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

In this insightful and well-researched book, Xiaoping Fang, a historian of both modern China and science and medicine, has taken on the familiar topic of China and Western biomedicine, providing a new way to think about Chinese health politics and practices during the second half of the twentieth century. Drawing on government documents, anthropological studies, pharmaceutical trade journals, and a number of intriguing oral interviews with local practitioners, Fang focuses on Jiang Village in Zhejiang Province in eastern China. His case study shows, in contrast to the influential legacy formed in the wake of Maoist propaganda, that the official barefoot doctor program (1968–1983) was in fact a pivotal stage in the displacement of traditional medical practices in rural China and helped to facilitate the growing domination of Western biomedicine. Indeed, barefoot doctors were part of a wider effort to marginalize both folk medicine and what came to be called traditional Chinese medicine (TCM). Barefoot doctors, he argues, were never the practitioners of a “halcyon” Golden Age of preventive health and low-tech medicine despite stories told by Maoist officials and American visitors—stories that created a vision of a non-hierarchical “people’s medicine” that profoundly influenced global health policy in the 1970s and 1980s and still lingers in WHO guidelines. In a nuanced discussion of modernization, professionalization, and medical pluralism, Fang examines the experiences of an array of medical practitioners from the 1950s to the 1990s along with the villagers who sought them out.

The practices and careers of two practitioners in Jiang Village illuminate many of the changes in medical politics, technology, and ideology that are at the heart of this book. In the late 1940s Chen Hongting, a savvy TCM physician, transformed his successful private practice into an approved “union clinic” run as a doctors’ collective under the new Communist government, giving himself a high salary. The clinic gained further power as it responded to national hygiene campaigns in the 1950s. While public health interventions, directed by clinic physicians, led to significant amelioration of diseases such as hookworm and malaria, the smiling peasants portrayed in government posters were in reality not so enthusiastic. So unpopular, for example, was the taking of stool samples as part of the schistosomiasis campaign that Chen Hongting had to threaten to deny villagers their daily meal at the union canteen if they did not comply. Other than for Communist Party members, the union clinic was not free, and, according to one villager, the result of the clinic’s refusal to treat a fifteen-year-old girl because her family could not pay was the girl’s death a few days later. Both local and regional bureaucracies helped to expand biomedical pharmaceutical sales, and villagers began to rely on certain biomedical drugs. Yet despite its support by regional officials, the union clinic did not control most medical practice in the village or the surrounding region. Villagers continued to go to folk healers for the treatment of heatstroke, bone fractures, and bloated stomachs, and also sought out healing offered by nuns and monks in temples as well as by disabled fortune-tellers who practiced outside the temples.

Following Mao Zedong’s directive to “stress the rural areas,” the organization and content of medical care in Jiang Village changed significantly, and a second type of practitioner emerged: feisty politicized Maoist physicians eager to gain government recognition, here exemplified by Chen Hongting’s nephew and apprentice Chen Zhicheng. In 1966 Chen Zhicheng organized a coup at what was now designated a commune clinic. He accused his uncle of being a Nationalist, had him paraded through the streets in a dunce’s cap, and cut his monthly salary in half. Chen Hongting remained an ordinary member of the clinic staff until he retired in 1976, and he never reconciled with his nephew. Chen Zhicheng became the clinic director of a reorganized facility now subsidized by finances...