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China

Where Medical Services Actually Work

by Geoff Mason

Before Liberation in 1949 China was racked with famine and disease. Millions of people fell victim to malaria, schistosomiasis (snail-fever) or VD: malnutrition and opium addiction were rife.

Dr Joshua Horn, the famous British surgeon, who visited NZ last year, writes in his book A way with all Pests: "Poverty and ignorance were reflected in a complete lack of sanitation, as a result of which fly and water-borne disease such as typhoid, cholera and dysentery took a heavy toll. Worm infestation was practically universal, for untreated human and animal manure was the main essential soil fertiliser. The people lived on the fringe of starvation, and this so lowered their resistance to disease that epidemics carried off thousands every year. The average life expectancy in China in 1935 was stated to be about 28 years..... Conservative estimates put the infantile mortality rate at between 160 and 170 per thousand live births."

Today the Chinese people eat well and stay healthy, while in most other Asian countries the available health care remains as wretched as ever. Vegetables, fruit, fish, meat and poultry are readily available at stable low prices. China was the first country in the world to virtually eliminate VD. Opium addiction was wiped out within five years. Schistosomiasis has been largely brought under control and malaria eliminated. Infantile mortality is down to levels comparable with Scandinavian countries.

How has all this been achieved? How are further advances being made?

In 1949 a People's Government took power. The war against the Kuomintang and all foreign invaders was won by the great majority of Chinese people uniting behind the leadership of the Communist Party. The war against "poverty and ignorance" has been fought by the same combination of forces. In the field of health, as in other fields, the evidence was before our eyes throughout our visit to China.

No vested interest has been allowed to stand in the way of improving the health of the people, following these basic guidelines. Traditional medicine is made to serve the future. Foreign medicine is made to serve China. Medical knowledge is more and more "demystified", spread among the people and to the farthest corner of the country. It is not confined to a small number of people with University education.

Diseases and unhygienic habits have been fought through the method of the "three-in-one combination": leading cadres (party workers), medical workers and the broad masses of people have organised together and carried out nation-wide sanitary campaigns to wipe out major diseases and to exterminate "the four pests" (flies, mosquitoes, rats, bedbugs).

In communes, schools, factories and neighbourhoods — all living and work-places — routine medical care is available on the spot and preventive measures are organised. More serious illnesses and injuries can be immediately transferred to a hospital which equipped to deal with them. The total number of hospital beds in China has increased by 19 times with before 1949.

In Shanghai we visted a housing resettlement area where 10,000 families are served by eight medical clinics and a medium-sized hospital. The clinics treat all common illnesses such as colds and diarrhea. Some doctors and nurses stay inside to give treatments while others tour the neighbourhood checking on prevention measures against disease. The hospital was a white washed functional building with facilities for injections, dentistry, herbal medicines, X-rays and minor surgery, among other things. (Major surgical cases go to a larger city hospital.)

As seemed common in China, the staff was very enthusiastic about their work. Potentially dusty buildings were kept clean. Old equipment was painstakingly maintained. At this hospital the staff was very proud of their new modern X-ray machine, made in Shanghai.

Here we saw people undergoing acupuncture treatments for a strained back and varicose veins. Now famous in the West, acupuncture is one of the most dramatic and wide-ranging legacies of Chinese traditional medicine. In 1929 it was banned by the Kuomintang government but the ban was largely ignored by the people. Since 1949 traditional medicine has been encouraged and further developed. Acupuncture is now extensively used even as anaesthesia in major operations.

In a primary school clinic in Shanghai we saw children being treated for shortsightedness. A needle was injected deeply into the cheek about an inch beneath the eye, causing no apparent pain. A medical worker gave us statistics for the last group of children to be treated for severe shortsightedness. Ten out of 16 fully recovered — the rest showed some, but not full, improvement.

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In recent years much progress hat been made in acupuncture treatment of deaf-mutes. At a Talien school for deaf-mute children, we learned how PLA soldiers have experimented on them selves in order to find the best possible techniques for the children. We saw the children being treated in a classroom as they practised making different sounds in each other's ears. At this school, out of 307 deaf-mute children, 270 have been receiving treatment - 17% have shown "obvious" improvement, 72% "some" improvement, and 11% no improvement. Some of the students put on a concert for us before we left and the intensity of their efforts and new found confidence was vary moving.

A factory we visited at Shenyang (Northeast China), building heavy machinery, had a medical staff of 200 and a hospital with 270 beds to serve a staff of 10,000 workers. Treatment is free for the staff, half-price for their families. While recovering, patients are on full pay. We were told there are few serious accidents because safety education is given every Saturday morning.

