The “barefoot doctor” (chijiao yisheng), which is to say a doctor who also worked as a farmer in a commune production brigade, was an iconic figure that emerged during China's Cultural Revolution. Barefoot doctors received basic medical training so they could provide treatment, perform public health work, and support family planning in rural villages. Deploring the fact that medical resources were concentrated in urban areas, in 1965, Mao Zedong demanded that a vast effort be mounted to provide rural areas with good health care. He promoted plans to send educated youth to the countryside, while equipping both poor peasants and sent-down high school students with basic medical training in a short period of time. This policy gave rise to the barefoot doctors.
Past research on barefoot doctors has mainly focused on their role in the Chinese medical system, and their influence on that system's success, failure, and feasibility. Xiaoping Fang, by contrast, takes a social history of medicine perspective, employing gazetteers, oral histories, and archival materials related to seven counties in Zhejiang Province (with an emphasis on Jiang Village) to analyze the role that barefoot doctors played in introducing Western medicine to rural China. Although it was common for barefoot doctors to use a combination of both Chinese and Western medicine, Fang shows that from 1968 to 1983, the emphasis was on Western pharmaceuticals. Barefoot doctors reduced the use of Chinese medicine, for reasons that included changes in healing style and medical beliefs (such as using Western medical kits, administering injections, obtaining blood samples, and collecting human feces), and the relative difficulty of collecting medicinal herbs at that time. Simultaneously, the price of Western pharmaceuticals had dropped, they were easy to obtain, and, in many cases, they produced immediate results.
The book begins by tracing the origins of the barefoot doctors to the older tradition of village healers. It then explores the formal implementation of the barefoot doctor policy, discussing the modes of knowledge transmission, the use of pharmaceuticals, the institutionalization of healing, and professionalization. Chapter 1 considers the change in the modes of transmission that brought Western medical knowledge to the rural areas, examining, for example, the establishment of union clinics and the abolishment of private medical practice. Chapter 2 describes the Western techniques and products that barefoot doctors were known to have used in their daily medical practice and public health work, including pharmaceutical tablets, medical devices, intra-uterine devices, injections, and vaccines. Chapter 3 contends that the barefoot doctor program effectively converted rural populations to a preference for Western medical treatments and that, as a result, Chinese herbal medicine lost much of its support. Chapter 4 discusses a general Westernization of healing styles and medical beliefs, concluding that pharmaceuticals became overused. Chapter 5 sketches a shift from home treatment to hospital-based care, the growth of a referral system, and the formation of what the author calls “the dumbbell-shaped structure of a three-tiered medical system,” in which communal clinics (the middle tier) diminished in significance and were overshadowed by the district clinics and cooperative medical service stations at the top and bottom tiers. Chapter 6 provides further insights into the group identity and social status of barefoot doctors, and into their relationships with their patients. Finally, the concluding chapter explores the significance of the barefoot doctors in the transformation of rural medicine and the interrelationships between them, the socialist state, and villagers.
This book is a must-read for everyone who has an interest in the history of barefoot doctors. One great strength of this study is the author's use of a combination of interviews and gazetteers, materials that permit a fine-grained picture of Jiang Village at the time that barefoot doctors brought Western pharmaceuticals into the countryside. This book also offers rare insights into the role of barefoot doctors in the villages and in the national healthcare system, noting, for example, that they did not always participate in farming.
While Fang's claims about the Westernization of rural medicine are compelling, important questions remain. First, existing barefoot doctors’ manuals have suggested that when the barefoot doctors were first sent to the countryside, they would have relied on acupuncture, Chinese herbal medicine, and tuina (a massage technique). Yet the book does not say whether acupuncture and tuina were marginalized or replaced, an important issue that bears directly on the relative status of Chinese healing in the countryside. Second, the distinction between Chinese and Western ideas and techniques—and thus the implied competition between them—is not necessarily as clear as the book suggests. Sydney White, for example, has observed, “The use of injections of antibiotics is closely linked to health bolstering techniques from Chinese medical epistemology.”Footnote 3 In other words, Western pharmaceuticals were transmitted to villages in the guise of Chinese medicine. Similarly, according to Fang, Chinese patent medicines were becoming increasingly popular in villages and many of these medicines had properties similar to Western pharmaceuticals. One must thus ask: to what extent was the popularity of Western drugs in Jiang Village driven by these conflations of or perceived similarities between Western and Chinese therapies? A final issue pertains to regional variation: do the conclusions of this book square with the recollections of the still-living barefoot doctors who trained and worked in other regions of China's vast territory? Fang's impressively detailed study of Zhejiang will provide an important reference point for future research into the influence of the barefoot doctors on rural health care.
