Dr Bannerman of Ghana acted as Team Leader to the group , and is also the Secretary of the Working Group on Traditional Medicine at

Study ^{ToliT in} China

Community health specialists and senior health administrators from 29 developing countries con- verged on Peking in August to begin a Study Tour on traditional Chinese medicine arranged under the auspices of

and

Dr Bannerman of Ghana acted as Team Leader to the group , and is also the Secretary of the Working Group on Traditional Medicine at

head- quarters. On his return to Geneva he was interviewed for this special issue of World H ealth.

WH: Dr Bannerman, what was the objec-

tive of' this Study Tour involving so many senior health officialsfrom the developing countries?

BANNERMAN: The main purpose was to give participants the opportunity to study how China has harnessed its pre- cious legacy of traditional medicine to the needs of its vast rural populations, and has combined the traditional Chinese system with "Western" medi- cine. The group had the opportunity to study the training of health personnel including practitioners of traditional Chinese medicine and the barefoot doc- tors. We also learnt something about the use of medicinal herbs, the preparation and production of pharmaceuticals and the use of special methods such as acu- puncture for treating various disorders and for anaesthesia. The study was in fact multisectoral, and we were exposed to agricultural and irrigation projects, housing schemes, rural development and so forth.

WH: One gets the impression that the division which is very noticeable in the rest of the world between "orthodox" and

"traditional" medicine is much less pro- nounced in China. Is this the case, and to what degree has the older system been integrated with more modern aspects of medicine?

<l A veteran herb grower shows a team of

medical workers how to distinguish medicinal herbs during a plant-gathering session on the slopes of Mount Huangshan, China.

(Photo WHO/Chinese Ministry of Health)

BANNERMAN: As was emphasized by the late Chairman Mao, traditional Chinese medicine has a great storehouse of knowledge. Chinese pharmacology is therefore being integrated and various institutes and hospitals for the practice of Chinese medicine have been established.

At the first national health conference held in 1950, three principles were adopted: firstly, to serve the wod·kers, peasants and soldiers; secondly, the pre- vention of disease; and thirdly, integra- tion of traditional Chinese and "West-

ern" medicine. In 1953, Premier Chou

En-Lai endorsed the fourth principle:

"to combine health work with mass movement". The people are educated to combat disease by themselves and not to rely exclusively on health workers.

The difference between "orthodox"

and "traditional" medicine is therefore much less pronounced in China. Many of the orthodox-trained doctors receive orientation in traditional Chinese medi- cine and practise both systems. It has therefore become difficult to draw a defi- nite line between the two. Their attempts at integration have evolved into what they now call the 'New' traditional Chinese medicine, which can be de- scribed as the application of modern scientific principles to the traditional Chinese system. The integration of tradi- tional Chinese and modern medicine is now an established policy and is by no means an expedient. Veteran practition- ers are involved in shaping the 'New' traditional Chinese medicine. Some teach in medical colleges and are often consulted in matters relating to medici- nal herbs and plants.

In 1965, priority in health work was

given to the rural areas where 80 per cent of the population live. The doctors are now community oriented and 70 per cent of the graduate doctors work in rural areas. The "mass-movement" has been responsible for the virtual extinction of the four pests- rats, flies, mosquitos and bed-bugs.

WH: What did you see which might be regarded as the kind of simple medical technology that might well be transferred to and adapted by other countries?

BANNERMAN: Offhand, I would say the use of acupuncture for the treatment of disease, the relief of pain and for pur- poses of anaesthesia. About 70 diseases can be treated with acupuncture alone and some 200 when used in combination with herbal medicines. Training in the use of acupuncture is essential, if the transfer of this technique is to be truly beneficial. The equipment is relatively simple and, in essence, all that one needs is the acupuncture needle which can be inserted into the appropriate point and rotated to and fro with the index finger and thumb. But recently an electrical machine has been developed which intro- duces regular electrical pulsations to the needle and thus produces the desired effect.

The application of acupuncture for purposes of local and regional anaesthe- sia is well developed. Many procedures on the head and neck, such as dental extractions, and eye, ear, nose and throat operations were demonstrated. We also saw major abdominal operations like total hysterectomy and prostatectomy- all under acupuncture anaesthesia.

