Rural doctors in China / by Wei Yingying

Rural doctors in China Skilled in both modern medicine and traditional Chinese medicine, the rural doctors who work at the village level are proving their worth in preventing and treating disease 11 over China's vast hinterland there are some 1.3 million " rural doctors " working busily to prevent and treat diseases. The title of rural doctor is given to those who have received a certain period of pro- fessional training. After several years of professional practice , they are sent to the nearest county hospital for advanced studies which usually last for two to three years. In some cases they may stay for five years . In Jishan county of Shanxi province there are 440 rural doctors serving a population of some 250,000. The county is divided into 11 townships , each with a clinic staffed by between three and seven such doctors, and is again subdivided into 196 villages with 216 village health centres. At present , 60 per cent of the " rural doctors " of Jishan county have reached a professional level equivalent to that of medium-level medical school graduates; some have even attained the level of medical college graduates. During their advanced studies, most of them are instructed in both modern medicine and traditional Chinese medicine. Consequently they are able to apply both forms of medicine in the treatment of such common diseases as acute and chronic gastntls , intestinal illness , viral hepatitis, tracheitis , bronchial asthma , emphysema and pneumonia. They can also make correct diagnoses in pa- tients with rheumatic or congenital heart disease, ovarian cyst or uterine A village woman in Jishan county receives a thorough physical check-up from rural doctor Zhang Ruilien. Photo W HO 24 by Wei Yingying fibroid, which they then refer to the county hospital for treatment. Lian Junlun is one such other rural doctor and heads the Nanyang village health centre which is staffed by six rural doctors . He has set up seven Miss Wei Yingying is a staff journalist on the Beijing health newspaper Jian Kang Bao. observation beds in the health centre for patients of cardiovascular diseases and cerebrovascular ailments , while in the village he has arranged home care for patients who are confined to bed . On one occasion Lian met a peasant suffering from acute abdominal pains and diagnosed it as a case of chole- cystitis (inflammation of the gall-blad- der). The patient was rapidly transfer- red to the county hospital, and made a full recovery five days later. His work and that of his colleague has been much appreciated by local villagers , who consider the health centre to be an advanced health unit and Lian himself a model worker . Heng Yuan'Er is a rural doctor in Taiyang village and is particularly skilled in gynaecology, obstetrics and paediatrics. As a result of her work she has wide experience in treating trichomonas vagina/is, cervicitis and pelvic inflammation , as well as certain conditions often seen in children such a dyspepsia, pneumonia and vitamin deficiency. Chen Haoshou, on the other hand, is a rural doctor in Lianbao village and W ORLD HEALTH, July 1986 Familiarity with all the children in the com- munity helps to prevent the onset of infec- tious and other diseases. Photo WHO his experience is first and foremost in treating primary and secondary epi- lepsy with traditional Chinese herbal medicine and with acupuncture . In recent years he has successfully treated 408 patients from seven different pro- vinces. One patient had suffered from epilepsy since he was 17 years of age, and had been treated unsuccessfully on several occasions before turning to Chen Haoshou for treatment at the age of 29. The treatment lasted for three months and proved highly effective. These rural doctors are also respon- sible for providing primary health care and carrying out disease prevention. They stand in the forefront of China's three-tiered medical care system (county, township and village) in the rural areas. At each of the village health centres, they keep a set of health records for the local villagers. W oRLD HEALTH , July 1986 And these records prove that the rural doctors have a very important role to play in preventing diseases. It is largely thanks to them that the en- vironmental hygiene and the health in general of Jishan county has been dramatically improved. A "rural doctor" since the age of 29, Duan Tongshun, has had profes- sional training for five years, and is now attending a spare-time training course in traditional Chinese medi- cine. He is personally familiar with every child in the village under the age of 15. At his health centre he keeps a special record of children's health. When a batch of vaccines arrive, he can complete the vaccination work within one day to all local children- although there are more than 100 of them. Not a single case of infectious disease has occurred m the past three years. To meet the needs of pregnant women, each village health centre is staffed by at least one woman rural doctor who takes care of maternal and child health. These skilled women give periodical pre-natal .check-ups, refer the mothers to county hospital or township clinic whenever an abnor- mality is suspected, deliver the baby under hygienic conditions, undertake post-natal visits, and give guidance on breast-feeding and rearing the baby. They also advise and supervise the village nursery and kindergarten on health matters. Thanks to these disease prevention activities and to the medical and health care services, Jishan county has witnessed a notable decrease in the occurrence of infectious diseases. There have been no cases of acute infectious disease for a number of years, and no case of poliomyelitis for the last two years . A comparison between the first ten months of 1984 and the same period in 1985 has shown that the occurrence of en- cephalitis B decreased by 25 per cent, of epidemic haemorrhagic fever by 75.8 per cent, and of viral hepatitis by 70.3 per cent. Much of this improve- ment is due to this hardworking corps of rural doctors. • 25