What capitalist societies can learn from China’s barefoot doctors

The people who were chosen by their communities to become barefoot doctors studied anatomy, bacteriology, disease diagnosis, acupuncture, family planning, maternal and infant care, and traditional and Western medicines with teams of medical staff. All received a barefoot doctor’s manual - a comprehensive guide to the many health issues they were trained to treat.

The people who were chosen by their communities to become barefoot doctors studied anatomy, bacteriology, disease diagnosis, acupuncture, family planning, maternal and infant care, and traditional and Western medicines with teams of medical staff. All received a barefoot doctor’s manual – a comprehensive guide to the many health issues they were trained to treat.

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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’
An herb grower teaches barefoot doctors about medicinal plants, Mount Huangshan, China, 1977

An herb grower teaches barefoot doctors about medicinal plants, Mount Huangshan, China, 1977

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.

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Images

Wikipedia: Barefoot doctor

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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