In the Spirit of Dr. Norman Bethune: The Barefoot Doctors of China, 1974

Part 2 of 2.

The two doctors making their rounds.

TLC Editor's Note: The barefoot doctor program emerged in response to a severe shortage of doctors in rural China, where most physicians were concentrated in urban areas. Before 1949 and the triumph of the Revolution, there were only about 40,000 doctors for a population of roughly 540 million, leaving rural communities vulnerable to diseases such as schistosomiasis. The program was formalized after Mao Zedong’s 1965 directive, which emphasized the need to address the urban bias in healthcare and provide medical services to the 80–90% of the population living in rural areas. The goal was to train one barefoot doctor for every 1,000 rural residents.

Barefoot doctors were typically farmers, folk healers, or recent middle and secondary school graduates who received three to six months of basic medical training in anatomy, bacteriology, disease diagnosis, acupuncture, Western medicine, birth control, and maternal and infant care. They continued to work in the fields while providing healthcare, reflecting the program’s integration into rural life. Their primary focus was preventive care, including hygiene education, immunizations, sanitation programs, and basic treatment for common illnesses. More complex cases were referred to township or county hospitals.

The barefoot doctor program dramatically improved rural health outcomes. It contributed to reducing infant mortality, eradicating smallpox, controlling tuberculosis and schistosomiasis, and increasing life expectancy from 35 in 1949 to 68 by 1979. The program also promoted family planning and basic hygiene, helping to modernize rural healthcare while remaining extremely cost-effective. By the 1970s, there were approximately 1 million barefoot doctors serving rural communities.

It is regarded as one of the great successes of the Great Proletarian Cultural Revolution.

Here we bring the first of two articles about these doctors from China Reconstructs Magazine in April 1974.

China Reconstructs Editor: There are now over a million peasant-doctors in China — people trained during the cultural revolution who continue their regular farm work but also serve the communes' brigade members as "barefoot doctors" (called this because the practice started in the south where they often work barefoot in the wet paddyfields). The "barefoot doctors" are a new and rapidly developing force in China's rural medical and health services.

Medical schools have trained a large number of doctors in the 25 years since liberation. But China is a developing country with a huge rural population (80 percent), and medical schools alone could not meet the need for doctors. Training thousands of "barefoot doctors" therefore became highly important to rapidly improving medical and health work in the countryside.

There is a great interest abroad in "barefoot doctors". Many of our readers ask, "What kind of doctors are they? How are they trained? What role do they play in China's medical and health work?"

The following two articles, about "barefoot doctors" in Yungfu county in the Kwang-si Chuang Autonomous Region [ the Kwang-si Chuang Autonomous Region is now known as Guangxi Zhuang Autonomous Region - ed. TLC] give some answers. On China's southern border, subtropical Kwangsi has 20,840,000 people of many nationalities. Before the liberation in 1949, health conditions here were terrible and disease rampant. Twenty-five years of Party led efforts, especially since the cultural revolution began, have created a medical and health network which protects the people's health. The region's 30,000 "barefoot doctors" and 150,000 production-team health workers play a key role in the prevention and treatment of disease in the countryside. Yungfu is one of Kwangsi's 82 counties.

In the Spirit of Dr. Norman Bethune

By CHUN SHENG

Early one winter morning, an unexpected event happened in the Shuangchiang brigade of the Lungchiang commune lying among mountains 20 kilometers northwest of the county town of Yungfu. Just as the members of the Chiaotou production team were getting ready to go to work in the hills, Mo Laoman rushed up, saying, "Uncle Huo-sheng's had a relapse! He's already unconscious and will soon be dead, come and help!" He sent a young man off to the brigade to telephone Mo Huo-sheng's two sons who were working away from home, and got some team members to make arrangements for the funeral.

Brought Back to Life

"Barefoot doctor" Li Mu-chiao heard the young man making the phone call. "Why didn't you come earlier for a doctor?" he asked reproachfully.

"It was a sudden attack, and it was too late to save him."

Li Mu-chiao at once consulted woman "barefoot doctor" Hsiao Yu-ying. They both thought of what Chairman Mao had said; "Heal the wounded, rescue the dying, practice revolutionary humanitarianism." Inspired by the Canadian internationalist fighter Dr. Bethune's spirit of extreme responsibility in his work and warmth toward the people, they decided that as long as there was a spark of hope, they should do everything to save the man. Hsiao Yu-ying sterilized the instruments while Li Mu-chiao went ahead with the emergency kit.

At Mo Huo-sheng's home Li found the family sobbing with lowered heads and some neighbors were gloomily dusting off the coffin. Pale as a sheet. Mo Huo-sheng was stretched out on a lounge chair on the left of the room. His wife's eyes were red and swollen from crying.

The unexpected entry of the "barefoot doctor" surprised every one, and especially moved the old woman.

Li Mu-chiao put down his medical kit, said a few words to comfort the old woman, asked about the patient's condition and then examined Mo Huo-sheng. He could feel no pulse and the patient's limbs were cold, but there was still a faint heart beat. From the patient's case history and condition, he thought it was probably shock caused by excessive bleeding in the stomach, and there was still hope. Immediately he injected coramine, lobeline and vitamin K in an attempt to save him. Everyone gathered around without uttering a sound. After about half an hour. Mo Huo-sheng slowly opened his eyes and moved his lips, bringing joy to the grief-filled spectators.

By this time Hsiao Yu-ying had arrived, and she began to help Li Mu-chiao give injections and set up an intravenous drip. Six hours of intense work from ten in the morning to four in the afternoon brought Mo Huo-sheng back to life.

For the People's Health

The news spread quickly through the villages of the commune, where it met with wide praise. But people were not too surprised, since they had heard many stories of how these two "barefoot doctors" gave brigade members warm, conscientious care.

Li Mu-chiao and Hsiao Yu-ying are both from poor-peasant families in the Shuangchiang brigade. These two members of the Communist Party were raised here on Mao Tsetung Thought; after liberation. The history of disasters generation after generation for lack of medical care and the lofty spirit of Dr. Bethune encourage them to put their whole heart into their work as "barefoot doctors" protecting the people's health.

To be ready for patients at all times, they have put up a bunk in the clinic and take turns sleeping there. When there is a patient in critical condition, they keep a watch at the bedside through the night. Either of them makes the rounds of the other villages in the brigade. Day or night, rain or shine, they always answer calls.

The more cases Li Mu-chiao handles, the more he feels the need to improve his skill. Though his income is not large, he never stints on buying medical books. He once spent 15 days going into the hills to gather herbs with a veteran herbal doctor. Moved by his desire to learn, the old doctor gave him all the prescriptions he had accumulated over long years. He often brings back new varieties of medicinal herbs and plants them in the brigade's herb garden.

Hsiao Yu-ying is particularly concerned with women's health and knows the general physical condition of most of the brigade's women. Whenever she makes the rounds of a village, she always goes to see the expectant mothers and those who have just given birth. To persuade a woman having difficulty in giving birth to agree to be moved to the clinic for delivery, with tears in her eyes, she once recalled the painful lessons of other women in the village.

These two "barefoot doctors" often encourage one another with Chairman Mao's words in praise of Dr. Bethune's selfless spirit: "A man's ability may be great or small, but if he has this spirit, he is already noble-minded and pure, a man of moral integrity and above vulgar interests, a man who is of value to the people."