The Prescriptions of Chairman Mao

Peking has banned the publication of medical journals since 1968, and if the authorities compile comprehensive statistics, they arc unknown in the West. But when a handful of American physicians and scientists followed the table tennis players last year, expert outsiders got a good look at how Maoist medicine is being practiced today. TIME interviewed four of the doctors: Paul Dudley White, the Boston cardiologist; Samuel Rosen, a Manhattan ear specialist; E. Grey Dimond, provost for the health sciences at the University of Missouri's new Kansas City School of Medicine; and Victor Sidel, head of the department of social medicine at Montefiore Hospital in New York. Their stays ranged from two weeks to a month, the most recent in September. On balance, all four were favorably impressed with what they saw in the cities and the countryside. Their appraisal:

The Communist regime made an early policy decision to marshal all medical manpower for two basic missions: to make some sort of care available to the entire population and to drill the people into becoming active participants in public health campaigns. This approach consciously downgraded advanced research in pure science and exotic new techniques such as heart transplants. Clinical treatment and preventive measures monopolize Chinese medicine.

Barefoot Doctors. Training has been reorganized to meet these goals. The classical six-year curriculum has been cut in half. Each of the three years is punctuated by periods of military training, manual labor and political indoctrination. Before graduation, the students also get a good deal of on-the-job experience, and training includes Western medicine and the traditional Chinese arts of acupuncture and herb treatment. As a result, China is turning out far more doctors than in the past. Overall figures are not available, but there are some indicators. In the four decades prior to the Communist takeover, Sidel reports, First Peking Medical College had just over a thousand graduates. Since 1949, there have been more than 10,000. Despite the speedup, Sidel says, "the Chinese are the first to admit that they are still limited in manpower and resources."

They partly offset the shortage with the use of paramedics, who are called "barefoot doctors" in rural areas and "Red Guard doctors" in the cities. They are peasants, housewives and factory workers who divide their time between their regular jobs and medical duties. Based in commune dispensaries or urban "lane clinics," the paramedics get little formal training; they learn by watching and listening to physicians.

The barefoot doctor's basic assignment is to know his co-workers and neighbors intimately, keep immunization records on each individual assigned to him, keep track of the contraception methods used by each woman in his jurisdiction, and arrange for consultation with a real doctor when necessary. The government has been heavily promoting birth control and immunization against contagious diseases; the barefoot doctor is the grass-roots salesman of these programs.

Conquering VD. Hygiene is another of his specialties. From the beginning, the prescriptions of Chairman Mao have emphasized cleanliness. Repeated campaigns against disease-carrying insects seem to have succeeded. Schistosomiasis, one of the world's most debilitating diseases, produced by tiny blood flukes, has been checked, says Rosen, by communal efforts to stamp out snails that carry the parasites. White believes that typhoid, malaria and cholera--among Asia's ancient enemies--are now well under control. Venereal disease is virtually extinct. The victory over VD probably results as much from the repression of prostitution and promiscuity as from public health measures.

Discipline and political theory, in fact, are large elements in Peking's medical policies. Dispersing health care throughout the country took on new momentum when the Cultural Revolution began in 1966. With a determination possible only in a dictatorship, the government ordered one-third of the country's medical personnel into rural areas, where perhaps 85% of the population lives.

Soldiers, peasants or workers who wish to become trained physicians must have the approval of their fellows and the party leadership of the farm or factory. A newly graduated doctor is obliged to return to serve the community that sponsored him. He may also be assigned to a mobile health team that provides care for the most remote villages. Says Rosen: "China is one vast study in the delivery of health care."

That delivery is organized in a pyramid system, starting at the bottom with the local health stations manned largely by the paramedics. A work brigade of perhaps 2,500 people, the basic unit in a rural commune, is served by a staff of one physician and a few barefoot doctors and midwives, supplemented by mobile health units. Next comes a district hospital that takes care of more serious cases for a larger territory. It is staffed by several physicians and trained nurses in addition to paramedics and is equipped with laboratory and X-ray facilities. On top of the pyramid is the major urban hospital. Only at this type of institution are there specialists prepared to do intricate open-heart surgery and other sophisticated procedures. All four American observers believe that the Chinese do them well. Dimond reports that the urban hospitals are clean and well equipped, even by Western standards.

Political indoctrination pervades all levels of care. The head of a hospital is a political education officer who is also chairman of the institution's revolutionary committee. Prior to undergoing operations, patients frequently meet with members of the surgical team to reaffirm to one another how good health benefits the People's Republic. Some patients go under anaesthetic clutching copies of Mao's Quotations.

If the political dues are high, the financial costs to the patient appear to be low. The visitors were told that the average Chinese worker, who earns $30 a month, pays the equivalent of 9-c- a month for each member of his family. This provides all medical care free for himself and at half price for his family. However, treatment for family members in serious cases appears to be more expensive; the Americans heard that some families had a choice between drawing on personal savings or getting assistance from communal relief funds. In a hospital, a patient pays only for his meals.

No Psychiatry. Patient care frequently combines the oldest and newest in Chinese medicine. The traditionalist practitioners are often asked to deal with ailments that appear to be psychosomatic (psychiatry as practiced in the West seems to have no counterpart in China today). Acupuncturists and Western-style physicians practice side by side, and there has been much experimentation with acupuncture as an anaesthetic. White recalls being asked whether Americans could help formulate a scientific explanation of acupuncture's pain-killing qualities.

"For their problems," says Dimond, "they have made superb solutions--understanding, of course, that they are willing to give up personal independence." China has not, to be sure, produced a medical Utopia, and conditions may be different in parts of the country as yet unseen by Americans. But only 25 years ago the principal causes of death in China were malnutrition and infectious diseases--the marks of a poor and medically backward society. Adequate diet and vigorous public health measures have changed that. Respiratory ailments remain a major problem because the Chinese are heavy smokers; the authorities have done little to discourage the habit. As more and more Chinese survive into adulthood, many of them are dying of cancer and heart disease, the same illnesses that kill the majority of Americans.

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