Rx for the World’s Most Populous Nation

THE OPEN MIND
Host: Richard D. Heffner
Guest: Dr. Ma
VTR: 11-16-86

I’m Richard Heffner, your host on The Open Mind. The meeting of East and West is seldom achieved as drastically or productively as in the person of today’s guest, medical doctor George Hatem, Dr. Ma Hah-Dah, whose Chinese given name means ‘Virtues from Beyond the Seas.’ Born in Buffalo, New York, an undergraduate at the University of North Carolina, Dr. Ma is now a Chinese, a Senior Advisor to the Ministry of Public Health of the People’s Republic of China.

Dr. Ma is here in America as the winner of the Albert Lasker Public Service Award for those remarkable public health efforts of his which radically eliminated venereal disease in China, the world’s mot populous nation. As a Western-trained physician, he had joined Mao Zedong and Zou Enlai in serving the Red Army’s desperate medical needs after thee Long March, later turning to accomplishments in public heath control that have been compared in importance to the eradication of yellow fever and the bubonic plague.

Indeed, one could not help but wonder if Dr. Ma’s lessons might not be learned here, in our effort to contain the scourge of AIDS.

It would be folly not to recognize and applaud the beginning efforts at public education about this deadly disease that even now are being undertaken at local levels. But our nation is so large, our population so enormous that Dr. Ma’s Herculean efforts, and prodigious success, in eradicating China’s more widespread venereal disease epidemic might be of use to us.

So, Dr. Ma, as I welcome you here today, I wonder if there are lessons from your work in China that we might adopt in our care concerning AIDS?

Dr. Ma: That is too difficult a question to start with. The problem is that both like venereal diseases… AIDS is one of them…. Are so intertwined with the social fabric of a society – its social, economic, cultural background – that we refer to them as social diseases. And our attempts to handle them medically or technically have to be supported by social changes and understandings; used together to attach this problem of AIDS. That’s the only lesson that we had in China was that you need both social science and natural scenes combined.

Heffner: Do you think you had an advantage in terms of the social framework in China in eradicating venereal disease that perhaps we do not have in this country now?

Dr. Ma: Perhaps we have. At that time it was a very interesting situation. It was right after liberation. The peasantry, of which China has about 80% on the land, were so happy with their lot of being liberated from the usury and the landlords and the starvation and taxation – they were given land. So they supported and were committed to the government because the land was given to them by the new regime. So in our efforts for venereal disease eradication they cooperated very strong because we said, we’re sent by the government to help you. Venereal disease is a disease of the old society, we’ve thrown the old society, we’re building a new society. You’re not responsible for your venereal disease. And if you’re going to build a new society, if you are going to build Socialism, you can’t take the old ills of the society into the new one. So why don’t you come and get your venereal disease examinations and treatment.” That put a political flavor to it and took away the stigma attached to it at the same time. Now that was part of the picture that existed at that time in China. So we had the advantage of a – of a social background and developed on the basis of liberation. Of course, there are many other aspects to it, like liberating the prostitutes. Prostitution was a very commercial operation in China, just like in many other societies. It had a strong economic base. Women were forced into prostitution and most of the attempts at making a living were forced into a form of prostitution. There were sold by their families just to keep them alive and so forth. Now, to handle prostitution we have to give women their liberation. We had to give them an economic independence. We had to educate them so that they had other means of earning a living. Women don’t usually go into prostitution for purely economic reasons, or for the love of the thing. They’re forced into it in one way or another by the social pressures and economic pressures. Each society has its own cultural and historical and moral backgrounds on which you have to build your programs. And in the same way in the United States or any other country.

Heffner: It’s interesting thought that you use the word ‘liberation.’ I understand it’s historical leaning in terms of China. Here there are so many who feel that it is indeed liberation – liberation from old moral standards – that has been basic to the kinds of sexual activity that have lead to the spread of AIDS, and I wonder if you are aware of the degree to which there are people in this country now who suggest not liberation but it’s opposite in order to contain the spread of AIDS.

