Only four patients a day flow 27 yuan, this doctor's three generations of life condensed a piece of history.

Text . . . Yang Yu Wu has 792,000 rural doctors in 2019, 53,000 fewer than in 2018.
father was the first generation of barefoot doctors who provided the most basic medical services to 900 million farmers in an age of lack of medical care and medicine.
Cao Xuancai with idealism after a period of glory moment, but now, age, education and other factors become a bump in front of the face.
now his son also wants to take over, but has been helpless.
the life story of three generations, from barefoot doctor to village doctor, from brilliant to falling history microcosm.
"Give me a box of ibuprofen, and recently my migraine was committed again."
a 35-year-old woman in a shirt and uniform walked into the clinic and spoke with her eyes straight to the medicine rack and did not see the doctor, Cao Yucai.
Cao only got up, take medicine, scan, collect the account, the lady turned away.
1, 2020, less than a minute later, the woman was not facing a doctor at all.
Cao said, now people come to buy medicine but ask him, "before the doctor-patient cooperation, now is the customer first."
this day, the clinic came a total of four people, a day of running water 27 yuan.
Cao is the village doctor of Meixuan village in Shanglo City, Shaanxi Province, compared to this clinic in Zhongcun town, about 10 minutes outside the Meixuan village health room is even more deserted.
the day before Cao Xuan only stayed there, except for an old man in the neighboring village to chat with him, the rest of the time no one patronizes.
Med too few people to see a doctor, the whole village population is only 1140, young adults have gone out to work, leaving less than half, and the county hospital from Meixian village only about an hour drive, " (the villagers) a little sick to go to the county hospital, " Cao said.
fewer patients and fewer doctors.
the end of 2019, there were 792,000 rural doctors in China, compared with 845,000 in 2018, a decrease of 53,000 in one year, and 1.023 million in 2012, a decrease of 231,000 in seven years.
there are 533 village doctors in Shanyang County, accounting for 57% of those aged 41-60 and 13% over 60 years of age;
the characteristics of low academic qualifications and older age.
country doctor's predecessor, Barefoot Doctor, had nearly 5 million people at its best.
in an era of lack of medical care and medicine, they provided the most basic medical services to the 900 million farmers of the time.
, education, age and other factors become a bump in front of us, and with it brings income, old-age care and a series of problems.
Cao's father and dead wife are also village doctors, sons also want to be village doctors, their grandchildren three generations of life story, from barefoot doctors to village doctors, from brilliant to falling history microcosm.
from barefoot doctor to village doctor out of Xi'an City, along the highway to the southeast 150 kilometers, is Shanyang County.
from the county town, along the 219 township road into the depths of Qinling, all the way to the east 40 kilometers, then to the village town.
, 52, has been practiceing medicine since 1994 in Meixuan village, about 8 kilometers from zhongcun town.
He is not tall, very thin, speaks a thick Shaanxi dialect, and drives a white Jetta with a Shaanxi A license plate- which his youngest son bought for him in Xi'an five years ago.
people who couldn't get to the car, they got out of the car and walked.
Cao's father Cao Xianwen, 81, began to practice medicine in the village at the age of 17.
primary school, he was counted as a cultural man in the village, medical skills rely on self-study.
, he is also well-famous, often a neighboring county private car to pick him up to see a doctor, medical expenses to see a person in good faith, a cigarette, a bottle of wine are OK.
June 26, 1965, Mao Zedong issued instructions to focus on health care in the countryside.
, relying on the rural cooperative medical system, the country vigorously trained semi-medical and semi-farm health personnel, known as "barefoot doctors."
Cao Xianwen can not ride a bicycle, no matter how far to walk, many times, the doctor back to the dark, can only walk by the moonlight, walk to a mountain, hear far and near the ground wolf, heart, the mountains often wild boars infested, suddenly sprang out, but also scared people not light.
the 1970s, when Cao was only a child, he often followed his father to the doctor, he remembers once, father and son in the vast mountains uphill and downhill, turning over seven mountains in a series.
period, barefoot doctors reached their peak, with nearly 5 million people, far more than the total health workforce (2.2 million health workers) that the Ministry of Health had at the time.
health system, an industry insider said that at the climax, cultured youth from a production team elected, sent to the county Health School training for about six months, go back to be a barefoot doctor.
barefoot doctors focus on chronic diseases and some routine public health programs, emergency, first aid is also an important work, such as eating stuck, cardiac arrest and so on, can be rescued in a timely manner.
