The Death Of A Doctor in Fujian
(International Herald Tribune) Healthcare falls short, Chinese tell leaders. By David Lague. August 20, 2005.
A hard-hitting report issued earlier this month by the Development Research Center, one of the government's top advisory bodies, concluded that the switch to a user-pays health system has been a failure. It noted "to our shame" that the World Health Organization ranked the Chinese health system as one of the most unfair in the world. "Most of the medical needs of society cannot be met because of economic reasons," the report said. "Poor people cannot even enjoy the most basic health care."
The World Health Organization asserts that the solution to the current crisis is for the state to reassume a leading role in the system. "The government needs to rethink and reinvest," said Henk Bekedam, the organization's representative in China. "At this moment, the only people who can get health services are people who can pay." Health experts agree that one of the major achievements of China's health system before 1978 was the provision of basic medical care for all urban and rural Chinese.
The Development Research Center's report states, and most experts agree, that the quality and sophistication of medical treatment available in Chinese hospitals has increased dramatically in recent decades. However, deep cuts in government health outlays have forced hospitals and clinics to raise the bulk of their income from medical services and the sale of drugs.
Drug sales accounted for up to half the operating revenue of some hospitals.
"The final result is that hospitals and doctors choose and use medicines in terms of maximizing their own profit," the report said. However, in the absence of widespread medical insurance, many Chinese, particularly the 800 million living in rural areas, cannot afford treatment when they are ill. Critics cite China's official 2003 national health survey, which found that about 64 percent of people in big cities who should have been treated by a doctor as inpatients chose not to do so because of the cost. In rural areas, that figure was more than 73 percent.
The above is the macroscopic description. The following is the microscopic examination of one case about social attitudes towards the situation. Very simply put, a certain doctor was killed by a patient whom he treated but whose condition apparently did not improve. By an overwhelming margin, Internet commentators applauded the killing of the doctor. But should they find out something about the doctor and the patient first, before jumping in glee? The following Nanfang Daily article examines the two principals and the people around them.
This case study is very disturbing. What would you do if you were the widow of the murdered doctor? You have the right to get on the Internet to express your platitudes about your husband. But you will be drowned out by tens of thousands of voices of hatred in the very democratic Internet, where each voice is given the same weight.
[translation]
On the afternoon of August 12, Dai Chunfu, an expert who receives special subsidies from the State Council, was attending an out-patient clinic at the Fujian Chinese Medical School's National Medical Clinic was stabbed to death by a patient.
This news item was carried quickly on many websites, and drew comments from netizens. The surprising thing was that while medical students express their shock and sorrow to the media, the websites carried large amounts of criticisms. But those criticisms were not directed towards the knife-wielding patients; instead, there was curses and spitting against the deceased doctor.
"He deserves it!"
"This is killing one to warn a hundred!."
"I want to kill those doctors too."
"There is a reason why this saying is so popular: the angels wearing white are one of the ten 'black' character types!"
Some netizens cited personal examples, such as doctors demanding bribes and prescribing the wrong medicines, etc.
According to a survey at an Internet portal, 80% support and sympathize with the patient killing the doctor, and the opponents and neutrals each account for 10%.
Obviously, most of the few supporters come from the medical field: "During the 2003 SARS period, we were elated in our courage. So how did the 'white angels' become 'white wolves' all of a sudden? During the SARS period, there was ironclad evidence for the citizens to see that the medical doctors' skills and ethics. They had high technology, high risks, high sacrifice and high physical strengths. But the media and the government officials were either forgetful or prejudiced, and they could not get past this insignificant sideshow."
There were obviously also those close to the deceased. For example: "Those who did not understand the truth ... 8.12, we shall remember because you have not finished yet."
Yet those voices drew more curses: Why do mean by not understanding the truth? If it is really true that he "had good medical ethics and good medical knowledge," then why didn't he cure a case of prostate inflammation?
One netizen sighed: An excellent doctor was brutally murdered by an insane thug, but the cultured and knowledgeable netizens applauded -- what has the world come to? What is the reason that make the doctor pay with his life?
In a post identified as noteworthy at a certain website: "The conflict between doctors and patients is due to government inaction and the total loss of medical ethics and commitment to heal and save lives." Someone then said that there are major problems in the relationship between doctors and patients. But nobody analyzed what was meant by "government inaction" and "total loss of medical ethics."
When the name "Dai Chunfu" is searched on the Internet, apart from the many reports on the murder case, there are some medical news reports. This reminds us that Dai is a famous Fujian doctor who specialized in male problems.