Dr. Ma: I don’t think you can use any other kinds of methods just by saying liberation and non-liberation. When you begin to define liberation you get to the point where there is a definite line. Where liberation harms the other person, you’ve goon too far with your liberation.

Heffner: That’s a – that’s a political approach to medicine. Does that mean that medicine is practiced far differently in China than it is here?

Dr. Ma: I think it has much more of a social and a community base in China than it has here. The government has taken the responsibility, a definite responsibility for the health of its people. And if it sticks to that principle, then it has to provide all the means necessary to make people health.

Heffner: Were social controls very important in the eradication of venereal disease?

Dr. Ma: Well, social controls weren’t that important. I think what was important is the question of one, changing the economic basis of life for people, and when a person is poor and poverty stricken and destitute, he can’t absorb any education that warns him of dangers, the dangers, say of venereal disease. His immediate danger is his starving to death. So the controls are not – is in a different context than that. The controls we used were of an educational nature because no laws or rules or regulations can intrude into the bedroom and be effective. And we tried passing all kinds of laws, in the beginning our eradication of venereal disease campaigned and they didn’t work. For example, we insisted that you have a serologic examination before marriage. That was a form of control. Now, with 800,000,000 peasants, or 500,000,000 peasant at that time, in the countryside, there was no mechanism to give and make and do that many serological tests – there is nobody to do it! So the law was an empty law because you couldn’t provide the ways to apply it. So the controls that we used really – the most fundamental were economic or educational. Those were the two main measures that we thought were effective.

Heffner: You are no stranger to this country – you were born here and spent many years here. How confident do you think we are – how capable are we to wage a similar educational campaign successfully?

Dr. Ma: I think you’d have to find the proper ways to do it. Now, for example, in our venereal disease campaigns, we outlined a series of clues. If you had any one of nine or ten symptoms related to syphilis or gonorrhea, or if you suspected you had any of these clues, we ask you to report for an examination. And we education the people about these clues in open meetings, where we sat down and discussed with them why we are doing this and what these clues meant. And I can imagine, if in one of these tremendous high-rise apartment houses, you put op a bulletin board that Saturday afternoon we are going to have a session on venereal disease clues and we ask all members to come to the meeting in the afternoon, I don’t think you’d get many people here. You’d have to find another method, you’d have to find your own method of doing these things. I’m not really competent to outline measures of this country now, even though I was born here. The thing is much more complicated.

Heffner: Of course, I obviously am pressing on this question of control and whether control, central control… a social, political determination in China to eradicate syphilis, to take all the steps to eradicate other venereal diseases… whether it’s possible to have a parallel national effort in a country that puts its emphasis, as our does, upon individual satisfaction, individual activity. And I wonder if you have any observations on that?

Dr. Ma: The aspect that… the corollary to tat, when you speak of individual and rights and privacy and all this, there isn’t the other corollary to it – not doing harm to anyone else – and it’s very rare that you can keep to the rule if you say you are free, you are independent, you can do whatever you want. Once you push a highly individualist society, the ‘I’ becomes much more important than any side relationships, and you don’t have time to think of your fellow man – he falls behind in the race, that’s his problem. In China, we have a different attitude in the sense that we felt we’re responsibility for all our people, not only for the individual, and we felt that by taking care of all the people, we also took care of the individual because we don’t think there is a contradiction between the rights of the people and the rights of the individual. And then you come to the semantics part of it and you say, ‘what is the rights of the people? Every country determines their own rules and definitions of rights and so forth. And over the period of history, these questions of rights of the individual have held a very important element in developing a progress of society. Now the mix between a collective rights and individual rights, if you find the proper mix; I think you can direct efforts much more effectively for the common good.

Heffner: Do you think Americans have found a proper mix? In your field, in medicine?

