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Barefoot Doctors and the ￢ﾀﾜhealth Care Revolution￢ﾀﾝ in Rural China

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Barefoot Doctors and the ￢ﾀﾜhealth Care Revolution￢ﾀﾝ in Rural China Full text provided by www.sciencedirect.com Endeavour Vol. 41 No.3 ScienceDirect Barefoot Doctors and the ‘‘Health Care Revolution’’ in Rural China: A Study Centered on Shandong Province a b Sanchun Xu and Danian Hu a Liaoning Shihua University, No. 1, West Dandong Road, Wanghua District, Fushun 113001, Liaoning Province, China b The City College of The City University of New York, 160 Convent Ave., New York, NY 10031, USA Barefoot doctors were rural medical personnel trained decades of wars, epidemics ran rampant, health situations en masse, whose emergence and development had a were extremely poor, modern medical resources were de- particular political, economic, social, and cultural back- ficient, and peasants’ medical care relied primarily on ground. Like the rural cooperative medical care system, various folk medical practitioners. The state thus orga- the barefoot doctor was a well-known phenomenon in nized traditional folk medical practitioners to set up “unit- the Cultural Revolution. Complicated regional differ- ed clinics.” Most of these united clinics became commune ences and a lack of reliable sources create much difficulty clinics after 1958 when the People’s Communes were for the study of barefoot doctors and result in differing widely established in the country. Meanwhile, mobile opinions of their status and importance. Some scholars urban medical teams and higher-level clinics or hospitals, greatly admire barefoot doctors, whereas others harshly such as united clinics, also trained many rural health criticize them. This paper explores the rise and develop- workers ( ), who were responsible for vaccination, ment of barefoot doctors based on a case study of patriotic hygiene campaigns, reporting epidemic out- Shandong province. I argue that the promotion of bare- breaks, health education, and first-aid treatments. Thus, foot doctors was a consequence of the medical educa- a three-tiered rural health system, encompassing hospi- tion revolution and an implementation of the Cultural tals at the county level, commune clinics, and hygienists at Revolution in rural public health care, which significantly the village level, was gradually established. By 1959, the influenced medical services and development in rural country’s overall morbidity and mortality rates had areas. First, barefoot doctors played a significant role in dropped significantly and, as Li Hong-he notes, “people’s accomplishing the first rural health care revolution by life expectancy was almost twice as long compared to that 1 providing primary health care to peasants and eliminat- of before the liberation [in 1949].” ing endemic and infectious illnesses. Second, barefoot Rural medical problems, however, were not complete- doctors were the agents who integrated Western and ly solved. Peasants often either had no access to medical Chinese medicines under the direction of the state. As an treatment or simply could not afford it. In the early essential part of the rural cooperative medical system, 1960s, many high-ranking party officials deplored the barefoot doctor personnel grew in number with the serious problems in rural medical service after return- system’s implementation. After the Cultural Revolution ing from their trips to rural areas during the socialist 2 ended, the cooperative medical system began to disin- education campaign. Dissatisfied with the urban-cen- tegrate—a process that accelerated in the 1980s until the tered pattern of health care development, Mao Zedong system’s collapse in the wake of the de-collectivization. issued a directive on June 26, 1965, and demanded As a result, the number of barefoot doctors also ran “shifting the focus of medical and health care services down steadily. In 1985, ‘‘barefoot doctor’’ as a job title on rural areas.” The Ministry of Health, which Mao was officially removed from Chinese medical profession, derided as “the health ministry for lords,” responded demonstrating that its practice was non-universal and immediately by sending more mobile teams of medical unsustainable. personnel to the rural areas, where they trained some local peasants as part-time health workers who were Introduction later referred to as “barefoot doctors” during the Cul- ’ At the establishment of the People s Republic of China tural Revolution. (PRC), vast Chinese rural areas had been ravaged by 1 Corresponding authors: Xu, S. ([email protected]) Hu, D. ([email protected]). Li Hong-he, Xin zhong guo de yi bing liu xing yu she hui ying dui (1949–1959) [The Keywords: The Cultural Revolution (文化 革命); Barefoot Doctor (赤脚医生); Rural Epidemic and Social Responses in New China: 1949–1959] (Beijing: Zhong gong dang Cooperative Medical System (农村合作医疗制度); Health Care Revolution (卫生革命); shi chu ban she, 2007), 276. 