Barefoot doctor
They included farmers, folk healers, rural healthcare providers, and recent middle or secondary school graduates who received minimal basic medical and paramedical education.
[1] With the onset of market-oriented reforms after the Cultural Revolution, political support for barefoot doctors dissipated, and "health-care crises of peasants substantially increased after the system broke down in the 1980s.
[9] Union clinics, owned by the state but run by the resident doctors, became one way of dealing with the lack of sufficient healthcare in rural areas.
[6] Mao Zedong himself noted the disparity between the quality of urban and rural healthcare in what is now known as the June 26th directive, and this prompted the beginning of the barefoot doctor program.
[3] As Gross (2018) mentions, an important part of Mao's plan was the movement of sending doctors, to serve in the countryside (Chinese: 下鄉; pinyin: xìaxiāng).
[1] Hesketh and Wei (1997), on the other hand, mention that although some were unhappy, other urban doctors were grateful for the lessons they learned while living as peasants.
[1] Barefoot doctors were often fairly young, which Fang (2012) attributes to the fact that the state wanted them to be able to support rural healthcare for the foreseeable future.
[1] Fang (2012) also describes that physically weak or disabled people often trained to become barefoot doctors, as the job was much less hard on the body than agricultural labor.
[1] Fang (2012) explains that, due to tradition, many females felt uncomfortable being examined by male doctors, and, as a result, silently had a host of diseases, especially gynecological ones.
Alternatively, practitioners went on herb-collection trips twice a year, which served to replenish the medicinal herb supply in rural areas.
[16] Gross (2018) describes that herbs provided an inexpensive, easily accessible method for rural healthcare in contrast to the expensive tools used by scientific medicine.
[18] Barefoot doctors often spent as much as 50 percent of their time on farming, which Rosenthal (1982) explains meant that the rural farmers perceived them as peers and created a sense of equality between physician and patient.
[20] This includes Chen Zhu, China's former Minister of Health, who practiced as a barefoot doctor for five years before going on to receive additional training.
[14][8] This shift caused a privatization of the medical system, which marginalized barefoot doctors and their focus on preventive medicine and primary healthcare.
[7] Without the public-service oriented work of barefoot doctors, "health-care crises of peasants substantially increased after the system broke down in the 1980s.
[13] These individual, local governments had to collect funds through taxation, which led to imbalances between areas with wealthy and poor citizens.
[22] 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.
[6] The work of the barefoot doctors effectively reduced healthcare costs in the People's Republic of China, and provided primary care treatment to the rural farming population.
[6] The World Health Organization (WHO) regarded RCMS as a "successful example of solving shortages of medical services in rural areas".
[6] China's entrance into the United Nations (UN) and WHO, raised the visibility of the barefoot doctors' effectiveness of providing primary healthcare at an affordable cost.
[23] Moreover, the success of the barefoot doctor model demonstrates that many diseases in poor countries can be prevented and solved without significant financial resources or technological transformation.
[6][23] Instead, both Zhang and Unschuld (2008) and Cueto (2004) show that the barefoot doctor system exemplifies that adequate political focus on support of rural-based and non-commercial forms of preventive healthcare and primary care treatments can change the health landscape of a nation.
[13] Through such significant improvements, the state of China's public health was nearing that of more Western countries toward the end of the barefoot doctor era.
[8][25] This was hailed as a revolutionary breakthrough in international health ideology - it called for local communities participating in deciding healthcare priorities, called for an emphasis on primary and preventive healthcare, and most importantly sought to link medicine with trade, economics, industry, rural politics and other political and social areas.
The resurgence of interest in preventive medicine, primary healthcare, and holistic approaches to social welfare worldwide is leading to positive revisitations of the legacy of barefoot doctors.
[27] In 1977, Jean-Pierre Willem created an international humanitarian apolitical non-governmental organization of doctors called Médecins aux pieds nus [fr] (MAPD) 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 Médecins aux pieds nus Canada working with Mark Smith in the United States.
