Abstract
This chapter depicts the experience of a group of relatively disadvantaged doctors—the former ‘barefoot’ doctors. The barefoot doctors, who had been motivated to work hard and contribute to the health of the mass peasants since the collective era, had improved health care in the rural areas. Yet in the post-reform era, they were quickly forgotten in the state’s aims of economic development, the scientific development of medicine, and the modernisation of the health system. Barefoot doctors changed to village doctors, had to continue medical practice without any salary or a pension. They lack institutional training and qualifications, are viewed by the authorities as being inadequate and in need of self-investment and self-transformation. Indeed, these former barefoot doctors actively fostered their own transformation by gaining further training and qualifications, working hard to earn their own salary. However, it is not easy or feasible for every doctor to rapidly adapt to the market. Old, vulnerable, and less productive, many of them become uncompetitive in the market. The former barefoot doctors become increasingly disappointed when they are confronted with subsistence needs, sense their loss of status, and perceive the difference between themselves and other professional groups. They began to put their pension claims into action.
Part of this chapter was published in China Perspectives 2016/4 (http://www.cefc.com.hk/issue/china-perspectives-20164/) (Tu 2016). This article is reproduced with permission. Thanks for the reviewers’ critical comments.
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Notes
- 1.
The program started from 1965 and became internationally influential in the 1970s. The system was acknowledged by the WHO for securing people’s basic health care rights and was a major inspiration to the primary health care movement, leading up to the Alma-Ata conference in 1978 (see Cui 2008).
- 2.
In the post-reform era, although many former barefoot doctors become village doctor, other people (such as new practitioners graduated from local medical school) also join the village doctor group. Thus village doctors are not a homogeneous group.
- 3.
The data of 1 million came from various predictions and checks through interviews and internet search. However, there is no official data about the actual number of former ‘barefoot doctors’ who are still alive.
- 4.
The numbers of barefoot doctors increased rapidly between the middle 1960s and the Cultural Revolution (1966–1976). By 1977, the number of barefoot came to a peak. The number in 1977 was recorded in Riverside County Medical Chorography (1988) and Riverside County Chorography (1990). The current number of former barefoot doctors comes from predictions by local village doctors and health officials. Besides these ageing former barefoot doctors, there were also thousands of former paramedical workers, who served in the rural areas during the collective era, demanding proper compensation, but their voices are not as loud as the voices of these former barefoot doctors. I could not collect enough materials about this group, which is thus outside the scope of this chapter.
- 5.
Due to the shortage of public healthcare services, in 1980, the Ministry of Health issued a Report on the Granting of Permission for Solo Private Medical Practice (Weishengbu guanyu yunxu geti kaiye xingyi wenti) (http://law.people.com.cn/showdetail.action?id=2568900, retrieved 17 February, 2010), which recommended legalising private medical practice while regulating it strictly.
- 6.
Improper design, such as these clinics do not have a toilet, it is not convenient for patients who need to go to toilet after taking drips; improper locations, most of these clinics are located at the side of rural road for official checks. The donation of new clinics to poor areas by Chinese Red Cross Foundation originally aims to relieve poverty and improve fairness. However, in practice, it increases sense of injustice among village doctors. Besides, since the new healthcare reform, the local authority has named two kinds of village clinics. One is advanced new village clinics (jiaji cunweishengshi), which have better facilities and are mostly operated by relatively younger village doctors. The other is ordinary village clinics (putong cunweishengshi), many of which are in poor conditions and mostly operated by elderly village doctors who cannot renovate their clinics to become an advanced one. The former clinics also get more subsidies than the latter ones.
- 7.
Data comes from Riverside County Medical Chorography (1988) and Riverside County Chorography (1990).
- 8.
The local government regulates that male village doctors over 60 years old and female village doctors over 55 years old will not be given medical practice licence. However, without pension, many elderly village doctors continued medical practices in the rural areas.
- 9.
In the post-reform era, many of the former barefoot doctors become the village doctor, however, ‘village doctors’ in rural areas are actually a diversified group. They included former barefoot doctors who are between 50 and 80 years old now; the village doctors who started medical practice in the post-reform era (some of them are the sons and daughters of the former barefoot doctors, see Huang et al. 2002: 363–371); and former township/commune hospital professionals who took village doctor role after their hospital dissolved in the 1980s and 90s. The writing of ‘village doctors’ in this section still focuses on the group of former barefoot doctors who continued medical practices in the rural areas after the changes in the 1980s and 90s, although some of their situations are experienced by all village doctors.
- 10.
Although the ‘one-child policy’ formally started in 1980, the birth control efforts had already initiated in the 1970s and came to the peak in the 1980s.
- 11.
For instance, in May 2014, the central government released the document ‘2014 Working Tasks to Deepen Healthcare Reform’ (CPG 2014). It suggests transferring 40% of all public health work to village doctors.
- 12.
The subsidies have increased gradually over the years, but have yet reached a satisfactory level for village doctors.
- 13.
This is similarly found by Kipnis (2008) among Chinese workers who describe the performance audits in the market era as ‘socialist’ rather than neoliberal governmentality.
- 14.
This new market ‘work-reward’ logic is somewhat different from the ‘work point’ system adopted in the socialist period. ‘Work point’ was very crude evaluation. In Riverside County, a barefoot doctor’ daily work was counted as 1.2 ordinary villager’s daily work points, but they needed to take many works that were not evaluated. The market ‘work-reward’ logic tends to put everything into evaluation, village doctors have clear ideas about the value of their labour and have specific demand of the amount of monetary rewards.
- 15.
As I show in this article later, many factors contributed to the fact that the former barefoot doctors are treated differently from other groups, such as the former barefoot doctors’ inability to organize themselves to act collectively, the large number of former barefoot doctors that made solving their pension issue difficult financially (compared with the relatively smaller number of village teachers and veterans).
- 16.
See one of the video about village doctor’s miserable life: ‘Xiangcun yisheng de xinsheng’ (The voices of village doctors), available at http://v.youku.com/v_show/id_XMzkyOTYyNzcy.html, retrieved 27 October, 2014.
- 17.
For instance, the coastal Guangdong Province began to give livelihood subsidy to these former ‘barefoot doctors’ and midwives who served in the rural areas during the collective era (see China Daily 2013). In Jiangsu Province, elderly village doctors were given public employee pension insurance (see People’s Net 2013).
- 18.
Central People’s Government, PRC. ‘Guideline to Further Strengthen the Building of Village Doctor Team’ (Guanyu jinyibu jiaqiang xiangcun yisheng duiwu jianshe de zhidao yijian). Retrieved on 11 November, 2017 (http://www.gov.cn/zwgk/2011-07/14/content_1906244.htm).
- 19.
No matter was doctors in the Maoist era really act ‘selflessly’ and ‘heroically’, the good doctor in official discourse was frequently depicted as acting ‘selflessly’ and ‘heroically’.
- 20.
See the official web of Chinese Medical Doctor Association at http://www.cmda.gov.cn/ (in Chinese), http://cmdae.org/en/index.php (in English), retrieved March 24, 2013.
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Tu, J. (2019). Practice of the Self: ‘Barefoot Doctors’ in Post-reform China. In: Health Care Transformation in Contemporary China . Springer, Singapore. https://doi.org/10.1007/978-981-13-0788-1_7
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