A 35 year old woman in a shirt uniform walked into the clinic. As she spoke, she looked straight at the medicine rack instead of seeing doctor Cao cuncai. Cao cuncai got up, took the medicine, scanned and collected the money. The lady turned and left.
on August 1, 2020, in less than a minute, this lady doesn’t seem to be facing a doctor at all. Cao cuncai said that now people do not care about him when they come to buy medicine. “In the past, it was doctor-patient cooperation, now it is customer first.”. On this day, four people came to the clinic, and the running water was 27 yuan.
Cao cuncai is a village doctor in Meicha village, Zhongcun Town, Shanyang County, Shangluo City, Shaanxi Province. When Cao cuncai stayed there the day before, no one visited him except an old man from a neighboring village who chatted with him.
there are too few people to see a doctor. The population of the whole village is only 1140. The young and middle-aged people have gone out to work, leaving less than half of them. Moreover, the county hospital is only about an hour’s drive from Meicha village, “go to the county hospital if you are a little sick,” says Cao cuncai.
fewer patients and fewer doctors. By the end of 2019, there were 792000 rural doctors in China, compared with 845000 in 2018, a decrease of 53000 in one year; 1023000 in 2012, and 231000 in seven years.
there are 533 village doctors in Shanyang County, 57% of them are 41-60 years old, 13% are over 60 years old, 62.3% are technical secondary school or equivalent, and 30.3% are not educated. It shows the characteristics of low educational background and older age.
barefoot doctors, the predecessor of rural doctors, had nearly 5 million people at their best. In the era of lack of medicine, they provided the most basic medical services for 900 million farmers at that time. Up to now, educational background, age and other factors have become a barrier in front of them, which will bring a series of problems such as income, pension and so on.
Cao cuncai’s father and dead wife are also village doctors, and his son also wants to be a village doctor. The life story of their three generations is a historical miniature from barefoot doctor to village doctor, from glory to decline.
out of Xi’an City, drive 150 kilometers southeast along the highway, and you will find Shanyang County. Starting from the county, along 219 Township Road into the depth of the Qinling Mountains, one road east 40 km, then to Zhongcun town.
Cao cuncai, 52, has been practicing medicine in Meicha village, about 8 kilometers away from Zhongcun Town, since 1994. He is not tall and thin. He speaks strong Shaanxi dialect and drives the white Jetta with Shaanxi a license plate. He bought it for him in Xi’an five years ago by his younger son. The journey is far away. The car is a safer means of transportation than a motorcycle. He got out of the car and walked.
Cao Xianwen, the father of Cao cuncai, is 81 years old and began practicing medicine in the village at the age of 17. When he graduated from primary school, he was regarded as a cultural man in the village. His medical skills depended on self-study. Today, he is also well-known. Private cars from neighboring counties often come to pick him up to see a doctor. His medical expenses depend on his sincerity. A cigarette or a bottle of wine will do.
on June 26, 1965, an instruction was issued to require that the focus of medical and health care should be placed in rural areas. From then on, relying on the rural cooperative medical system, the whole country vigorously trained half medical and half agricultural health personnel, known as “barefoot doctors”.
Cao Xianwen can’t ride a bicycle. No matter how far away he is, he has to walk on foot. Most of the time, it’s dark when he comes back from a doctor’s visit. He can only walk by moonlight and walk to a certain depression. When he hears the wolf howling from far and near, he is afraid. Wild boars often appear in the mountains, and they suddenly come out, which also frightens people.
in the 1970s, when Cao cuncai was in his teens, he often went out with his father. He remembered that once, he and his son went up and down among the vast mountains and climbed seven mountains in a row. During this period, barefoot doctors reached their peak, with nearly 5 million people, far exceeding the total number of health manpower owned by the Ministry of health at that time.
a person in the health system said that at the climax, educated young people were selected from a production team and sent to the county health school for training for about half a year, and then they went back to work as barefoot doctors.
barefoot doctors mainly focus on chronic diseases and some routine public health projects. Emergency and first aid are also important work, such as food jam, cardiac arrest, etc., which can be rescued in time.
during the visit with his father, the belief that medicine can bring benefits to farmers is also gradually rooted in Cao cuncai’s heart. He remembers that a little boy with legs curled up for no reason, after half a year’s treatment by his father, he slowly stood up, and later resumed walking, married his daughter-in-law and gave birth to three children.
Cao Xianwen often teaches his son that there are two professions that are most respected and always needed, one is a doctor and the other is a teacher. Cao cuncai deeply believed that he was willing to be a doctor just like his father.
in the 1980s, the rural collective economy disintegrated and the cooperative medical system collapsed. Cao Xianwen changed from a “barefoot doctor” to a “rural doctor”.
in 1990, Cao cuncai was admitted to Shanyang health vocational school, and he was the first student enrolled in the school. When he graduated in 1994, due to his outstanding performance during his internship, Cao cuncai stayed in Shanyang County Hospital of traditional Chinese medicine as a physician. It was a death event that made him decide to return to his hometown.
at that time, a village woman was about to give birth. When he went to deliver the baby, he found that the uterine contraction of the woman was not obvious, and there were also painless bleeding symptoms. He judged that the village woman was likely to have placenta previa, so he suggested that he should be sent to the county hospital. However, the village woman’s grandfather, a barefoot doctor in the local area, made his own decision and only burned the old tree bark into ash and mixed sugar water for the lying in woman to drink, without taking any more treatment measures.
when he received the notice again, the pregnant woman had died of massive hemorrhage. Cao cuncai was deeply touched by this tragic scene. The professional level of barefoot doctors was so worrying that he decided to resign from the hospital of traditional Chinese medicine and return to the village as a village doctor.
