Healthcare and the Politics of Medicine in the Maoist and Post-Maoist, China

This paper draws its thesis on the focus of Healthcare and the politics of medicine in the Maoist and post-Maoist. This dissertation will evaluate the three modes in which Chinese barefoot doctors succeeded in reaching revolution of medicine in villages in China as healers. Structural evolution, professional formation, and medical contestation were instituted by the radical changes under socialism of medical pluralism (White BFD 488). The paper will also analyze the surfacing of these barefoot doctors following the vibrant incorporation of plural medical structures and state medical model structures since the 1950s. The confinement of union clinics first will be analyzed and their essence to the healers from the plural medical structure of rural China. The paper will further evaluate how the Cultural Revolution forced the village medical environments to move from the union clinic’s model to barefoot doctor oriented model with eventual establishment founding of the state’s medicine.

A barefoot doctor was health worker in China’s villages from the year 1968 to 1983 under the community’s system format. Young commune members were chosen to join as barefoot doctors. Training was offered for a short duration after which they went to their homes ready to offer medical treatment and attend to health practices. This way, they formed the novice grouping of a 3 tier state medical structure. The structure comprised the commune, county, and village level. The villagers intern were obliged to pay a specified fee, forming cooperative medical services. The medical services led to the establishment of medical service stations managed by the barefoot doctors. At times when the villagers required treatment they were offered a cost free service and medication (White BFD 488).

Starting the year 1978, the barefoot doctors’ program turned to gradually crumble after the introduction and implementation of rural transformation policies and the disintegration of the residents’ commune structure. Those barefoot doctors who excelled in their medical exams and proceeded practicing the task in villages were labeled as village doctors.  By the year 1983, the cooperative medical services had ceased to practice in most of the Chinese villages. From their foundation, the barefoot doctors since then attracted the minds of scholars, also social commentators purposely for 3 reasons. One, they were linked to the political ideologies of Cultural Revolution, which took China from the years 1966 to 1976. They offered a revolutionary imagery of rendering medical services while making trips barefoot through rice paddies in a quest to call in health and medical work and put the emphasis on the rural localities. Second, the barefoot doctors’ program was considered both within and outside of China, to efficient medical finance collecting models and a low-cost elucidation built around the readily available native medicines. These aspects were further linked to achievements in primary health markers from the year1949 to 1983. Lastly, the lack of medical welfare for resident and the deteriorating rural health conditions under the market’s economy in present day China villages have resulted to a re-evaluation of barefoot doctors in the 1970s. From here, emerged lessons about the convergence of Chinese and the Western medicine. Converse to most of the rhetoric encompassing the program, all the barefoot doctors established Western medicine to a wide cabal of the Chinese countryside whilst gradually marginalizing Chinese medication as a form of pharmacopeia knowledge, and healing traditions. Second, they generated a 3-tier medical structure with themselves as the bottom and the community clinics, union clinics, as relatively marginalized central. Third, they developed an improved medical profession nearly from scratch in the reestablishing medical contexts of the Cultural Revolution from their enclosed village communities. The barefoot doctors assisted in spurring the transformation of social dedication in Chinese villages. Recently, scholars have reviewed the issues of barefoot doctors and their attribution to the public healthcare in the historical background of modern China, mostly within the dissertation of modernization and state building. For instance, some analyzed the barefoot doctors by evaluating continuities in the rural health policies in 20th century of China from the Communist to the Nationalist period. They pointed out the nationalist government’s proposal on the concept of the state’s medicine, or medication for everyone, in the 1930s. The nationalist government thereafter became the chief theme to public healthcare in the 20th century in China.

Given China had a large rural population, the institution of the state medical formation in rural environments turned the key subject of state medication. A patterned interconnected body of facts deliberate practices governed by an individual paradigm of identification, prevention, the meaning, and treatment of the sick. The availability of more than one clinical structure in the same community constitutes to plural medical arrangement. In this case, the medical orientation in China’s society was again plural. This is emphasized by the fact that there existed various healers serving the same space. Usually, Chinese and Western medicine doctors were considered to as professional healers. Snake doctors, Bone-setters, traditional midwives, and heat-stroke acupuncturists, and many more were non-professional healers. The nuns, monk, or sorcery healers from religious and supernatural parties were also a part of this entire collection. In addition, neighbors, family members, and friends with specified skills could be categorized as popular healers.

