I’m currently reading a book titled “Serve the People: Observations on Medicine in the People’s Republic of China.” Written in 1973, it is a report made by a married American doctor couple who were invited to visit China in 1971 and then 1972 by the Chinese Medical Association. The book details the radical changes in medicine, healthcare, and the health of the Chinese people beginning after liberation in 1949.
Before the revolution, China was known as the “Sick Man of Asia” because its people suffered from nearly every form of nutritional and infectious illness. The basis of this was…”the cruel poverty in which the vast bulk of the population lived, a poverty made all the more cruel in light of the wealth that had been removed from China by foreign entrepreneurs, and the relative affluence in which the small fraction of wealthy Chinese landlords and businessmen lived.” The only form of medical care available for the majority of Chinese at the time was through traditional healers, many who were not well trained in the field itself. In addition, preventative medicine did not exist and so the vicious cycle of poverty and starvation perpetuated itself.
After liberation, venereal disease, smallpox, cholera, plague, and opium addiction were quickly eradicated through the mass participation of peasants and workers in concert with the doctors (trained in both western and traditional technique), nurses, physicians, etc., who held their positions by virtue of their desire and motivation to serve the people, not simply their expertise or degrees. There was an exponential increase in the amount of doctors (related to the transformations and expansion of education to the formerly oppressed), hospitals, medicines, and facilities in general. The ideological basis for this transformation lay in using medicine to serve working people, giving preventative medicine priority over curative medicine, uniting traditional with western practitioners, and integrating health work with mass movements.
The hospitals in the neighborhoods, districts, cities, and rural communes were mostly run by “three-in-one” ” revolutionary committees”: usually soldiers from the People’s Liberation Army (whose function was more based on community rather than military service), a cadre member (ie a leader in industry, agriculture, govt, culture, or Communist Party), and a medical care rep, usually a doctor, nurse, or health worker. Although this form of political power was very widespread in China particularly during the Cultural Revolution, there were tendencies towards the creation of a technical and managerial elite standing above and separated from the masses, depending on the location, leadership, and social history of the medical institution. The point, however, is the experimentation with new methods of power was won through popular struggle which attempted to break down the centuries-old division between those who work with their hands and those who work with their minds, ie the mental-manual labor division. For example, nurses in hospitals played significant roles in medical decision making while doctors, whom we see as “untouchables” and above manual labor in the West, themselves participated in daily and routine tasks which are normally assigned to nurses and other personnel.
In the cities there existed different levels of political power, ranging from the group, residents’ committee, neighborhood, district, and municipality. At the level of residents’ committees, the health care work was run and done by Red Medical Workers, most of whom were women who lived and worked in the same area as the people they served. Their training lasted about a month or two and consisted of simple medical examination measures, preventative work (exercise, diet, birth control, etc), western and traditional techniques, and a period of training and supervision. A major role these Red Medical Workers played was in the dissemination of birth control information and measures. They would routinely visit all the women on their block to encourage the use of contraception and gave it away for free. If women wanted to abort, which was legal and completely free, they were referred to the nearest district or city hospital.
Urban factories were major health care sites as well, organized to meet the needs of workers and their families, usually free of charge. Worker-doctors were selected amongst their fellow workers to provide basic medical care, centered around prevention. Workers received regular medical examinations. What I found really interesting is that many factories, besides being sites of material production, designated times for political study, mass meetings, and exercise, uniting all-around development and struggle with manual labor and production. When does that happen under capitalism?
Most importantly though, were the changes in the countryside. At the time, about 80% of China’s population lived in the rural areas. By the lates 1950s and 60s, after the agrarian revolution which put the land in the hands of individual peasants and economic cooperatives were established to plant the seeds for a more socialized mode of living, the commune arose out of that development. It was a political and economic unit, an internal government of sorts that was based on production teams (usually a couple families), production brigades (made up of several production teams), and the commune, the overarching organization which looked over all aspects of commune life: production, education, health, etc. Due to the introduction of Soviet economic methods in the early 1950s and the remaining oppressive division between rural and urban areas , the urban centers were developing faster than the rural areas and this was reflected in the medical system. In the late 1950s, during and after the Great Leap Forward which attempted to overcome soviet methods which perpetuated capitalist divisions, “barefoot doctors”, or peasants who’d received basic medical training, came onto the scene. This was a result of thousands of urban youth and intellectuals moving to the countryside to aid in the transformation of the most backward and impoverished areas in China, going against the tendencies to live a comfortable life in the cities (which lived off the countryside). As a result, hundreds of thousands of such barefoot doctors were trained in rural hospitals. It’s important to note that these barefoot doctors saw themselves as peasants before medical workers, never above or too dignified to engage in productive work. The barefoot doctor, like the Red Medical Workers, and urban and rural commune members in general, received their pay based on the total amount of social wealth produced by the unit and the amount of work points they’d collected, thus creating a distribution based more or less on an egalitarian scale. This what only socialist revolution can do.
So, take a look at our medical care system. America today spends about half of all medical dollars IN THE WORLD, yet fails to provide adequate and equal treatment for all its citizens. Hospitals are run like corporations, led by doctors who are more concerned with status and wealth than disease prevention and wellness of the people they’re supposed to serve. People are left with thousands of dollars in hospital bills if they lack coverage. People of color in the U.S., regardless of class, face higher rates of infant mortality, diabetes, malnutrition, all symptoms of the social disparities in this country which dictate who gets what in terms of medical services. Most astonishing is the lack of talk in the White House or Congress debating healthcare reform of the one thing which would create a socialized healthcare system in the U.S.: profit. Their coziness with the insurance and medical corporations simply doesn’t allow it. You can tell the real views on human beings a society has based on how its medical system works (or how it doesn’t work). What does it say about America and capitalism?