Barefoot Doctors and Western Medicine in China by Xiaoping Fang (review)

Based on archival materials and oral history interviews, this book uncovers the relationship between barefoot doctors and Western medicine in China during 1968–85. As Xiaoping Fang puts it, it “demonstrates that a key impact of the barefoot doctor program was facilitating the entry of Western medicine into villages hitherto dominated by Chinese medicine through scientization, institutionalization, and professionalization, which led to a marginalization of Chinese medicine” (p. 3). This unexpected outcome challenged government propaganda and standard recognition of barefoot doctors as being instrumental in carrying out the integration of Chinese medicine with Western medicine, which had been actively promoted by the state since the mid-1950s.

International interest in the Chinese barefoot doctors can be traced back to the 1970s, after the People’s Republic of China was admitted into the United Nations in 1971, and then reopened after President Nixon’s trip to China in 1972. With careful official guidance, Western medical practitioners and governmental officials who visited China were impressed by what they saw in the affordable, cooperative medical system. The group of young, rural health workers with basic medical background practicing in their local villages attracted much attention; their fame reached a peak worldwide when a World Health Organization (WHO) conference signed the Alma-Ata Declaration to promote primary health care and advocate “Health for All,” which was viewed as being inspired by Chinese experiences.

Yet the barefoot doctors’ actual experiences, problems, and preferences easily fell into historical oblivion under the shroud of official propaganda. The typical description of their healing methods is “one silver needle and a bunch of herbs.” Fang’s fieldwork-based study reveals the microcosms of health and disease in seven counties in Hangzhou Prefecture, especially in Jiang village, which is now a suburban area of Hangzhou, the provincial capital city of Zhejiang. Fang’s account brings to life those otherwise faceless individuals or at best stereotyped official protagonists, such as Wang Guozhen, who, hailed as the first barefoot doctor, gave a speech at the 1974 session of WHO in Geneva.

Drawing from historical data and interviews with former barefoot doctors and villagers, chapters 2, 3, and 4 offer a convincing picture of Western medicine taking over in the rural area he chose for study. According to Fang, a shifting pattern of knowledge transmission, pharmaceuticals supply, and healing techniques all contributed to the dominance and popularity of Western medicine. His work reduces the contest between Western and Chinese medicine in the rural arena to a practical level, especially through a data-informed analysis of price, supply, and consumption of pharmaceuticals. From the beginning of the 1960s, technical competence in the Western pharmaceutical industry grew and production capacity increased. In order to promote affordability, nationwide price reduction was dictated in 1969. “Prices for 1,230 kinds of antibiotics, sulphanilamides, fever-reducing medicines, pain-relieving medicines, vitamins, hormones, and other medicines were reduced by 37.2 percent” (p. 78). “Vaccines and other epidemic prevention medicines were provided free of charge” (p. 81). By contrast, the Chinese herbal medicine campaign that came later in the 1970s in fact was a passive reaction in order to control costs. Even with official advocacy and requirement, the general situation for Chinese herbal medicines was not satisfactory in Hangzhou Prefecture. Because Western pharmaceuticals were easier to prescribe and quicker to act, their consumption became more prevalent, as indicated by local data (p. 113).

The barefoot doctor program, an indigenous product of socialist China, actually provided the real context for Chinese villages to encounter Western medicine for the first time. This book offers a novel view of how it worked and what the consequences were. As a case study, it should arouse interest in further research, to see whether its conclusions can be generalized for such a vast and heterogeneous country. For historians of technology, it shows that technology really matters in medical transitions. The large-scale production, distribution, and application of technological inventions in medicine finally consolidated scientific...