Following his father's visit, the belief that medicine can bring well-being to farmers is also slowly rooted in Cao's heart, he remembers, a little boy who somehow struted his legs, after six months of his father's diagnosis and treatment, slowly stood up, and then resumed walking, and married his wife, gave birth to three children.
cao Xianwen often taught his son, there are two professions most respected, but also has been needed, one is a doctor, one is a teacher.
Cao Xuancai deeply thought, he quietly set up in his heart volunteer, hoping to be a doctor like his father.
the 1980s, when the rural collective economy disintegrated and the cooperative health care system collapsed, Cao Xianwen changed from a barefoot doctor to a "village doctor".
1994, Cao Xuancai inherited his father's "clothes" and became a village doctor in Meixuan village.
Cao and his parents.
the following pictures were taken by Yang Wei.
an idealist of the old glory in 1990 Cao Xuancai was admitted to the Shanyang County Health Vocational School, is the school's first intake of students.
he graduated in 1994, Cao stayed at Shanyang County Central Hospital as a physician because of his internship, and it was a death that made him decide to return to his hometown.
At that time, a village woman was about to come to the basin, he went to give birth, found that the maternal contraction is not obvious, there are painless bleeding symptoms, he judged that the village woman is likely to be the front placenta (refers to the placenta tissue extended to cover the inner mouth of the cervix, Can cause serious prenatal and/or post-natal bleeding), it is recommended to send to the county hospital, but the village woman's grandfather is the local barefoot doctor, self-advocacy, only the old bark burned gray to sugar water for the mother to drink, did not take more treatment measures.
he was notified again that the mother had died of haemorrhage.
this tragic scene so that Cao was deeply touched, the original barefoot doctor's professional level is worried to such a point, then decided to resign from the hospital, back to the village as a village doctor.
more than 50 classmates also have 3 or 4 after graduation as village doctors, but some from business, some turned teachers, but also remain in the village medical posts, only he alone.
teacher Xu Wei only appreciated his tough and learned quality, during the guard school to Cao Xuancai more relevant photos.
Xu wrote in an article: "Later, I went to the county hospital, often found that he transferred patients to come up, and from time to time received his inquiries about a certain disease diagnosis and treatment of the telephone, but also heard a number of experts in the county hospital said Cao Xuancai consulting medical problems, it can be seen that he is how good to learn."
later Xu from politics, no matter how the official title changed, Cao Still called him Mr. Xu.
, he consciously mixed poor, afraid of the teacher disappointed, every time to the county dare not visit.
Back in the village, Cao Xuancai won the trust of the villagers, when most of the rural birth attendants are women, he is a rare male birth attendant, but whether it is their own village or the mother of the neighboring village are called him to pick up, each year to give birth to more than 20 newborns, one after another can charge more than 200 yuan of medical fees.
in Shanyang County Central Hospital internship, Cao Xuancai received surgical technical training, only to come out to work he was also bold.
In 1996, a villager cut wood when mistakenly injured the Achilles tendon, feet pulled down, that person suspected that the medical costs are too expensive, dare not go to the county hospital, find Cao, call him boldly, and then what kind of his own recognition.
Cao and his wife to cooperate, playing drugs, antibiotics, another needle stitched the broken tendon back, and then the man slowly resumed walking.
Cao remembers that the operation used 5,600 yuan of medicine, "if sent to the county hospital, not 2000 yuan not to come", talking about this paragraph, Cao Xuan only proud full.
Between 1994 and 2000, village doctors in accordance with the distance, a 5 to 10 yuan at a time, when the drug zero price policy has not yet been introduced, selling medicine money is also their own, he is human and kind, villagers often bring him a bottle of wine, a bag of rice, a bucket of oil and other small gifts.
Cao said, during that period do not say how much money can be saved, at least pocket money is not lacking.
in 1999, he built a two-story building next to his parents' old house, the land, the price calculated a total of 70,000 yuan, he paid 20,000, to the geological team's uncle borrowed 50,000.
at that time, the county town of ten thousand households are less, their own two-story small buildings are real scenery.
In 2000, Cao Xuancai converted the first floor of the new house into a six-room isolation clinic of 100 square meters, with a diagnostic room, treatment room, observation room, pharmacy, data room, duty room, is the town's first Class A standardized pharmacy.
-storey building of Cao Yucai, the old village health room is located on the first floor.
From brilliant to fall in 2013, the village health room moved out of Cao's home, moved to a new site 5,600 meters from home, his wife died, Cao Xuancai also moved to the town to rent a house.
