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DOCBBEIT B - .' SO 010 140 » . . Perex, Joel '. Ba,refoot~rDoctors. Occasional Paper lo. 77-4. . State Oniv. of lew York, -S^ony Brook. Aserican Historical Association Faculty Development Program. ",'"".. 77 .

•»BS PUCE 'BP-S0.83 BC-IL1.67 Pies Postage. - D1SCBIPTOBS Idolt Education; Comparative Education; *Foreign Countries; Health Services; *Bedical Assistants; *Bedical services; Ion Western civilization; •Preventive Bedicine? Public Health; *Rnral Areas; •Sanitation * « &.-'.' <•**10BB1IPIBRS ABSTRACT . ^ ! . • • A description of "barefoot doctors" in the People's Bepvblic of China is presented. These peasant, doctors are commune Ivy joclters who have taken basic courses in medical treatment. Because 80S of the population livep in a rural agricultural setting, And Because most doctors and medical services are*located in cities, ' there is a serious need for medical personnel in the rural areas of the country. After Chairman Bao declared in T965 that emphasis- in *'. «• medical and health work .should be stressed in rural areas, i 1 preparation of "barefoot doctors 11 began. They are selected by fellow commune workers on the basis of intelligence, educational lefel, • desire to become doctors, and will to serve the commune. The* can be of any age or sex.'All undergo three to six months formal training in either a ccmanne hospital, agricultural college, or medical college. This is followed by on the job training. Courses include anatomy, . physiology, pathology, , and medicinal herbs. Bafcf-c '«- responsibilities are environmental sanitation and preventive .,They supervise collection, treatment, storage, and; use of human excrement for fertilizer; spraying of pesticides; and storage' of drinking water. They/dispense first aid, immunizations, and health examinations; and decide when a perdon should be sent to the commune hospital. (Author/A?)

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OCCASIONAL PAPER SERIES '* . • % tDiKATtOM THIS DOCUMENT HAS KEN. REPRO­ DUCED EXACTLY AS *ECeiVC(r*ftOM DR, Eu SEIFMAN, SERIES EDITOR TMC mfmc.fi*. *%- «»- --..------— STATED DO NOT NCCESSAKlLT xEntk- SENT OFFICIAL NATIONAL INSTITUTE OF EDUCATION POSITION 0* POLICY

ilWWVW Occasional Paper #77-U '-./ by. J&el Perez

AMERICAN HISTORICAL/ AssociATiofi FACULTY' DEVELOPMENT PROGRAM THE STATE'UNIVERSITY OF NEW YORK, STONY BROOK, NEW YORK .-/ •*>;•-;,.. ^ «• \ ' * - -"^

PREFACE .- i

Drawing heavily upon official sources published in The People's * Republic of China, Joel Perex places the development of the "barefoot doctor* in the context of two major milestones in health work in the P.R.C.,'the broad guidelines established by the National Health Cqpgress i,n August 1950 and flao'tse-tung's June 26, 1965 Directive which criticized^the discrepancy between the quality of in the cities and the rural areas (with 90% of China's vast population), and which sounded the call: "In medical and health work, put the stress on the rural areas." - v~ The 'barefoot doctor? is a unique feature of medical and health • care in'The People's Republic of China. Joel Perez presents a concise introduction to their training and,function, inclu4ing an explanation of the orgin of the phrase "barefoot doctor" which has been applied to these rural pace-medical workers who serve at the - grass roots level of China's vast program of prevention of illness and medical and health care system.

Dr. Eli Selfman General Editor \ Stony Brook AHA/FDP

7 Probably one of fhe most important, innovative, and provacative teaching theories is being used to train and select "barefoot- doc tors" in China. About eighty percent live in a rural agricultural setting. of the Chinese people T­ (approximately 600million people).. Prior to 'liberation, a lack, of public hygie ie, constant outbreaks of different ., ar.d parasitic problems Killed a large number of the Chinese neople. Hospitals, doctors, and medical services w.-.ich were very scarce, were located in the cities mainly and • were available only to the wealthy who could afford them. Shortly after liberation, China's first National Health . Congress established the following guidelines: (August 1950')' t 1. Health 'care should primarily serve the masses v of tr.e Iab6rin^ people, the worKers, tne peasants, and the soldiers. 2. The emphasis should be placed on preventive : medicine. . 3. There should -be close unity between the . traditional and modern doctors. ' k. Whenever possible, health work snould be > conducted b./ ^nass campaigns with ac-tive participation of medical workers. ' !fow'ever, it was not. until Chairman Kao Tse-Tung's June 19cp .' directive; "In medical and Health work-, put' the stress o,n the rural o"eas.",. that t;.e peasants' in the rural areas .be^an v receiving -.edical services. Prior to the direct'. ve dnly 'a i * ». f^w country nospitals were established setting r up "eplde.r.ic, prevention centers, and communes and x bri>;ades set up enly v - - 2 - ' \• -. ' .. simple .medical Organizations. Liu ShaorChi* s* revisionist ; /•'. I ' • . line was putting the stress on the cities and ignoring the countryside in public health* Medical setups in the brigades ' ."' ".-'/ , / • •• t were shut down! and commune became private clinics' . • of. a fe* doctors. The best doctors were concentrated in '• ' ; ' r ' '. county fend higher level hospitals where they "specialized" • < '-—J;- I • ••'••• •in difficult case4» The rural areas were going back to the . old situation of i\ few doctors without enough 'medicine. M-edical schools since liberation (were unable t.o meet' the ^ ~ t * * need'for doctors ^specially in a developing country like China. Training thousands--of "barefoot-dpctors" therefore - became very important to improving medical and health work . 1 * I , in the countryside. During the in 1966, , tfae People^? tiberation Army had organized more-than 60,000 nfedical te'ams, nnde up ofr half a-million medical workers^© tt'cur the coun'tryiide. They treated 75 million peasants and nelped, 29,000 production brigades set up.'or improve furth-er their co*operatJve medical service, and train 770,000 "bare­ foot doctors" and nealth workers. Peking health"departments : • / .. • v rer.t out more than i 5,OOQrneciical amd •hfealth t workers in over 3CO mobile tear.c touring mountainous areas'and th.e %country­ •siJe/. Many medical workers, including doctors,, settled in in the -border areas and villages to" 'help, carry on. the rev­ ' Tolult.on in .:.eJi*cal and health''work. • / . A s^ift of emphasis from urban to - care ' : p;iyes the rThinose 'aiatr.orities tr.e realizatLon ^t:at 4 .tne , , couatry as a w .ole is acriciiLturally . based. T~her'efore, .

