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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.