China’s barefoot doctors

Chinese barefoot doctor uses her needles to treat a production brigade worker

Chinese barefoot doctor uses her needles to treat a production brigade worker

Barefoot doctors (Chinese: 赤脚医生; pinyin: chìjiǎo yīshēng) are farmers who received minimal basic medical and paramedical training and worked in rural villages in the People’s Republic of China. Their purpose was to bring health care to rural areas where urban-trained doctors would not settle. They promoted basic hygiene, preventive health care, and family planning and treated common illnesses. The name comes from southern farmers, who would often work barefoot in the rice paddies.

In the 1930s, the Rural Reconstruction Movement had pioneered village health workers trained in basic health as part of a coordinated system, and there had been provincial experiments after 1949, but after Mao Zedong’s healthcare speech in 1965 the concept was developed and institutionalised. In his speech, Mao Zedong criticised the urban bias of the medical system of the time, and called for a system with greater focus on the well being of the rural population. China’s health policy changed quickly after this speech and in 1968, the barefoot doctors program became integrated into national policy. These programs were called “rural cooperative medical systems” (RCMS) and strove to include community participation with the rural provision of health services. Barefoot doctors became a part of the Cultural Revolution, which also radically diminished the influence of the Weishengbu, China’s health ministry, which was dominated by Western-trained doctors.

Training

The barefoot doctors usually graduated from secondary school and then received about six months of training at a county or community hospital, though training length varied from a few months to one and a half years. Training was focused on epidemic disease prevention, curing simple ailments that were common in the specific area, and were trained to use Western medicines and techniques. An important part of the Cultural Revolution was the movement of sending intellectuals, and in this case doctors, to serve in the countryside (Chinese: 下鄉; pinyin: xìa xiāng). They would live in an area for half a year to a year and continue the education of the barefoot doctors. About a fifth of the barefoot doctors later entered medical school.

Work

Barefoot doctors acted as a primary health-care provider at the grass-roots level. They were given a set of medicines, both Western and Chinese, that they would dispense. Often they grew their own herbs in the backyard. As Mao had called for, they tried to integrate both Western and Chinese medicine, like acupuncture and moxibustion. An important feature was that they were still involved in farm work, often spending as much as 50% of their time on this – this meant that the rural farmers perceived them as peers and respected their advice more. They were integrated into a system where they could refer seriously ill people to township and county hospitals.

Barefoot doctors provided mostly primary health care services, and focused on prevention rather than treatment. They provided immunisations, delivery for pregnant women, and improvement of sanitation. The income of the barefoot doctors was calculated as if it were agricultural work; they were paid roughly half of what a classically trained doctor made. This funding came from collective welfare funds as well as from local farmer contributions (from 0.5% to 2% of their annual incomes). This program was successful in part because the doctors were selected and paid by their own villages. By the 1960s, there were RCMS programs in 90% of China’s rural villages.

The work of the barefoot doctors effectively reduced health care costs in the People’s Republic of China, and provided primary care treatment to the rural farming population. The World Health Organization regarded RCMS as a “successful example of solving shortages or medical services in rural areas”. Because of barefoot doctors providing primary health care so that basic health care is an affordable cost and give China’s entrance into the United Nations (UN) and WHO. Moreover, this also represents that some certain diseases in poor countries can be solved but just need adequate technological solution. (me: ‘…certain diseases in poor countries can be solved by just having an adequate technological solution’?)

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The above sentence ‘Barefoot doctors became a part of the Cultural Revolution, which also radically diminished the influence of the Weishengbu, China’s health ministry, which was dominated by Western-trained doctors’ is noteworthy, pointing to the potential of an ethic oriented towards the society rather than towards the individual, and motives of profit and power.

How might the philosophy and experience of China’s barefoot doctors be applied to the problem not only of health care in capitalist Australia generally, but particularly to that in rural Australia?

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10 thoughts on “China’s barefoot doctors

  1. wow, interesting that Mao was concerned about the health and well being of farmers since the estimates of the numbers of peasants he purposively starved to death range from 40 to 55 MILLION. Maybe he realized he’d indulged in over-kill (while the graineries were full, people died eating mud and leaves off trees) and had to do something to protect the remnants of the rural population he hadn’t knocked off so that the factory workers (producing worthless ‘steel’ which was done all over the country) would have something to eat.
    Good Morning, Filipo!

