Barefoot Doctors Make a Comeback In Rural China

PETER WONACOTT – THE WALL STREET JOURNAL

Trained as a Nurse, Ms. Li Treats Datang Village; Delivering a Baby for $4
Copyright THE WALL STREET JOURNAL
September 22, 2005
DATANG VILLAGE, China — Shortly after Li Chunyan married five years
ago, she sold her wedding gifts — two water buffaloes — and set up a tiny
medical clinic next door to a pigpen. Her only competition in this hamlet
with no running water was a witch doctor who treats patients by chanting
and ringing bells.
Villagers have opted for Ms. Li’s conventional cures. As a graduate of
a three-year nursing-school program, the 28-year-old is by far the
best-trained healer in these parts.
On most days, she’s busy treating colds and fevers. When called, she
climbs terraced hills of rice and cabbage to deliver babies in villages that
have no doctor. “Even the witch doctor comes to see me now,” boasts Ms. Li,
a petite woman who keeps her hair pulled back in a neat knot. “He gets
the sniffles.”
In this remote corner of China’s southwest Guizhou province, Ms. Li is
helping revive one of Mao Zedong’s storied successes of the 1960s and
’70s: the “barefoot doctors,” countryside medics who did a lot to reduce
infant mortality and eradicate contagious diseases. Local authorities singled
out candidates, who continued to work as farmers and didn’t wear shoes in
the fields. In three to six months of training, they learned to promote
hygiene, treat basic ailments and deliver babies.
Now, amid a collapse of health care in China’s countryside, and looming
threats of global pandemics, this vestige of communism is making a
comeback.
Despite a push to recruit more barefoot doctors, Ms. Li is still a
rarity. Local authorities in her county of Congjiang want doctors for each of
their 360 villages, but they can’t pay them and haven’t met that goal.
Barefoot doctors don’t get subsidies from the state, compared with village
doctors who are paid a small salary of about $100 a month.
As a result, most barefoot doctors are as poor as their neighbors.
Among
Ms. Li’s 25 classmates graduating in 2000, in a program funded by the
World
Bank, only a few stayed in the field of health. Most quit for jobs in
the
cities that paid better. Ms. Li accepts IOUs as payment from her
patients,
also, chickens, ducks and eggs. She has walked hours to other villages
to
deliver babies for as much as four dollars and as little as six cents.
Part of her training came from one of Mao’s original barefoot doctors:
her
father, Li Hanming. In 1965, Mr. Li, a middle-school graduate, got six
months’ training before he began to treat patients at the village
commune.
Today, locals seek him out for his knowledge of Western and traditional
Chinese medicine. Once a week, the 61-year-old scours the sides of
mountains for shrubs and roots to treat colds, sore throats and
diarrhea.
Mao’s barefoot doctors helped change China. Thanks to vaccination
programs
begun in the 1960s, China was among the first developing countries to
eradicate highly infectious diseases like smallpox and polio. By the
1970s,
China had outstripped other developing countries, including Malaysia
and
Indonesia, in reducing infant mortality. At the time, about 85% of
China’s
rural residents had access to community-financed health care.
But in China’s shift to a market economy, many of these achievements
have
come undone. That’s partly because Beijing dismantled the communes,
which
heavily subsidized health care, and stopped paying barefoot doctors.
Many
returned to the fields. Others opened shops and relied on selling
medicines
at inflated prices to stay in business.
Through the 1990s, health-care costs soared, while rural incomes did
not.
Fears of health costs are among the main reasons the Chinese save so
much
money; people are expected to pay in cash before treatment, and many
must
resort to borrowing from families and friends. The World Health
Organization recently ranked China fourth worst among 190 countries for
equality of health care.
In March, a think tank under China’s State Council, or cabinet, issued
a
rare scathing report on health care, judging decades of reform
“unsuccessful.” Last month, Chinese Premier Wen Jiabao pledged to
extend
subsidized health care to rural residents.
Foreign health experts believe the risks of China’s health failures are
high — and not just for China. If swaths of the world’s most populous
nation lack rudimentary health care, diseases such as SARS, AIDS, or
flu
outbreaks originating from birds and pigs, will have an easier time
spreading globally.
Ms. Li is part of efforts to remedy these problems. Under one proposal
from
the China Economy Research Center at Peking University, barefoot
doctors
would be encouraged by the government as they were in the old days.
They
would receive free training and government-paid salaries, and they
would
spearhead health education and vaccinations.
Critics say such proposals are too romantic. Village and barefoot
doctors
“have essentially become drug peddlers,” says William C. Hsiao, a
professor
at Harvard University’s School of Public Health. He is leading a
project to
improve health-care coverage in China’s rural areas. Mr. Hsiao says
semitrained medics aren’t the answer. What China’s farmers really need
in
today’s market economy is affordable insurance and doctors whose
services
are monitored by an elected village committee, he says.
Where Ms. Li works, about 1,200 miles from wealthy Shanghai, many
farmers
can’t even afford a minimum level of health insurance. Most families
earn
less than $60 a year, well below China’s poverty line. A Chinese ethnic
minority, known as the Miao, populates nearby villages. Women dress in
black tunics and carry sloshing water buckets up dirt paths. Older men
stash wads of homegrown tobacco in checkered head kerchiefs and smoke
from
skinny wood pipes.
Ms. Li went to Datang because she fell in love with a local boy, Meng
Fanbin, an ethnic Miao who was her middle-school classmate. After they
graduated, Ms. Li went on to nursing school. Mr. Meng enlisted in the
army
because his parents couldn’t pay for more education.
When the two married, Ms. Li’s in-laws gave them the two giant water
buffaloes. Ms. Li promptly sold both for $250, well below the market
price.
With the cash, she built her clinic in a corner of their house.
Patients
simply arrive at her doorstep when they need care. At 10:45 one recent
evening, a woman lingered in the shadows as the family cleared away
dishes
from dinner of beef and red chili peppers. After quick conversation,
Ms. Li
used scissors to break sealed glass vials. She gave a runny-nosed
2-year-old an injection of antibiotics and a traditional Chinese
medicine
to relieve his fever. The woman offered two yuan bills, or 25 cents.
Ms. Li
took only one.
The next morning, roosters were crowing when her first patients arrived

