The return of China's barefoot doctor: a flu-driven stop-gap measure

■"Barefoot Doctors Make a Comeback In Rural China: Trained as a Nurse, Ms. Li Treats Datan Village; Delivering a Baby for $4," by Peter Wonacott, Wall Street Journal, 22 September 2005, p. A1.

Mao created an army of "barefoot doctors" in the 1960s and 1970s as a low-cost way to extend medical networks into rural regions beset by pervasive poverty. They did a lot of good along the way, reducing infant mortality and curbing contagious diseases.

But when China shifted to market economics under Deng, the communes fell apart in the countryside and health care stopped being subsidized with things like the barefoot docs. Rural incomes did not keep pace with urban ones, so good healthcare became very hard to find in remote agricultural regions.

Now, the 4th Generation leadership of Premier Wen Jiabao and President Hu Jintao have shown a real focus on dealing with the needs of the rural poor, speaking to my theory that The Train's Engine Can Travel No Faster Than Its Caboose, a phrase that popped out of my mouth during my presentations in China last August and now recounted in an entire chapter section in Blueprint for Action.

So Wen and Hu push to revive the program, yet some critics say it's a waste of time, as these lightly trained medics mostly just hand out antibiotics indiscriminating. Hell, we have highly-trained and highly-paid doctors in America who can do that!

Still, I think it's good that Wen and Hu continue to emphasize the needs of the rural populations left behind by the fast moving train that is China's globalizing economy. In BFA, I call this "caboose braking."

It matters, because when you don't pay attention to such things, you end up with things like SARS, Avian Flu, or New Orleans after Katrina.