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We saw the highly successful treat- ment of extensive burns in the general wards by the application of only one set of surgical dressings medicated with medicinal herbs and without resort to specially equipped intensive care units; the management of fractures by employ- ing small padded splints; and the care of patients with acute abdominal condi- tions such as perforated peptic ulcer, appendicitis and extra-uterine pregnan- cy- all of these by combined traditional Chinese and "Western" methods. All these could be readily replicated in many developing countries. The techniques for preparing medicinal herbs and plants as powders, tablets and liquid extracts us- ing relatively simple locally manufac- tured equipment proved of great interest to us. What might perhaps be more difficult to emulate is the capacity for hard work, resourcefulness, motivation 24

and discipline we encountered m every community we visited.

WH: Is the famous barefoot doctor part of the traditional system or is he regarded as a totally modern phenomenon of Chinese public health?

BANNERMAN: The well-known barefoot doctor is very much part of the tradi- tional Chinese system. They used to be called "peasant doctors", but acquired the title "barefoot doctor" not because they walk barefoot but as a reminder of the fact that many of them spent a greater part of their time with other members of the community in the rice- paddy fields.

Barefoot doctors are trained in the first instance for six months, and those who show keen interest in health work and

Study Tour in China

Left: The simplest of equipment suffices to prepare traditional herbal medicaments and roll them into pellets. The pharmacopoeia of traditional Chinese medicine has long proved to be a great storehouse of knowledge.

(Photo WHO/R. Bannerman)

Right: Health students practising acupuncture techniques on each other. An acupuncture needle carefully planted above this girl's nose will act as a local anaesthetic. The application of acupuncture for local and general anaesthesia is well developed in China, and is used even for major abdominal operations.

(Photo WHO/L. Ambrose)

wish to follow it as a profession can become fully qualified doctors through further training in colleges. Work as a barefoot doctor has now become an im- portant entry point to medical college and university. On the average, they spend about two-thirds of their time each year in agricultural work and industry and the rest in health work. They are very much a part of their community and are selected initially for health work by members of the community.

WH: Your colleagues during the Study Tour came from all parts of the world. Do you feel that they had ideas to offer which China might find worthwhile taking up and adapting?

BANNERMAN: We were asked this ques- tion in various forms during the tour.

None of us could really make any con-

crete suggestions. We have to remind ourselves that China has a population of an estimated 850 million. The basic necessities such as electricity, water sup- ply, adequate sewerage and refuse dis- posal were available equally in both ur- ban and rural areas. The people ap- peared well nourished and adequately housed; everybody was well clothed and nobody wore rags or went barefoot. We were told that there was total employ- ment with generous pension schemes for women at 55 years and men at 60, ade- quate educational facilities and, of course, total health care for all. There was no evidence whatsoever of the infla- tionary trends that have recently gripped the rest of the world. In a situation like this one could only marvel and wish a friendly people greater success.

There could, however, be greater mechanization especially m agricul-

ture- provided that did not cause unem- ployment in any way. I personally con- sidered the absence of private motor cars from the roads a great boon, and the use of bicycles contributory to good health.

WH: It will no doubt take some time for the ideas exchanged during the Study Tour to be evaluated. What use is WHO going to make of its new view on tradi- tional Chinese medicine?

BANNERMAN: We prepared a question- naire for the participants before the tour started and happily there was 100 per cent response. Every participant stated that the tour was truly worthwhile and should be repeated for other, smaller groups on a yearly or even twice-yearly basis. Many took the opportunity to re- examine their own priorities and decided that national priorities in several coun-

tries required urgent review. Health problems were never presented in isola- tion and the part played by agriculture, housing, jobs, water supply, and educa- tion (academic, technical and political) were all very obvious to the discerning eye. The developing countries certainly have a great deal to learn from China, and ^WHO could well make an in-depth study of the 'New' traditional Chinese system, particularly in terms of cost benefits and technical cooperation, with a view to adapting the system for use in various developing countries that might be interested.

The most attractive feature to us from the developing countries is the extent to which China has improved the quality of life of her people and achieved total health coverage within one generation.

There is no such parallel in ancient or modern history. China is unique! • 25