The Barefoot Doctor

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In 1949, after decades of civil war and famine, the Chinese Communist Party (CCP) took control in a country where the countryside and some cities were ravaged by the Three Diseases (三病) of edema, gynecological problems, and child malnutrition (Zhou, 2015: 42). Infant mortality rates in areas without modern medical resources were estimated at 250-300 per one thousand live births and maternal mortality at 15 per one thousand births, which critics blamed on traditional midwives whom they accused of employing inadequate and unsanitary methods (Johnson and Wu, 2014: 56). For the CCP, medicine and public health was not just a welfare concern, but that of national economic and military efficiency—health programs would increase the agricultural productivity vital to China’s economic recovery and introduce the new “socialist rationalization” to every sphere of life, transforming old, diseased individual bodies into a socialist collective body of men and women fit for the new socialist state (Zhou, 2015: 42).

On June 16, 1965, one year before the Cultural Revolution, Chairman Mao Zedong issued a “Directive on Public Health” calling for the diversion of healthcare resources from cities into poor rural areas (Xun, 2015: 51). Among the ensuing reforms was a program that gave selected villagers basic medical training, enabling them to deliver services like immunization, delivery and care for pregnant women, and improvement of sanitation relying on Western medicine, simple surgical operations, and some traditional Chinese medicine (TCM) (Zhang and Unschuld, 2008: 1866). These medically-trained villagers, who were mostly young men and some women, became known as the “barefoot doctors”, as they still spent some time in “barefoot” farming labor and received work points and income equivalent to agricultural workers rather than certified doctors (Fang, 2014: 155). A pre-existing cooperative medical system had started in the mid-1950s, in which healthcare stations were collectively financed by villages. Services encompassed three levels: hospitals on the county level, health institutes on the commune level (weisheng suo 衛生所), and health stations on the village level (weisheng shi 衛生室) (Pang, 2014: 845). With the addition of barefoot doctors, the new medical system allegedly benefited more than 500 million rural people, and by 1975, there were 1.5 million rural doctors in China (846).

In the 1980s, reform led to dismantlement of the cooperative medical system, and in January 1985, the Ministry of Health canceled the title of “barefoot doctors”. Its practitioners became village doctors or moved to other occupations (Zhang and Unschuld, 2008: 1866). Former barefoot doctors are now mostly retired. Despite their popularity as revolutionary images at the time (Fang, 2014: 268), few current academic or popular works capture their personal narratives. This research project seeks to do so, in the context of exploring how former barefoot doctors express their individual memories through narratives and the ability of those narratives to produce transgenerational memory that shapes Chinese society into its future.


Women Doctors in Rural China

Wang Xilan (往西兰), Yin Xiarong (殷秀荣), and Li Guizi (李桂芓) are three former female barefoot doctors who worked in gynecology. Most barefoot doctors were male, but female doctors were specifically recruited to take care of female patients and work as midwives (Pang, 2014: 849), because obstetrical and gynecological work was considered improper for male barefoot doctors, and many female patients were unwilling to seek reproductive care from men (Fang, 2014: 52). Despite the predominance of men on the ground, cultural representations of barefoot doctors such as propaganda and film primarily portrayed attractive young women working in idyllic rural communities (Pang, 2014: 837). Laikwan Pang argues these images exhibited traditionally feminine characteristics like caretaking and comforting that were condemned as politically regressive in other arenas (Pang, 2014: 841). They softened the image of the CCP’s reforms, while still presenting the female barefoot doctor as an aspirational political model for other women: caring, feminine, but strong workers for the advancement of the state.

Figure 3.  Liang Hongtao. 1972.  A Good Physician for the Peasants , propaganda poster. Shanghai People’s Publishing House. From Pang, Laikwan. 2014. “The Visual Representations of the Barefoot Doctor: Between Medical Policy and Political Struggles.”

Figure 3. Liang Hongtao. 1972. A Good Physician for the Peasants, propaganda poster. Shanghai People’s Publishing House. From Pang, Laikwan. 2014. “The Visual Representations of the Barefoot Doctor: Between Medical Policy and Political Struggles.”

Figure 4.  Cheng Yanning (陳衍寧). 1974.  New Doctor in the Fishing Village  (漁港新醫), oil on canvas. From Pang, Laikwan. 2014. “The Visual Representations of the Barefoot Doctor: Between Medical Policy and Political Struggles.”

Figure 4. Cheng Yanning (陳衍寧). 1974. New Doctor in the Fishing Village (漁港新醫), oil on canvas. From Pang, Laikwan. 2014. “The Visual Representations of the Barefoot Doctor: Between Medical Policy and Political Struggles.”

