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In the footsteps of an iconic figure

PALLAVI AIYAR

The China-India Joint Medical Mission, organised to commemorate the visit of an Indian team of doctors to war-ravaged China in 1938, brings much-needed medical facilities to one of the poorest areas of China.


The sun shone white in the mid-morning sky but the frozen earth of Gegongcun village, a cluster of brick and clay hamlets in northern China’s Hebei province, remained unyielding. Tracks of ice lined the barren fields. The villagers’ faces were tomato red with the cold, their bodies swollen with the layers of clothes they wore in the futile attempt to keep warm.

This was one of the poorest areas of China, isolated from the changes sweeping across other parts of the country. On this morning in mid-January however, the outside world made a dramatic entrance into Gegongcun, in the shape of a shiny bus adorned with a wide red banner. The bus came to a shuddering halt and from it descended a crowd of both Indians and Chinese, bearing stethoscopes and antibiotics. The banner on the bus revealed their identity. “China-India Joint Medical Mission”, it stated in English and Chinese.

An earlier mission

Photos: Pallavi Aiyar

Dialogue across borders: Dr. Kotnis’ photo in the Tang County museum (left) and Dr. Anuradha with Zhou Lu Hua.

The joint medical mission was inaugurated by Prime Minister Manmohan Singh and Chinese Premier Wen Jiabao, during Singh’s visit to Beijing on January 14. But, to understand the presence of the mission in this hardscrabble village in central Hebei, one must go back 70 years in time to 1938.

At the time, even as civil war between the Communists and the Kuomintang ravaged the country, Japanese forces had attacked China. Under-equipped and out-numbered, the communist guerrilla soldiers sought outside assistance in their fight. Marshal Zhu De, the commander of the Eighth Route Army, wrote to Jawaharlal Nehru, then leader of the Indian National Congress, for help.

In response, Nehru decided to despatch a five-member team of doctors to China, laden with precious medical supplies. The team reached southern China in September 1938, slowly making their way up to the revolutionary base of Yan’an in north China’s Shaanxi province by February 1939 where they took up positions in the Eighth Route Army military hospital.

One member of this medical mission was a doctor called Dwarkanath Kotnis. Kotnis was 28 at the time and had only recently graduated from medical school. With slicked-back hair and a shy smile, the young Kotnis was a simple middle-class boy from Sholapur in Maharashtra. He would however, go on to become the single most enduring symbol of the Hindi-Chini Bhai Bhai sentiment, characteristic of the 1940s and 50s; his story taught in primary schools across China for decades.

Kotnis was the only member of the medical team to never return to India. He stayed on, fighting on the Chinese side and eventually joined the Communist Party of China. In mid-1940 Kotnis was sent to work in Hebei province, arriving in Gegongcun Village in August, where he stayed treating the war-wounded for the rest of his life.

In Gegongcun, Kotnis met Guo Qinglan, a medical practitioner also with the Eighth Route Army, whom he married and had a son with two years later in August 1942. Four months on, in December of the same year, he died, possibly of malaria, a disease that was endemic in China at the time.

Kotnis went on to become valorised as a “fellow traveller” in Chinese communist lore. He was hailed as a “foreign friend” of China’s, his sacrifice to the communist cause taught to school students across the country. Memorial halls and museums in his memory were established in all the places he had once worked in.

In a museum at the headquarters of Tang County, to which Gegongcun belongs, room after room is filled with Kotnis memorabilia. Pictures of his high school back in Sholapur are arranged next to books he read and implements he used while treating patients. Giant posters depicting his meetings with various Communist leaders dot the building.

Earlier this month, more then six decades after Kotnis’ death, Indian doctors found themselves in Tang County, once again. The China-India Joint Medical Mission 2008 was set up to commemorate the 70th anniversary of the landing of the 1938 medical mission. Comprising 20 doctors, 10 each from India and China, the idea was for the mission to revisit areas associated with Kotnis’ time in China and offer free medical consultations to the rural poor in keeping with the spirit of service that the 1938 team had represented.

After meeting with Prime Minister Manmohan Singh and Premier Wen Jiabao in Beijing, the group thus set off for a four-day trip through Hebei, including stops at the provincial capital Shijiazhuang, Tang County headquarters and Gegongcun village.

Revered hero

“I’d seen the movie, ‘Dr Kotnis Ki Amar Kahani’ as a child and read the Amar Chitra Katha comic book about him,” recalled Dr. Puneet Goyal, a cardio-anaesthesiologist from Sanjay Gandhi Post Graduate Institute of Medical Sciences in Lucknow, aboard the bus taking the team from Shijiazhuang to Tang County.