When the event took place, there was no warning indication.
At around 3pm on August 12, the weather was hot and humid. Dai Baojin came to the Clinic Number 1 at the Fujian Chinese Medical School's National Medical Clinic. He held a large green envelop in his hand, inside of which as a knife. He sat there waiting for the specialist. Nobody paid attention to him.
Meanwhile, inside a room for the families of members of the Fujian Chinese Medical School, Dai Chunfu was playing a flute during his spare time. The flute gives him peace. He has often told his students: Doctors are suppose to heal people and save lives; if they are of poor quality, how can they save people?
Five minutes later, Dai Chunfu went downstairs and then entered the National Medical Clinic. This is a clinic associated with the Fujian Chinese Medical School and all the doctors are instructors at the school.
3:10pm.
Dai Chunfu entered the clinic office. He said hello to his assistant Huang Suixin and then he sat down.
The patients waiting outside saw Dai Baojin stood up and raced to the door of the clinic office. From the green envelop, he took out a knife that was more than 40 centimeters long. Without saying anything, he thrust the knife several times into the chest and stomach of Dai Chunfu.
Although Dai Chunfu had practiced martial arts before, he was surprised by this sudden attack. He used his hands to protect himself and he pushed Dai Baojin aside. Then he ran out of this office door while holding his wounds.
Huang Suixin recovered from the initial shock and grabbed the square chair and charged towards Dai Baojin. He blocked Dai Baojin with the chair, then he pushed hard and ran away himself in the opposite direction.
The hall was filled with patients. A Mister Lin was making a telephone call right outside the front door of the Chinese Medical Clinic. He looked up and saw Dai Chunfu grabbing his stomach with his left hand and stumbling out of the front door. He headed towards the May 4 Road in front of the hospital. There was a waiting taxi and Dai Chunfu opened the door and wanted to get into the front seat next to the driver. But before he could close the door, Dai Baojin had arrived and grabbed him. Dai Baojin then stabbed Dao Chunfu another five to six times. The taxi driver stepped on the gas pedal and charged towards the emergency room of the Fujian Province Number Two People's Hospital with the car door on Dai Chunfu's side still ajar.
At 3:20pm, the emergency room doctor pronounced Dai Chunfu dead.
Later, in the police car, a police officer asked Dai Baojin why he killed. He replied that ten years ago, he went to see Bai Chunfu about his inflamed prostate gland and it did not get any better. Later on, he went to seek treatment at various other hospitals and found that he has been losing more weight.
"I suspected that he lied to me. So I want him dead," Dai Baojin's voice sounded very elated.
On the evening of August 12, 50-year-old Yuan Qiong kept calling her son's mobile telephone but there was no answer.
Later that evening, several police officers appeared. They said that Dai Baojin was in a fight and they wanted to investigate. The police asked about Dai Baojin's medical condition and took away all his medical records and the very few books, leaving behind a receipt.
"There used to be many more medical records at home, but Dai Baojin threw them out. The police took what was left." When she spoke about those medical records, Yuan Xiong began to cry. This touched her sorest point: her elder son Dai Baojin is 29 years old, but his life over the past dozen of years were about seeing doctors.
In Yuan Xiong's recollections, Dai Baojin had constipation and other minor problems since he was 10 years old. The family income was spent on medical expenses. "We have been in business so many years, and we spent everything on him," Yuan Xiong said.
They used to live in a village near Fuzhou, and then they started a hardware store in Fuzhou. Since moving to Fuzhou, Dai Baojin went to see the doctors on his own. "He wouldn't let us go with him. When he came back, he wouldn't tell us what his problems were." The family did not dare to ask. They were used to Dai Baojin throwing a fit when he was in bad mood. So they could not say what Dai Baojin really had. Vaguely speaking, they seemed to think it seemed to constipation or hemorrhoids.
Yuan Xiong thinks that her son is somewhat strange. Every time that he wants to see a doctor, he asked his family for money. "Usually, he wanted 300 to 400 RMB. He put the money in his pocket. Then he said 'maybe it won't be enough' and he wanted another 100 or 200 RMB." After he got the money, he would leave quietly. When he came back, he would say nothing. He would go into the kitchen and boil medicine. The Dai family used about two canisters of natural gas each month, to the point where Yuan Xiong sometimes even wondered if their supplier was shortchanging them.
