Rural health care policy aims to let "barefoot doctors" have clinics

Yu Bing, a 40-year-old village doctor in southwest China, is on call 24 hours a day to provide anything from medical advice and treatment to conducting epidemic prevention checks in the mountainous village of Shuichao. "It isn't rare for me to be woken by patients at two or three in the morning," Yu said. As the only doctor in the remote village in Hezhang County, Guizhou Province, Yu is constantly busy, but he feels content when comparing his past job as a "barefoot doctor" with the present work in the village clinic. Dr. Yu's office, a 60-square-meters cottage, is divided into a pharmacy, a diagnosis room and a therapeutic room. It is also equipped with necessary medical instruments. "My family used to dine, sleep and treat patients in the same cottage, and like all the other barefoot doctors, I only had three medical instruments in the past: a sphygmomanometer, a stethoscope and a syringe," he said. The barefoot doctor's cottage has been refurbished into a real clinic with the government's funding support for improving the rural health care system. Yu is one of more than 1 million village doctors providing basic medical services to nearly 700 million Chinese farmers. A majority of them began their training as barefoot doctors. Barefoot doctors acted as a part of an extensive health-care system promoted by late Chinese leader Mao Zedong. The number of barefoot doctors was officially 1.46 million in 1980. The name "barefoot doctor" came from their farmer-style appearance. Despite lack of professional training, they provided the basic medical needs for China's huge rural population during the country's planned economy era, when 90 percent of China's population enjoyed life-long, government-subsidized health care. The system started to collapse in the early 1980s with the end of collective economy in rural areas, according to Chen Xiwen, an expert on rural issues who serves as deputy director of the Leading Group on Rural Work of the CPC Central Committee. Farmers could not afford the surging medical expense as subsidies were cut and the user-pays system was introduced. Rural medical facilities lost government financial supports and many had to close down. Thousands of barefoot doctors lost their jobs. As a result, rural China witnessed a vast shortage of doctors and medical facilities. The Chinese government has been making efforts to improve health care services in rural areas through a new program called "one clinic in each village" or "one village doctor for every 1,000 farmers," in line with a health guideline released by the General Office of the State Council in July. To improve village doctors' living conditions, the government has also planned to improve their subsidies and income. A pension program is expected to be launched soon for that purpose, according to the guideline. In addition, special funds have been established in many provinces and regions for the purchase of medical instruments and providing professional training to village doctors. "We farmers like village doctors because they are always there to help and are familiar to us," said Zhang Zhihe, a farmer in Lishan Village, Nanchang County of eastern Jiangxi Province. He said it would take him an hour to go to the township hospital if there was no village doctor. Zhang Xingde has been practicing in Lishan Village for more than 40 years. However, the 63-year-old barefoot doctor-turned clinic head can not figure out whether he is a private doctor or a doctor under the government health system. He recalled that he struggled to be an independent doctor in the village, even after the government gave up the extensive health care system in 1980s. While in the early 1990s, village officials persuaded him to turn his private clinic into the village clinic though the government did not invest a penny. Zhang through his own conscientiously-driven initiatives took responsibility for providing health care and epidemic control for the whole village. "In the early 1970s and 1980s, many farmers volunteered to receive training to become barefoot doctors even though medical facilities and funds were scarce. Doctors enjoyed relatively high social status," Zhang recalled. Zhang's son Zhang Hua took after his father and gave up the opportunity to work in a city hospital and came back to help his father in the village clinic, after he graduated from Jiangxi Medical College in 1988. "With increasing government funding, the environment and facilities in many village clinics have begun to be improved, and they would attract more medical students in the future," Zhang said hoping the younger generations of village doctors would provide more professional medical care services to farmers than barefoot doctors like him.