- Barefoot Doctors and Western Medicine in China by Fang Xiaoping
This illuminating study corrects what we thought we knew about that evanescent character the Barefoot Doctor, invented in 1968, widely acclaimed inside and outside China, and officially discarded in 1985. It is based on local archives in seven counties of Hangzhou prefecture and intensive interviews with residents of one village and with others in the Hangzhou area. The author grew up “in the late 1970s … in a small village high in the mountains of Zhejiang Province,” and, when he was ill, was treated with medicines that came from barefoot doctors (p. ix). This is actually a history of health care for poor peasants in villages like his from 1949 more or less to 2003, when this project began.
The picture of barefoot doctors promoted by the Chinese government conveyed the idea that these young farmers, equipped with “a silvery needle and a bunch of herbs,” were using integrated Chinese and Western medical knowledge to deliver affordable care to everyone. Their training in the foundations of Chinese medicine was actually too scanty to be very useful. Fang richly documents his argument that they “effectively converted rural populations to a preference for Western medical treatments” (p. 3). The book traces the creation of medical institutions at the levels of the county, of what became the commune and then the township, and of the village that became a production brigade during the Great Proletarian Cultural Revolution and, afterwards, again a village. He shows that the communes’ clinics failed to play an essential medical role in the system as the barefoot doctors in the villages took over. He also asserts that the reforms, from 1978 on, consolidated the status of barefoot doctors, as those who learned more and passed examinations were reclassified “village doctors.” As private practitioners, over the ensuing decade, they became members of the local elite. Fang does all this in an impartial way, with ample documentation at each step. As a local, he gained access to data, from archival reports to personal views, that would have been denied to outsiders.
The story begins in 1952, when the new government organized at the township level what it called “union clinics,” staffed by doctors already in practice who had to equip and support themselves. They were responsible for treating the masses, providing preventive medicine, teaching public health training health workers, and, of course, supporting [End Page 256] government campaigns. The part-time peasant health workers that they trained were assistants, not independent therapists. In 1965, the production brigades were required to have two assistants, one of whom was female, both “nominated by the masses” and trained by mobile medical teams from the cities and by union clinic doctors. They were taught to treat common diseases and to conduct public health campaigns, not in the union clinics, but part-time in their villages as they continued their agricultural work.
Fang does not make clear how far this program evolved during the early turmoil of the Cultural Revolution. It was superseded in September 1968, in response to Chairman Mao’s call to focus on medical care in the rural areas, by the announcement of a “newly emerged thing,” the barefoot doctor, who did much the same thing without supervision. These half-therapists, half-farmers, were part of an important national innovation, the cooperative medical service. This was a form of medical insurance, in which each member of each commune contributed the equivalent of a few cents, matched by twice as much from the production team. After paying an even smaller registration fee, the individual received medical care without any additional costs. The task of the barefoot doctors was to provide such care in every village, providing truly accessible, affordable care to its members for the first time. The barefoot doctors also led environmental sanitation and public health campaigns, and referred upward those patients they were unqualified to treat. By 1970 there were over 11,000 barefoot doctors and nearly 4,000 cooperative medical service stations in...