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    • Good morning to you too, Austin, and thanks for expressing your view.

      I should first reply directly to your comment.

      There has been enormous loss of life and immense suffering as a result of government policies in both the Soviet Union and China.

      This loss of life and suffering are used in capitalist nations as justifications for ‘sticking with’ capitalism – ‘capitalism good/communism bad’ – or most simply, ‘communism bad’. The message is as crude as that.

      It completely discounts both the histories of those countries (profound, widespread poverty) and the fact, recognised by the leading Bolsheviks, that socialism can never ‘succeed’ in one country – to function optimally, it must be international.

      The message also fails to mention the unrelenting efforts by capitalist nations to destroy socialism, to prevent the possibility of its appearance by any and every means and even to attack the memory of it (Russia will never be forgiven).

      I think that fundamental to the immense loss of life and suffering in both the Soviet Union and China were:
      > that world socialist revolution did not happen
      > that these were the first two socialist nations, built on the basis of mass poverty
      > that both attempted to ‘over-jump’ the capitalist stage (Lenin tried to address this with his NEP before Stalin got control; the Chinese have been and continue to be far more successful in this respect, since the reforms of Deng Xiaoping).

      But what of the loss of life and suffering resulting from the dynamics of capitalism – not only from wars (the first and second world wars in particular – including the Holocaust and the nuclear bombing of Japan, twice) and depressions (the depression in the thirties in particular) but as a result of the fundamental message of capitalism – the driving requirement at its core – that one views one’s relationships, both with others and the world in terms of exploitation?

      We have one world with a population of seven billion. What is the best way forward?

      What is there in the world, theoretical or practical, that can contribute to that best way?

      This is why I have posted this article from Wikipedia, with a few thoughts of my own.

      There is a great deal of potential for health care in a society by reflecting on how China’s barefoot doctors were trained, how they were organised and how they worked:
      > though not fully qualified doctors, they had the possibility of becoming so
      > their funding sources were both broad and local
      > they focused on preventive care
      > their role reduced health care costs
      > qualified doctors were sent from the cities, as part of their social obligation, to work with them – in other words, social obligation was fundamental to Chinese health care.
      > they used both traditional and ‘Western’ medicine
      > they lived and worked as members of a community – they also farmed – thereby earning the trust of their community
      > above all, they were motivated by a social ethic. When I discussed the barefoot doctors with a Chinese friend who was a doctor in Beijing she said ‘they came from a different time, more moral’

      Doctors in Australia have been extremely reluctant both to give up any of their procedures to those less qualified and to accept a perspective on health care other than one consonant with their mantra of ‘evidence-based’ (so often shown to amount to pro-the drug industry and pro-surgery, and often amounting to the rejection of evidence), arguing a concern for patient safety.

      The reluctance, even refusal, still, of Western doctors to have an wholistic approach to health care and medicine (contrary to all the evidence), to appreciate the relationship between how a person thinks and feels and the health of their body would be incomprehensible if one didn’t see the forms for surgery and all the little hand-outs from drug companies on their desks.

      An equivalent of the barefoot doctors could form another level in the provision of health care not only in urbanised regions but particularly in sparsely populated areas – such as in Australia. It should not be a matter of either (the fully qualified professional)/or (none at all)

      I have no doubt that the traditional methods and ways of thinking (communal and grounded in nature) of Australia’s Aboriginal people would have a great deal to offer in this regard.

      Precisely because the ethic of the barefoot doctors represents an approach to health care contradictory to the nature of capitalism (socialist, not exploitative and profit-driven), the lessons they embody will most probably be lost on a capitalist West.

      I understand that with the gradual loosening of economic constraints in China (a necessary but complex and delicate development that the Chinese have so far managed very well since a process of reform was initiated by Deng Xiaoping) the Western view of health care is also, most unfortunately, (re)gaining influence.