another two children with colds. They got the same injections, plus
some
cough syrup made from snake bile.
Experts have criticized the overreliance on antibiotics among doctors
to
treat patients in the Chinese countryside. But Ms. Li says her strategy
is
to stem sickness before it spreads.
The only patient staying in the clinic was Wu Laonong, who had turned
to a
witch doctor in May to try to stop the bleeding after the birth of her
son.
The family paid 35 cents to drive away evil spirits, but the woman soon
slipped into a coma. A week later, the family had sold livestock,
borrowed
from friends and raised $1,700 to admit her to the county hospital. Ms.
Li
chipped in an additional $360 from her savings to keep her there.
After Ms. Wu regained consciousness several weeks later, she couldn’t
speak
or walk. So she checked into Ms. Li’s clinic and began to receive daily
doses of glucose, vitamin C and Chinese herbs through an intravenous
drip.
Now the 27-year-old Miao woman groans out orders to her husband to feed
the
baby and laughs when Ms. Li’s son spreads lipstick on his leg. Above
the
clinic, the woman’s father and brother are building a new addition to
help
repay Ms. Li for her care.
Ms. Li wants to build a new clinic. Donors who read about her work in a
local Chinese newspaper contributed enough to start, but the structure
remains a half-completed brick husk. Another setback: a young village
girl
who had expressed great interest in an apprenticeship stopped coming
around. “I am the first barefoot doctor in this village,” Ms. Li says
proudly. “I hope I’m not the last.”




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