i 5 -3--. . ,--•••" : •' ; ' : •'. '"/ ' .:' "-•"'• , . v • * « long range* rural basedVhealth care plan... • they arast hpve » ' •-'.-.- v... extreme shortage of medical However, there'was an immediate ' * * thp£e areas. To change the shortage of medical ­ personnel .in t \ workers in the remote mountaiffous areas'and. the. minority area?, China's educational system was revised. ' In medicine.this meant reducing the number of courses taken, and reducing the^length of schooling required. ' * - • ' Rural populations had a^ history of being severely shorted in medical personnel. Agricultural workers are being trained • / to help meet the- needs of the countryside medically. These • » workers are trained in basic medical procedures and then j return to serve t.ieir home areas.

9 \ - . The "barefoot doctor 11 or pensant doctor is a commune worker who has ta»cen basic courses in medical treatment^ He ' or she gives medical treatment without leaving productive ­ ...... * t •.vork. The name originated in the south where tnese peasants - work barefe t in the rice paddies. They should not be confused with regularly trained docrots,/ since they are considered .peasants rather than health workers In %^atistics. The responsibilities of/ a "baraaoot-doctor" vary from. . region to "region, and commUne to commune, but on the whole they do tt.e snme basic functions./ A w,or.ian Tioetan "barefoot­ / '/ * doctor"' • performs basically th* sane functions as a southwest ''barefoot doctor" every7 thouari / one/ is on a herding production ' / • ' : team ana the other on a gr^in /producing production team • * respectively. They are r7fesp.disease. Immunization' has helped'to control the spread of small pox, measles, and other dangerous diseases. • « • \ therefore he is K "barefoot doctor" works in the field;%• ' ' readily available for medical emergencies. He determines whether a patient should go to a commune hospital orCnot. ^ An example of this responsibility occurs when a peasant in > • . » the fields has 3 pain in^the stomach. The peasant doctor may » decide' it is a etomach spam and' not appendicitis and would S« give him medicine without seeding "him to the hospital. ^ It snould be remembered tnat the barefoot-doctor may only give' treatment for min.;r and common diseases. A typical peasant > •• doctor's medical bag will concist of traditional Chinese r.erbs,, and 'suph tnings as aspirin, antacids, and penicillin, 6.:ow;.:ig tne. unity between traditional Chi_nere ^medicine and •"o-iern ''.rstern medicine. • •« * .- .".election of "ba.-efoot^d,octors" is very dlrferent from .VesLern norms.' Th'ey -re cr.osen by their fellow peasants on the production, team. Usually- t .e.y are young peasants around twenty years of age and can be either m^le or female. Usually, t ey are -.icke'i for t eir intelligence', educational level, * % . (junior'middle» school), desire to become, doctors, and especially •*. •" ' • ' ' - ' * rVheirVunselfish attitude to serve ti;e commune. training of the "barefoot-doctor" Varies from place to • * - « place in China. This is usally due to tne fact that they • S •• « - , train during slack times'in their production brigades. For instance; a "barefoot-doctor" who is in a grain production • < . » team will be busy during planting and .harvesting time, but­ • have tine to 'train during the growing season. A Tibetan i \ * herdsman wo is a "barefoot-doctor" "may have a shorter .. ; j > • 'slack' period.—Basically, they all* have a three to six months v , 4 •period of formal training either in a commune hospital, county - , 4 hosnital, agricultural coTIege, or even a medical college.­ » a The studies include basic theoritical subjects such as, anatomy, physiology, and pathology, as well as traditional^­ • , Chinese medicine such as acupuncture and medicinal herbs. " , This is followed by on-the-job training in a commune, which may consist of identifying contaminated'water, eggs or « 9 worm parasites in excretion, learning how to diagnose common - • • -v "•­ spreading of them, which is a cdmbination diseases. and 6top the " % * . of tr.eory and practice. ' • • ' "Barefoot-doctors" are taught to "put prevention first." This'is the reason for regular health'examinations, mass drives for environmental sanitation, immunizations, and post-illness follow-up. Aj.1 these precautions 'help prevent the spread' of infectious .diseases and stopping epidexics. '• V. . ' • Treatment given by "barefoot-doctors" is very limited in surgical and general medicine. Their basic function is en­

