Medicine and public health in China have made tremendous developments through implementation of the following four principles under the guidance of Chairman Mao’s revolutionary line: medical and health work must serve the workers, peasants and soldiers; put prevention first; unite doctors of traditional Chinese medicine with those of Western medicine; and health work must be integrated with mass movements.
This is the first of four articles explaining how these principles have promoted our health work. —Ed.
[The author is a vice-chairman of the Revolutionary Committee of the Chinese Academy of Medical Sciences and a well-known urologist.]
ONE of the first principles for medical and health work adopted immediately after the founding of New China was that it must serve the workers, peasants and soldiers. This was based on Chairman Mao’s instruction that “this question of ‘for whom?’ is fundamental; it is a question of principle.” In a socialist state led by the working class and based on the worker-peasant alliance, the workers and peasants are the masters, and the soldiers of the People’s Liberation Army are armed workers and peasants. As they make up the overwhelming majority of the country’s population, medical and health work undoubtedly must serve these working people. This “for the workers, peasants and soldiers” principle demands that all medical work, whether it be the prevention of disease, clinical practice, scientific research or the training of personnel, must proceed from serving the workers, peasants and soldiers.
In class society medicine always serves a particular class, and the direction of its development varies with the social system. The principle of “for the workers, peasants and soldiers” has achieved great results in effecting a fundamental change in the orientation of old China’s medical and health services which served the exploiting classes.
Before liberation doctors trained in modern medical practice were few in number and they were mostly confined to the large cities. As most chemo-therapeutics and medical appliances were imported, only the handful of rich could afford their use. There was not even minimal medical care in industrial and mining areas, and in the rural areas, apart from some practitioners of the then much despised traditional medicine, modern medical facilities were non-existent.
The number of senior grade medical workers turned out since the founding of New China is more than 27 times the total trained in the 20 years preceding the country’s liberation. The number of hospital beds has risen more than 21-fold and the country is now basically self-sufficient in medicines and equipment, with some for export. Prices of medicines today are only one-fifth those of early post-liberation years. By and large, a national medical and health network covering both the urban and rural areas has been established. The people’s health has improved visibly as a result of the development of socialist revolution and socialist construction, the gradual bettering of living standards and medical and health services, and the popularization of sports among the masses.
The two-line struggle over the question of “for whom” in medical and health work was a bitterly fought issue prior to the start of the Great Proletarian Cultural Revolution. For quite a long time after liberation, due to the interference and sabotage by Liu Shao-chi’s counter-revolutionary revisionist line, the stress was on the cities. Although there were some improvements in rural medical and health services compared with pre-liberation days, the question of acute shortage of both medical personnel and medicines remained to be solved.
In June 1965, Chairman Mao severely criticized the Ministry of Health as the “Ministry of Health for Urban Overlords” for not paying attention to medical work in the rural areas. Chairman Mao issued the directive: “In medical and health work, put the stress on the rural areas.”
That was the crucial point in the struggle between the two lines in medical and health work. Because agriculture is the foundation of China’s national economy and the peasantry makes up 80 per cent of the population, a medical and health system designed to serve the people must not ignore the peasants, but should devote the main attention to changing the severe shortage in doctors and medicines in the rural areas. Energetic efforts should be made to fundamentally close the gap between urban and rural conditions and make medical and health work serve the majority, instead of just a small percentage of the population.
A tremendous change in rural medical and health work has been brought about in the space of a few years owing to the implementation of Chairman Mao’s directive mentioned above. By 1973, incomplete figures showed that more than 100,000 medical and health workers had voluntarily left the urban areas to settle in rural areas, mobile medical teams touring the countryside by turns had become an established system and the number of barefoot doctors who are both medical personnel and peasants had passed the million mark. Every rural people’s commune today has a hospital and every production brigade (made up of one or more villages) has its own clinic. Rural health services have improved and preventive work has been strengthened. Peasants can now have prompt medical attention locally. More than half the brigades have a co-operative medical service financed by the commune or the brigade itself out of the public welfare fund, and rural commune members contribute only a small annual premium into the fund which then covers all their medical expenses.
Putting the stress in medical and health work on the rural areas has already shown initial results. However, bringing about a thorough change will take some time yet.
One important aspect of serving the workers, peasants and soldiers is doing a good job of medical and health services in industrial and mining enterprises.
