After working 13 years in the small, dank room in the only health center of Hebian Village, Xu Chaofen is determined to leave town.
Xu and her rural doctor husband rake in a monthly income of merely 2,000 yuan (316 U.S. dollars) in the rural medical center in southwest China's Guizhou Province, barely enough to cover the family's expenses. When the center is not busy, her husband acts as a truck driver to earn some extra money.
"My son is attending primary school, so our budget is tight," Xu said as she tried to wring out a quilt after rain seeped through cracks in the center's ceiling. All throughout the small center were signs of water damage, accompanied by a damp smell. It rains a lot in Guizhou.
"After years of working as rural doctors, I really can't see us living a better life if we stick with our jobs," she said with resignation. "Maybe we will go to the eastern seaboard to find better jobs."
With 649,000 health centers spread across 589,000 villages, China is in desperate need of village doctors. But the country is struggling to keep rural doctors, as a great number, like Xu Chaofen, are increasingly reluctant to stay at their jobs due to barriers such as low pay, identity crisis and poor career prospects.
Many rural doctors have expressed the desire to leave their jobs, according to a survey by Ma Wenfang, a deputy to the National People's Congress and a rural doctor himself. The survey, reported Monday by the web portal Netease.com, was conducted across 100 Chinese villages in the provinces of Shandong, Henan and Hunan.
Ma found that all 100 doctors surveyed reported low salaries, with their highest monthly income standing at a little more than 1,000 yuan. The lowest was only 60 yuan.
"Their complaints have included 'low income', 'no social insurance' and 'few job prospects'," Ma said.
RURAL DOCTORS' PLIGHT
Established in the 1950s, rural doctors in China once enjoyed high social status and were well paid. But as China's medical system reform gains steam, their earnings have dwindled.
For 55-year-old Huang Aimin, practicing rural medicine has given him the best and the toughest experiences of his life.
"In the past, being a rural doctor was regarded a great honor and I was well respected," said the rural doctor in Laodun Village, east China's Jiangsu Province. "I could also make a decent salary because I was allowed to have up to 50 percent of the commission for each drug I prescribed," he added.
In 2009, China scrapped doctors' commissions from selling drugs by introducing the national basic drug system, cutting Huang's annual income by half to less than 20,000 yuan.
A national basic drug catalogue followed, which decreased the number of drugs. Many commonly used drugs in rural areas were not listed in the catalogue. This has decreased the number of Huang's patients because many rural residents had to go to big hospitals in cities to seek better treatment.
The government subsidized rural doctors after the reforms, but Huang said the subsidies are limited, and that he is still struggling to make ends meet.
"I might have to find another job," he said.
Adding to the woes of rural doctors is an identity crisis.
A national guideline encouraging medical workers in rural areas to get registered, receive training, pass an exam and get a license has been in force since 2004.
Tashi Yang, head of the health bureau in Muli Tibetan Autonomous County in southwest China's Sichuan Province, told Xinhua that many older medical workers were "barefoot doctors" who had difficulty getting a license.
These people were basically students or simple villagers trained in first aid after the founding of the People's Republic of China in 1949. They delivered basic medical services in China's vast, remote rural areas, where previously healthcare had been primitive.
These services were essentially free and were crucial to the doubling of life expectancy in China from 35 years in 1949 to 68 years by 1978.
These practitioners, however, were far from well educated. "They prescribed based mainly on their personal experiences, and didn't know much about medical theory," Yang said.
According to official statistics, almost half of Chinese rural doctors do not have proper school diplomas and most of them are not qualified to take the country's doctor qualification test. That means many village doctors are not officially recognized as "doctors".
Of the country's 1.38 million rural doctors, only around 300,000 have received licenses, government figures show.
In central China's Hunan Province, about 90 percent of local rural doctors are "unqualified", according to the provincial health and family planning commission.
A rural doctor in Hunan told Xinhua that without a license, they are always regarded as "unofficial medicine practitioners" and are susceptible to medical disputes. They are not covered by the social insurance system like their urban and township counterparts.
"If you get involved in a medical dispute, you could be charged with 'illegal medical practicing'," the doctor said. "I've been working as a doctor for decades, but am I officially a doctor? I cannot say for sure."
Poor career prospects are another pain ailing the profession.
In his office in the remote Pingshan County, Guizhou Province, Deng Guangfu frets over the difficulties of keeping doctors for the county hospital.
Deng, an official with the county's health and family planning center, said stories of struggling rural doctors are abound, making new doctors frightened of being stuck in the countryside forever.
"Many of those having been employed by the hospital just walked away after seeing gray-haired doctors still working in the poorly equipped hospital after so many years," Deng said. "Some doctors sent to Guizhou's cities for study never returned."
MORE ATTENTION NEEDED
Experts say more attention should be given to village doctors if China wants to maintain quality medical service in rural areas.
Li Guangyi, a researcher with Guizhou's health and family planning commission, said that the government should step up investment, enhance free medical training and improve welfare of village doctors to provide better services for rural residents.
Authorities have rolled out a series of measures to help rural doctors lead better lives.
In March, the State Council, China's cabinet, released a document for better treatment of village doctors.
The document ensures one doctor for every 1,000 rural residents. These rural doctors will get extra training for free, better opportunities to further education, preference in their future careers, along with higher pay and pensions.
More preferential policies will be rolled out to improve the livelihood of village doctors, according to the National Health and Family Planning Commission.
"I hope that in the future, village doctors can live better lives so that we truly want to stay in our jobs," said Sha Jishu, a village doctor in Guizhou.
