Care in the countryside
Rural Health Cooperatives, Barefoot Doctors, Contemporary Organisational Models and
the Lessons of History: China c. 1965-2010
In 1965 Mao Zedong announced his support of the establishment of health co-operatives to
provide healthcare to the vast expanses of rural China that did not have easy access to
hospitals. This scheme provided basic public health training for local peasants, ‘barefoot
doctors’, who then administered to their communities, typically focusing on preventative,
rather than curative medical techniques.
Barefoot doctors and the Rural Co-operative Medical Systems (RCMS) of which they were
part became a powerful symbol of the Cultural Revolution. They provided not only an
economic and practical means of improving national standards of health, but also
underscored the political ideals of the Chinese State — providing a proletarian vision of
relevant medical care (utilising both Chinese and Western medical techniques) in contrast to
the bourgeois self-interest that elitist Western, urban-based, medicine symbolised.
Furthermore, the idea (in existence since the 1930s as part of the wider ‘Gung ho’ cooperative movement), firmly underscored Maoist priorities of sponsoring agricultural
production through communal organizational models of economic management.
Yet the life of the health cooperative was relatively short lived. Although internationally
lauded by the WHO as cheap and effective means of supplying rural healthcare during the
1970s the scheme was nevertheless formally abolished in China in 1981. RCMS somehow
seemed less relevant as China moved towards a free market economy and the commune
system of agricultural cooperatives also folded. This institutional transition will be used as a
framework to understand broader economic, social and political changes in China.
This paper, co-authored by a Medical Historian and an Organisational Behaviourist,
concludes by making some interdisciplinary reflections on the links that can be made
between studying health in history and achieving a deeper understanding of modern health
policy. After outlining the history of health co-operatives in China, it reflects on initiatives,
since 2002, to revive health cooperative schemes for rural areas in PRC. How has the history
of health in China informed the modern drive towards the establishment of rural healthcare
co-operatives in China today? To what extent do these new schemes diverge from the
earlier schemes and how might we historically account for these changes in emphasis? Is
there room for co-operatives in the Chinese society currently dominated by state and
private capitalism?
Andrea Bernardi, Anna Greenwood
The University of Nottingham, China Campus
Healing the Countryside: Medical Student Volunteers in Rural Romania, 1934-1938
This paper examines the ways in which rural health and hygiene were integrated into a
project of ‘militant sociology’ aimed at modernising interwar rural Romania and how, in turn,
involvement of medical practitioners in this project resulted in the medicalisation of rural
social problems. In the mid 1930s, scores of medical students and young doctors from the
main Romanian universities joined the Royal Student Teams, becoming volunteers in a
mission go to the countryside and apply their knowledge and skills to improve the health
and hygiene of villages across the country. This project, called ‘cultural work’, was launched
in 1934 by the sociologist Dimitrie Gusti and was funded by King Carol II. Based on Gusti’s
social theory, this targeted four main areas: the body, the work, the mind and the soul of the
peasant. Specialists from academic disciplines corresponding to these areas were recruited
to work in individual villages: a doctor and a sports teacher for the body, an agronomist, a
vet and domestic scientist for health and work, and a priest and a teacher for the mind and
the soul. Comparing the textbooks and rules of cultural work with the field reports of the
medical students and doctors, this paper examines both the organisers’ official agenda on
rural health and the hygiene and the participants’ experiences and interpretations of their
mission. My main argument is that the presence of medical practitioners in the teams
exerted a strong influence on the wider project, resulting in a ‘medicalised vision’ of the
rural world in general and of the peasant body in particular. As doctors became aware of the
social context of rural health and hygiene, the other members of the teams used a medical
vocabulary to understand the social problems they confronted.
Raluca Mușat, School of Slavonic and Eastern European Studies, UCL
Non-specialist health workers in the delivery of mental health care in India: an historical
perspective
In India, the gap between those who need mental health treatment and those who get it is
large and there are too few psychiatrists to cope with this burden. The National Mental
Health Programme of India (initiated in 1982) and several important international
documents and programmes over the past four decades, have called for an increase in the
use of non-mental health specialists to address this treatment gap. This paper, based on oral
history interviews with key informants, will analyse the recent history of mental health
policy making in India. The research focuses specifically on past efforts and barriers to
shifting mental health tasks from specialists (psychiatrists, psychiatric nurses/social workers)
to non-mental-health-specialists within primary health care. These can be physicians, nurses,
and lay health workers who have some training/duties within mental health care.
Thirteen oral history respondents so far interviewed as part of a PhD thesis, were chosen to
represent a wide range of views on community mental health developments from postindependence (1947) to the current mental health programme. These included people ‘from
within’ the policy arena (policy makers, bureaucrats) and observers (those who had
worked/were working within local or international programmes). Informants were chosen
from different stages over time in policy making. The interviews have been assessed in the
context of other material on mental health policy such as published reports. The study
suggests there have been several stages in the development of community and primary
mental health care and in the use of non-mental health specialists. Factors influencing the
lack of development of non-specialist care appear to have included political or professional
apathy or obstruction. But other issues have helped the non-medical developments: recent
increasing political and financial support; and the growth of the rights-based movement and
of the NGO sector in the 1990s. These prior experiences will, it is hoped, inform national and
district mental health policy and programmes in India today.
N. van Ginneken, V. Berridge and V. Patel (LSHTM)
Anglo-American relations and public health nursing in the East of the British Empire
The Director for the East for the International Health Board of the Rockefeller Foundation,
embarked on ‘world trips’ examining healthcare in Asia from the 1910s to 1930s. His candid
accounts provide an extraordinary comparative perspective of healthcare in British colonies
in East and South East Asia, including nursing policy and practice. Not only did the RF critique
British colonial healthcare provision, but the organisation also collaborated with colonial
governments. Public health nursing was of major importance to the strategy of the IHB,
which attempted to influence British colonial healthcare policies in this area. One case study,
the Rural Sanitation Campaign in the Straits Settlements, British Malaya, from 1925-28, will
be explored in detail. Two nurses from the Overseas Nursing Association in Britain were
funded by the RF to study public health nursing in the United States in order to spread what
the RF perceived as a more developed American professional expertise into the British
Empire.
This paper will contextualise the RF approach to British nursing as symptomatic of a
broader 'Americanisation' strategy. We shall argue that influencing British nursing in key
strategic sites was seen as a 'gateway' to the empire and securing the cultural dominance of
American nursing throughout the nursing world.
Dr Rosemary Wall and Professor Anne Marie Rafferty, King’s College London