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Return of the shamans

By: Jasper Becker, October 19, 1999

Before Xie Jinhao, a young village doctor in Guangxi's northern mountains, set off to trek back to his home village, he hitched the box of vaccines over his shoulder and let out a deep sigh. "No one comes to see me for treatment," he said. "They only come if the shamans can't do anything."

Among the timbered villages of Dong and Miao scattered across Rongshui county, local witch doctors now vastly outnumber the barefoot doctors introduced in the heyday of Maoism.

In Dr Xie's village of 200 households, a 90-minute hike away from the county clinic at Danian township, he said there are now five or six practising shamans.

"The shaman's fee is four yuan and a meal for a consultation but I am cheaper, I don't ask to be fed,' complained Dr Xie who is returning after training by Medecins Sans Frontieres (MSF).

In the 1950s, the Communist Party arrested the shamans and banned all their activities. Yet since the dissolution of the people's communes in the 1980s, they have made a comeback all over the mainland as the rural public health system has collapsed. The barefoot doctors have now been renamed "village doctors" while the witch doctors are now referred to as "traditional medical practitioners".

Dr Xie's father was a barefoot doctor who, after minimal training, could earn work points in the commune by enforcing Beijing's health campaigns to improve public sanitation. These efforts helped eradicate many communicable diseases. But now his son is struggling to regain the confidence of his fellow villagers in the curative powers of Western medicine.

"It is a war out there," admitted Dr Yan Qingcheng, an ethnic Miao who trained as a professional doctor and now works at Danian clinic.

One of his patients, a 30-year-old Miao villager whose 40-day-old son has a high fever, said many villagers believe the shamans possess magical powers.

"The witch doctors will go into a trance to divine the illness and then summon a spirit to help. Sometimes they will also kill a chicken or an ox," she said.

People often did not like to go to hospital if they were sick because the cost of treatments was prohibitive and often ineffective.

"There are many fake doctors in China and too many others with little training," said Dr Marcel Roux, head of MSF in China.

"People first consult the shaman, then the barefoot doctor who gives them an injection, and if that does not kill them, then they go to the township clinic," he said. "At the hospital, the staff first find out how much they can pay before deciding on a treatment."

In Ya Guang village, not far from Danian township, the village doctor is 37 -year-old Xie Pengfei, a member of the Dong minority who earns his living from farming. He has had one year of medical training and is supposed to recommend serious cases of illness to doctors at the township clinic or the county hospital.

He tells a story, which may be typical, of one of his patients. "Earlier this year I had a patient, a 54-year-old man who fell sick and became paralysed from the waist down. I think he had rheumatism. His family eventually took him to the prefectural hospital in Liuzhou. His family sold all their timber and animals, borrowed money and spent thousands of yuan on treatment but he died."

Village doctors like to prescribe tablets and injections because they earn money this way but often the treatment is misapplied and can be dangerous. This may have been the case with Dr Xie's patient who became paralysed when Dr Xie treated him for rheumatism.

"I charge 1.2 yuan (HK$ 1.10) for an antibiotic tablet but if they have a severe cold then I give them an injection which costs 10 yuan," he said.

With per capita cash incomes as low as 200 or 300 yuan a year, no one can afford a full course of antibiotics so treatments are doomed to fail. Even in local hospitals, doctors are eager to put patients on drips or to prescribe the wrong medicines. Dr Roux said he came across a case of a child with diarrhoea who was given atropine, a drug used in anaesthesia, and who consequently died.

Government officials who struggle to find the wages of professional health workers in urban centres, cannot offer support to the demoralised village doctors. The Government is also reluctant to again outlaw the shamans.

The resurgence of popular faith in the curative powers of these shamans parallels the explosive growth of Qi Gong sects such as the recently banned Falun Gong. Its adherents were mostly urban people who, unable to afford medical fees, instead put their faith in the magical powers of charlatans.

Dr Roux said of health care in the region: "Beyond the level of county government, it is like a jungle out there. Even the Chinese do not know what is going on." Deaths from disease are not registered because the patients never attend a local clinic.

Because many children are not registered by parents trying to evade the birth control policy, he suspects immunisation rates are much lower than reported. "We suspect the rate is not 80 per cent but 50 per cent or even 30 per cent," he said.

Yet Xie Jinhao is optimistic that when he does get back to his village with the vaccines, he will still be able to immunise many children against rubella and measles: "I can help people if they let me."