Through the meandering mountain roads, be it rain or shine, 70-year-old Zhou Fengyong rides her bike at least five days a week - to see her patients.

Similarly, somewhere along the Zhengdongbao village in outskirts of China, another rural doctor Zhang Hong, 45, treats patients at odd hours. He recalled opening his door at six in the morning to a man who had carried his frail elderly father all the way to the house.

“We have to treat patients whenever there is a call or a knock on our door, even if it’s in the middle of the night.”

Like Zhou, Zhang is one of the village doctors who have been the health guardians to more than 600 million rural Chinese in the mainland. They peddle to rural patients who are weak and elderly, and cannot afford high medical costs.

“We keep track of people’s health status so that we can design a more personalised health management plan for them,” says Zhou.

Barefoot doctors brought healthcare to rural areas

Many village doctors are offsprings of the 1950s barefoot doctors who had their origins in Shanghai when many farmers who worked barefoot on the farms were given short training of three to 12 months, with the focus on prevention, maternal and child care, and collecting disease information.

Gradually, in the early 1980s, many have taken to the wheels to become village doctors after passing an examination, while those without qualifications would serve as health workers alongside village doctors.

To the villagers, these rural doctors are lauded as the foundation of rural healthcare and once enjoyed high social status and attractive pay. In rural areas, where travelling to the nearest city hospital is often unaffordable, the population turns to village doctors.

“Our village doctor has taken care of my family for decades,” one elderly woman said about Zhou. “We can’t thank her enough.”

But along with the country’s shift towards more market-oriented healthcare reforms, their income dwindled and in some counties, more than half of the villages do not even have village doctors.

Huang Aimin, 55, a village doctor in Laodun village, said, “In the past, being a rural doctor was regarded a great honour and I was well respected.”

Low salaries pushing village doctors away

Policies are in place for better healthcare, yet they have not been adequate to address the needs of rural doctors. The biggest hindrance is the low remuneration.

Most of these doctors did not complete high school and many do not receive monthly salaries or benefits such as pensions and annual leave. Instead, they are often on a 24-hour call and take on additional roles of being a nurse, caretaker and health consultant.

Many rural doctors are abandoning their jobs, according to a 2014 survey of 100 Chinese villages by Ma Wenfang, a rural doctor and deputy to the National People’s Congress. All doctors surveyed reported low salaries, with their highest monthly income just above 1,000 yuan, (MYR640) and the lowest being 60 yuan (MYR39).

“Their complaints have included low income, no social insurance and few job prospects,” said Ma.

China’s government has introduced subsidies would allow village doctors to earn an average 3,300 yuan (MYR2,120) per month — an incentive that would make the profession much more attractive to rural farmers.

However, in many areas across the country, these subsidies have been withheld, according to medical reform expert Xu Yucai.

A challenge despite government efforts

With an increased life expectancy, chronic diseases will inevitably surge, implying the need for a strong primary healthcare system and more rural doctors engaging with the rural population.

Despite efforts to retain rural doctors such as the “Rural Health Project”, supported by the World Bank, it is still a challenge, especially when the government has to provide not just bigger salaries, but also pensions and insurance for the ageing generation of village doctors. In fact, many village clinics have closed due to lack of government funding.

Evidently, the initiatives rolled out have sidelined rural doctors, and unless a reconstruction of this rural workforce is on the way, the barefoot doctors would find it burdensome to trudge on. MIMS

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