Dr. Bethune, The Doctor Who Helped the New China: Part 2
BETHUNE IN CHINA. THE MAKING OF A HERO (1938–1939)
In October 1937, Bethune, now 48 years of age, recognized that the Sino-Japanese conflict in the most populous country in the world was to be a momentous event and he was able to convince the Canadian Communist Party and the China Aid Council based in New York to send him to China to organize medical care for Mao Tsé-Tung’s Eight Route Army, one of the main military forces of the Communist party of China. In early January 1938, he traveled from Vancouver to Hong Kong with Jane Ewen, a Canadian nurse from Winnipeg. It took them a further three months to travel by train, by horse and on foot under daily Japanese attacks to reach Yenan in northern China , where Mao’s headquarters were located.
On arrival in Yenan, he met Mao, who had heard of Bethune’s heroics in Spain and wanted him to duplicate these efforts in China. Bethune’s plan was to establish mobile surgical units and travelling blood banks, and he assured Mao that he could reduce casualty mortality rates by 75%. Soon after, he was made Commander of all Chinese medical forces. The fact that Bethune was a card-carrying communist with credentials from the Communist Party of Canada was instrumental for him to get accepted by Mao and the Eight Route Army.
He resumed performing surgery after two years without having done any operating (Figure 19), and he not only treated war wounds but also took time to deal with civilian illnesses as well. He renovated existing primitive hospital facilities and opened a ‘model hospital’ in a Buddhist temple on September 15, 1938. Unfortunately, the hospital was destroyed by the Japanese forces three weeks later. The hospital was eventually relocated in Shijiazhuang and renamed the Bethune International Peace Hospital. The hospital still exists today and has become a 2000-bed ultramodern facility.
Recognizing that his Chinese colleagues were completely untrained but dedicated, intelligent, anxious to save and aspiring to be of aid to suffering mankind, he gave them daily courses on basic anatomy, physiology and how to treat minor wounds. He understood that more doctors and nurses were needed, and he took young peasants, whom he called “barefoot doctors, docteurs aux pieds nus” and graduated them in one year for doctors and six months for nurses. In a letter to Dr Louis Davidson, a well-known New York thoracic surgeon, which was reprinted in the Baltimore Evening Sun on January 13, 1940, Bethune wrote the following :
The work I am trying to do is to take peasants (boys) and young workers and make doctors out of them. They can read and write and most have a knowledge of arithmetic. None of my doctors has ever been to college or universities, and none has ever been in a modern hospital (most of them have never been in any hospital), much less a medical school. With this material, I must make doctors and nurses out of them- six months for nurses and one year for doctors-. We have 2,300 wounded in hospitals all the time. These hospitals are merely the dirty, one-story mud-and-stone houses of out-of-the-way villages set in deep valleys, over hung by mountains, some of which are 10,000 feet high.
After the war, barefoot doctors became very important in the Chinese health care system because they could provide medical services in rural communities. At one point, there were more than one million barefoot doctors in China, but they no longer exist, having been gradually replaced by ‘administrators’. Bethune laid the groundwork for a medical school, now located in Changchun, Jilin province, and wrote an English medical textbook that was later translated in Chinese. In modern China, the Jilin University medical school founded by Bethune is one of the few to be recognized as an Advanced Institute by the Central Government. This is where, one of the authors of this manuscript (JD) spent a sabbatical year in 2008–2009.
He designed operating equipment, which included a collapsible operating table, antiseptics and sterile gauzes that could be packed in wood boxes and brought to the battlefields on the backs of three mules. Most, if not all, of the surgical instruments that he used were made by local carpenters and blacksmiths. The operating unit included Bethune, two Chinese doctors, one interpreter that Bethune had trained as an anesthetist, a cook and two orderlies. Bethune’s stamina, his ability to improvise, and the speed and relative roughness with which he operated (so frequently criticized in his Montreal days) now became indispensable assets . He would often be warned ahead of time that a major battle was to take place and he would move his unit and equipment near the battlefield. His slogan was: “Doctors go to the wounded; do not wait for the wounded to come to you”.
He took soldiers as brothers and treated villagers as his relatives. When soldiers heard that Bethune would be at the front to take care of the wounded, they chanted: “Attack, attack, Bethune is with us”.
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On October 28, 1939, he cut his finger with an osteotome while doing an open reduction of a fractured tibia, and some days later, he operated bare-handed on a soldier whose scalp injury was infected. Interestingly, Bethune did most of his operating in China bare-handed, not only because surgical gloves were unavailable but also because he preferred it that way. On November 11, he wrote the following:
I came back from the front yesterday. There was no good of my being there. I couldn’t get out of bed or operate… I think that I have septicemia or typhus fever.
Soon after, an abscess of his finger developed, followed by upper limb gangrene, and sepsis. Bethune, who was conscious to the end, and who had refused to have his arm amputated, died on November 12, 1939, only 18 months after his historical meeting with Mao. Of note, Bethune had given some time before his personal supply of sulfamides to wounded soldiers.
A long procession of comrades and soldiers carried his body for four days along icy mountain paths to a place of relative safety in Shansi where he was buried in a United States flag because no Union Jack flag could be found. In 1952, his remains were taken to the Revolutionary Martyr’s Cemetery in the suburbs of Shijiazhuang, located approximately 300 km from Beijing. Across the street from the cemetery is the Bethune International Peace Hospital, where a memorial hall inside the hospital attracts thousands of visitors every year.
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