Barefoot doctors
Encyclopedia
Barefoot doctors are farmers who received minimal basic medical and paramedic
al training and worked in rural villages in the People's Republic of China
. Their purpose was to bring health care to rural areas where urban-trained doctors would not settle. They promoted basic hygiene
, preventive health care, and family planning
and treated common illness
es. The name comes from southern farmers, who would often work barefoot in the rice paddies.
In the 1930s, the Rural Reconstruction Movement
had pioneered village health workers trained in basic health as part of a coordinated system, and there had been provincial experiments after 1949, but after Mao Zedong’s healthcare speech in 1965 the concept was developed and institutionalized. In his speech, Mao Zedong
criticized the urban bias of the medical system of the time, and called for a system with greater focus on the well being of the rural population.
China’s health policy changed quickly after this speech and in 1968, the barefoot doctors program became integrated into national policy. These programs were called “rural cooperative medical systems” (RCMS) and strove to include community participation with the rural provision of health services.
Barefoot doctors became a part of the Cultural Revolution
, which also radically diminished the influence of the Weishengbu, China's health ministry, which was dominated by Western-trained doctors.
curing simple ailments that were common in the specific area, and were trained to use Western medicines and techniques. An important part of the Cultural Revolution was the movement of sending intellectuals, and in this case doctors, to serve in the countryside (Chinese: 下鄉 pinyin
:xìa xiāng). They would live in an area for half a year to a year and continue the education of the barefoot doctors. About a fifth of the barefoot doctors later entered medical school
.
and moxibustion
. An important feature was that they were still involved in farm work, often spending as much as 50% of their time on this - this meant that the rural farmers perceived them as peers, and respected their advice more. They were integrated in a system where they could refer seriously ill people to township and county hospitals.
Barefoot doctors provided mostly primary health care services, and focused on prevention rather than treatment. They provided immunizations, delivery for pregnant women, and improvement of sanitation. The income of the barefoot doctors was calculated as if it were agricultural work; they were paid roughly half of what a classically trained doctor made. This funding came from collective welfare funds as well as from local farmer contributions (from 0.5% to 2% of their annual incomes). This program was successful in part because the doctors were selected and paid by their own villages. By the 1960s, there were RCMS programs in 90% of China's rural villages.
The work of the barefoot doctors effectively reduced health care costs in the People’s Republic of China, and provided primary care treatment to the rural farming population. The World Health Organization regarded RCMS as a “successful example of solving shortages or medical services in rural areas”.
The barefoot doctor system was abolished in 1981 with the end of the commune system of agricultural cooperatives. The new economic policy in China promoted a shift from collectivism to individual production by the family unit. This shift caused a privatization of the medical system, which could not sustain the barefoot doctors. The barefoot doctors were given the option to take a national exam, if they passed they became village doctors, if not they would be village health aides. Village doctors began charging patients for their services, and because of the new economic incentives, they began to shift their focus to treatment of chronic conditions rather than preventative care.
By 1984, village RCMS coverage had dropped from 90% to 4.8%. In 1989 the Chinese government tried to restore a cooperative health care system in the rural provinces by launching a nationwide primary health care program. This effort increased coverage up to 10% by 1993. In 1994 the government established “The Program”, which was an effort to reestablish primary health care coverage for the rural population.
In 2003 the Chinese government proposed a new cooperative medical system that is operated and funded by the government. This program is run more like an insurance program. It pays 10 Renminbi per year for each person covered by the program, and by ensuring coverage for serious diseases. This new program relies heavily on lessons learned from the times of the barefoot doctors, but faces many challenges in providing sufficient, cost-effective care for China’s rural populations.
conference in Alma Ata, Kazakhstan
in 1978 where the Alma Ata Declaration
was signed unanimously. This was hailed as a revolutionary breakthrough in international health ideology - it called for local communities participating in deciding health care priorities, called for an emphasis on primary health care
and preventive medicine
, and most importantly sought to link medicine with trade, economics, industry, rural politics and other political and social areas.
created an international humanitarian apolitical NGO
of doctors called Medecins Aux Pieds Nus in France.
Volunteers work in Burundi
, Colombia
and Southeast Asia with local healers to develop "medical garden" for herbalism
and make essential oils for gemmotherapy
. In 1999, Jean-Claude Rodet
became the first president of Medecins Aux Pieds Nus Canada
working with Mark Smith
in United States.
This NGO leads ethnobiological
missions based on "proximity, prevention
and humility"
A Barefoot Doctor's Manual: The American Translation of the Official Chinese Paramedical Manual (Philadelphia: Running Press, 1977). ISBN 091429492X.
