File Name: barefoot doctors and western medicine in china .zip
They included farmers, folk healers, rural healthcare providers, and recent middle or secondary school graduates who received minimal basic medical and paramedical education. They promoted basic hygiene , preventive healthcare , and family planning and treated common illnesses. In the s, 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 , but after Mao Zedong's healthcare speech in the concept was developed and institutionalized.
ISBN: This illuminating study corrects what we thought we knew about that evanescent character the Barefoot Doctor, invented in , widely acclaimed inside and outside China, and officially discarded in
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During the Chinese Cultural Revolution —76 , Chairman Mao fundamentally reformed medicine so that rural people received medical care. His new medical model has been variously characterised as: revolutionary Maoist medicine, a revitalised form of Chinese medicine; and the final conquest by Western medicine.
However, rural people and local governments valued treatment expertise, causing divergence from this ideal. As a result, Western and elite Chinese medical doctors sent to the countryside for rehabilitation were preferable to barefoot doctors and received rural support. Initially Western-trained physicians belittled elite Chinese doctors, and both looked down on barefoot doctors and indigenous herbalists and acupuncturists.
However, the levelling effect of terrible rural conditions made these diverse conceptions of the doctor closer during the Cultural Revolution. For these villagers, class category proved to be insignificant relative to the medical expertise of the professionals.
Cultural Revolution methods, particularly barefoot doctors, fascinated international health policy makers and strongly influenced the WHO declaration on Primary Health Care in at Alma Ata, one of the key landmarks in global public health.
In addition, unlike earlier scholarship, which focused almost exclusively on barefoot doctors and the new phenomenon of mass medicine, this paper explores the hidden role that expertise played in making the system function.
The disparate understandings of medicine during the Cultural Revolution probably reflect the difficulty of finding credible sources. Earlier scholars s had access only to government propaganda while visiting medical delegations viewed only model sites, leading their scholarship to replicate the government version of revolutionary medicine. It was this medical model that they disseminated to the World Health Organization.
Since archives opened, there have been almost no full length monographs on rural Maoist medicine. Likewise, oral histories can involve government intervention, censorship within the interview process and danger for the participants. This exploratory paper partially circumvents these issues by piecing together four types of sources. How and why grassroots medical practices differ from government mandates over time is ascertained from archives prior to the Cultural Revolution drawn from three famous health campaigns patriotic health, schistosomiasis, and four pests and several case studies: Jiangsu and Jiangxi Provinces rural areas , Yujiang County a backwater county in Jiangxi Province , Shanghai one of the most advanced cities in China , and Qingpu a Shanghai suburb that was originally a county in neighbouring Jiangsu province.
Finally, the paper is dependent on extensive memoirs and oral history accounts in both English and Chinese from elite Chinese, Western and barefoot doctors posted to many parts of the country who can retrospectively report more openly on their experiences during the Cultural Revolution. These sources make clear that each region created a unique medical synthesis depending on the availability of particular medicines, medical infrastructure and medical practitioners, but that there are common trends in how and why rural practice diverged from state mandates.
This paper elucidates these trends and delves into the new types of practices that arose in the countryside. Prior to the Cultural Revolution, Chinese medicine stemmed both from elite traditions and indigenous rural traditions. By late imperial times, elite Chinese doctors based their medical practice on classical medicine tomes and their training on a highly respected master doctor, often a family member. Some did come from credible rural medical lineages, but many others were considered quacks by other physicians and patients alike.
Rural people, noting their expense and low cure rates, used them as a last resort. In the past, elite Chinese medical doctors mainly treated urban and wealthy clients. Wikimedia Commons , Wellcome L Licenced under Creative Commons Attribution 4. Western medicine was introduced to China by medical missionaries from many countries, who brought different variants of Western medicine, as well as aspects of traditional Western medicine that is, ideas influenced by miasmas and humours.
It was also introduced by Chinese students studying Western medicine in Japan. In terms of rural areas, the Chinese state tried to establish one hospital in each county during the Republican era —49 and wartime public health efforts —45 occurred in rural south-west China near the provisional capital of Chongqing.
Some medical missionaries also practised in rural areas. Despite these efforts, few rural people encountered Western medicine before the Maoist era. They used their dominance of the first National Ministry of Health, started under the Nationalists in , to try to eradicate their medical competition, resolving at the first National Board of Health Conference in February to abolish Chinese medicine.
Although unsuccessful at eradicating Chinese medicine, the resolution profoundly affected it. Sean Hsiang-lin Lei finds that, for the first time, Chinese medical practitioners were inspired to work together to develop a new, unified and scientised version of Chinese medicine, aligned with the state.