When Dai Baojin encountered a good doctor, he would come home to tell his family about how famous this doctor was and his prescription would cure his illness. Dai Baojin has visited all the famous doctors and medical hospitals in Fujian. Every time, Dai Baojin would come back with a huge pile of medicine. He would take them for a few days, and then throw them out because he did not think they were effective. Then he would immediately go to another hospital.
After a dozen years, the family has spent nearly 200,000 RMB on medical bills. "We've borrowed more than 50,000 RMB from relatives," said Dao Baojin's dad Dao Laohan. When they could no longer sustain it, an overseas aunt too Dao Baojin's younger brother to work in Canada so that he can help to support the family.
Dao Baojin did not work. His preoccupation was to run around to seek the magical formula that will cure his illnesses. But the results never satisfy him. He stays home all day. There are finger marks on the wall of the living room, measuring 6 to 7 centimeters long and more than 1 centimeter deep.
Dao Baojin has no friends. When the police came to investigate, they found his mobile phone. They wanted to find some clues, so they turned it on. There was only one telephone number that was called in or out. His mother Yuan Xiong said, "That is the telephone number for the hardware store. We use the phone to tell him to come down to eat meals."
Yuan Xiong felt that her son was getting weirder and increasingly volatile. Since 2002, he had beaten everyone in the family: parents, younger brother, younger sister. Dai Baojin's temper has even inflicted itself upon a customer of the hardware store, when he punched a businessman from Lianjiang county.
For Dai Baojin's sake, Yuan Xiong once told him to look for religion. Dao Baojin said, "I don't believe in anything else but medical science."
Since July and August, the last three medical receipts of Dai Baojing were: July 25, 88 RMB; July 29, 214 RMB; August 3, 266 RMB.
In Yuan Xiong's memory, in the most recent period, Dai Baojing began to complain that the previous doctors gave him too much laxatives so that he lost the function of his digestive system. That was the reason why he could not get relief. During the two days before the murder, there was nothing unusual. Dai Baojin just slept on his bed or stare into space. He only came downstairs to eat.
At noon on August 12, Dai Baojin ate a bit as usual. Yuan Xiong asked him if there was enough rice, but Dai Baojin said that he did not feel like eating. After finishing eating, Dai Baojin saw that his father's sock that was hung out to dry had fallen on the ground. He picked it up again. Then he went back into his room. That was the last time that Yuan Xiong saw Dai Baojin.
Since the afternoon of August 12, the family could no longer contact Dai Baojin.
On August 20, a pale Huang Suixin was sitting alone in the dormitory. Ever since the incident, he had to take a Chinese sedative in order to sleep. As soon he lays down, he would think about that scene again and he is afraid. Huang Suixin did not want to see Dai Chunfu's wife because he felt guilty. "If I had been able to stall for my time with the chair, maybe teacher Dai did not have to die." The people around him comforted him, "You were very brave already."
Huang Suixin has assisted Dai Chunfu for almost two years. He has never seen the murderer Dai Baojin. He even wondered if this over-stressed patient got the wrong person. Presently, Huang Suixin is in the second year of graduate school and he has doubts about wanting to become a doctor: "You never known if a patient from ten years ago may suddenly want to take your life now for some reason."
At the Chinese Medical Clinic, there is an atmosphere of insecurity. All the doctors are worried and they demand the clinic to offer protection. Someone said that they get worried when there are too few cases; or perhaps they can see the patients together. Director Zhang Wenzhong was in a difficult position: "I cannot very well assign a bodyguard for each doctor, or check at the gate if a patient is carrying a bomb."
The people at the Chinese Medical School were even more disappointed by the Internet comments. From their viewpoint, the curses of the "greedy doctor who killed people" was most unfair to Dai Chunfu.
Fifth year student Liu Songji remembered the first time that Dai Chunfu taught the students how to inject a little rabbit. Liu Songji thought that he was loving, "Teacher Dai said to use the needle tip to touch the small animal, so that it can feel that you are trying to please. Then you can do the injection."
The students recalled all the good things about Dai Chunfa. "He taught classes that were humorous, and he taught us everything in his toolkit without reservation. The undergraduates could take his notes for photocopying and even the auditing students can do the same."
They were sad that fate is so unpredictable. "Many people do not understand this profession. That individual had long-term prostate inflammation. It is a difficult illness to cure. It is one of the four major male diseases, and it is not completely solved in medical science."
From Huang Suixin's viewpoint, Dai Chunfu was able to resist temptation. "There are these pharmaceutical representatives who wander outside the clinic. He has always rebuked them: Don't come here again! Even if you did, I won't see you! So those pharmaceutical representatives don't come to see him anymore. Teacher Dai said: I can't use the medicine sold by these pharmaceutical representatives because I don't know what their effects are. Chinese medical treatment do not necessarily require expensive medicine."
