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

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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

Liaoning Shihua University, No. 1, West Dandong Road, Wanghua District, Fushun 113001, Liaoning Province, China

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

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

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

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.

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.

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

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.

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

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,

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

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

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

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,

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. used to refer to all rural grass-roots health workers in

general as barefoot doctors. But strictly speaking, bare-

foot doctors only meant those serving part-time as health

Victor H. Li, “Health Services and the New Relationship between China Studies

workers for production brigades while remaining as ag-

and Visits to China”, The China Quarterly, No.59, 1974, 566–579.

David M. Lampton, “Public health and politics in China’s past two decades”, ricultural laborers; the health workers serving produc-

Health Services Reports –

, Vol.87, No.10, 1972, 895 904. tion teams (each production brigade had at least several

Sean Hsiang-lin Lei, Neither Donkey nor Horse: Medicine in the Struggle over

China's Modernity (Chicago: University of Chicago Press, 2014).

6 9

Yang Nianqun, Remaking “Patients”: The Politics of Space in the Clash between Mao Ze-dong, Jian guo yi lai Mao Zedong wen gao [Mao Zedong’s Manuscripts

Chinese and Western Medicine, 1832–1985 (Beijing: Zhong guo Ren min da xue chu Since the Founding of New China] (Beijing: Zhong yang wen xian chu ban she, 1987),

ban she, 2006), 379. 557.

7 10

Fang Xiaoping, Barefoot Doctors and Western Medicine in China (New York: Xu San-chun, “Dang dai zhong guo he zuo yi liao zhi du qi yuan tan lun” [“A

University of Rochester Press, 2012). Research into the Origin of Contemporary Chinese Cooperative Medical System”],

Chunjuan Nancy Wei, “Barefoot Doctors: The Legacy of Chairman Mao’s Health- Journal of China Agricultural University 30, no. 3 (2013): 40–45.

care,” in Mr. Science and Chairman Mao’s Cultural Revolution: Science and Tech- Zhang Kai-ning, Wen Yi-qun, and Liang Ping, Cong chi jiao yi sheng dao xiang

nology in Modern China, ed. Chunjuan Nancy Wei, Darryl E. Brock (Lanham, MD: cun yi sheng [From “Barefoot Doctor” to “Village Doctor”] (Kunming: Yunnan ren min

Lexington Books, 2013), 251–280. chu ban she, 2002), 20. www.sciencedirect.com Download English Version: https://daneshyari.com/en/article/5130225

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