Tang Meifang has been a village doctor since she was thirteen-years-old. Today she represents the entire health care system in one of the most remote communities in southwestern China.

Tang Meifang has been a village doctor in China’s Yunnan Province for twenty-seven years, but she doesn’t look much older than thirty.

Dr. Tang, a diminutive woman with piercing eyes, laughs heartily. “I am forty years old,” she says, flashing a brilliant smile. “I started working as a doctor when I was only thirteen.”

For more than two decades, Tang Meifang has been the village doctor and, indeed, the whole health care system in the small mountain village of Xi Gan Li, one of the most remote communities in southwestern China’s Huaning County.

To reach Xi Gan Li, population 403, one must travel down twelve miles of a rutted dirt road that snakes through a steep mountain gorge. On the left is a precipitous drop into a foaming river. On the right, a sharp cliff rises straight up and out of sight. Boulders the size of small cars litter the road.

Dr. Tang grew up not far from Xi Gan Li, and her childhood experience inspired her to become a doctor.

“In the village where I was born, people’s health was very poor,” she says. “When people got sick, they had to go far away to see the doctor. For some this was impossible, and they just died. I felt bad about this, and I wanted to do something to help them, so I decided that I would become a doctor.”
Dr. Tang started her career in medicine at only thirteen by apprenticing herself to three doctors in a nearby village.

“I helped out in the clinic and would go with them when they visited patients,” she says. “I didn’t receive any formal education. I just learned step-by-step how to help people. Soon I was a village doctor myself.”

After liberation by Mao Tse Tung's army in 1949, China underwent massive social and economic change. The rural Cooperative Medical System–a vast health network personified by village doctors like Dr. Tang–brought basic preventive health care to 90 percent of China’s rural population, resulting in dramatic reductions in mortality and disease over the next two decades.

And, even though the economic reforms of the late 1970s replaced Mao’s socialist economy with a privatized system, the village doctor is still the foundation of the Chinese healthcare system, particularly in rural areas where eighty percent of China’s 1.2 billion people live.

As the village doctor in Xi Gan Li, Dr. Tang presides over a small, one-room clinic next to her house. There is no formal reception area, so waiting patients must share space in the courtyard with a dozing pig and errant chickens who wander freely in and out.

“Please excuse the chickens,” says Dr. Tang, laughing. “Xi Gan Li is a poor village and we live very close together.”

Despite her remote location and conditions that some in the West might view as primitive, Dr. Tang manages to stay current with medical developments in China.

“I receive fifteen hours of training each year at the county hospital and the county anti-epidemic station,” she says. “That’s how I keep up on new treatments. Otherwise, we don’t find out much in Xi Gan Li.”

Because of her county training, Dr. Tang is taking an active role in China’s national effort to halve the number of infectious tuberculosis patients by the end of this decade.

One-third of the world’s population is infected with tuberculosis, the leading infectious killer of adults. In developing countries, where only two cents out of every ten health care dollars is spent on tuberculosis control, TB causes 26 percent of avoidable adult deaths. The situation is particularly critical in Asia, home to two-thirds of the world’s infected people.

Even though there have been substantial improvements in the health of the Chinese people over the past 50 years, tuberculosis remains a major public health problem in this vast and populous country. TB is still one of the most important single causes of premature mortality, with deaths from the disease averaging more than 250,000 annually.

“For many years, China had very high rates of tuberculosis,” says Dr. Tang. “It was viewed as a disease of the poor, and you couldn’t do anything about it. In a village like Xi Gan Li, if you got TB, it was your problem. Even if you went to the doctor and got treated, you generally didn’t get better. So people developed a very fatalistic view of TB.”

Recognizing tuberculosis as a major public health problem, China launched an ambitious program of TB control in 1992 to increase the cure rate and reduce transmission through control of the most infectious cases.
China models its TB program on the World Health Organization’s experience which has shown that DOTS therapy–in which health workers observe TB patients taking daily doses of four different drugs for six months–results in dramatically increased cure rates at a relatively low cost.

“Huaning County adopted DOTS in 1995,” says Dr. Tang. “Since then, the cure rate for TB has risen to more than 93 percent.”

Today Dr. Tang is treating one TB patient in Xi Gan Li who has been receiving therapy for six weeks.

“His wife told me that he coughed every day,” says Dr. Tang. “She thought that he had a cold, but I suggested that he go to the Huaning County anti-epidemic clinic where he was diagnosed with tuberculosis.

“He brought the pills back here to me, and now he comes here every morning at nine o’clock and I give them to him. He is very cooperative. He knows that if he takes this medicine he will get better.”

The last TB patient that Dr. Tang had in Xi Gan Li was not so lucky. He stopped taking his medications and died.

“At first he took the medicine regularly,” says Dr. Tang. “Then he started to feel better, so he stopped taking it. Then he died. If he had been treated under the DOTS program, I’m sure he would be alive today.”

To make sure that the villagers of Xi Gan Li know about the symptoms of tuberculosis – and that there is a cure–Dr. Tang does a great deal of patient education. In her role as local health care leader, she makes presentations at village meetings, uses the village blackboard to publicize the disease, and talks to villagers individually when she visits their homes.

“I tell people that there is hope. That they can be cured if they take their medicine.”

Under China’s new economic reform, patients now have to pay for their medical treatment, which means that poor families have greater difficulty in getting access to essential health care. DOTS has a special appeal in a poor village like Xi Gan Li because it is less expensive than the older, standard treatment for TB.

“Before DOTS, TB treatment would cost a patient more than 1,000 Yuan (US$125),” says Dr. Tang. “Now it will take only 500 to 600 Yuan (US$65). If the patient has difficulty paying, treatment is paid for by the county TB project. My current patient receives his treatment free through the county project.”

Patients aren’t the only people who receive support from the county. Dr. Tang receives both moral and technical support through the project from Dr. Zhang Guohua, Chief of the TB Prevention and Control Section of the Anti-Epidemic Station of Huaning County.

“I am familiar with DOTS because Dr. Zhang taught the method to me,” says Dr. Tang. “Dr. Zhang even comes here and encourages the patient to keep up his treatment. He has been a big help.”
Dr. Zhang is unusual in medicine today–even in China–in that he still makes house calls. Even though Huaning County is very mountainous, with many remote villages, Dr. Zhang still visits every TB patient in the county to offer encouragement and monitor treatment.

“Before the tuberculosis project, we only observed patients taking the drugs one time per month,” says Zhang, a rugged, forthright man with a ready smile. “Now the direct observation is done daily. Because of that the cure rate for TB has gone up dramatically, and our success is due to the efforts of village doctors like Dr. Tang.”

In her twenty-seven years as a village doctor–from a girl of thirteen to a woman of forty– Dr. Tang has seen many changes in Xi Gan Li. One of them is hope where there was none.

“For a long time, nobody thought you could cure TB,” she says. “You just died from it. Now we feel that the TB epidemic in Huaning County is becoming controlled.

“We are trying our best. We know that, if we persist, we will succeed.”