Grass-roots medical and health organizations were established in all industrial and mining areas following liberation, and in 1951 the “Labour Insurance Regulations” were issued by the state in which it is stipulated that all enterprises set aside a monthly sum for labour insurance. Carried out over the last 20 years or so, these regulations have provided free medical care to workers and staff members and funds for treatment of injuries and disabilities, death benefits, old age pensions and maternity care.
Working conditions in factories and mines have been constantly improved. Health and industrial departments at all levels pay special attention to the prevention of occupational diseases and hazards. Peking alone has nearly 60 factories engaged solely in making protective clothing and safety devices and appliances.
Apart from research on wound surgery, the most important aspect of medical work in the Chinese People’s Liberation Army is to protect the soldiers’ health. Army medical personnel make regular calls on soldiers wherever they are stationed—island outposts, frontier posts and barracks—to treat patients and take preventive measures against diseases. Since the start of the Cultural Revolution, teams of army medics have been sent to rural areas, particularly the remote frontiers and out-of-the-way villages in mountain areas, to treat the sick. The peasants warmly welcome these teams.
Like those working on other fronts, medical and health workers in China place primary importance on serving the people wholeheartedly. The medical profession in the old days was a way and a means of winning fame, position and high income. The medical workers today follow Chairman Mao’s teaching that “they must gradually move their feet over to the side of the workers, peasants and soldiers, to the side of the proletariat, through the process of going into their very midst and into the thick of practical struggles and through the process of studying Marxism and society.” They criticize the bourgeois idea of seeking fame and fortune and are striving to remould their world outlook, despising all ideas of seeking personal fame and gain while taking pride in doing all they can for the public.
Inspired by the concept of serving the people wholeheartedly, New China’s medical and health workers refuse to be shackled by dogmatism and past experience and have thought up ways and methods of bringing their subjective initiative into full play to conquer diseases once falsely believed to be “incurable.”
Many examples can be cited to demonstrate how medical workers, out of profound love for the workers, peasants and soldiers, shattered ideological fetters and smashed through so-called medical limitations to restore the seriously ill to health.
One good example is the instance of removing a 45-kilogramme abdominal tumour from a peasant woman in 1968 by the People’s Liberation Army medical workers. The tumour had been discovered four years earlier. But owing to the interference of the revisionist line at that time, even some of the big hospitals held that it was “inoperable.” The tumour grew from the size of a bowl until it filled the abdomen and half of the thoracic cavity. Unable either to sit or stand, the woman had to lie on her side or kneel. Guided by Mao Tsetung Thought, medical workers in a Peking unit of the People’s Liberation Army, after careful examination and analyses ascertained the benign nature of the tumour and successfully removed the tumour to give the 37-year-old woman a new life.
In 1963, Shanghai worker Wang Chun-po’s right hand was severed above the wrist by a punching machine. Surgeons of the Shanghai No. 6 People’s Hospital replanted the hand and six months later the patient was able to use it again. For the last ten years he has been working as usual at his job. This first successful replantation has been followed by others. In recent years restorative surgery, particularly reattachment of extremities amputated by trauma, has been performed in many cities and towns and by mobile medical teams that tour the countryside. Successful rejoining of arms, hands, palms, legs and fingers are on record.
Another example is the successful treatment of extensive burns. Before liberation, hospitals in this country seldom treated cases of severe burns because the victims, the working people to be precise, could not afford hospital treatment. It was generally accepted that cases of burns covering upwards of 80 per cent or third degree burns on 30 per cent of the body surface were fatal. In 1958 medical workers in Shanghai, under the leadership of their Party organization, for the first time successfully treated a steelworker with burns covering 89 per cent of his body, of which 23 per cent were of third degree. Since the start of the Cultural Revolution at least 14 cases with burns of over 90 per cent of the body surface, of which 70 per cent were of third degree, have been saved.
Going to factories and villages to work and live with the workers and peasants has led China’s medical workers to understand the masses and form closer ties with the working people. This has helped implant in their minds the idea of serving the people wholeheartedly and encouraged them to proceed from the proletarian class stand to do their utmost for the sick and injured and help them regain their work ability so they can continue to take part in socialist construction.
The concept of serving the people wholeheartedly motivates Chinese medical workers to work hard and raise their professional proficiency and make new achievements.