October 19, 1999	atimes.com

China China's rural population faces medical catastrophe By Antoaneta Bezlova RONGSHUI, China - All that Liang Youngwei's family needed to save his life was money. He was 54 years old and had cut trees in the mountains near his home village, Yaguang, all his life. But he became paralyzed from the waist down, and no herb brews or massages could help him. He died in three months. Yaguang's village doctor Xie Hongwei claims Liang had rheumatism, but he had been given injections at the township hospital which only worsened his condition. ''We needed to send him to the prefecture hospital in Liuzhou, which is 10 hours drive from here,'' recounts Xie, still shaken by the death. But to be admitted and treated there, Liang needed 5,000 yuan ($600). With his annual earnings less than 500 yuan, he could not afford to pay even the deposit for admission to the hospital. ''His family borrowed some money and sold some timber, one pig and a couple of chickens, but all they could scrape together was 1,000 yuan,'' says Xie. Liang never made the 10-hour journey to Liuzhou and died in his bed. The plight of Liang, who was never diagnosed and was treated with dubious medication by poorly qualified doctors, is replicated in millions of rural households across the most populous nation in the world. His resignation to dying at home rather than drain his family's finances is another facet of the deepening crisis in public health that plagues rural China. ''It is not a common crisis which needs some emergency relief,'' says Dr Marcel Roux, head of the China mission of the humanitarian group Doctors Without Borders. ''It is a monstrous catastrophe for millions of rural people in China who cannot afford any medical care. The public health system in the villages is simply not working.'' The unfolding of the crisis, which has only now begun to emerge from behind the thick curtain of propaganda, has taken place over the last 20 years since China began introducing market reforms. A whole era of free preventive care and universal access to medical treatment ended with the collapse of Mao Zedong's people's communes. Under the collective system, 90 percent of the rural population were provided with virtually free health services. But the dismantling of the collectives in the late 1970s put an end to the cradle-to-grave welfare, and now only 10 percent of rural people receive medical care. The state has virtually withdrawn from the countryside where 800 million peasants - two-thirds of China's population - live. Financial responsibility for health care has been handed to local governments. In poor regions like Guangxi and most of the country's impoverished interior, the absence of state funding meant the end of health care in the 1960s. ''We discovered things were better when they had public health campaigns led by the 'barefoot doctors' of Mao Zedong, although the medical care then was very poor,'' says Dr Roux. ''Everywhere we went in Guangxi, Shanxi and other provinces, we saw ghost hospitals with falling roofs and rusting equipment from the 1960s.'' Shi Rongsheng, a medic from Rongshui county, says: ''Right now, we are fighting a battle we thought was finished years ago. Tuberculosis and typhoid, which were well controlled in the past, are on the rise. In the township of Danian alone we have 300 cases of TB out of 13,000 people, and those are only the cases we know about.'' Roux contends the authorities don't know what is going on in the villages in poor regions. ''Beyond the county level, it is a jungle,'' he says. ''We think the level of health care in Africa was better, for sure. In Africa, there are good African physicians and health workers. In China, they don't have the knowledge, they don't have the structure nor the people to organize any health care.'' After years of declines, the infant mortality rate - a basic indicator of a nation's health - has been rising steadily since the mid-1980s. It was officially put at 34.7 per thousand in 1981, but is presently estimated by the UN Children's Fund as 52 per thousand. More alarming is the huge gap that has opened between the developed coastal regions and the rest of the country's poorer regions, where the infant mortality rate is four times higher. ''We estimate that only 50 percent of rural children are vaccinated,'' says Dr Philippe Legall, who works on a pilot project of the Doctors Without Borders in Rongshui county. AS a result, public health experts are seeing a rise in infectious diseases and epidemics. Tuberculosis and neonatal tetanus kill more than 200,000 children in China every year while hepatitis, tuberculosis and AIDS are spreading. The lack of state funding and control means that the health system is driven entirely by economic motivation. Underfinanced and often unpaid for months, local medics are scraping to find their own sources of income. They have begun charging fees for injections and drips while disregarding any other less lucrative treatment. When medical workers from the Doctors Without Borders first came to Guangxi in 1994, they came to deliver emergency aid after floods deluged many parts of the province. To their horror, they saw hospitals where children with diarrhoea were injected with atropine, an aneasthetic. The parents had borrowed money and local doctors made money, but the children died. ''It made my hair stand on end,'' recalls Dr Roux. ''In a way, it was worse than hearing all these stories about 1950s' 'barefoot doctors' who were sewing on arms that had been severed. At least, they did it for the lack of medicines and equipment, not for the lack of money.'' (Inter Press Service)

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