Huang Suixin felt that most netizens did not understand teacher Dai Chunfu. For the first few days after the incident, he and other students at the Chinese Medical School got on the Internet to express their opinions in order to tell the truth about teacher Dai Chunfu.
Huang Suixin's fellow student Zaho Jianye wrote "An open letter to the respected leaders and the public" to ask for a fair assessment of teacher Dai Chunfu. The article said that certain Internet portals deliberately led public opinion to pin the current conflict between doctors and patients on a single good doctor, and therefore our esteemed teacher became the object of a flogging.
They issued a call for those colleagues, students and patients who have actually come into contact with Dai Chunfu to stand up and speak the truth!
Indeed, there was a post from a patient at the National Medical Clinic who said that in the spring of 2002 he suffered from a case of long-term throat inflammation, he spent more than 600 RMB at two hospitals without result but he came to the National Medical Clinic and got cured after spending a grand sum of 11 RMB and taking some Chinese medicine.
But very quickly, these favorable comments were overwhelmed in numbers and some of them were even deleted.
Several days later, Huang Suixin has given up the war of opinions: "It is hard enough to change one person's mind. Forget about changing the public's opinions."
At 10am on August 20, the doors of the Dai Chunfu residence finally opened.
At the altar, the smoke flowed around the candles. On top of the Chinese harp, there were pine branches. The widow looked sad.
Dai Chunfu's photograph faced the war. On one war, there is the photograph taken on the tenth anniversary of Dai Chunfu's marriage to Weng Xiaohong, with their daughter around their knees. The daughter is now 13 years old.
...
Overtime was a routine circumstance for Dai Chunfu. When he was late for lunch, his family would call him and he always said, "The patients had a hard time trying to get an appointment. Let me finish seeing the patients, or else they will have to wait further." Weng Xiaohong remembered that the record was set when he saw 82 persons in one session.
Even though the pressure from work was great, Dai Chunfu was always optimistic and calm. He was happy to help others. Some patients whom he has never met looked up information about him from the Internet and contacted him through email, and he was always willing to reply and give them prescriptions for free.
"I asked him if he ever prescribed the wrong medicine? He said that it is not possible, because he is very confidence about his prescriptions. I have never heard of a misdiagnosis by him," Weng Xiaohong recalled. When he treats a dismissed worker, he would note in the patient's record 'laid-off worker' to remind other doctors that they should prescribe less expensive medicine.
For those patients who have more complicated conditions, Dai Chunfu gave them his personal number. "Nine out of ten telephone calls at home was for him. Occasionally, Weng Xiaohong found that to be annoying, "Our family didn't even have a chance to sit down to chat. We speak a few sentences and then some patients calls."
"Just before you entered the door, a patient called to ask if Doctor Dai is here." Weng Xiaohong told the person, "Doctor Dai is no longer here."
Weng Xiaohong was wrapped in the pain of losing her husband. When the students told her about the unfavorable Internet comments about Dai Chunfu, she said that she had no time and she was in no mood to see for herself. "The person is already gone, so it is quite meaningless to talk about that."
She was shockingly understanding and forgiving about the aggressive comments on the Internet: "From the viewpoint of someone else who does not understand Dai Chunfu, I might have thought the same as well. The image of doctors is extremely bad right now," Weng Xiaohong said. Her younger sister sometimes does not dare to tell her co-workers that her brother-in-law is a doctor.
"The patients are socially vulnerable. But the doctors are socially vulnerable as well." Weng Xiaohong currently works at the Fujian Chinese Medical School Research Institute and believes that much of the patient-doctor conflict was due to problems within the system. As a result, the doctors become the target boards. "A few days ago, the State Council research organization has acknowledged that the medical reforms had been unsuccessful." But Weng Xiaohong thought that it is too abstract to talk about those kinds of problems, when all she wanted was for her husband to live well. That idea was an unfulfilled wish.
On the study desk, there were some papers for a book edited by Dai Chunfu. It was scheduled to be published on August 25, so that the students can use it as learning material when school starts on September 1. To meet the deadline, Dai Chunfu asked his wife Weng Xiaohong and his student Huang Suixin to proof-read the draft.
On the morning of the incident of August 12, Dai Chunfu even sent a SMS to his editor, guaranteeing that the draft will be ready by August 13.