Early efforts at modernising Chinese medicine resulted in new Chinese medicine schools and research institutes during the Republican Era — While living in the Shaanxi—Gansu—Ningxia Border Region in the s, Mao came to a very different conclusion about the relative merits of Chinese and Western medicine based on practicality and population size. If the government truly wanted to provide affordable medical care, it had better depend on this relative multitude of rural practitioners who only required inexpensive local herbs and a set of needles.
As a result, starting from at the First National Health Conference and increasing significantly in the mid-fifties, the new Ministry of Public Health was mandated to promote co-operation between Chinese and Western doctors. By , Mao was extremely frustrated by the unwillingness of the Western medical establishment to incorporate either affordable Chinese medicines or ideologically based Party guidelines into their practice. Most Western doctors, fearful of medical malpractice, insisted on practising medicine based on normative practices and proven drug regimens, making rapid expansion of rural care almost impossible.
As of , of the 1. For change to occur, something had to pulverise the basis of both types of medicine. Mao was happy to supply the necessary hammer. Mao brought medical care to the countryside with a number of practical changes to the pre-existing medical structure. First, he forced about one-third of Western doctors and elite Chinese medical practitioners from both the civilian and the military medical systems to serve in the countryside, initially as rotating medical teams, and later, after , as permanently rusticated doctors.
Doctors at all levels participated in this mandate: from top urban physicians to bottom-level doctors in commune hospitals, all were sent down to the villages.
Shorter training ensured a rapid expansion of medical talent all slated to serve in the countryside. Starting in September , the national government promoted the idea of rapidly trained and cheaply paid paramedics, called barefoot doctors, discussed below, who were supposed to make health care more affordable.
Later, in December , the government encouraged communes to establish co-operative medical services whose precarious funding base came from fees paid by commune members and brigades. This campaign not only increased the availability of herbs, which had been in short supply, but also disseminated the message that using local herbs was patriotic and preferable to other options.
Together these changes resulted in a large expansion of the rural medical system. Originally, there were county or district hospitals, and inferior commune hospitals; now commune hospitals were upgraded, and the system extended downward to include clinics at the production brigade level.
The barefoot doctor programme, the most famous of these changes, became emblematic of the entire effort to transform rural public health. They were supposed to receive three to twelve months of medical training, though many received much less, and then return home to practise. Ideally, initial training was supplemented with further classes or work under more experienced doctors.
Training involved learning to identify and treat common diseases with Chinese herbs, some Western drugs, a limited number of acupuncture points and minor surgery. Barefoot doctors were supposed to collect, grow and process medicinal herbs, improve sanitation, educate villagers about hygiene and disease prevention, and take a leadership role in the public health and vaccination campaign of the moment.
While statistics from the Cultural Revolution are always suspect, one study found that from to mid there were about 1. Mao envisioned barefoot doctors at the centre of a new type of revolutionary medicine. These vanguard barefoot doctors would also create a new nexus of medical talent in the countryside, helping empower their rural communities.
Yet, despite his best efforts, the all-pervasive Mao cult, and the intimidation and violence of the Cultural Revolution, this study finds that the parameters of his revolutionary medicine were radically altered in the countryside. How was this possible?
Moreover, once provincial leaders had to collect statistics and report their successes in front of peers, it became politically dangerous to fail. As a result, some provincial leaders quietly made structural adjustments and leadership choices that placed those with medical expertise in a position to alter campaign practice. During the early Cultural Revolution provincial activities were too transparent for central directives to be avoided and it was dangerous not to comply.
Therefore, provinces sent urban medical personnel down to the countryside, shortened medical training, opened new short-course medical schools in counties, sponsored co-operative medical services and herbal medical campaigns, and generated barefoot doctors on a large scale. However, as the national government moved on to new mandates and the government and society increasingly decentralized, a space was created for rural provinces to quietly make their own decisions.
The prominent barefoot doctor is in the front, but the less obvious Western doctor actually leads the way. Used with the permission of Chinese copyright law, Articles 21 and 22, 5. However, during the Cultural Revolution, decentralisation and attacks on the bureaucracy made health campaigns their problem. Chaos at the top and the purging of many high-level Party leaders provided a space for county, commune, brigade and production team cadres to make up their own minds about how to run the campaign.
When they reached the bottom they were spoiled. Local leaders noticed that they maximised their political capital when sent-down doctors practised medicine, rather than labouring ineffectively in the fields. You tell me — are you more important to us as a doctor or as a peasant like us? Because of this, the work was of high quality. As a result, they quietly provided support that allowed these battered doctors to maintain some degree of professional identity, even as the national government sought to strip them of their credentials.
