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Medical team conducting annual medical examinations of Marshallese people who were exposed to radioactive fallout from an atmospheric nuclear weapons test in 1954.

Barefoot Doctors (赤脚医生), and their impact on launching chronological evolution of primary care medicine

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Medicine is the science of healing and beyond. It’s merely about conveying the comprehensive state of bodily, emotional, psychological, and social well-being into a solo harmony at a given epoch and dwelling that gave the availability of resources and economic status. Medicine is a science that has made tremendous headway over the past century. Yet, it’s dispersion across the socioeconomic landscape has considerably languished. Prominent people with sincere feats have strived to salvage the broken healthcare system. In an exertion to ascertain the medical service delivery model is considered to be convenient for everyone but also affordable, the kind of care that wouldn’t impose living at the mercy of the third-party interest.

But, who Were barefoot doctors?

The intuition of barefoot doctors was the upshot of the 1920″ Rural Reconstruction Movement” in China by the motivation of a Chinese mentor and organizer who was well comprehended for his work in mass literacy and rural reconstruction, Y.C. James Yen and Liang Shuming started as a pilot program in rural China that was ultimately industrialized after the year 1930, With the permission of late communist leader Mao Zedong. The crusade was deemed like a battle until was adapted. It kick-started as an unrestricted and independent during the ruling of the Chinese Nationalist government at the time but was perceived robust to that of the revolutionary alternative plan matched by Mao Zedong’s Communist Party.

Barefoot doctors (Chinese: 赤脚医生; pinyin: chì jiǎo yī shēng) were at large the group of rice farmers, with traditional folk healers, rural health care providers, and graduates who held minimal basic medical and paramedical training working in rural villages. The goal was to deliver healthcare to rural neighborhoods where urban doctors would not toil. The barefoot doctors aided and facilitated essential hygiene, preventive healthcare, and family planning. They furthermore dealt with common ailments. The title epitomizes those southern farmers, who would often work barefoot in the rice paddies, and simultaneously acted as medical practitioners.

The barefoot doctors were commonly secondary school graduates who hence acquired three to six months of extra training at a county or community hospital; they functioned as a primary healthcare provider at the grassroots tier and were provided permission to dispense western and Chinese medicines.

barefoot doctor
source: body-languages.net

Salary of barefoot doctors was estimated as if was farming labor; reimbursed half of what a classically-trained doctor would have earned.

In one of his famous speeches, Mao Zedong denounced the municipal prejudice of the medical system of the moment and called for a policy with a greater priority on the wellbeing of the rural community in what became the June 26th directive. After that speech in 1968, China’s health policy changed. The barefoot doctor’s program became an integral part of the national healthcare system under the designation of “rural cooperative medical systems.” The barefoot venture strove to encompass community participation with the rural provision of health services. Major civic reform by the Chinese government is enticing the attention of the world health organization (WHO) in 1978 at the Alma-Ata declaration ratifying the already adapted criterion as a pinnacle for the upsurge of primary care medical practice method in the world. The sentiment inspired by the rulings in China revolutionized the state of patient care in China’s rural areas and across the globe.

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The barefoot doctor’s system was short-lasting, as was repealed in 1981 with the end of the social network of agricultural cooperatives. But its heritage has undoubtedly been ripening famous around the world under the titles of primary care medicine and allied providers. The rawer economic policy in China stimulated a transition from collectivism to individual exposition by the family unit. The barefoot doctors model officially culminated by the advent of Chinese healthcare reform of 1985, when the term ‘barefoot doctor’ was eliminated from the healthcare system and replaced with the designation and the concept of ‘village doctors that provoked the shift towards privatization of the healthcare system, and marginalizing barefoot doctors along with their emphasis on preventive medicine and primary healthcare. Hence, the barefoot doctors were offered the choice to take a national exam, and if passed, they would come to be village doctors. If not, they would be considered village health aides. A handful of village doctors later admitted to medical school in the path to earn a medical degree.

In its way, the barefoot doctors voyage considerably curtailed healthcare expenses for the People’s Republic of China while provided primary care treatment to the rural farming populations. The World Health Organization (WHO) regarded the rural reconstruction movement as a victorious illustration of unraveling scarcities of medical services in rural districts because the barefoot doctors furnished the critical primary health care at an affordable cost and assured China an essential seat at the United Nations (U.N.) and WHO.

The secret for the success of the barefoot doctor campaign

There’s no place for an argument that the task of Y.C. James Yen and Liang Shuming was genius of its time. It not caressed on one of the most pressing dilemmas of the moment but also dealt with it from its grassroots. Not surprising enough was picked up by the communist political party as a tool to defeat the nationalist administration, even though was not a socialist doctrine at its start. It had to be repented and reclassified initially through the bureaucratic overtake by the agricultural cooperatives of the communist regime, later transitioning from collectivism to modest socialist family unit portrayal, and abolished and reformed under the concept of ‘village doctors, hence shifting towards corporatization of the healthcare system. The original version succeeded not by its bureaucratic understanding but based on the reality that was the grassroots solution; it empowered individuals and, most of all, was personal. Barefoot doctor’s principle was about a person; not groups; was around skills, not titles; about community, not politics. The bottom-up restructuring was in the berth of top-down solutions. It defined the Hippocratic medicine restored to meet the public medical necessities of their time.

