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The COVID-19 pandemic has spawned two healthcare crises: the first focused on containing the disease’s widening footprint, and the second, a behavioral health pandemic created by stress, anxiety and social isolation. Addressing both of these issues requires a population health approach. As such, there is much to be learned from an innovative program known as the barefoot doctors, that originated in the early days of the People’s Republic of China.
Following 22 years of civil war, the new Communist regime that emerged in 1949 was faced with a severe shortage of healthcare workers. Historians estimate that the number of allopathic physicians with college training at the time might have been as few as 40,000-85,000, yielding a physician/population ratio of about 1:14,000. (Burns & Liu, 2017). Compounding the problem, most of these physicians resided in urban centers: inaccessible to rural residents who comprised the vast majority of China’s population.
Barefoot doctors provided their rural neighbors with health education and preventative care in a culturally competent manner
Chairman Mao understood that the health of the proletariat was essential not only to the country’s financial wellbeing, but his political future as well. He came up with the rather ingenious idea of teaching the farmers to take care of each other. (Valentine, 2005).
The newly formed Ministry of Health recruited young adults in rural communities with a basic (e.g. high school) education, to eradicate schistosomiasis, also known as “big belly” or snail fever. The disease, caused by parasitic flatworms, attacks the GI system and urinary tract, and is fatal if left untreated.
Newly recruited healthcare workers received a crash course in medical training, including anatomy, bacteriology, acupuncture, maternal and infant care, traditional Chinese and Western medicines (npr.org). The term, barefoot doctors, originated in Shanghai because farmers in the south often worked barefoot in the rice paddies. (who.int.).
Barefoot doctors provided their rural neighbors with health education and preventative care in a culturally competent manner. Dr. Liu Yuhzhong, who began his career as a barefoot doctor said:
“There are great advantages to having a barefoot doctor in the village. The patients are all my neighbors. I know each family’s situation, lifestyle and habits. Since I see my patients very often, even if I cannot diagnose precisely the first time, I can follow up closely and give a better diagnosis the next time.” (who.int.). Yuhzhong eventually obtained his medical license and continued to practice medicine in this village through the 1980s. (who.int.).
Despite a lack of medical supplies and equipment the barefoot doctors’ movement effectively brought much needed services to the populations it served. The rural cooperative healthcare system covered 90 percent of China’s rural population at its zenith in the late 1970s, prior to being dismantled as a result of the country’s economic liberalization (Burns & Liu, 2017).
The lesson that we, as behavioral health practitioners can take from this, is the tremendous power that lies unharnessed within our communities. Given the limited number of clinical psychologists and psychiatrists practicing in primary care and specialty health clinics, how can we utilize these untapped resources to increase our footprint in the wake of the COVID-19 pandemic? Although safety net organizations have traditionally interfaced with community resources including places of worship, recreation centers and the public schools, there is no cohesive, national framework within which to organize and optimize such efforts.
The coming months will be a period of tremendous challenges that can, if properly addressed, result in significant advances for the behavioral health profession. By more effectively integrating with the community, we can increase our reach, and assume a leadership position in the move towards a “new normal.”
Burns, L. & Liu, G. (2017). China’s Healthcare System and Reform. pp. 34-36. Cambridge University Press.
Valentine, V. (2005). Health for the Masses: China’s ‘Barefoot Doctors.’ In Rx for Survival: A Global Health Challenge. npr.org.
China’s village doctors take great strides. (2020). In Bulletin of the World Health Organization. Vol. 86/12/08-021208.