Medical reform in Modern China – 回眸近现代中国医改进程 – English

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Medical reform is currently on everybody’s lips due to events in the last few decades. The focal point of medical reform exists as the problem of ‘difficult and expensive’. In fact, concerning medical problems in China, the problem has existed for more than 20 years. From the introduction of Western medicine into China, and the fight for dominance with TCM, to the patriotic public health movement, the ‘eliminate the four harms’ and the ‘barefoot doctors’ campaign, and finally to medical reform and opening up period, especially after the 90’s, with a long term perspective, China’s Medical Reform has already continued for more than 100 years. And if we are to investigate medical reform through the long course of history, we would actually discover that there are many worthwhile studies and that can be drawn from. Concerning the medical reform seen below, it is doubtless that there is still great progress to be made.

1. Political metaphor and collision of Traditional Chinese Medicine and Western Medicine

Chinese medical reform dated back to the period during which Traditional Chinese Medicine and Western Medicine (also called new med. And old med.) fought for medical dominant, and the nation established a formal medical system. this process was called “the nationalization of medicine”. obviously, there was deep social background behind the nationalization: political metaphor of “Sick man of East Asia” and the aggressive spread of diseases without the awareness of public hygiene.

“Disease” is exactly a metaphor. Susan Sontag had deeply researched this. She thought that a disease of body would transfer into a moral criticism and then became a Political oppression. Since modern times, Chinese people had been fighting sensitively under the metaphor and the shame of semicolony. Then, china started a long process of medical reform with the double requirement To actually change the health of Chinese people and to get rid of the discrimination.

Before the formal beginning of medical reform, TCM ,which comparatively progressed slowly and existed for a long time , conflicted and conbined with western medicine, and lost the dominance.

Before the 20th century, there was no national medical network either in the city or the countryside. In the city , doctors practiced medicine in hospital, and the countryside had a similar situation, but for the vast in territory, doctors would provide medical treatment at patients home. And the nursing is mainly completed at home, hospitalization did not exist.

Originally, Western doctors did not understand: Chinese doctors are not just experts at curing illness, they’re also community coordinators, social workers comforting their patients. For that reason, the modern clinics they established might cause fear among patients used to be treated at home.

In 1899, a British doctor called Howie performed his first surgery in China: the removal of a woman’s diseased eye. The theatre was very peculiar: the operating table was set under a tree, and surrounded by curious and suspecting villagers. When doctor Howie finished his operation, he returned the diseased eye carefully soaked in alcohol to the patient, because if he didn’t do that, rumours would spread and ruin his work. At that time, many Chinese people believed that Western missionaries were stealing organs from Chinese people to make medicine, because they could not accept that missionaries could build hospitals in China, and could not trust to receive cure in such an isolated and awe-inspiring medical environment.

1930年,还有人说西方医疗空间“宇墙崇闳,器械精良,由门而庭,俨如王者,病者受传呼而入,则入于博士诊病之室,白昼而玻窗也,必四围周以曼幔,绝不通一线之阳光,张电灯而从事,病者仰视,如见阎罗王”。As to Chinese medicine, it does not form a unified system, but all sorts of different forms of medicine that appeared over the course of its history survive alongside each other. In addition to traditional Chinese medicine, or ‘Confucian medicine’, there is ‘witch doctors’, ‘herbal medicine’, “游医”,以及在民间观念中并不属于医者范围的“接生姥姥”和“阴阳先生”,甚至是顶香看病的“香头”,这些力量都在和中国边缘的地带游走,深切地影响着民众的医疗生活。


2: towards a national system, the Lan Ansheng model


这其中兰安生模式起到一个很重要的意义。上世纪30年代,美国人John B. Grant(中文名兰安生)担任北京协和医学院公共卫生系主任,他在北京设立了6个卫生试验区,覆盖了当时北京内、外城的大部分人口。这样,使医疗监控的区域扩大,并使医院医疗的空间和民众生活的空间被迅速结合起来。卫生区建立起来后,通过医护人员的不断登门访问,监控变得非常制度化。这一医疗模式被称为“兰安生模式”,后来在上海、天津、南京、广州等地区都建立了类似的卫生区组织。这样,医疗结束了散布民间的状态,被制度化了。


