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  • Barefoot Doctors and Western Medicine in China by Xiaoping Fang
  • Howard Chiang (bio)
Xiaoping Fang, Barefoot Doctors and Western Medicine in China
Rochester, NY: University of Rochester Press, 2012. xvi +294 pp. £60.00, hardcover, £19.99, paperback.

At the peak of the Cultural Revolution, the barefoot doctor initiative and the production brigade medical stations where these practitioners worked were established to improve health-care service across rural China. The story of barefoot doctors formally began in 1968, when the People’s Daily published a report in September announcing “a revolution in medical education through the growth of the barefoot doctors” in a Shanghai commune; another article that December introduced the “cooperative medical service” in the Leyuan commune of Hubei (31–32). Technically speaking, “barefoot doctors” ceased to exist in 1985, when the health minister Chen Minzhang announced the end of the term’s usage in official Chinese discourse (175). Few aspects of Maoist China have acquired global repute as positive as the barefoot doctor program. In the late 1970s, the program even appealed to the World Health Organization (WHO), which promoted it as a model of primary health care and preventive medicine for developing countries (2).

Drawing on local archives, published sources, and interviews with former barefoot doctors and, to a lesser extent, their patients, this book significantly deepens our understanding of the role that barefoot doctors had played in transforming medical practice, ideas, education, market, institutions, and professionalization in the socialist period. Although the book is centered on Jiang Village, Yuhang County, in Zhejiang, this microhistorical focus enables the author to deduce broader compelling insights concerning the significance of the barefoot doctor program for rural health-care reform since the early 1950s. The context for this narrative took concrete shape with the advent of the Communist regime in 1949, when county hospitals gradually replaced existing county clinics (which had been primarily administered by the Nationalist government) and, more importantly, when township-level union clinics were developed to form a two-tier state medical system. The introduction of barefoot doctors in the late 1960s generated a further downward extension of this system. The rise of cooperative medical [End Page 493] services turned previous union clinics into commune clinics and set up medical stations at production brigades, which became the primary affiliation of barefoot doctors.

Whereas revolutionary discourses branded barefoot doctors as agents of syncretism between Chinese medicine and Western medicine, this book makes a decisively different argument, one that may appear rather counterintuitive: “A key impact of the barefoot doctor program was facilitating the entry of Western medicine into villages hitherto dominated by Chinese medicine through scientificization, institutionalization, and professionalization, which led to a marginalization of Chinese medicine” (3). For instance, Western medical training, medical textbooks, practical education, and self-study all “Westernized” how barefoot doctors acquired medical knowledge, replacing the master-disciple relationships or family traditions that had long characterized the mode of knowledge transmission in Chinese medicine. Meanwhile, the increasing availability and decreasing prices of Western pharmaceuticals that came with the arrival of barefoot doctors in the villages seriously challenged the popular acceptance and practical legitimacy of Chinese herbal medicines. In this process, villagers formed a comparative impression of Chinese and Western medicine: they began to view the former as a slower, gentler approach that targeted the “roots” of illnesses and the latter as a quicker, more convenient approach that relieved “symptoms.” Yet over time, the author argues, the healing style of barefoot doctors shaped the villagers’ pharmaceutical consumption behavior and ideological preference for Western medicine.

Framing the barefoot doctor program as “a pivotal stage in the displacement of Chinese medicine by Western medicine in rural China” (181), this book also brings to light the often-neglected history behind the institutionalization and professionalization of medicine beyond the urban context. Between the late 1960s and early 1980s, cooperative medical services facilitated the shift in the site of daily medical encounter from bedsides to hospitals. An important consequence of this shift was what the author calls the “dumbbell-shaped” structure of the three-tier medical system. Because the commune clinics (the middle part of the system) tended to have poor medical facilities, and the role of barefoot...

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