At a glassware factory in Talien we heard of technical reforms suggested by workers and technicians for health reasons. Glass is no longer blown by mouth. Water now runs through the crushing machinery to keep the air from being dirty. Recent X-rays of workers found no trace of silica lung disease.

At this factory we heard of shortcomings in sanitation which still remain to be solved. At some other places it was surprising to see workers without adequate footwear or eye protection. Without doubt these problems will be defined and dealt with in the near future.

For, the advances in health care in China have not been without setbacks. They have only been made through careful analysis of problems in the light of practical experience, with the constant aim of "serving the people".

During the Cultural Revolution, when struggles took place on all fronts against the restoration of capitalism, it was realised that health facilities were still too much concentrated in the cities, at the expense of the countryside where 80% of the people live.

Since then the revolutionary call has been: "In medical and health work, put the stress on the rural areas". Tens of thousands of roving medical teams were sent to the countryside to treat and help prevent disease, and to train rural medical workers (the "barefoot doctors"). Within a few months the barefoot doctors were able to combine routine medical work on their communes with continued study and training. Many of them have gone on to full medical college.

Since late 1968 self-reliant co-operative medical care systems have gradually been created throughout the countryside.

We visited the July 1 People's Commune on the outskirts of Shanghai which has a population of 16,900. There is one main hospital. Eleven production brigades each have a health centre, 88 production teams each have a clinic. All commune members pay 1 yuan per year to receive free medical treatment. (Average earnings ara 300—400 yuan per year each). Before 1949 about 50% of the population in this area suffered from snail-fever — now this has been virtually wiped out.

At a health centre we talked with one barefoot doctor — her partner was out working in the fields. She usually sees about 10 patients per day; the few patients with serious complaints go to the commune hospital. She gives many vaccinations and innoculations and, for instance, the last case of polio there was in 1960. She received four months initial training and every year has one to two months further theoretical training at the country hospital.

Such services can be found all over the Chinese countryside, though specific details may vary. For example, at the Hsien Chiao People's Communse hear Kwangchow members pay 30 cents per month to the co-operative medical scheme. This commune has its own workshop for manufacturing many drugs and is self-sufficient in the production of herbal medicines.

In Peking we visited the Chi Shuie Tan Hospital, a large and prestigious place with 210 doctors, all graduated from medical college, and 220 nurses. It has 520 beds and serves 130 different organisations (factories, schools, government offices — 130,000 people in all) and 20,000 local residents. Patients needing specialised orthopaedic and traumatological (severe wounds) treatment come from all over the country.

Because of the different kinds of training medical staff have received, division of labour occurs, but it is not rigid. The common aim is to speed up the recovery of patients so they can resume their jobs and normal lives. If doctors have time they help nurses and orderlies with basic patient care apart from treatment. Everyone helps with keeping the hospital clean. Patients are kept fully informed about their illness and treatment so they can help their own recovery.

This particular hospital has three roving medical teams which are sent in rotation into the countryside, sometimes thousands of miles away. Medical workers constantly visit local factories, schools and streets to assist with prevention and treatment - they also take part in physical labour and learn as much as possible about the people whose health they are serving. This year four teams of medical workers were sent to help with the wheat harvest.

In sunlit six-bed wards patients in blue pyjamas were lying on top of their beds. Surgeons proudly introduced us to some of them who greeted us cheerfully: a girl with an arm rejoined after it was severed in an industrial accident; another girl who was crushed by a train: she had her left foot successfully joined to her right leg and would later be fitted with a new artificial left leg. One patient who had lost a thumb had had his fourth finger transplanted and could now write again.

We also saw fractures successfully treated through combination of Chinese traditional and Western methods. While using X-rays to examine their work and placing more stress on accurate reduction, Chinese doctors prefer to immobilise the fracture with a short splint rather than a plaster cast, thus allowing suitable movement to the joints above and below. Results have shown that patients suffer less pain, treatment is shortened by one-third to one-half compared with the old Chinese or Western method alone, and complications such as joint stiffness and muscle atrophy are rare.

Chi Shuie Tan is obviously one of the most advanced hospitals in the world, especially in the field of rejoining severed limbs. Postgraduate students come from all over China "to achieve perfection". Other Chinese hospitals are world leaders in fields such as healing serious burn cases.

Spectacular advances are consistently made through dedicated and scientific analysis of theory and practice. Doctors we spoke to could not understand questions about "mercy-killing". There is no such debate in China. No disease is seen as absolutely and forever incurable.