全世界公共卫生学起步于第一次世界大战后,而兰安生面前的中国,并没有任何一个可以去实现公共卫生的基础元素:普遍贫穷、缺乏卫生设施、系统不健全、文盲泛滥、政府不稳定、没有任何现代的医疗保健系统。面对落后混乱的现状,兰安生开始了为医学社会化努力的历程,起点就是协和医学院的公共卫生课程,以及东城一座破庙改造的“卫生示范区”。当时协和有一股贵族气味,兰安生的到来,给正处在思想塑型期的协和医学生们,上了一堂堂生动的民生课,这些课的主旨是:走出医院,走进胡同,超越个体,关注更广人群,到达底层北京人生活的真实世界。在北京一座旧庙的基础上改造的卫生示范站,是1925 年兰安生与政府合作的结果,后改名为“北平市卫生局第一卫生事务所”,经过努力,十年中“一所”管理的居民区域,死亡率从22.2%下降到18.2%。

When Lan Ansheng was in China for sixteen years, he was full of dreams and passion, so much so that people started saying he was ‘a bolshevik of the medical profession’. When he died, he was awarded the highest recognition by the US medical health association, and recognised for its ‘great scientific foresight and statesmanship’.

3. Medical reform experiment: the dream of Cheng

After all, the construction of the “Lan An Sheng” model is a kind of urban behavior. However, in the countryside it is conducted by Chen Zhi Qian, a student of Lan An Sheng. Chen, a graduate of Xiehe, was influenced greatly from Lan An Sheng. Have attending one of Nan’s lectures, Chen was surprised to find the total difference between the lessons of the Public School of Hygiene and the previous traditional lessons. Lan An Sheng invited Yan Yangchu to Xiehu to instill strength into the doctors, by giving a lecture on the current social economic situation in the countryside of China. At the same time, due to the introduction of Nan An Sheng, Chen and Yan became friends, and then the model of the medical experiment of Dingxian and Chen Zhi Qian was at last realized.

At that time, the rural construct experiment was mostly concerned with rural health care, such as conservation of rural hygiene of Zhou Ping in Shan Dong, the Xugong bridge of Jiang Ling and the construction of a Farmer’s Hospital of Wu Jiang in Anhui, and so on. Amongst them, Ding Wian’s experiment, hosted by Yan Yangchu had the biggest impact. The rural construction experiment of Ding Xian started in 1926, and continued up until 1937 when the Japanese army invaded and occupied Huabei, the experiment was forced to stop. In 1932, Chen-Zhi Qian started an experiment in Ding Xian, during which the pioneered model of Ding Xian and village level 3 health care and became the model of that time.

In the model of Lan An Sheng, amounts of medical resources mainly concentrated in metropolitan centers, which are above the county level. How to make the resources used by countryside has already quickly became a content of rural social reform of that time. After the experiment of Chen Zhi Qian, he observed deeply that doctors trained in high level medical practice would stay in the cities and not leave. What’s more, the investement of the model of Lan An Sheng is too large, so it was only suited for big cities. As for this, he criticized that the best doctors should use the most advanced instruments and have the best bed-side manner. The most popular doctors in Chinese society work especially with a select few men and women in today’s society. Therefore, he mediated and put forward that the point of the rural medical reform consists in achieving two goals, including commercial medical prices, and instruments and localization of medical personal training.




4. Medicine under political discourse

After 1949, as China’s leadership was undergoing great change, the Health system also changed a great deal. The combination of medical and political movement was of great importance.










5. A return of the Medical system to normal, including inherent flaws.

After 1978, The National Health Campaign was added to the construction of socialist culture and ideology. The programs reached all levels of society down to country township level. Some examples include programs to eliminate localized diseases in the 50’s, and the ‘two controls and five reforms’ campaign. In the 70’s, the programs were gradually replaced by distinct city centered campaigns, such as the ‘medical school’ or ‘civilized city’ approaches.

Definitely, social medical work was expected to shake off the basic model of mass movement and ultimately become the work of medical experts, to underline and stress ‘high-end, advanced and effective’’ medical technique. 当时,有一些医学科班毕业的医生,他们发表文章呼吁,说赤脚医生不行,技术太差,只能满足头疼脑热的治疗,社会应该培养高精尖的医生。随后整个医疗体制开始改革,走向市场化,大量的投资进入城市,投资大医院,买先进仪器,转移之后农村赤脚医生的体系自然就瓦解了。





Six, learning from history: Reform must serve the general public





(本文参考了杨念群《再造“病人”》、胡宜《送医下乡》等专著. For that, we wish to thank their authors.)

‘In the same boat’ magazine, 2012, issue 7

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Source : my1510

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French-Australian writer, educator, sinophile. Any question? Contact