Shamans return as Mao's ‘barefoot doctors’ fade away

By Antoaneta Bezlova, Asia Times, 6 October 1999

DANIAN, Guangxi—The pastoral scenery of this border area of Guangxi province, where wooden-hut villages hide in the curves of the mountains, has become the backdrop for an unusual tug of war.

A growing flock of shamans is challenging a thinning battalion of village doctors who are left to defend the fading reputation of Mao Zedong's once famous army of barefoot doctors.

The shamans, they all have their own deities, says Xie Jinbao, who works as a doctor in the village of Muye, Danian township. They call the deities and when they talk to them, they are in a trance. Sometimes they demand to kill a chicken or even a cow to find out about an illness.

In Muye, a village of 1,200 people deep in the mountains where no car has ever reached, there is a thriving community of six witch-doctors. What can one person like me do against six of them, Xie shrugs.

His worn-out doctor's bag is packed with measles vaccines. Xie, 27, is on a two-hour treck by foot from the township hospital to Muye where he is scheduled to vaccinate children. If it were not for the children's vaccinations, the peasants wouldn't come to me at all, confesses Xie. They have known my father who was a 'barefoot doctor' for years. They know me, but they still go to the witch-doctors.

And it is not because of the money, Xie says. He would charge them just four yuan for a consultation and a simple medicine, while the village shaman will ask for a meal on top of his fee. They simply don't trust me, he concludes.

To the villagers, Xie represents a health system they have learned to distrust and shun. The disillusionment grew gradually, hidden from the eyes of the outside world which had applauded the success of Mao Zedong's public health campaigns in the first decades after the communist revolution.

With the collapse of Mao's peasant communes in the late 1970s came the collapse of rural health care. The state withdrew from the rural world where it had acted as a provider of free preventive care and had guaranteed access for treatment to everyone. During the 1980s, along with market reforms unleashed by Deng Xiaoping, China introduced health reforms based on decentralization and privatization, which meant that patients were charged medical fees.

The result for peasants was dramatic: if in Mao's era 90 percent of the rural population was guaranteed basic medical care, now the system covers less than 10 percent of rural people.

Here in Danian, which is in one of the officially designated poor counties of China, farmers earn less than 500 yuan ($60) a year but a consultation plus outpatient treatment at the township hospital comes to 30 yuan on average, while admission to the hospital would swallow up to 300 yuan.

In case of serious illness, a choice has to be made: wait for death, or go deeply in debt, says Dr Marcel Roux, head of the China mission of the humanitarian group Doctors Without Borders. Sometimes it can take ten years for peasants to pay the money back. Sometimes paying back the hospital bills will ruin their whole family.

Too poor to afford professional health care, peasants choose to forego the village doctor and consult the local shaman.

In Danian where mostly minority communities of Miao and Dong live, the shamans' sway has often had disastrous results. In 1993 and 1994 for instance, there was an outbreak of typhoid fever and many peasants died because the witch-doctors said there was no need for hospitalization.

The old health system under Mao was better in a sense that once there was a case of cholera or leprosy, the patient would be immediately isolated, recounts Shi Rongsheng, the chief medic in the Danian township hospital. Each village had two people working on prevention care and doing the epidemiological surveys.

Mao's barefoot doctors were minimally-trained peasants whose political fervor made up for their lack of ability. Even so, they succeeded in eliminating epidemics thanks to mass sanitation campaigns and regular vaccination drives. The state generously subsidized everything.

Now, peasants must pay for the services of village doctors who wear shoes but who are as poorly qualified as their predecessors. In contrast to the barefoot doctors though, who were paid by the state, village medics earn their living by reselling drugs to patients and charging consultation fees.

If I don't have any patients this month, I will not have any salary, says Xie Jinbao. So he is helping his father till the land and sell herbs in the township.

The system is simply not working anymore, observes Dr Roux. And how could these local medics work if they don't get even the meager 50 yuan they are supposed to get from the local governments?

With more and more people turning to the witch-doctors, some people say we should launch a campaign against them, says Dr Yang Qingcheng, a medic at the Danian hospital. But I think they are really needed in the villages where farmers are very poor. They know all the herbs and people trust them.

Mao Zedong once tried to eliminate all shamans, along with what he believed were feudal superstitions. Their resurgence is a proof of the failure of China's health reforms.

(Inter Press Service)