      Filippo

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      • Thank you for this thoughtful response to my (what else is new) someone abrupt and (I’ll admit it) reactive comment. It’s in part becuz I really just learned (re-learned, I guess) about Mao’s atrocities and, in part, I’m reacting to The Holocaust (capital T, capital H) that we never hear the end of when millions upon millions upon millions of people were bombed to death (thanks to the USA, largely) or starved to death (thanks to Mao) or treated miserably and then starved to death (thanks to Stalin). I recently had a nasty flu for three weeks and spent all my time on my (red) sofa watching youtube where I learned an awful lot about ‘industrialization’ (which means going into a country and raping it to get the natural resources and turning the poor into slave labor), the rise of the British Empire (which was largely driven by drug dealing and turning millions of brown skinned people into slaves). So. I emerged from my history lesson more pessimistic than before, which is saying something.
        I am without hope for the future of the planet. We are procreating at a nauseating rate, turning the oceans into garbage dumps for our incessant use of plastic bags, bottles, etc which kill the poor creatures who live there while the masses are being diverted by the fraudulent ‘global warming’ crisis.
        I am not convinced that human beings are the greatest thing that ever happened to Earth. Everything else would have been much better off if we had never happened.
        You, on the other hand, see hope and can find things to champion and I admire that about you. I end up diverting mself with, of all things, baseball. Talk about a useless activity, run by the corporate media and greedy, filthy rich team owners! I realize all that, but love that there’s something that can turn my brain off. Other than listening to zz top.
        In my opinion, North America would have been much better off if it had never been ‘discovered’ by white people. There would be lots of buffalo, foxes, wolves, bears, otters, beavers, no land ownership, a lot less Kardashians and no AIPAC. Maybe the same is true of Australia, altho you all got the Sydney Opera House out of the deal (smile).
        Thanks for being so patient with my somewhat explosive responses.
        Your friend on the internet
        Austin

        Liked by 1 person

      • Hi Austin, thanks for your, above all, sincere comment. I, too, have My Major Frustrations – a bit of it leaked into a recent comment, in which I used the expression ‘sewer rat’. In your reply you stated that you like sophistication – including in philosophy. Now, I may be mistaken, but I took that as a tap on the wrist which resulted in me not only removing that expression from my comment and doing a bit of tidying-up around it but also in doing an entire post in reply to you. Marvellous, the power of guilt and what it can generate (including, on my part, constructive thought)! Very best wishes, Filippo

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  2. I still remember growing up in Northern Transylvania where knowledge about what these barefoot doctors are doing was passed down from generation to generation as a basic knowledge of what household chemicals, spices, herbs are good for, etc. We went to a doctor only if popular remedies didn’t work, and the doctor’s first question was if you tried herbal teas, etc before going to him. Nowadays, people wait 4 to 6 hours sometimes in the ER for a sore throat, and pharmacists warn you that if you take two aspirins at a time you will suffer severe stomach bleedings, while on the tin it says you can take 1 to 3 at a time etc, and at supermarkets you can’t buy more than two boxes of paracetamol at a time, because of health and safety regulations, yet national health services are on the brink of collapse because they spend billions on useless procedures. There’s a hefty price to be paid for thinking that people must be taken care of, instead of letting tjem and teaching them to care dor themselves.

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    • Hi Moshe, if I were a doctor who thought of my skills as a means of generating money for me (I suspect this might be related to why medicine is the course in highest demand at universities), I would think of all procedures I did as entirely useful. If the national health service collapsed on the way, that definitely wouldn’t be good – it would negatively affect me. Best regards, Phil

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    • There’s much to be said about the role of profit in the medical and pharmaceutical communities in market and mixed economies. I live under a universal healthcare system that is transitioning to two tier (unsurprisingly, social reforms roll back under the global capitalist system). Doctors are under enormous pressure to conform to the current recommendations, even when evidence to the contrary, to avoid possible remedies that traditional medicines might offer, as they tend to be plant based, and offer little in way of profit, and so the research tends to be minimal or non-existent, and the doctors must go with big pharma. A brilliant nursing student I know will not even consider doing an md due to the liability associated with the position, an instead opts for a masters in nursing. With the explosion of internet, more people are opting for alternative medicine and self treatment when possible, naturopathic doctors are popping up as well, but this is of course private, and not universally accessible, and is heavily criticised…

      It’s been interesting to read about different routes to making healthcare more accessible in rural and less accessible regions.

      Like

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