- Barefoot Doctors and Western Medicine in China by Fang Xiaoping
Cultural Revolution, People’s Republic of China, alternative health workers
When American diplomatic delegations traveled to the People’s Republic of China during the 1970s, they were deeply impressed by rural medicine in the Maoist state. Physician Victor Sidel spoke glowingly of “barefoot doctors,” health workers who had received minimal training in Chinese and Western medicine and who performed basic medical care in rural areas (Victor W. Sidel, “The Barefoot Doctors of the People’s Republic of China,” New England Journal of Medicine 286 , 1292–300). But Fang Xiaoping argues in his excellent new book that barefoot doctors were more than just a scattered collection of individual health workers. Western medicine came to dominate rural China during the socialist era from 1949 to 1976, and barefoot doctors were critical agents of this transformation. Fang uses oral interviews and archival documents to build a case study of rural medicine in Jiang Village, outside the city of Hangzhou in Zhejiang province. In providing an in-depth study of the barefoot doctors, Fang makes an important contribution to the work of Kim Taylor, Miriam Gross, Sydney White, and other scholars of medicine in the early People’s Republic of China. Fang’s discussion of competition and cooperation among Western, Chinese, and folk medical traditions in Zhejiang also offers a useful meditation on issues of medical pluralism in the Chinese context, following the work of Arthur Kleinman.
According to Fang, barefoot doctors in Jiang Village occupied the lowest level of a three-tier hierarchy that characterized the rural medical infrastructure of the early People’s Republic. At the top were county hospitals, which the early People’s Republic typically created after 1949 by appropriating preexisting structures in Zhejiang. During the early 1950s, individual townships established intermediary “union clinics.” And at the lowest rank, brigade medical stations emerged in 1969 with the state’s establishment of the [End Page 343] barefoot doctor program to train rural health workers. In the 1970s, rural Chinese in Zhejiang increasingly sought treatment in clinics or hospitals outside their villages. Barefoot doctors facilitated this shift because they referred villagers from brigade medical stations to union clinics, then up to county hospitals. In the early 1980s, a reimbursement policy allowed villagers to bypass the poorly equipped and underfunded union clinics, which became primarily administrative units. Fang describes this evolution as the emergence of a “dumbbell-shaped” medical hierarchy in which barefoot doctors and county hospitals became increasingly important.
After 1969, Western medicine came to dominate rural areas like Jiang Village, in no small part because it was easier for barefoot doctors to learn and use than the often voluminous and complex prescriptions of Chinese medicine. A 1969 reduction in pharmaceutical prices and renewed state efforts to distribute basic medical instruments, like stethoscopes and thermometers, also popularized Western medicine among barefoot doctors in the villages outside Hangzhou. In contrast, barefoot doctors were loath to use Chinese drugs because they were difficult to cultivate, identify, and process. Although Chinese Communist Party doctrines formally advocated the integration of Chinese and Western traditions, in reality villagers in Zhejiang followed the preferences of their barefoot doctors and primarily favored Western medicine.
By the end of the Cultural Revolution, rural populations in Zhejiang recognized barefoot doctors as medical professionals. Although the government of the People’s Republic ostensibly defined barefoot doctors in terms of their dual roles as workers and healers, it also facilitated their professionalization. The state created a coherent group identity for barefoot doctors by minimizing group conflicts and by marginalizing competition from alternative traditions like folk medicine. Although the program has functionally disintegrated, many former barefoot doctors continue to practice medicine today. Fang argues that although new licensing requirements and rural reforms imposed during the 1980s forced many barefoot doctors to quit practicing medicine, those who remained developed new, stronger professional identities as rural health workers because licensing examinations had given them useful credentials.
This book is an important new study of...