Barefoot doctors and the medical pyramid.

Abstract

China is still a predominantly rural country and the key figures in a decentralized pyramidal rural system of medical responsibility are farm workers who have been given basic medical training. They give simple medical treatment or advice but they also continue to do their former agricultural work. Their main duties are in health education and preventive medicine. Generally their training program consists of a basic 3 month course at the commune or county hospital followed by periods of further training of 1 to 3 months in later years and augmented by teaching from mobile health teams or urban doctors who visit the rural areas. Commune health care consists of health stations for production brigades and a commune hospital which offers a fairly wide range of treatments for common or recurrent disorders staffed by medical specialists. Medical problems too complex for commune hospital staff are referred to the county hospital. There are more than 2000 counties in China each of which has a hospital ranging in size between 100 and 300 beds. The medical pyramid provides not just a hierarchy of specialization of treatment but also a hierarchy of medical training. The rural health workers and their urban counterparts--the factory health workers at the bottom have only a rudimentary education; the commune hospital staff roughly parallel general practitioners and the specialists at the top have undergone extensive training. The traditional physicians responsible for a vast amount of primary care provide China with many doctors with no ambition for urban practice. This situation may change however as fewer recent medical school graduates have been educated in traditional medical colleges and may specialize.