Maoist revolutionary medicine should have had great appeal to villagers as it alleviated two of their biggest problems: cost and access. The combination of the co-operative medical services, barefoot doctors with low salaries, acupuncture and herbal medicine made rural medical care eminently affordable. Similarly, due to the vast expansion of medical personnel down to the new brigade-level clinics who were willing to make home visits, it was now possible to get medical help without losing time at work.
However, having solved these two essential problems, pragmatic villagers now wanted treatment that worked. In contrast to Mao, they were unconcerned about class labels, ideology, indigenous pride or even whether the doctor came from the village.
The main test of new physicians was effective treatment. For example, Ban Xiuwen, a famous Guangxi elite Chinese medical doctor and professor labelled a Rightist and sent to the countryside to be re-educated was ordered not to let villagers know his profession.
Over time they knew what I really did. From then on, people looking for a doctor and medicine came in an endless stream. Their limited knowledge combined with minimal supervision led to frequent misdiagnoses.
An oral history compendium of barefoot doctor accounts from all over China repeatedly indicated that their biggest problem was insufficient knowledge. Even though I studied at the health school, when I tried to use it I always felt at a loss…. I bumped into some things where I was apparently right, but actually wrong. If you could wield two needles it was enough. Only in did I attend a half-year of free training. Moreover, Western drugs produced in Chinese factories and local herbal medicines had poor quality control.
Rural areas also often lacked supplies such as masks, gloves or autoclaves, making rural deliveries particularly fraught and infection control almost non-existent. Finally, the empowerment of both patients and barefoot doctors led to devastating results. Patients took charge of the medical relationship, demanding drugs they liked or had seen being effective on a neighbour.
Further, impoverished patients sometimes refused to go to expensive hospitals for care, even when barefoot doctors told them the medical problem was too complicated or dangerous for them to treat. Moreover, local health departments were loathe to call problematic barefoot doctors to account, as they might get in trouble for not supporting Maoist medicine.
Instead of favouring revolutionary medicine, villagers supported professional expertise by voting with their feet. When he used up his three formulas without seeing any effects, he would run out of ideas….
PDF | On Oct 1, , Vivek Neelakantan published Fang Xiaoping, Barefoot Doctors and Western Medicine in China (Rochester, NY.
Hank had gone outside to look for Marty, who was supposed to be meeting them. Kathryn was tired and wondered how long it would take to get to wherever they were headed. She had no interest in looking at a map of the country and knew nothing about where they were going, how far it was, or even in what part of England it was situated. Barefoot Doctors and Western Medicine in China is based not only on research on the ground, but on a thorough study of the pertinent scholarly literature.
- Но немец даже не шевельнулся. Росио изо всех сил уперлась руками в его массивные плечи.
Простыня на его половине кровати была холодной. Дэвид исчез. Значит, приснилось, подумала Сьюзан и села в кровати. Комната в викторианском стиле, сплошь кружева и антиквариат - лучший гостиничный номер в Стоун-Мэнор.
- ТРАНСТЕКСТ вышел из строя. - Коммандер, - вмешалась Сьюзан, - я хотела бы поговорить… Стратмор жестом заставил ее замолчать. Глаза его неотрывно смотрели на Чатрукьяна. - В него попал зараженный файл, сэр.
Barefoot Doctors and Western Medicine in China, by Fang Xiaoping. Rochester, NY: University of Rochester Press, xv + pp. US$ ISBN.
Стратмор молчал. Положение оказалось куда серьезнее, чем предполагала Сьюзан. Самое шокирующее обстоятельство заключалось в том, что Танкадо дал ситуации зайти слишком. Он должен был знать, что случится, если АНБ не получит кольцо, - и все же в последние секунды жизни отдал его кому-то. Он не хотел, чтобы оно попало в АНБ. Но чего еще можно было ждать от Танкадо - что он сохранит кольцо для них, будучи уверенным в том, что они-то его и убили.
Пятидесятишестилетний коммандер Стратмор, заместитель оперативного директора АНБ, был для нее почти как отец. Именно он принимал ее на работу, именно он сделал АНБ для нее родным домом. Когда десять лет назад Сьюзан поступила в агентство, Стратмор возглавлял Отдел развития криптографии, являвшийся тренировочной площадкой для новых криптографов, криптографов мужского пола. Хотя Стратмор терпеть не мог выделять кого-нибудь из подчиненных, он с особым вниманием относился к своей единственной сотруднице. Когда его обвиняли в фаворитизме, он в ответ говорил чистую правду: Сьюзан Флетчер - один из самых способных новых сотрудников, которых он принял на работу.
- Он нацелен на фильтры безопасности. Фонтейн побледнел.
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During the Chinese Cultural Revolution —76 , Chairman Mao fundamentally reformed medicine so that rural people received medical care.