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
al training and worked in rural villages in the People's Republic of China
People's Republic of China
China , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...
. Their purpose was to bring health care to rural areas where urban-trained doctors would not settle. They promoted basic hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
, preventive health care, and family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
and treated common illness
Illness
Illness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...
es. The name comes from southern farmers, who would often work barefoot in the rice paddies.
In the 1930s, the Rural Reconstruction Movement
Rural Reconstruction Movement
The Rural Reconstruction Movement was started in China in the 1920s by Y.C. James Yen, Liang Shuming and others to revive the Chinese village. They strove for a middle way, independent of the Nationalist government but in competition with the radical revolutionary approach to the village espoused...
had pioneered village health workers trained in basic health as part of a coordinated system, and there had been provincial experiments after 1949, but after Mao Zedong’s healthcare speech in 1965 the concept was developed and institutionalized. In his speech, Mao Zedong
Mao Zedong
Mao Zedong, also transliterated as Mao Tse-tung , and commonly referred to as Chairman Mao , was a Chinese Communist revolutionary, guerrilla warfare strategist, Marxist political philosopher, and leader of the Chinese Revolution...
criticized the urban bias of the medical system of the time, and called for a system with greater focus on the well being of the rural population.
China’s health policy changed quickly after this speech and in 1968, the barefoot doctors program became integrated into national policy. These programs were called “rural cooperative medical systems” (RCMS) and strove to include community participation with the rural provision of health services.
Barefoot doctors became a part of the Cultural Revolution
Cultural Revolution
The Great Proletarian Cultural Revolution, commonly known as the Cultural Revolution , was a socio-political movement that took place in the People's Republic of China from 1966 through 1976...
, which also radically diminished the influence of the Weishengbu, China's health ministry, which was dominated by Western-trained doctors.
Training
The barefoot doctors usually graduated from secondary school and then received about six months of training at a county or community hospital, though training length varied from a few months to one and a half years. Training was focused on epidemic disease prevention,curing simple ailments that were common in the specific area, and were trained to use Western medicines and techniques. An important part of the Cultural Revolution was the movement of sending intellectuals, and in this case doctors, to serve in the countryside (Chinese: 下鄉 pinyin
Pinyin
Pinyin is the official system to transcribe Chinese characters into the Roman alphabet in China, Malaysia, Singapore and Taiwan. It is also often used to teach Mandarin Chinese and spell Chinese names in foreign publications and used as an input method to enter Chinese characters into...
:xìa xiāng). They would live in an area for half a year to a year and continue the education of the barefoot doctors. About a fifth of the barefoot doctors later entered medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
.
Work
Barefoot doctors acted as a primary health-care provider at the grass-roots level. They were given a set of medicines, Western and Chinese that they would dispense. Often they grew their own herbs in the backyard. As Mao had called for, they tried to integrate both Western and Chinese medicine, like acupunctureAcupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
and moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...
. An important feature was that they were still involved in farm work, often spending as much as 50% of their time on this - this meant that the rural farmers perceived them as peers, and respected their advice more. They were integrated in a system where they could refer seriously ill people to township and county hospitals.
Barefoot doctors provided mostly primary health care services, and focused on prevention rather than treatment. They provided immunizations, delivery for pregnant women, and improvement of sanitation. The income of the barefoot doctors was calculated as if it were agricultural work; they were paid roughly half of what a classically trained doctor made. This funding came from collective welfare funds as well as from local farmer contributions (from 0.5% to 2% of their annual incomes). This program was successful in part because the doctors were selected and paid by their own villages. By the 1960s, there were RCMS programs in 90% of China's rural villages.
The work of the barefoot doctors effectively reduced health care costs in the People’s Republic of China, and provided primary care treatment to the rural farming population. The World Health Organization regarded RCMS as a “successful example of solving shortages or medical services in rural areas”.
End of barefoot doctors in China
Two-thirds of the village doctors currently practicing in rural China began their training as barefoot doctors. This includes Chen Zhu, China’s current Minister of Health, who practiced as a barefoot doctor for five years before going on to receive additional training.The barefoot doctor system was abolished in 1981 with the end of the commune system of agricultural cooperatives. The new economic policy in China promoted a shift from collectivism to individual production by the family unit. This shift caused a privatization of the medical system, which could not sustain the barefoot doctors. The barefoot doctors were given the option to take a national exam, if they passed they became village doctors, if not they would be village health aides. Village doctors began charging patients for their services, and because of the new economic incentives, they began to shift their focus to treatment of chronic conditions rather than preventative care.
