Tang Meifang has been a village doctor for 27 years, but she doesn’t look much older than 30.
Tang, a diminutive woman with piercing eyes, laughs heartily. “I am 40 years old,” she says, flashing a brilliant smile. “I started working as a doctor when I was only 13.”
For more than two decades, Tang has been the whole health-care system in the mountain village of Xi Gan Li, one of the most remote communities in southwestern China’s Yunnan Province.
To reach Xi Gan Li, population 403, one must travel down 12 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.
Tang grew up near 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.”
Tang started her career in medicine at 13 by apprenticing herself to three doctors in a neighboring 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.”
An estimated 2 million village doctors are the foundation of the Chinese health-care system, largely because 80 percent of China’s 1.2 billion people live in rural areas.
As the village doctor in Xi Gan Li, Tang presides over a one-room clinic next to her house. There is no reception area, so waiting patients must share space in the courtyard with a dozing pig and chickens that wander freely in and out. “Please excuse the chickens,” says Tang, laughing. “Xi Gan Li is a poor village, and we live very close together.”
Despite her remote location and conditions that Westerners would consider primitive, Tang manages to stay current with medical developments in China.
“I receive 15 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, Tang is taking an active role in China’s national effort to halve the number of infectious tuberculosis cases by the end of this decade.
One-third of the world’s population is infected with tuberculosis, the leading infectious killer of adults, according to World Health Organization data. In developing countries, where only two cents out of every 10 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 individuals.
“For many years, China had very high rates of tuberculosis,” says 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.”
China launched an ambitious program of TB control in 1992 based on the World Health Organization’s success with a therapy in which health workers observe to make sure TB patients take daily doses of four drugs for six months.
“Huaning County adopted (the therapy) in 1995,” says Tang. “Since then, the cure rate for TB has risen to more than 93 percent.”
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 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 9 o’clock and I give them to him. He is very cooperative. He knows that if he takes this medicine, he will get better.”
Tang’s last TB patient was not so lucky. He stopped taking his medications and died.
“At first he took the medicine regularly,” says Tang. “Then he started to feel better, so he stopped taking it. Then he died. If he had been treated under the (monitored) program, I’m sure he would be alive today.”
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.
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, Zhang 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 27 years as a village doctor 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.”