8 .;; _ _ - 6 - . cy vironmental Sanitation and preventive medicine. They handle • *. . * * • *• routine medical problems like minor cuts, stomach achQs, and the sprt. Patients with, serious problems are sent to the i » .. commune hospital. However, many "barefoot-doctors" have saved lives'in emergencies. One peasant doctqr saved the life of a baby with a high fever. She stayed up with the baby all night giving him medicine. The* f next day the•» fever broke. Another example was the "barefoot-doctor." who saved a man from, \ . ' . .' • '• » ' bleeding to death by suturing the-wound. * A "barefoot-doctor"1 is similar to ; a "worker-doctor" of " • • the factories and the '"neighborhood health worker" of the . * t areas. 'The "worker-doctor" of trie factories looks'arfter urban • • 35-50 workers.^ He makes sure th-ey are up-to-date on immun­ izations, prevents t-he spread of infections,, and treats corriTon illnesses like a stomach ache, headache, and helps doctors in emergencies. The "neighborhood health worker" is concerned with immunizations,* sanitation, public , (Giving out birth control information), and preventing disease. Basically all these categories are alike. However, a "barefoot-doctor" is trained more tna.n the usual two weeks « of the others "and oerforms many more functions. * t Many 'communes are trying to organize tneir workers to *form a co-operative medical system. € Eacn commune member would pay a small•annual preraiumj—usually one yuan,'(3.50), and his production brigade would allot part of its public welfare funds to cover'the medical fees of commune members. Treatment is free or partially free depending on- the brigade's

9 This accomplishes "Medicine $fcd Health foi ' * - • ' iort term t>bjective of a "barefoot-doctor**- is to ' y solve the immediate shortage of health- care workers in r^ral * > - • >. _ • • f areas. Peasant-doctors have helped remedy the unavailability * * ' * "•*.'* of doctors, drugs, and facilities in the countryside. jThey' • ."*•'»•* have helped give medical treatment to the masses. ,The long term aim is to improve the quality and" quantity of paramedical

personnel, and also expand and improve medical, facilities.at t the communes and production brigades.

10 -: >*""-— *v.

."B I B~L -I 0 G R A P H Y

Periodicals: •-.'•'• ' ' •» 1. American Journal of Chinese Medicine. Vol. IV,. no.-3 ~ (Autumn, ..1976) pfts. 297-5IX). • ' .' ' i . , ., • ."/'", 2. China Pictorial. "Peking MedicaV-Teams in th« Hoshi Corridor." Vol, 6 , (April 1-976) pps. "18-21. 3*. . China Reconstructs. • " 'Ba'refeet-Doctors' An Army of -Vol. XXIII. no; 4,' (April 197^) •. • PPS;New Doctors."6-vp. . ••-.--. k. •• - "Hea"lth andMedical Care for the People." Vol. XX, no. 6, (June 197U pps. 2-5... "More and Better Equipment for the Countryside." .Vol. XXH, no. 12, (December 1973) pps. 15-1-6. ' ' ,­ 6. "A Steel-Mills 'Barefoot-Doctors.''', 1974) pps. 6-9. Vol. XXIII, -no. 7, (July • 7. "A. Tibetan Doctor .'Chingweng'." .Vol. XXIII,- no. ^, (April 19A) PP.' 33-35.' 3. Eastern Horizon. "The Barefoot-Doctors."- Vol. XV, no. 1, (January 1976)"pps. 20-26. % r • • 9. Peking Review. "Barefoot-Doctors arfd Co-operative . Medical S'-stem." No.. 9 {February 25, 1977) " pps. 19-23. .• • 10. "Co-operative Medical Service and Barefoot Doctors in China's-Rural Areas." ' v » No. 28 (July U, 1 >75) pps. -20-21. 11. • "11th Anniversary of Chairman Mao's Directive on Medical and Health Work Marked." , No. 28 (July 9, 1976) pps. 6. • 12. "Profound" Revolution on ti.e Health ' Front." ;io. 27 (July 2\ 1976) pps. 18-19. 13. U.S. Consol^te General.v Hong'Kong.' "Barefoot-Doctqr." —————^o. 12 (March 6, 197j>) pps. 19.

II ^ f 14. ' tl.S* Consolate. General,-Hong Kong, •" "South China Pro­ .vinee'Expands Medical and Health Work." NoT 4t (September 25, 1972) pps. 1rt2 im

15. .' ». "Stockbreeding Commutes in Northwest China H»ve .Good Medical -; Service." ''No. 3\ (July 24, 1973) pps," O6-.158,

12