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Conquering VD. Hygiene is another of his specialties. From the beginning, the prescriptions of Chairman Mao have emphasized cleanliness. Repeated campaigns against disease-carrying insects seem to have succeeded. Schistosomiasis, one of the world's most debilitating diseases, produced by tiny blood flukes, has been checked, says Rosen, by communal efforts to stamp out snails that carry the parasites. White believes that typhoid, malaria and cholera—among Asia's ancient enemies—are now well under control. Venereal disease is virtually extinct. The victory over VD probably results as much from the repression of prostitution and promiscuity as from public health measures.
Discipline and political theory, in fact, are large elements in Peking's medical policies. Dispersing health care throughout the country took on new momentum when the Cultural Revolution began in 1966. With a determination possible only in a dictatorship, the government ordered one-third of the country's medical personnel into rural areas, where perhaps 85% of the population lives.
Soldiers, peasants or workers who wish to become trained physicians must have the approval of their fellows and the party leadership of the farm or factory. A newly graduated doctor is obliged to return to serve the community that sponsored him. He may also be assigned to a mobile health team that provides care for the most remote villages. Says Rosen: "China is one vast study in the delivery of health care."
That delivery is organized in a pyramid system, starting at the bottom with the local health stations manned largely by the paramedics. A work brigade of perhaps 2,500 people, the basic unit in a rural commune, is served by a staff of one physician and a few barefoot doctors and midwives, supplemented by mobile health units. Next comes a district hospital that takes care of more serious cases for a larger territory. It is staffed by several physicians and trained nurses in addition to paramedics and is equipped with laboratory and X-ray facilities. On top of the pyramid is the major urban hospital. Only at this type of institution are there specialists prepared to do intricate open-heart surgery and other sophisticated procedures. All four American observers believe that the Chinese do them well. Dimond reports that the urban hospitals are clean and well equipped, even by Western standards.
Political indoctrination pervades all levels of care. The head of a hospital is a political education officer who is also chairman of the institution's revolutionary committee. Prior to undergoing operations, patients frequently meet with members of the surgical team to reaffirm to one another how good health benefits the People's Republic. Some patients go under anaesthetic clutching copies of Mao's Quotations.
If the political dues are high, the financial costs to the patient appear to be low. The visitors were told that the average Chinese worker, who earns $30 a month, pays the equivalent of 9¢ a month for each member of his family. This provides all medical care free for himself and at half price for his family. However, treatment for family members in serious cases appears to be more expensive; the Americans heard that some families had a choice between drawing on personal savings or getting assistance from communal relief funds. In a hospital, a patient pays only for his meals.