With the eruption of the Cultural Revolution, rather, the plural medical structure was totally reordered once more. The former health workers linked to union clinics were referred to as barefoot doctors, dropping their earlier titles, and given practical charge at village levels to cooperative medical services. These were the incarnation of the principles in health and medical work. The emphasis was put on the rural areas. Eventually, they were customized into commune clinics that could be financed. They got direct state investment and subsidies. Private medical practitioners were prohibited and criticized or asked to bond to the state medical structure. Healers for supernatural sects and religious backgrounds were discontinued, while the likes of folk healers, such as, herbal medicine men, were dissolved to the cooperative medical centers under barefoot doctors. Following these changes, barefoot doctors surfaced as new and dominant types of healers. They supplemented the entire establishment of a 3-tier and, therefore, fulfilled the long held Chinese objective of extending the state’s medicine to China’s countryside.

The research on the history of medication in China has been spellbound by the tension amongst Western and Chinese medicine since the first encounters in the early 19th century. There exist scholarly consensus around the re-establishment of Chinese medicine the rural areas and villages after the legitimization by the socialist structure of Maoist China. The reputed easy and low cost availability of local medicine additionally gave fame to the rural Chinese health care internationally.

The wide attention given to Chinese medication in this political construction, however, barred the role of biomedicine, Western medicines in Chinese villages at the same time. Although, the Chinese medication framework was promoted by the state, Western medicines themselves also endured a dynamic development procedure, including the implementation of new medical invention and the institution of medicines

Present critics in the current rural health matters, in China, incorrectly supposes that the wide coverage of cooperative medical practices above the barefoot doctors eliminated the bottlenecks of rural healthcare in all Chinese villages in the 1970s. It was the breakdown of the cooperative medical structure, including the dissolution of the barefoot doctors during the period of the rural transformation, ear marked the start of a decline in China’s rural health. Although, the count of barefoot doctors against medical centers dwindled after 1983. The doctors on barefoot maintained a top degree of continuity as medical professions. More significantly, the dissolution of the cooperative medical practices under the reform policy took the role of enhancing the operations of the barefoot doctors’ medical professions by introducing in exams and competitions (White M&M 179).

Alongside the decline in all the medicine prices, the enhancement of medical knowledge, institutionalization of pandemic control, the permanence of barefoot doctors professionals in medicine under the name of the village doctor has been in the past significant, in rural China. This procedure presented an extraordinary outline to the creation of medical professionals, established by the state, local to a society, and enhanced through having endured the profound social shifts (White ICWM 50). Barefoot doctors eventually formed new medical professions in Chinese rural areas and villages. The foundation of medical careers in various eras and regions also indicated different ways in the social past reputation of medicine in China. From this, the historical context, barefoot doctors established their profession. It can be argued that intelligent doctors in historical Chinese society gradually marked the increasing understanding of their common occupational identities, interests, and values, with consideration to their medical knowledge. The native establishment of medical associations surfaced at irregular intervals from the mid Ming era and beyond.

However, thorough the entire process, the state did not take a stand or any role. Dating from the late 19th century, both select doctor and the state plat formed the development of the present day medical profession. On the other hand, the western medicine proficient groups surfaced. (White ICWM 48).

The associations, Medical schools, and alternatively, the state begun to intrude into the establishment of the medical careers through the placement of regulations. What lead to the outlay of the present day Chinese medical profession formation was the disagreements that emerged between the western and Chinese medicine and also the Republican government’s intrusion to demolish Chinese medicine structure together, formed the perfect recipe to the establishment of the current Chinese medical occupation. This rejuvenated the awareness among the Chinese medicine doctors’ of medical professionalization, and started the development of professional associations that formed the foundation of journals or schools, and many more (White ICWM 96).

 After the formation of communist China in the year 1949, the state depicted its remarkable influence in the professionalization, in medicine. Considerably, the shortage of required resources led the state to be the chief driving pressures in that process. The foundation of the barefoot medical careers was a characteristic example, although, it was normally regarded as a de-professionalization, contrasting to the professionalization of influential physicians.

Introduction involved set aspects of professionalization, all together, even though this begun from zero level in the rural village society constrained by tense political climate. During the 1970s, on the other hand, the barefoot doctors were separated from all agricultural work in the fields. Dissimilar to their fellow villagers, the barefoot doctors, turned to be doctors who owned shoes, ironic to their title, unlike the barefoot villagers. Although these doctors from then were paid relating to a work point formula that also applicable to the rest of the villagers, they were depicted belonging to unique category of employees. This gave room barefoot doctors to wedge out a location for themselves as full time professionals within the Chinese villages (White M&M 179).

It is, therefore, imperative to consider the developments that the Chinese healthcare and politics in medicine in the rural areas of China has molded today’s excellence in the field.

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