to solve the rural problem which is short of few medicines of medicine, but with the development of economics and society, it is outstanding day by day that the team that this property is fuzzy faces the problem. "Present rural doctor with in the past totally getting the same. Medicine half agricultural, half in the past, rural the intersection of doctor and 90% time make doctor now, launch the public service, it is unable to accumulate and solve the problem of supporting parents through one's own agriculture. " Popular science Liu Lan, division chief of place of the department of public health of Kweichow Province says. The hygiene system staff members at the basic level of Yunnan-Guizhou Sichuan generally reflect, according to the present state, most village medicine is very difficult to devote all heart and soul to in fact while offering medical treatment preventing from, health care service for villager. Not settling the worry of medicine of village well, the team is difficult to stabilize, even may become a factor which influence the local stability. Reporter Ye JianPing Li JinFeng Ji ZhePeng Round-up report
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