13 August 2012

The concept of a healthcare system that creates locally-provided "barefoot doctors" who offer first-line healthcare is a brilliantly simple solution to providing much-needed healthcare in impoverished and outlying rural areas in developing countries where local people have no access to health services.

Acupuncture is the perfect tool for barefoot doctors as it is cheap, easy to teach, replicable and sustainable. It is quickly effective in relieving pain and illness and has no harmful side-effects. In many conditions it completely relieves  the symptoms, effecting a lasting cure.

Originating in China, the original barefoot doctors have dramatically improved overall health and access to healthcare in Chinese rural communities over the last 6o years. Their work in the 1950s helped control major epidemics and infectious diseases. Death rates fell dramatically, particularly infant mortality. The term “barefoot doctor” was coined as the original trainees were local peasants, often farmers, working barefoot in the rice paddies. They received a short training course in basic preventive and curative medicine, using acupuncture, herbal and western medicines.

Today, the term barefoot is generally understood to mean working in basic conditions, usually in isolated and rural areas, without the support structure of hospitals and other medical facilities or personnel to hand.

Barefoot doctors were a major inspiration for the WHO conference in Alma Ata, Kazakhstan in 1978, where they were lauded as a breakthrough in the way healthcare was provided.

Barefoot Clinics' goal is to provide economically viable and sustainable healthcare in remote and impoverished regions of the developing world. We recognise that a local healthcare centre that provides treatment and comfort to the sick and suffering, is a vital part of a healthy and optimistic community. Quite simply, in a poor community, no work can mean no food for the family.

Applying the barefoot model outside china
So far, working in India and Nepal, we have trained 25 barefoot doctors and have helped establish 12 free clinics that are administering acupuncture treatments to up to 1500 patients per week.

With regard to the need for healthcare, the figures speak for themselves: Nepal is one of the poorest countries in the world, with an average salary of less than one Euro a day. The doctor/patient ratio is 1:6000. Similarly, in India, there is a health crisis, with even the most basic of care not  reaching many rural areas. According to the Medical Council of India, the doctor/patient ratio is 1:1700.  To further exacerbate the situation, Indian doctors upon graduating, are opting for urban practices or joining the lucrative brain drain and emigrating.

Teaching and practising barefoot  acupuncture in India and Nepal
It is has been fascinating to play a part in introducing acupuncture healthcare to rural villagers who, largely illiterate, have no understanding of how the human body works, even in the most basic sense, let alone know anything about acupuncture.

The ingenious solution provided by Barefoot College, Tilonia (http://www.barefootcollege.org/) to educate the villagers about these new healthcare services  was to create an evening's entertainment in the villages via a Puppet Show. The acupuncturist puppet explained  acupuncture to the villagers and demonstrated with a patient-puppet how acupuncture is carried out. Through fun, magic and ragging, the benefits were explained and fears dispelled.

The students
Our 25 students who have now graduated as barefoot doctors,  have been truly wonderful. They have such enthusiasm for learning and have developed a real love of acupuncture, becoming capable and confident practitioners. We have a close, trusting and sharing relationship in the classroom. Their naturally bright and loving manner is always evident.

Living Conditions

As a British woman, used to all mod-cons, for Leilani Lea, the founder and director, this rewarding relationship goes a long way to compensate for living in the most basic of conditions. Sometimes the water supply can be cut off for days at a time. Electricity and internet supplies are intermittent. In Rajasthan, the housing manages to be equally uncomfortable for soaring summer temperatures and minus 3 nights in winter. Personal hygiene amounts to no more than a bucket of cold water. The diet is monotonous consisting of mainly chilli, chilli and more chilli, with rice and dahl thrown in and an inadequate amount of vegetables. No fruit, no salads, nothing much else really. Day after day. Despite all this, the work makes Leilani profoundly happy.

The patients
What joy to see patients being successfully treated by new students: a paralysed patient taking their first steps or asthma sufferers breathing more easily. Then there are the patients - those who live on nothing, yet will still  pick you a bunch of flowers en route to the clinic or offer milk from their cow or vegetables from their garden. Patients rarely complain about discomfort during treatment and are very compliant and accept whatever you tell them - coming back as often as you require for more treatment. Their way of being, is at base so good, so simply pure, with nothing unkind, harsh or judgemental in their nature. There are few psychological complications. Patients will tell you about their physical ills but look at you blankly if you ask how they feel, or about their emotions. Life is hard and yet quite simple. Walking hours a day, up and down hills, will make their knees ache. They break into happy smiles when their knees are comfortable again.

Working in our clinics
We do, of course, observe hygiene protocols with patients but the severe shortage of water and simple conditions that the patients are living in means that they come to the clinic unwashed. I remember in Nepal the nuns laughing in the clinic as I tried to source which of the 3 women lined up on the bench was the one smelling so ripely; in fact it was all three. In the heat of June, they are fly-magnets, and it is extraordinary to see a patient enter the clinic literally followed by a swarm of flies. You get used to your cleansing alcohol swabs always coming up black with dirt and you become inventive, for example, telling a patient to come back in the afternoon when a bucket of hot water to soak their feet will be part of the treatment for their pain - which in fact it is; but the main reason is to soak off the almost impenetrable layer of dirt!

Word travels fast and clinics can get extremely busy – we can see up to 100 patients per day quite easily. Therefore we are running a multi-clinic always, and time is of the essence. We  have to quickly decide on the treatment needed and then administer it as rapidly and accurately as possible with absolute attention on the patient. As I say to my students: when you have a needle in your hand, there is nothing and no-one except you, your patient, and that exact acupoint that you are about to needle. You give it all 100% of your love and attention. Then you move on. You frequently have to needle straight through clothing and take other 'short-cuts' that would horrify western purists. The patients love the relaxation that acupuncture provides and respond easily and quickly to the calming and energetic aspects of treatment - you see it in their faces although I doubt that they could express it in words.

A different criteria is needed for treatment so we have developed protocols for endemic local problems: chronic conjunctivitis, pterygium, paralysis, asthma, painful joints and a myriad of ills that plague the local population and interfere with their ability to work. These protocols have proved to consistently produce good results, quickly and efficiently. In effect, we have re-written the barefoot doctor manual according to modern needs. We are bringing rapid relief to many which allows them to work again, free of discomfort and pain.

Barefoot Clinics is helping to greatly improve the lives of many poor people in India and Nepal.

Please help us to achieve our goal of continuing to develop the barefoot doctor tradition in developing countries www.barefootclinics.org.uk