ABSTRACT

In the wealth of the biographical material about Mao Zedong, there is no shortage of accounts of his outrage. But my impression is that nothing could match the level of anger he showed one day in 1965. The following figures are what had provoked him: in 1965, there were 1.5 million medical professionals in China; 80 percent of the most senior professionals were located in the cities. Specifically, 70 percent of all medical professionals were working in large cities, 20 percent were in county seats, while only 10 percent were in rural areas. Rural areas accounted for only 25 percent of national medical expenditure, while the remaining 75 percent was spent in urban areas. Mao concluded, “The Ministry of Health only serves 15 percent of the total population, and this portion of the population are primarily city lords. The vast majority of peasants receive neither medical treatment nor any medicine. The Ministry of Health is not the people’s ministry of health. Let us call it Ministry of Cities, or Ministry of Lords, or Ministry of City Lords” (Mao 1965b: 2974). Why did Mao lose his temper? To understand this, we must go back to the situation of medical care in rural China in the 1950s. Since the beginning of the People’s Republic, efforts at medical reform had not significantly altered the existing order or the dominance of Western medicine within urban areas, and

efforts to bring medical care to the countryside had faced significant difficulties. In the 1950s, medical resources in rural areas were concentrated primarily in cooperative clinics. Cooperative clinics played an important role in reorganizing the patterns of local traditional medicine by organizing and concentrating dispersed doctors of traditional Chinese medicine in order to better serve the process of collectivization of the rural economy and social structure. This process did not increase medical resources, but merely reorganized the population of medical professionals on the level of the township. Grouping doctors of traditional Chinese medicine together into concentrated clinics in fewer locations made it possible to make better use of their skills, but also made seeking medical treatment inconvenient for many villagers who were used to seeking care close to home. The Chinese state was aware of the problem of the shortage of medical care in rural areas, and experimented with various ways to improve the situation. Various mobile medical service teams were deployed throughout the vast countryside, to allow peasants living outside the townships to have better access to medical care. The members of those medical teams were by no means “lords,” nor did they only serve “lords.” But these efforts had not managed to resolve the problem of providing accessible medical care for the public good. Peasants had themselves been trying to figure out ways to deal with medical emergencies. In 1958, an author named Zhao Zhenheng described the establishment of a small clinic by Qunying Cooperative of Hongliang Township in Xishui County, Hubei Province. In July of that year, some 30 members of the cooperative had suffered from colds, diarrhea, and bouts of sunstroke. If every sick person had another person taking care of them, around 60 laborers out of a total of 197 laborers in the cooperative would have missed work. Inspired by the example of a public mess hall that had been established in the county, the head of the cooperative came up with the idea of “setting up a small clinic.” With the assistance of the county health station, they emptied two rooms, whitewashed the walls, and sterilized them. A healthcare worker and a nurse were the only labor needed to staff the project. Then, the cooperative spent several yuan purchasing medicines, refined grain, eggs, and sugar. All sick villagers were persuaded to stay in this clinic, and the township arranged for a doctor to come to the clinic several times a day. The clinic had reduced the amount of labor required for taking care of the sick from 30 workers to two (Zhao 1958: 37). Afterwards, 110 cooperatives of the same district set up their own small clinics. Although a variety of experimental projects had been made with the aim of improving medical care for peasants, Mao could not help but lose his temper. China’s healthcare service seemed to take a step toward reform only when a new political campaign was underway; healthcare reform had come to seem merely a manifestation of the frequency of new political campaigns. The implementation of mobile medical care in rural areas had had the effect of a downpour: little had really changed below the surface after each rain. Mao in particular insisted that the work of medical care that had been implemented as

part of the “Four Clean Up Campaign” should not end.1 Mao’s outrage in 1965 focused on two problems. One was to make medical resources secure in rural areas. His idea was that the good doctors should go to the countryside, leaving only less skilled doctors in the city, such as those who had only recently graduated from medical education institutions. As a result, starting in 1965, a large number of medical professionals were sent to serve rural areas. In some places such as Baoshan, Yunnan Province, medical professionals from the province, prefecture, and county were sent out to rural areas between the winter of 1969 and the spring of 1970. Through these measures, the number of professional medical personnel working in rural areas increased to 238 persons, or 90.1 percent of the medical personnel in the entire county. Mao was especially troubled by a second concern: the state’s current inability to systematically localize the training of rural healthcare workers. It had been over 30 years since 1931, when Chen Zhiqian had successfully promoted the training of healthcare workers in rural areas, and the three-tiered healthcare network that Chen proposed had become the basic policy of China’s rural medical reform. Chen had been satisfied with these reforms, but Mao was not that sanguine. What most disappointed him was that those at the bottom of the three-tiered healthcare network-healthcare workers-had not yet played a significant role in medical reform. In addition to traditional Chinese medicine, there existed in rural areas a large number of folk healers similar to caoyi ( herbalist) or bannongbanyi ( a farmer working part time as a healer). Those yeyuyisheng ( spare-time doctors, or amateur doctors) were different from professional doctors of both Western medicine and traditional Chinese medicine, or TCM, but were not the same as shamans. They won the hearts of peasants with their manner, and the convenience they provided. But they had been excluded from the official system of healthcare provision until 1961. There were 9,304 such healers in Hebei Province, a number that equals 38 percent of medical personnel at the commune health station who were above the level of medical workers. But these healers had long been viewed as yongyi ( quacks) or jianghuliuyi ( quacks moving around)—people who were uneducated and possessed no real skills, and whose activities in the commune were thus restricted (Neibu cankao (Internal Reference Materials) 1961). What most concerned Mao at the time was the place of TCM in society. It was clear to him that the key to the success of rural medical reform was in making the best use of the medical resources that the majority of the population already accepted. This was not Western medicine, which was favored by only 15 percent of the population-–the lords in the city. Nor were those resources represented by the wuyi ( shamans), who were viewed as too mysterious, subjective, and lacking in the foundation of empirical knowledge. Villagers had faith only in TCM. It was curious that, despite the importance of TCM, many Chinese intellectuals in the twentieth century took pride in criticizing it. Ding Wenjiang wrote a couplet:

Climbing the mountain / Relishing meat, and scolding TCM-I am old but my heart is not /

Enjoying calligraphy / Drinking wine, and imitating the official tongue-I know it is hard to do but do it anyway.