, the second floor of the old house is still hung with a faded, slightly dilapidated "Mei Fork Village Health Room" plaque.
and the health room is no longer there, it happened earlier.
In 2009, the national basic drug system was officially implemented, Mei fork village health room also implemented zero price difference of drugs, so that benefits to patients, in order to make up for the loss of profits of village doctors, the state policy provides for a certain subsidy to the village health room.
price difference, the variety of medicines is limited.
A new medical reform survey conducted by Zhu Hengpeng, a scholar at the Chinese Academy of Social Sciences, shows that after the implementation of the basic drug system, about 42.5% of the medicines used by village doctors in the past have not been included in the list of essential drugs, and the proportion of patients who do not go to the village health room because of the limited variety of drugs is as high as 72.5%.
At the same time, although the base medicine by the national unified procurement, but some have not squeezed out the false high drug prices in the water, such as Meifu village health room, higher than the market price of the drug has ginseng injection (village health room purchase price of 5 yuan / branch, retail pharmacies sell 3 yuan / branch ), double sodium chlorofenate slow release capsules (village health room purchase price of 10.45 yuan / branch, retail pharmacies to buy 5 yuan / branch), etc. , even if it will be reimbursed, the villagers would rather save the money on the new agricultural account for hospital reimbursement, and go to the market to buy affordable drugs.
in addition to seeing a doctor, Cao's other job is an instrument.
As an important part of the "fight against poverty", "healthy poverty alleviation" was pushed to the grass-roots level, requiring a good "three batch", that is, the major disease concentrated treatment of a batch, slow disease contract service management a batch, serious illness to protect a batch.
as the nearest "health guardian" to the villagers, a large part of the "health poverty alleviation" work fell on the shoulders of village doctors.
Cao yucai went to the villagers' home three or five times apart to measure blood pressure, measure blood sugar, record 14 items of public health, and take photos as a basis for keeping them.
says it takes at least 40 minutes to go to a home, most of which is spent on paperwork.
every once in a while, people in towns, counties, cities and provinces will come down to accept and verify whether the poverty alleviation work is in place.
most important basis is the integrity of the instrument.
documents accumulated by Li Shuncai's family.
December 2018, the Health Times published an article entitled "The primary care doctor is going crazy!" Fill in 40 kinds of forms a month, see a doctor can only take time! The article resonated at the grass-roots level.
According to incomplete statistics, rural doctors need to fill in the form in addition to health poverty alleviation, family doctors into the home service, daily chronic follow-up, but also need to fill in the file year-end summary, chronic disease management year-end summary, contract service annual summary and other summary statements, including roster 18, summary 7, table 16, follow-up form 2, other table 8 ... Medical treatment time is squeezed by paperwork, no one in the village health room to see a doctor to buy medicine, Cao Xuancai felt that the importance of village medicine work in the discount, coupled with convenient transportation, travel radius expansion makes more choices, the attitude of villagers to village doctors is also changing.
the health room sometimes can't come to a patient a day.
In 2016, Cao was awarded the "most beautiful village doctor" honorary title, Shanglo TV station for this production of a program, the need for village doctors in the village health room to see the scene, the staff set up cameras and so on for a while did not see people to come to see a doctor, they pulled Caoxuan to a health room in Shanyang County to shoot a few sets of shots.
the new Mei fork village health room, sometimes can not come to a patient a day.
most troubling to him is the fact that there are now two village doctors in Meixuan Village, 52, and Liu Youfu, 45, who teds himself in medicine after graduating from high school.
the division of labor between the two men is clear, Liu Shou village health room, at the same time responsible for rural cooperative medical reimbursement statistics, Cao is responsible for general diagnosis and treatment and the village's public health services.
sit on Cao's white Jetta, deep into the rural hinterland, in some farmers' outer walls, you can also see the color of the epidemic prevention slogan, Yu Xiu's brush words from Cao's hand.
during the outbreak, Cao was busy before and after, every day to go out to work back to the village households to take temperature, a household to touch the suspicious villagers, but also the clinic only 20 surgical masks donated to the village epidemic prevention team, he only issued by the epidemic prevention team 3 n95 masks to wear, adhere to nearly 3 months, the busiest time, a day walked more than 20,000 steps.
these jobs are unpaid.
14 mentally ill patients, 16 diabetics and 61 hypertension patients in Mei fork village in The People's Government of China.
these suffer.