By 1984, village RCMS coverage had dropped from 90% to 4.8%. In 1989 the Chinese government tried to restore a cooperative health care system in the rural provinces by launching a nationwide primary health care program. This effort increased coverage up to 10% by 1993. In 1994 the government established “The Program”, which was an effort to reestablish primary health care coverage for the rural population.
In 2003 the Chinese government proposed a new cooperative medical system that is operated and funded by the government. This program is run more like an insurance program. It pays 10 Renminbi per year for each person covered by the program, and by ensuring coverage for serious diseases. This new program relies heavily on lessons learned from the times of the barefoot doctors, but faces many challenges in providing sufficient, cost-effective care for China’s rural populations.
Historical legacy
The system of barefoot doctors was among the most important inspirations for the WHOWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
conference in Alma Ata, Kazakhstan
Kazakhstan
Kazakhstan , officially the Republic of Kazakhstan, is a transcontinental country in Central Asia and Eastern Europe. Ranked as the ninth largest country in the world, it is also the world's largest landlocked country; its territory of is greater than Western Europe...
in 1978 where the Alma Ata Declaration
Alma Ata Declaration
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care , Almaty , currently in Kazakhstan, 6-12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the...
was signed unanimously. This was hailed as a revolutionary breakthrough in international health ideology - it called for local communities participating in deciding health care priorities, called for an emphasis on primary health care
Primary health care
Primary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost...
and preventive medicine
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
, and most importantly sought to link medicine with trade, economics, industry, rural politics and other political and social areas.
International development with NGOs
In 1977, Jean-Pierre WillemJean-Pierre Willem
Jean-Pierre Willem, born 24 May 1938 at Sedan , is a physician and founder of Médecins Aux Pieds Nus. He led numerous humanitarian missions to help victims of catastrophes and conflicts...
created an international humanitarian apolitical NGO
Non-governmental organization
A non-governmental organization is a legally constituted organization created by natural or legal persons that operates independently from any government. The term originated from the United Nations , and is normally used to refer to organizations that do not form part of the government and are...
of doctors called Medecins Aux Pieds Nus in France.
Volunteers work in Burundi
Burundi
Burundi , officially the Republic of Burundi , is a landlocked country in the Great Lakes region of Eastern Africa bordered by Rwanda to the north, Tanzania to the east and south, and the Democratic Republic of the Congo to the west. Its capital is Bujumbura...
, Colombia
Colombia
Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...
and Southeast Asia with local healers to develop "medical garden" for herbalism
Herbalism
Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, herblore, and phytotherapy...
and make essential oils for gemmotherapy
Gemmotherapy
Gemmotherapy [from Lat. gemma, bud, and New Lat. therapīa, Grk. therapeia, medical treatment] is a form of herbal medicine that uses remedies made principally from the embryonic tissue of various trees and shrubs , but also from the reproductive parts and from newly-grown tissue Gemmotherapy [from...
. In 1999, Jean-Claude Rodet
Jean-Claude Rodet
Jean-Claude Rodet ND, born 1944 at Saint-Vérand, Rhône, is a French-speaking Canadian author, trainer and consultant in nutrition. He has a doctorate of agronomic sciences and an honorary doctorate in natural medicine...
became the first president of Medecins Aux Pieds Nus Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
working with Mark Smith
Mark Smith
Mark Smith may refer to:*Mark A. Smith, professor of pathology at Case Western Reserve University*Mark S. Smith, American biblical scholar, professor at NYU*Mark Smith , designer of radio-controlled model airplanes...
in United States.
This NGO leads ethnobiological
Ethnobiology
]Ethnobiology is the scientific study of dynamic relationships between peoples, biota, and environments, from the distant past to the immediate present....
missions based on "proximity, prevention
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
and humility"
Further reading
Traditional medicine in contemporary China: a partial translation of Revised outline of Chinese medicine (1972) with an introductory study on change in present-day and early medicine. Nathan Sivin (Ann Arbor: Center for Chinese Studies, University of Michigan, 1987. ISBN 0892640731.A Barefoot Doctor's Manual: The American Translation of the Official Chinese Paramedical Manual (Philadelphia: Running Press, 1977). ISBN 091429492X.
See also
- Public health in the People's Republic of China
- HeilpraktikerHeilpraktikerHeilpraktiker is the name given to a natural health professional in Germany and Switzerland. In Austria there is no such equivalent profession and patients do not have this option for health care...
a category of natural health workers in Germany and Switzerland - Barber surgeonBarber surgeonThe barber surgeon was one of the most common medical practitioners of medieval Europe - generally charged with looking after soldiers during or after a battle...
a historical category of health worker in Eastern Europe