Academic journal article China Perspectives

The Lost Generation: "Barefoot Doctors" in Post-Reform China

Academic journal article China Perspectives

The Lost Generation: "Barefoot Doctors" in Post-Reform China

Article excerpt

China's barefoot doctor system is known for having provided inexpensive and accessible medical care to its large rural population in the 1960s and 70s.(1) Barefoot doctors, chosen from local farmers, received basic medical training and then served in the rural areas with a focus on preventive and primary health care. The barefoot doctor system together with the Cooperative Medical System (CMS) in the rural areas became a model for the developing world, reflecting an approach to health care that was "egalitarian, grassroots-based, decentralised, de-professionalised, 'low-tech,' economically feasible, and culturally appropriate."(2) However, the system came to an end with the advent of market reforms in the 1980s, and many barefoot doctors either became private doctors or gave up medical practice. In 1985, the name "barefoot doctor" (chijiao yisheng) was officially abolished and replaced by the name "village doctor" (xiangcun yisheng).(3) More than three decades have passed since this dramatic change, and barefoot doctors seem to have been forgotten. However, the legacy of the barefoot doctor system is still felt in the hardships of aging former barefoot doctors who now find themselves pensionless. It is estimated that approximately 1.5 million people(4) worked as barefoot doctors in the collective era, and today there are still around one million(5) former barefoot doctors nationwide. Based on a case study in Riverside County, this article records the experiences of a group of former barefoot doctors, showing how they strive for payment, pension, and status in post-reform China, and how the historical experience of barefoot doctors can inspire health care reforms today.

The study is based on one year of ethnographic research in Riverside County (pseudonym) of Sichuan Province between October 2011 and October 2012. In early 2012, my acquaintance introduced me to a village doctor - Doctor Lian from Revival Town, who was in his 60s. I visited Doctor Lian and interviewed him and two more village doctors he introduced to me. The next morning, I got a phone call from another village doctor in the same town, who had heard of my visit and wanted me to visit him as well. "I have a lot to say," he stated on the phone. I went to Revival Town again and met Doctor Li, a 76-year-old former barefoot doctor. A few days later, another doctor from Revival Town called me and said that a group of them would be gathering for a meeting in the township hospital and would like to meet me afterwards to "express their thoughts." I subsequently met Doctor Zhao and around 10 other village doctors who were in their 50s, 60s, and 70s. All these doctors were former barefoot doctors who continued medical practice after their collective medical teams were dismantled. In my field, this group of former barefoot doctors appeared to be one of the most resentful groups in the on-going health care reform. After these encounters, I visited 16 village clinics and 12 private clinics around the county, meeting dozens of former barefoot doctors. I interviewed these doctors in groups or individually. All the interviews were written down the same day. I read the interview materials and field notes several times, jotting down thematic topics and issues that came up repeatedly. The accounts are based on these doctors' personal experiences, stories, and interpretations of their current situation. In the years following the fieldwork, I kept in contact with some of these doctors, following their recent situation. This article focuses on the transformation of this group of former barefoot doctors, who started medical practice in the collective era and continued medical practice after market reform.

Barefoot doctors in transition

A letter from a group of barefoot doctors

In the field, I collected several autobiographies and petition letters from former barefoot doctors, who eagerly wrote down their life stories. The petition letter to the government penned by 36 barefoot doctors in Revival Town is a telling example that summarises barefoot doctors' life histories, experiences, and expectations. …

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