But abolishing barefoot doctor was a mistake.

Let’s be clear! Barefoot doctor’s movement was eliminated, but not perished away or converted. It never intended to create a cartel of today’s preventative care by merit of primary care ownership. The barefoot movement of today would be much different from that of the 1930s in ways, but the fundamentals would stand uniform, although WHO was inspired by the Y.C. James Yen and Liang’s idea, but the international institution had to put their version of barefoot doctors programs to match the 20th-century corporate and political schemes, be it through licensing, accounting, and education monopoly. The modern primary healthcare model relies solely on the Top-down strategy, where the original rural reconstruction movement was an elemental community core concept.

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The sociopolitical climate was perfect for the barefoot doctor’s empowerment because the prevailing communist regime probably would have gained the upper hand against its nationalist rival by adapting the following policy, reforming it down the line.

What was the barefoot vision?

The Barefoot doctor’s mission was the visionary reflection of its founder, James Yen, who speculated in the sovereignty of small communities, individual reign, and rural life. His vision was right on the money for the purpose he congregated.

His mission was to abolish fascism and bigotry because he foresees them as the enemy of individual sovereignty. He predicted the barefoot doctors’ potential as an independently orchestrated socioeconomic movement. Still, he perhaps did not expect it taken up, used to leverage political power, wriggled, and wielded differently across the world. Ordinary people in rural communities served as His motivation. He believed in harnessing individual skills without prejudice of titles and glamour of being different, even though he was a Yale and Princeton graduate. James believed in curbing potential within every community synonymous with their particular culture and norms. For instance, combining Chinese and western medicine for rural Chinese rice farmers while applying a similar vision for the Philippine rural reconstruction movement differently.

He was a devoted Christian but was also realistic enough to adapt to the needs of people irrespective of their faith. To make sure the unbiased approach to the grassroots problem, Yen recalled his affiliation with the church and heeded himself as a “follower of Christ in relationship with Jesus, not as a “Christian,” which would affiliate his direct membership with church. He never flunked to criticized missionaries for not being in touch with the realities of Chinese rural necessities but exuberantly welcomed the support of those Chinese and foreign Christian organizations which addressed the crises of the village.

Irrespective of political affiliations Governments greeted his mission because his actions were sincere and libertarian. But those encouraged declined his legacy by redefining what he lived for at Yan’s prestige. His vision suits his era because was contemporary, liberated, touched everyone’s heart, and apolitical. More than anything was common sense.

Had it been attempted today would still work, in synchronous with the advancement in its adaptation of technology, resources, and strategy (collectively called modernization of Barefoot Doctors), generically referred to as Healthcare without Borders.

To the contrary of what was initially introduced and succeeded in the 1920 Chinese rural initiative, the 1978 Alma-Ata declaration was an utter letdown. The barefoot doctors were interpreted into nurse practitioners (N.P.), physician assistants (PA), midwives, family practice physicians, internists, and pediatricians through Licensing, Societies, and Political Corners. All labels and titles are disposed to serve as nothing short of words created as a caption to profile appointed skills in one class for one person, as the end outcome is still the skill that is important with prejudice of limiting Top-down control.

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What does barefoot doctor mission mean today?

We are headed in the wrong direction using the 1978 bombast. We are suffering the consequences of pivotal divergence after the pick of what was initially formulated to be for the people by the people. But today it merely reproduces the mission of the corporations by the governments employing people. That is precise to what mounts.

It’s not too late, as we have all the reserves to take healthcare beyond socioeconomic boundaries, as James Yan envisioned. It can be accomplished by laying the doctor’s patient foundation and building the technological and modern scientific structure over it. The system served well in the 1920s, is applicable today, and no qualm can be applied tomorrow. Thus, the social mindset and own independent reasoning must be sound and assured by the higher administration.

The populist mindset that has pivoted the barefoot doctor’s purpose has and will always stop to role, under the rigid application of the Population health system.

Personalized healthcare is Hippocratic medicine. Barefoot doctors were the epitome of personalized medicine of their epoch. Options, opportunity, realistic incentive expectations, long-term as well as short term strategic explanations that place individual circumstances at the center of the mission are fundamental to the success of those endeavors.

Barefoot legacy is long-lasting and serves as a definite streak on history even though was defeated on the political battleground. Because it is individuals; and is transparent. It can adapt to the moment and the economic situation. Most of all, it concentrates on the point of maximal need for change.

The bottom line

We are living in the infinity of obsolete definitions, where personalized is being presented by a hybrid model of population-based corporate medicine. When primary healthcare practice is being conveyed as a specialty where all it reflects is a managed care protocol established designation. Where the skills are hogged by medical, political, and license organizations where all the people need is raw skills and talents.

And faith, religion, conscience, humanity, sense of responsibility, or being yourself and collaboration towards a better life for everyone as the driving factor to secure the correct definition to the proper mission. That is what the Chinese farmer’s task implicated; as in, personalized accomplishments, instead of pursuing the corporate ordinance. Today, we vouch for it contrarily.

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Adam Tabriz
Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate and entrepreneur with 15+ years of success performing surgery, treating patients and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to Create a highly effective business model which alleviates the economic and legislative burden of independent practitioners, empowers patients and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.

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