From the bus windows, the naked branches of the trees that lined the road were dotted with frost. For most of the Indian doctors, that morning had brought their first sightings of snow, sending them into a tizzy of photo taking.

“But I had no idea he was so revered in China,” Dr. Goyal continued, his eyes widening expressively.

“Kotnis was very, very brave,” chipped in Dr. Wang Qiangxian, an orthopaedic trauma specialist from the Chinese contingent. “He came from a middle-class family and could have got a good job and had comfortable life in India. Instead he went to China in the middle of a war.”

Over the course of the next few days, the doctors from the two countries spent several hours chatting about everything from Hindi films to salary structures for medical staff.

A surprise upshot of some of these conversations was that ironically it was the Indian medical system that provided more welfare for the rural poor. Thus, although public hospitals in India were less well equipped and hygienically maintained than their Chinese counterparts, they were free. In China on the other hand, even State-owned hospitals charged relatively hefty fees from their patients regardless of their ability to pay, with the result that the majority of those in the countryside were simply unable to afford hospital treatment.

It had not always been so. For three decades after the communist revolution in 1949, China relied on a socialised health care system under which collective farms and factory communities took responsibility for the provision of health care. In the countryside, barefoot doctors, although only trained in the rudiments of medicine, provided medical services for all. It was a basic system, but functional and largely egalitarian.

An unequal system

Since embarking on economic reforms in the late 1970s, however, China went about systematically dismantling its own healthcare structures so that today the country has one of the most unequal public health systems in the world. In 2000, the World Health Organisation ranked China 144 out of 191 countries on the basis of fairness of access to health care and fairness of individual contributions to cost. India, with half of China’s per capita GDP, ranked ahead of the mainland at 112th place.

In Gegongcun, Zhou Lu Hua, an impossibly wrinkled 73-year-old woman, broke into tears while being examined by Dr. S. Anuradha of Delhi’s Maulana Azad Medical College. “I’ve been sick for so many years,” she wept, “but I just don’t have the money to go to a hospital.” Zhou suffered from hypertension and heart disease as well as osteoarthritis. Her husband had died of cancer the year before, at home. The family could not afford to have him admitted to a hospital.

Worried by the impending health crisis in the countryside, since 2003 Beijing has set up a new medical-insurance scheme which already covers around 80 per cent of all counties in the country. The scheme sets up a contributory system in which each individual pays an annual fee of RMB 10 ($ 1.3) to which the central, provincial and local governments all add a contribution. Those participating in the programme can then claim back 40-60 percent of their medical expenses.

But although a significant improvement on the previous situation, the scheme still tends to benefit richer peasants, while the poorest are unable to afford even the annual RMB 10 fee or to pay for medical expenses up front.

Several of the Indian doctors in the mission felt that policy makers in New Delhi should start thinking about insurance schemes for India’s rural majority as well. They were also impressed with the cleanliness, infrastructure and equipment to be found in even the district-level hospital in Tang County.

A conversation between Dr. S. Anuradha and a Dr. Li Qiongzhen of the Third Hospital, affiliated to Hebei Medical University was revealing. While Dr. Li was amazed to find that not only the vast majority of medical treatments in Maulana Azad hospital but even the meals provided to patients were free, Dr. Anuradha was impressed by the fact that Dr. Li’s hospital had more than two dozen dialysis machines compared to only seven at her own.

Need for dialogue

What quickly became clear was that more dialogue between the two countries on healthcare issues could be crucial at a time when both nations were experiencing rapid economic growth accompanied by a burgeoning rural-urban divide

Given the brevity of the time the medical mission spent in Hebei, its significance remained more symbolic than substantive. Nonetheless, doctors from both sides said they did feel inspired by the experience to look beyond their own self-interest to serving those on the margins of society.

“Dr. Kotnis spent many years in conditions of hardship that we can’t even imagine today,” said Dr. Subhransu Pradhan, a medical officer from Orissa’s Kalahandi district. “After this trip I feel very emotional and I’m moved to work much harder once I go back.”

Summing up his assessment of the mission’s achievement, Dr, Zhang Jinting, Vice President of the Second Hospital affiliated to Hebei Medical University said, “The mission’s significance was not medical so much as symbolic of the fact that medicine knows no borders or nationality.”

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