Dr. Ma: In medicine, I – I have a little bit of hesitation about it for the simple reason is that American medicine – I’m generalizing and I don’t have enough firm knowledge really to make all these statements I’m making. As a scientist I would look back and say you’re talking out of the top of your head. But for example, take the question that I’ve been think of for many years – the question of prevention in medicine. You can’t collect from an individual a fee for having prevented him from getting cancer of the lung. If I follow the woman, say for fifteen or twenty years, during her risk period, of getting breast cancer – regular examinations teaching her how to examine and so forth. I’ve devoted time, I’ve devoted effort, I’ve devoted knowledge. And after a time there comes the time when I send in my bill and I say, “now pay me for having prevented you from getting cancer.” And she’d probably throw me out the door. Which means that prevention in medicine has to be applied and carried out, which can’t be done on an individualistic basis. A private practitioner can’t collect fees for preventive medicine. That’s the – that’s the problem that’s bothering me all the time. Many times I’ve thought about it, we’ve talked about it with many of our colleagues. There isn’t a network or a system or a service that provides preventive medicine in the American medical set-up.

Heffner: And in China?

Dr. Ma: In China we have, because from the very beginning – with the problem of a billion people, you are never going to be able to treat all of them. It’s – the only solution you have is the prevention of disease. And that has always assumed a very high priority in our medical planning and strategy and so forth. We have a whole network that can apply preventive measures and that, I think accounts for why we are able to have a population in China that, let’s say, thirty-seven years ago the average span of life was only thirty-five or thirty-eight years, and today that has been raised after thirty-five or thirty-seven years, it’s been raised to sixty-eight something, point something years – a life span. That’s almost nearly doubled. And for women it is doubled. Form thirty-five to seventy. And we believe that has come from various elements in our medical services, but not only that. This is where, for example, feeling your people is part of preventive medicine. If they’re starving and they’re dying of nutrition or berry-berry or any of these nutritional diseases, the only way to prevent it is to give them something to eat. So we can apply prevention, both socially, economically and medically.

Heffner: What did you say – once again, being familiar as only one who was born here – what would you say, in terms of the American tradition, is the downside of what you are describing. It sounds almost utopian. But in our terms, what is the downside, if any?

Dr. Ma: Now, I don’t really understand that downside part (chuckle).

Heffner: Well, you talk about doubling life expectancy… those figures of life expectancy. Is anything gone with that? Has that been part of a pattern of behavior that for Americans who are more individualistically oriented, that it would loom as negative? There would be controls over the practice of medicine – there would be controls over my ability, as a citizen, to pick a physician of my choice. That sort of thing. What goes with the doubling of life expectancy?

Dr. Ma: Well, for example, the first thing that for us was feeding the posp0uloatoin. The second thing was preventing natal deaths. The retraining of midwives and giving the – the old style midwives being retrained. The whole education that went with this – of educating the mothers, educating the midwives, educating the medical profession and providing facilities for childbirth in better circumstances – either hospitalization or semi-hospitalization or hospitalization in their own homes. These measures helped to raise the average span of life. If a child died at the age of one and the other – and the old man lived until the age of ninety, you only have one forty-five year span of life, if that’s the way it was. That was part of the help. But I think the other aspects of raising the life expectancy– there are many other factors that enter into it. Including a quality of life, which means that you have education, you have going to schools, you illiteracy and all that, give people an understanding of more than just the ordinary things of life. If you have n aim in life, if you want to accomplish something, if you have the willpower to do things if you’re encouraged and models set up for you to emulate, I think that helps you bring on a … a will to live longer, so to speak.

Heffner: Do you think that kind of medicine, that kind of practice, or that kind of preventive medicine could be practices in this country, given its political ideology, given it’s political structure?

Dr. Ma: I think ways can be worked out to improve the application of prevention of medicine even in this society because it’s not an economic problem here.

Heffner: What if you…

Dr. Ma: ..I think it’s the whole system the way medical education and medical services have grown up in this country.

Heffner: Not outside of the social structure, though – within a particular social structure.