2 Traditional Chinese Medicine (传统 医). Yang Shang-kun, Yang Shang-kun riji [Yang Shang-kun’s Diaries], vol. 2 (Beij- Available online 8 July 2017 ing: Zhong yang wen xian chu ban she, 2001), 653. www.sciencedirect.com 0160-9327/ß 2017 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.endeavour.2017.06.004 Endeavour Vol. 41 No.3 137 Barefoot doctors provided primary medical care to pea- Based on primary sources from local archives, I address sants, eradicated many infectious and endemic diseases, these issues by examining the history of barefoot doctors and substantially improved peasants’ health. These with a focus on Shandong province. Located in the North accomplishments made them well-known domestically China Plain, Shandong is one of the most populous pro- as well as internationally, and the attention of many vinces in China. At the inception of the PRC in 1949, many researchers. Most studies have focused on why the low- infectious diseases ran rampant in Shandong. By the eve cost and primitive barefoot doctors could help achieve such of the Cultural Revolution, the health situation in rural health care improvements beyond what would be expected Shandong had improved somewhat, but many peasants 3 at China’s stage of economic development, how barefoot still suffered from various diseases. To some extent, Shan- doctors became a role model for other developing coun- dong is representative of China at large in these dimen- tries, and what changes they reflected in China’s medical sions. 4 politics. Few investigations have explored the develop- ment of medical science represented by barefoot doctors in From ‘‘An Old Matter’’ to ‘‘A New Thing’’ rural areas. On September 10, 1968, Red Flag magazine, an official Competing with traditional Chinese medicine, Western organ of the Chinese Communist Party (CCP) published medicine was not accepted in rural China before it under- an article entitled “Searching for the Direction of Medical went a long and complicated procedure of assimilation. Education Revolution from the Growth of ‘Barefoot Doc- The debates over the comparative merits of traditional tors’ in Jiangzhen Commune.” This article, which Mao Chinese medicine and Western medicine have never Zedong commented on and revised himself, referred to the ceased since the Republican period in the early twentieth part-time health workers who often labored barefoot in the century. Sean Hsiang-lin Lei has argued that, when Chi- fields as “barefoot doctors.” Although Mao’s remarks fo- nese medicine encountered a modern state like Republican cused on the reeducation of urban doctors and criticizing China, which attempted to reform the former, it turned the educational system as a whole, they were viewed as into a hodge-podge medicine different from traditional advocating for barefoot doctors. Four days later, the article 5 Chinese medicine. How was medicine actually developed was reprinted in the People’s Daily, another organ of the in rural China during the Cultural Revolution? How were CCP and the most authoritative newspaper in the country, 9 the Chinese and Western medicines integrated? What further spreading Mao’s words. Thereafter, barefoot doc- kind of role did barefoot doctors, who practiced both medi- tors were widely regarded as “a new thing” that emerged in cal traditions, play in the rural health care revolution? the Cultural Revolution. Yang Nianqun believes that barefoot doctors were resur- In reality, however, the barefoot doctor was not “a new gent traditional Chinese “herbalists” ( ) because they thing.” Barefoot doctors or peasant health workers were used medicinal herbs, acupuncture, and folk recipes in mainly responsible for disease prevention and providing 6 order to reduce drug costs. Fang Xiaoping demonstrates peasants primary medical care. Groups similar to bare- that barefoot doctors were the main channel through foot doctors appeared as early as in Republican China, which Western medicine not only entered the countryside such as the health workers trained by C. C. Chen in Ding 7 but also dominated the cooperative medical system. County, Hebei province, and those trained by the nation- Chunjuan Nancy Wei insists that, because of the imple- alist government in the health experimental zone set up 10 mentation of Mao’s idea of mass science in the field of by the government. After the establishment of the PRC, public health during the Cultural Revolution, the cooper- various offices concerning public health trained a large ative medical care and the three-tiered rural medical number of peasant health workers in an attempt to network based on barefoot doctors, scored outstanding eliminate infectious diseases and promote the p;atriotic achievements in rural medical and health care. Based hygiene movement in rural areas. Some of the barefoot on these achievements, Wei even challenged the conclu- doctors so-designated by Mao were originally rural health sion that the Cultural Revolution was a catastrophe for the workers trained in these earlier programs. After 1969, 8 scientific and technological development in China. Al- when the cooperative medical system was widely promot- though they have illuminated the historical importance ed, neither the media nor average people distinguished of barefoot doctors, these authors have not answered all between barefoot doctors and rural health workers and the questions above.
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