On the afternoon of January 12, 2019, the three former barefoot doctors got together in one of their homes for a conversation. It had been months since Wang, Yin, and Li had all been together, despite living within 30 minutes’ walking distance of each other. In Zhoukou city, they led lives of similar economic status, residing in small apartments on state pensions that covered their basic needs. Wang brought out a printed copy of her memoir, and the three women began to look over passages and reminisce together, since they had been coworkers. The stories that they recounted are too many to summarize here, but at one point I asked them about their experiences as women in a male dominated field, given that women had only recently been admitted into the medical profession at large. They said that they faced no discrimination, although in the area women made up perhaps only 10% of total barefoot doctors. All of them talked about the hardships of the role. In contrast to the clean, bright images presented by propaganda posters of female barefoot doctors, the actual job involved digging one’s hands into the mess, blood, and fluids that accompany disease and childbirth.


Traditional Chinese Medicine

Prior to health reform, much of the rural population depended on traditional Chinese medicine (TCM) and religious rituals to solve their health problems (Johnson and Wu, 2014: 52; Fang, 2014: 274). The Cultural Revolution sought to eradicate ritual practices but retained TCM as a part of the state-building project: it was a distinctively “Chinese science” that emphasized China’s cultural heritage (Hsu, 2008: 466). Until the late imperial period, traditional medical knowledge was transferred through three ways: self-study, studying under masters, and training within families, clans, and lineages. Family transmission was the predominant method, and a medical pedigree spanning generations was a criterion of proficiency, as reflected in the proverb ““Do not take medicine from a physician who is not a third-generation practitioner” (yibu sanshi, bufu qiyao 醫不三世, 不服其藥) (Fang, 2014: 43).

Other than their public health aims, rural healthcare reforms changed how medical knowledge was passed down, both for traditional and Western medicine. Rather than learning through family lineages, barefoot doctors underwent training programs that generally lasted no more than twelve months. To supplement their knowledge in the field, they relied on an unprecedented variety of medical publications that disseminated medical knowledge in China.

Zhang Mingbian is retired, but he still keeps a room filled with his medicinal ingredients and tools and occasionally treats patients in his home. For the interview, he wanted to hang up a red banner that was in his old workroom as an accreditation of his status. As a young man he learned TCM from his father’s close relative, who was also a traditional doctor, and memorized formulas from classical TCM textbooks; then, from the 1960s to 1980s, he was recruited by the government to work in Ge Dian, as well as sent to treat miners in Pingdingshan, a larger town about 160 kilometers west of Zhoukou.

Although traditional medicine doctors like Zhang Mingbian worked alongside barefoot doctors, Zhang Mingbian did not directly teach his medical knowledge to his son and grandson. He would not have been able to pass down his credentials, because by 1951, regulations governing traditional medicine doctors meant that they were not allowed to prescribe chemically compounded medicines, give injections without scientific training, or induce abortions. Moreover, they had to pass qualification exams which entailed knowledge of Western medicine (Fang, 2014: 45). These regulations largely shifted the job of knowledge transmission to the state.


The Village Doctor and the Clinic Doctor

Doctor Qi (齐) is a village doctor in Qi Zhuang, a small village near Zhoukou. Around 50 years old, he is of the same generation as Zhang Yong. He operates a village clinic in his courtyard, in rooms detached from his family’s living quarters. Absent the presence of a medicine cabinet, the rooms, consisting of a bedroom and a living room, might as well be a domestic space. During the course of an interview with him, two separate patients, an elderly woman with a tooth ailment and a young woman with a cold, walked in to be treated (no appointment was needed). From their interaction, it was clear that the patients and doctor were totally familiar to each other, being residents of the same village. Doctor Qi’s method of diagnosis consisted mainly of asking how the patients felt, a practice resonant with TCM where the patient has more control in their interactions with doctors than in Western practice (Fang, 2012: 162), although he gave them chemically compounded medicines rather than herbal remedies. The doctor-patient relationship seemed quite horizontal; like the past’s barefoot doctors, Doctor Qi was not above the community but a member of it (163).

For comparison, I visited a larger county clinic, which happened to be at the site of the old Ge Dian clinic. Unlike Doctor Qi’s clinic, this was housed in a one-story building built for the purpose. There were many more modern medical supplies, such as hospital beds and intravenous drips. With its fluorescent lighting and hospital furnishings, it could hardly be mistaken for a domestic space, and though the patients seemed comfortable, their relationship with the medical workers was less familiar than in Doctor Qi’s clinic. When I walked in with Wang Xilan, to my surprise, two of the patients at the clinic (both elderly women), recognized her, with one of them saying, “Isn’t that Doctor Wang?” It had been over a decade since Wang had retired, but the women remembered her from her long years working in the area.

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The Barefoot Doctor, a graphic novel-in-progress


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References

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