China's unique "barefoot doctor" system, the huge paramedical corps that his attracted world attention, is undergoing substantial change in the wake of complaints about incompetence and waste, foreign specialists said recently.
American health officials said during a visit to China that Chinese medical officials no longer heap praise on the program that at one time claimed as many as 1.8 million trained health workers. The U.S. specialists who have been here before, say the claimed size of the program seems to have shrunk to 1.4 or 1 million with indications that even that number is thought to be too large and too poorly trained.
"We've been told much of the time the barefoot doctor will just refer a patient to a county hospital, or the patient does'nt trust the barefoot doctor and demands a referral. So now the county hospitals are in a mess," said one U.S. health specialist who speaks Chinese.
The new move to provide bettertrained paramedics, perhaps based in the town hospitals rather than in tiny village clinics, reflects a basic shift at all levels of Chinese society and government. The leadership following the late party chairman Mao Tse -- tung is determined to rely more on well -- trained technicians and less on ethusiastic amateurs inspired by Maoist rhetoric.
What this will do to the health care available to China"s 800 million peasants is unclear, although some experts feel peasants will lose easy access to basic medicine. It appears that peasant doubts about the barefoot doctors have in part stimulated the changes.
Dilution of Peking's commitment to barefoot doctors is sure to be a blow to Western admirers of Mao and his Cultural Revolution of the late 1960s. Like the return of competitive college entrance exams and incentive bonuses, the health care change represents a retreat from what many inside and outside China have portrayed as a great experiment in creating a true egalitarian society.
One American specialist, who traveled here recently with U.S. Health Education and Welfare Secretary Joseph A. Califano, said he was convinced of the deemphasis of barefoot doctors after a briefing given Califano by Chinese Health Ministry official Chang Kan.
"What was interested was Chang barely mentioned barefoot doctors," the American said.
"Development is not balanced in our work," Chang said. "We are now emphasizing the raising of standards."
The concept of barefoot doctors was inspired by a Mao directive to "put the stress on the rural areas" in medicine and health. The term "barefoot" was designed to identify them with their poor, sometimes shoeless clients. Many of the paramedics are sons and daughters of peasants.
The program called for each to be trained for three months by urban doctors and medical students sent to the countryside. The paramedics learned first aid and identification of common disease, but it is unclear how rigorous their training was.
Chinese officials have indicated that after three years of mediocre harvests in the countryside, some peasants have begun to ask if they can afford to pay young, minimally trained health workers who do not do their share of field work. Some localities to let young and vigorous youths, those most likely to perform well as health workers, leave field work even to be trained.
Officials at higher levels have acknowledged reports of misuse of drugs. Some barefoot doctors apparently order mote than they need of antibiotics, a much sought after item here, and exchange them for such favors as movie tickets or special foods.
Peking officials recently have unveiled a budget for 1979 with unusual restraints on new spending and production. The governement seems to worry about what appears to be a deficit.
The official of useless construction projects and waste of government funds, and some problems of the barefoot doctor program seem also to qualify as waste.
Recognizing their lack of funds and doctors, Chinese officials say they must continue to rely on some version of the barefoot doctor program, if smaller and with better training important is continued relaiance on traditional Chinese medicines, vast collections of herbs that can be found cataloged in small drawers in many commune health stations.
Barefoot doctors also use acupuncture, but some visiting foreign doctors complain that needls are not sterilized and thus help spread hepatitis.