With one of the least expensive and most widespread medical care systems in the world, China has become a mecca for foreign health specialists eager to know more about barefoot doctors, acupuncture and centuries-old herbal medicine.
Many of China's people, though, are not so happy with the care they get. They carry on a love-hate relationship with their doctors and hospitals. They try to avoid what they see as chronically indifferent hospital care and resort instead to small-scale bribery that will get them special care, medicines or just a free sick-leave vacation.
"They don't take much time to find out what is wrong with you," said a Peking resident. "They just prescribe the first thing that comes to mind, whatever it takes to get rid of you." The cheap, widespread health care systems created by the Communist Party has helped provoke today's chronic medical difficulties. It caused the adult and infant death rate to plummet and so ensured that there would be 400 million more people to care for today than there were 30 years ago.
China has 1.8 million hospital beds, 23 times as many as in 1949. Every commune and neighborhood has a health center and large stocks of Chinese and Western medicines available cheaply. The country has 2.46 million medical personnel, of whom 390,000 are doctors.
The failings of Chinese education over the last 15 years however, have created popular doubts about the abilities of younger physicians. Patients ask the date of doctor's graduation. They begin to worry if it is after 1966, the beginning of the Cultural Revolution.
The number of doctors remains little more than half that in the United States, yet China's population is more than four times as large. "People just cannot find good doctors," said Yutai, a factory worker and the mother of a 5-year-old child.
In some parts of Peking, individuals with training in traditional Chinese medicine put up small posters advertising their services.They get a steady stream of patients, although hospitals also offer traditional medicine. For serious trouble, Chinese know they must go to hospitals. They habitually consult with friends and relatives first, trying to find a clinic where someone knows the doctor and can arrange that their aliment will receive special care and attention.
Many Chinese workers love to have an excuse for sick leave. The government policy dictates full pay for the first six months of sick leave and no less than 60 percent of pay after that. When visiting Chinese families, one regularly encounters seemingly vigorous men and women going about their home chores while ostensibly on sick leave.
At many overstaffed Chinese factories, the work is boring or infrequent. "It's quite popular to go out on sick leave," said Xinghua, a Peking construction worker.
A foreign diplomat complained about her staff: "For a cold, they take off a week. Of course, from their point of view, I'd do the same thing if I was paid so little."
Sick leave requires a doctor's signature. "When you go see the doctor it is best to bring some kind of small gift, maybe a tape cassette with some Hong Kong music on it. He will give you more attention and give you more days off," said one Chinese office worker. If the illness can be made to seem serious enough, wives or husbands assigned to jobs far from their families can move back home without losing income.
To help avoid the unpredictable care of doctors and hospitals, Chinese put great faith in medicines. Pharmacies are loaded with cheap cures, both bags of herbs and Western bottles of medicine. Families will carefully save whatever prescribed drugs are left over after a family member recovers. Some trade food or services for more drugs from nurses and pharmacists who have access to antibiotics and other hard-to-get potions.
Dr. Gilbert S. Omenn, associate director of the White House Office of Science and Technology Policy in Washington, has visited several Chinese medical facilities. "From what I was told and observed, I have little doubt that the Chinese greatly overprescribe medicines" of both Chinese and Western types, he said.
Chinese feel Western medicines are unusually potent, with often unpleasant side effects. Their own herbs are gentler but take longer to effect a cure.
The Chinese doctors are reluctant in minor complaints to use anesthetics. They are expensive and in the Chinese view dangerously interfere with natural processes, like pain. One Chinese friend told me his father, now 70, could not get a loose tooth pulled because it would require a painkiller. "They said he had high blood pressure and they just would not risk the consequences," his son said. In China, a hospital abortion, a common and somewhat painful operation, often is done without anesthetic.
Just getting to a hospital -- particularly in an emergency -- presents great difficulties to ordinary Chinese. In the countryside it is next to impossible to move people quickly to modern medical facilities. In emergencies, peasants will try to transport a patient by cart, hooked up to a tracotr. Otherwise they have to wait for the bus or balance the patient on the back of a bicycle. In the cities, the situation is not much better.
"You can often see people carrying children or old people seeming near death on a bicycle of the hospital," said Yutai, the Peking factory worker. "That's one reason why we Chinese like to have more children. So you have someone to take you to the hospital."
Calls to the Peking ambulance service usually produce nothing. "We have only about 20 vehicles here," said Xu Ying of the ambulance center near the Peking Hotel. "Our vehicles are poorly equipped and cannot come close to answering the volume of calls we get."