Barefoot doctor



Barefoot doctors (Chinese: 赤脚医生) were farmers who got basic medical training and worked in rural villages in the People's Republic of China to bring health care to areas where urban-trained doctors would not settle. The name comes from southern farmers, who would often work barefoot in the rice paddies. There were scattered experiments with this before 1965, but with Mao's famous 1965 speech about healthcare it became institutionalized, and 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.

Training
The barefoot doctors usually received about half a year, but sometimes as short as a few months, and as a long as one and a half years of training that was very focused on preventive medicine and curing simple ailments that were common in the specific area. An important part of the Cultural Revolution was xiaxiang (a movement of sending intellectuals, and in this case doctors, to serve in the countryside). 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.

Work
Barefoot doctors 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 acupuncture 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.

End of barefoot doctors
The barefoot doctor system was abolished in 1981 with the abolishment of the commune system of agricultural cooperatives. 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.

Historical legacy
The system of barefoot doctors was among the most important inspirations for the WHO conference in Alma Ata, Kazakhstan in 1978 where the Declaration of Alma-Ata 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 preventative medicine, and most importantly sought to link medicine with trade, economics, industry, rural politics and other political and social areas.