Where Have All the Barefoot Doctors Gone?, asks HSPH Doctoral Student

I am the daughter of a barefoot doctor. My mom was sent to a village in northern China to work as a barefoot doctor at the time she was a junior high school student. This was her first profession before she became a mechanical engineer later on. All of my impressions about her old profession as a ‘doctor' were from several black-and-white photos in the rural field and the skillful intravenous shot she gave to me at home. Now I am training in the Harvard School of Public Health. I began to realize how lucky I was to have those semiprofessional doctors around when I was sick but also how fortunate that I had not become the victim of their poor training.

— Lingling Zhang, HSPH doctoral student, from her award-winning essay, "Where Have All the Barefoot Doctors Gone in Pursuing a More Equitable New Health-Care System in China?"

In 1965, Chairman Mao Zedong ordered that China's health and medicine fields focus on residents of rural areas because the health of farmers was integral to sustaining China's agricultural sector. To provide such care, a generation of so-called "barefoot doctors" was developed. These individuals underwent short terms of intensive health care training. The barefoot doctors provided basic care that complemented the more formal medical system, and they became integral to China's health care system. Now, China is experiencing health care reform. The overarching question persists: How will China deliver quality, equitable health care to its people, while developing a health care workforce in a new era?

Lingling Zhang, a doctoral student in the HSPH Department of Population and International Health, pictured at right, reflected on this question in an essay entitled, "Where Have All the Barefoot Doctors Gone in Pursuing a More Equitable New Health-Care System in China?" The essay, published in The Lancet's 2007 anthology, Young Voices in Research for Health, was solicited from young professionals who are working on or who are interested in the broad spectrum of research for health. Zhang will be one of a group of winning essayists who will take part in Forum 11, an event that will take place in Beijing to debate critical research gaps and to mobilize campaigns to address the health needs of the poor and marginalized. The essay contest was sponsored by The Lancet and Global Forum for Health Research.

Zhang's interest in barefoot doctors comes from her own childhood. In her essay, she recounted a story in which a "doctor" without formal training gave her a shot to decrease a fever, only to make her more ill. She used the story to illustrate a dilemma China now faces: communities need doctors, and barefoot doctors have helped many people over many years. At the same time, these doctors need more formal training and skills.

"Health care has become a threat to impoverished families," wrote Zhang. "These problems have become the second top concern of Chinese people following the income problem. Barriers to access [to] care have been identified as an obstacle to building a harmonious society — the central goal of government policies. Reforming China's health-care system has been put on the policy agenda. Given my experience with barefoot doctors, I cannot help asking: how can barefoot doctors help in this new era?"

Zhang suggested that training local people remains an optimal solution for building sustainability in rural health care services. Community doctors are, she wrote, the continuation of barefoot doctors. But she urged that training of such doctors be appropriate and that access to care be equitable.

Before coming to HSPH, Zhang studied at Carnegie Mellon University, Kansas State University, and Central University of Finance and Economics, Beijing. In addition to her HSPH studies, Zhang is now working on the China Medical Board-sponsored project, Human Resources for Health in Rural China. After she graduates from HSPH in 2009, she wants to be employed in a position where she can work to reduce gaps in health care inequities.

"It will be very fortunate for me if my essay could serve as a mirror through which my personal experience could reflect certain existing problems and help reinforce some potential solutions to improve health care in underserved areas," Zhang said in an e-mail to HPH NOW.

Read Zhang's essay.

—Michelle Samplin-Salgado. Photo by Suzanne Camarata.