Dr. Ma: Well, let’s take a little bit of the history of American medicine, as I remember it. There was the period of the early nineteen hundred where medical education was very poor… doctors were being very poorly trained, they were delivering medical care in a very semi-scientific way. And there was the recognition of the need for public health services, water, sewage control, clean water, nutrition and so forth. And so there was, as the society grew a little more affluent, it put in sewage and water, clean water and vaccination campaigns and so forth, cleaning up yellow fever. In North Carolina, where we come from, we still had malaria, you had hookworm. In that period there were tremendous campaigns which took the form of preventive medicine – treating those that had it and prevent those that were getting it. There was this whole period of education in both public health and curative. The public health aspects were preventive. The Welch Report on American Medical Education, that’s about 1910, reversed the whole trend – the previous trends and injected a great measure of preventive medicine into medicine. And I think that was a period where this society, under those conditions, could provide preventive medicine. There isn’t the same encouragement or the same danger at present. It’s not that obvious and it’s not that frightening until you got to AIDS. I mean, you can say you have 400,000 deaths from cancer a year. That doesn’t frighten anybody. It frightens the individual if he gets cancer, but society is not tremendously frightened. It says, we’ll work on it, try to do something about it. And then you say, well, prevent smoking. So the Surgeon General writes on each package of cigarettes, ‘smoking is dangerous to your health.’ Well, that’s it. That’s preventive medicine? But you are not getting anywhere with that kind of thing because you have to go into this a little deeper. Then you run into various kinds of other difficulties – the financial – like we do in China even.

Heffner: What is your prescription for this country?

Dr. Ma: Well, I’m not giving any prescriptions for this country (laughter). I wouldn’t be that presumptuous. I think – I used to think in this way – if they’d give us only the tail end, where you round out figures of the health budget and the amount of money spent on health in the United States, if they would only give us the tail ends or the remnant parts of where you round it out, we could run the whole Chinese medical services very easily (laughter).

Heffner: You know, it’s interesting – you say that cancer doesn’t frighten us as a people sufficient, but AIDS does. Do you see this as one of those social medical developments that will make for a tremendous change in the way we look at ourselves and our own health?

Dr. Ma: It might because this is where both the medical aspects of AIDS and the social aspects of AIDS intertwine very, very intimately.

Heffner: Is there an AIDS problem in China?

Dr. Ma: No.

Heffner: How do you account for that?

Dr. Ma: Well, there’s a number of reasons it hasn’t come there. We’ve had one case that was imported. That is, one of the tourist groups that came in had one of their group. He was in a tour group and he had AIDS. He may or may not have known it, we don’t know, but his parents who we invited over because he was terminal within a week’s time when he got there, when they came over they said he knew he had AIDS. The parents knew he had AIDS. And it was a very short period there, it was only about a week’s time before he passed away. Now the only other thing that we’ve had with the AIDS problem is that in a certain period we imported blood products from different countries, mostly the United States, and there was one type of blood product that we gave to eighteen people. And amount these eighteen people, there are four who have antibodies against AIDS, which are called ARI and out of the eighteen there was only these four and we’re watching those four. But that came through using a blood product.

Heffner: If AIDS should surface in China, would your capacity for exercising educational and social control measures enable you to control it better than we can here?

Dr. Ma: Well, we’d have a pretty good chance of containing it. I would be able to say much more at present because there is no way of treating AIDS at present. That’s where…

Heffner: …I meant contain it.

Dr. Ma: We could contain it. I think we can.

Heffner: Education?

Dr. Ma: Education. Primarily education. There is no way of enforcing it by law. And through the ethics and morality and so forth of the Chinese people traditionally, they haven’t been as open minded about sex as this country has. And so the forms and methods and exotic aspects of things are not too common to our society there. So I think education wouldn’t – you – as we believe – if you give the knowledge to the people about a disease…

Heffner: … it will free them.

Dr. Ma: Not free them, it will at least give them a chance to fight the thing.

Heffner: Dr. Ma, that’s an optimisitc and a welcomed thought and on that thought I want to thank you for joining me today.

And thanks to you too in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, please do writhe THE OPEN MIND, P. O. Box 7977, FDR Station, New York, New York 10150. For transcripts, send $2.00 in check or money order. Meanwhile, as an old friend used to say, “Good night and good luck.”

Continuing production of this series has generously been made possible by grants from the Rosalind P. Walter Foundation, the M. Weiner Foundation of New Jersey, the Mediators and Richard and Gloria Manney, the Richard Lounsbury Foundation, Mr. Lawrence A. Wien, Pfizer Incorporated, and the New York Times Company Foundation.