among the more than 50 classmates, 3 or 4 became village doctors after graduation, but he was the only one who was still in the village doctor’s post, some were in business, some were transferred to teachers.
the teacher Xu Yucai appreciated his tenacious and studious quality. During the period of health vocational school, he took many photos of Cao cuncai. In an article, Xu wrote: “later, when I went to the county hospital, I often found that he transferred patients to the hospital, and from time to time I received his phone calls asking about the diagnosis and treatment of a certain disease. I also heard many experts from the county hospital talking about Cao cuncai’s consultation on medical problems. It can be seen that he is so studious.”.
later, Xu went into politics. No matter how his official rank changed, Cao cuncai still called him teacher Xu. Now, he consciously mixed up badly, for fear that the teacher would be disappointed, and he did not dare to visit the county every time.
back in the village, Cao cuncai was deeply trusted by the villagers. At that time, most of the midwives in rural areas were women, and he was a rare male midwife. However, mothers in his own village and in the neighboring villages asked him to pick them up. Every year, he delivered about 20 newborns, and he could charge more than 200 yuan for medical expenses.
during his internship in Shanyang County Hospital of traditional Chinese medicine, Cao cuncai was trained in surgical techniques and came out to work with great courage. In 1996, a villager accidentally injured his Achilles tendon when cutting firewood, and his foot drooped down. He thought that the medical expenses were too expensive, so he did not dare to go to the county hospital. He found Cao cuncai and called on him to accept it boldly. He knew what the connection was like. With his wife’s cooperation, Cao cuncai used anesthetics, antibiotics, and stitched back the broken tendon. Later, the man slowly recovered from walking. Cao cuncai remembers that the operation cost 5, 600 yuan for medicine. “If you send it to the county hospital, you can’t get down without 2000 yuan.” talking about this, Cao cuncai is full of pride.
from 1994 to 2000, the village doctor’s visiting fees ranged from 5 yuan to 10 yuan according to the distance. At that time, the zero price difference policy for drugs had not been promulgated, and the money for selling drugs was his own. He was kind and kind. Villagers often brought him small gifts such as a bottle of wine, a bag of rice and a barrel of oil when they went to see a doctor. Cao cuncai said that during that period, not to say how much money can be saved, at least there was no lack of pocket money.
in 1999, he built a two-story small building next to his parents’ old house. The land and wages were calculated to be 70000 yuan. He paid 20000 yuan and borrowed 50000 yuan from the uncle of the geological team. At that time, there were few 10000 yuan households in the county, and their two story buildings were really beautiful.
in 2000, Cao cuncai transformed the first floor of the new house into a 100 square meter six room isolation clinic with diagnosis room, treatment room, observation room, pharmacy, reference room and duty room. It is the first class a standardized pharmacy in the town.
in 2013, the village clinic moved out of Cao cuncai’s home and moved to a new site 5-600 meters away from home. After his wife died, Cao cuncai also moved to rent a house in the town. Now, on the second floor of the old house, there is a faded, slightly dilapidated plaque with the words “Meicha village clinic”.
in 2009, the national essential drug system was formally implemented, and Meicha village health office also implemented zero price difference of drugs to give profits to patients. In order to make up for the profit loss of village doctors, the national policy stipulates that village clinics should be given certain subsidies.
although there is no price difference, the types of drugs are limited. A survey report on the new health care reform led by Zhu hengpeng, a scholar of the Chinese Academy of Social Sciences, shows that after the implementation of the basic medicine system, about 42.5% of the drugs used by village doctors in the past have not been included in the list of essential drugs. The proportion of patients who do not go to the village clinics for treatment because of the limited variety of drugs is as high as 72.5%.
at the same time, although the basic drugs are purchased by the state, some of them do not squeeze out the water in the virtual high drug price. For example, in the health room of Meicha village, the medicines higher than the market price include Shenmai injection and diclofenac sodium sustained-release capsules. Even if they will be reimbursed, the villagers would rather save the money from the new rural cooperative medical scheme account for hospitalization reimbursement, and go to the market to buy affordable drugs.
in addition to seeing a doctor, Cao cuncai’s other work is a document. As an important part of the “fight against poverty”, the “healthy poverty alleviation” has been pushed to the grass-roots level at all levels. It is required to do a good job in “three batches”, that is, a batch of serious diseases are treated in a centralized way, a batch of chronic diseases are contracted for service management, and a group is provided with basic guarantee for serious diseases. As the closest “health Guardian” to the villagers, a large part of the “health poverty alleviation” work falls on the shoulders of village doctors.
Cao cuncai visited the villagers’ homes every three to five times to measure blood pressure and blood glucose for poor households with chronic disease records. He recorded 14 items of public health and took photos to keep them as the basis. He says it takes at least 40 minutes to go to a home, most of which is spent on paperwork. Every once in a while, people from towns, counties, cities and provinces will come down to check whether the poverty alleviation work is in place. The most important basis is whether the records are complete.
in December 2018, an article entitled “aroused the resonance of grassroots. According to incomplete statistics, in addition to health poverty alleviation, family doctors’ household service and daily follow-up of chronic diseases, rural doctors also need to fill in the year-end summary of files, the year-end summary of chronic disease management, and the annual summary of contracted services, including 18 rosters, 7 total summaries, 16 tables, 2 follow-up forms and 8 other forms
the time for diagnosis and treatment was squeezed by paperwork, and there was no one in the village clinic to see a doctor or buy medicine. Cao cuncai felt that the importance of village medical work was being discounted. In addition, the convenient transportation and the expansion of travel radius made more choices, and the villagers’ attitude towards village doctors was also changing.
Sometimes the clinic comes all day