Wang Shingwe's voice broke. "I have fulfilled my lifelong dream," he said softly, straining, it seemed, to hold back tears.
He pulled himself together, aware that a few in the group of American and Chinese medical students around the table were staring at him.
At 30, Wang is one of the oldest of 500 students, almost all under 21, in the second-year class at the Zhejjang Provincial Medical College, in Hangzhou. Until two years ago, becoming a doctor was his impossible dream.
Then, in the wake of the death of Mao Tse-Tung and the celebrated "smashing of the Gang of Four," the first medical school entrance exams in more than 10 years were given.
Competing against students 10 years younger who had just graduated from senior middle school courses in mathematics, chemistry, physics, and politics that he had finished in 1968, Wang scored among the fewer than 5 percent who won places at Zhejiang.
The story behind this achievement is a tale of individual determination. It also symbolizes the struggle of China's new breed of professional physicians for predominance over the traditional cures and "barefoot doctors" of old.
Even as a middle school student in Hangzhou in the mid-1960s, Wang's hopes for a medical career fired his efforts as he studied science and mathematics. But when he finished senior middle school, the Chinese equivalent of high school, at the height of the Cultural Revoluation in 1968, his medical college aspirations were ignored.
Along with tens of millions of other young people, 19-year-old Wang Shingwe was forced to leave his home and family for a new life in the countryside, far from Hangzhou.
"I didn't know when, or if, I would ever come back home," he said.
"For two years I cut wood," he continued. "At first I thought a lot about my family -- I missed them. But the peasants treated me well, and I got used to it."
In 1979, he was allowed to return to Hangzhou. "Most of us came back after two years," he said. His dream of medical school, though, remained out of reach.
During the 10 years of the Cultural Revolution and radical domination -- from 1966 to 1976 -- medical students were selected by political cadres based on "class consciousness" and "love for the poor and lower-middle-class peasants and workers," with little or no regard for academic qualifications.
The result, according to many Chinese medical workers and students, was mass admission of incompetents, often because they had the right political connections, while many of the brightest people tended the rice paddies.
Wang was not one of those chosen. "I taught English one year," he said, laughing at the thought that his broken English was once a model for students, "and then I became an electrical worker."
But his dream did not die.
"When I worked, I often spent much time studying radio, chemistry, physics, foreign languages, and math," he added. "I studied this by myself. When I had troubles, I went to my old teacher" from senior middle school. Wang studied, he explained, in the hope that somehow, someday, entrance exams might be reinstituted. But the years went by, and they were not.
Then in the fall of 1976, Mao died, the radicals were purged, and a pragmatic leadership emerged which set modernization in all areas, including health care, above class struggle as a national goal.
In medicine and other fields, educators reinstituted entrance exams like the one Wang took to win a spot at Zhejiang as the sole criterion of admission in an effort to marshal the best students for the modernization drive.
This new way of selecting medical students is only a small part of Chinese health officials' efforts to reshape the Chinese health care system into a more modern, technocratic form.
Interviews with a wide range of medical personnel, from commune health clinic workers to senior Minister of Public Health officials, show that big changes on many fronts are now under way.These changes include:
Downgrading of the role of legions of part-time, paraprofessional "barefoot doctors" romanticized during the Cultural Revolution as effective promoters of the peasants' health and political consciousness.
Stepped-up training of full-time professional doctors schooled in modern, Western medicine.
A new focus on the purchase and production of costly, high-technology medical equipment
A new stress on the physiological basis of many widely used traditional Chinese remedies such as acpuncture and herbal medicines, while dismissing folk theories for their effectiveness.
An upgraded biomedical research effort.
From the Great Leap Forward in 1958 through the Cultural Revolution, barefoot doctors -- peasants selected on the basis of political consciousness for three to six months of crash medical training -- were touted as China's unique and dramatically effective solution to the severe shortage of physicians in the rural areas where 90 percent of the Chinese people live.
Numerous American medical visitors to China in the early and mid-1970s wrote uncritically of Chinese claims that the so-called barefoot doctors successfully delivered a full range of medical services, even surgery. Some suggested the barefoot doctor concept as a solution to physician shortages in American rural and ghetto areas.
"But their capabilities were perhaps overestimated," said a Chinese observer of health policy, who asked that her name not be used. "We will now train more medical students as professional doctors. They will be required to go to the countryside. We are training barefoot doctors less as independent workers and more like aides to professional doctors."
Barefoot doctors are "now doing less treatment than during the Cultural Revolution," said a spokesman at Shanghai's nationally elite First Medical College, who agreed with a hearty laugh that most people in the countryside don't trust them.
China's doctors also seem about to go on a high-technology binge, at least to the extent that severe budget limits will allow.
Even the half-million-dollar Computerized Axial Tomography scanner, the king of costly medical machines and a political symbol of technological extravagance for many critics of the high cost of health care in America, has attracted intense Chinese interest.
While Chinese traditional remedies, such as acupuncture and hundreds of herbal medicines, remain in common use, some doctors have added new technological twists. Lazer stimulation of acpuncture points to control asthma and a stepped-up effort to use modern organic chemistry techniques to isolate the active substances of herbal remedies are two examples of the new direction in traditional medicine.
Furthermore, some traditional drugs -- including several isolated from such curious sources as unripe tangerine skin, snakes, tiger bones, and turtle bones -- are finding new applications in the treatment of many of the chronic ailments of older people.
The writer, a student at Yale medical school, recently visited China as part of a delegation of U.S. medical students. During their two-week tour, the delegates studied China's medical and social services, visiting facilities in different parts of the country and talking to a number of unusually candid Chinese health officials and doctors.
In this three-part series, Bloche, a former staff reporter for the Dallas Times Herald, describes Chinese efforts to deal with the pollution problems, illnesses and technological advances accompanying the country's industrialization drive.