by Fred Fortin
April 27, 2007 at 5:00 am
· Filed under Uncategorized
In a previous post I’ve argued that an activist public sphere squarely focused on health care needs to be mobilize in China. The public sphere is that panoply of independent non-profits, NGOs, advocacy organizations, mutual benefit associations that exists in the critical space between local communities and government. It’s here that the everyday work of reducing social conflict and managing change really takes place.
I’d like to explore this notion a bit further and get your views as to whether it helps us in understanding the unfolding dynamics of China’s health care reform movement. (Shall we call it that, a movement? Is that premature? Maybe this is a related question we have to ask ourselves as well.) The idea of a public sphere has been around for awhile and traces its origins back to Alexis de Tocqueville conceptions of civil society, a classically liberal requirement for thriving democracies.
Will Hutton in The Writing on the Wall sees the public sphere as a place “where a sovereign people thinks out loud” and believes China is in need of a “gamut” of these organizations. He cautions, however, that “getting them is not a matter of organizing a technocratic transplant or copying. It is a matter of revolutionizing Chinese non-market spheres and in particular accepting the idea of a public sphere that is independent of the state and the Communist Party.”
Wang Hui in his powerful book, China’s New Order, questions whether, in fact, mediating spaces exist in China where real social and political critique can take place. He believes that given the state’s inter-penetration of the public sphere, this kind of civic life may too compromised and simply too powerless to effect change.
Certainly we often see evidence that leads us to these kinds of conclusions. Guy Sorman’s recent report in the Wall Street Journal (subscription required) about Hu Jia and his work with those sicken with AIDS in China’s Henan, Province, is a case in point.
“As long as Mr. Hu worked alone to help the sick, bringing them clothes, money and food, the Party left him alone. But he has recently drawn attention to himself by urging the victims to form an organization that can demand more from the government. The Party will sometimes put up with isolated dissent, but it won’t tolerate an ‘unauthorized’ association. Several months ago, the government placed Mr. Hu under house arrest in Beijing.”
With this as a backdrop, it’s no surprise that non-profit organizations established by the government of China are frequently regarded by foreign and domestic critics as fake. But in true paradoxical fashion China has also seen a large increase in grass roots non-profits and foreign NGOs (non-government organizations). The historic relationships between China’s local non-profits and those related foreign NGOs, for example, paints a slightly more optimistic picture. As Nick Young observes, it is not the money that counts, so much as the contribution to the diversity of ideas in China.
“Today, those agencies all talk the language of gender equity, environmental sustainability, rights, community participation and – as a logical consequence of the participatory discourse – ‘local ownership’, localization and civil society development. NGOs have made a very substantial, and quite probably decisive contribution to that way of talking and thinking, about development, both through their own work and through their – sometimes quite fierce – criticism of the official aid community. International NGO programs in China are a significant part of the story of the country’s growing internationalization and opening up to the world.
The future of China’s public sphere is uncertain at best. But one view is of a highly vulnerable and tenuous non-profit infrastructure, with organizations trying to carve a path for health care, trying to see their way clear through some very treacherous political minefields, and tragically taking casualties as they go. As organizations continue to test the limits of openness and control, one hopes a synergy will emerge with health care reform promoting the future development of these organizations, and in turn be driven forward by them as well.
Our challenge, it would seem, is to look directly at the forces for change as well as the risks without either being dangerously naive on the one hand, or so ideologically compromised on the other, that the nuances of progress escape us. We do this, of course, with full awareness that our information is limited and that we may in the position of being objects of manipulation by larger forces. That, I’m afraid, is the hand we’ve been dealt.
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First of all, this article only provides a small portion. The complete version is here:
Medical workers in all levels and types of medical institutions will have ethic records and will be inspected and evaluated annually says China’s Ministry of Health.
The Ministry of Health and State Administration of Traditional Chinese Medicine jointly launched “Directions on Establishing Ethics Inspection and Evaluation System for Medical Workers”. It is the first time of raising the idea of building an inspection and evaluation system for medical workers in China. The result of the evaluation will be made public and directly connect with promotions, employment and performance-based salaries. The annual evaluation will be divided into three parts: self evaluation, section office evaluation and unit evaluation.
Ministry of Health says the evaluation result rankings will have four levels: excellent, good, average and poor. The main content of the evaluation will include medical action, dressing and attitude of the medical staff. Yet in this evaluation system, healing the sick and serving the people are the primary criteria within the judging framework.
If any medical worker has a poor performance, he or she will be punished accordingly. Eight types of behavior will be viewed as poor work: asking for money, goods or other profiteering from patients or their families in medical activities; accepting money given by companies who produce medicine, medical equipment, medical consumption goods or salesman of these companies in clinical diagnoses and treatment activities; violating policies of medical services and prices, charging more or charging privately which causes serious results; hiding, faking or destroying medical documents or relative files; careless performance which causes medical accidents or serious medical mistakes; giving fake medical advice or participating in fake medical advertisements or promotions; bad attitude in medical services which causes bad influence on others or serious results in the care of patients; other activity deemed to be serious violations of professional ethics or medical moral and ethics by the audit board.
www.chinesemedicinetimes.com
Taken from: http://www.chinacsr.com/2008/01/08/2…thics-records/
Personally, I think this is a good system, which reflects not only the core of Chinese society but also more of what healthcare is and/or should be. Interning with a work group in mid-South China for more than seven months last year taught me more than I could express here. One of them, of course, was practicing Chinese medicine within a society in which “face” is also important.
The ethics here serve as a reminder for health practitioners that their profession is one that is considered sacred, and is actually a return to some of the criteria utilized in the 1960s and 1970s. If anyone has the chance to read the book called “Serve the People” detailing Chinese Healthcare during that time, you might see where this is leading.
Also, let’s face it. Pharmaceuticals have been producing all kinds of unwanted and unintended side effects including the deafness of one third of all Chinese children. Many western medicne physicians have been courted by Big Pharma and highly rewarded through compensation similar to that experienced within the US in the 1980s. However, the value of a life and responsibility is a very serious thing in China. Look at the unfolding of events throughout the summer of 2007. Two officials within the equivalent of the Chinese FDA have been punished- one executed and the other imprisoned for life over corruption.
The Ethics Policy is the soft political way of saying there are harsh consequences for violating the sacred contracts within the profession itself. It is also placing all doctors and healthcare workers on level ground, not supporting any medicine above the other or valuing them in dissimialr or unequal manners.
Read in its entirety, I cannot help but wonder what would happen if the whole world adopted such policies. Would it raise the bar for many? Would we have more integrative or dedicated teams? Would it restore faith and perhaps bring more healing?
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