Barefoot Doctor – Can Xue

[Yale University Press; 2022]

Tr. from the Chinese by Karen Gernant and Chen Zeping

That was the vision, anyway: arm farmers with three to six months of medical training and “one silver needle and a handful of herbs.” Then send them back to their communities, where they would divide their time between working the fields and providing primary and preventative care to their neighbors. Officially launched in 1965, the “barefoot doctor” program transformed healthcare in rural China, boasting 1.5 million farmer-medics by 1975. The scheme brought low-cost healthcare to peasants fast, and influenced the World Health Organization’s landmark 1978 declaration on the importance of primary care.

The program ended abruptly with the market reforms of the 1980s, and has since been subject to critique, including historian Fang Xiaoping’s charge that barefoot doctors’ inadequate training in Chinese medicine “effectively converted rural populations to a preference for Western medical treatment.” But the design continues to inspire global health experts for its promise of an approach that is, as political scientist Shaoguang Wang summarizes, “egalitarian, grassroots-based, decentralized, de-professionalized, ‘low-tech,’ economically feasible, and culturally appropriate.”

This dream of accessible community medicine sets the stage for Can Xue’s latest novel, Barefoot Doctor. Under the benediction of a kindly mountain, local medic Mrs. Yi tends to her medicinal herbs and potential successors. Her gentle care inspires other barefoot doctors, who gather around her, over the course of book’s short episodes, like a conference of angels. And indeed, the doctors summoned become increasingly otherworldly: at least two of them may already be dead.

Among Mrs. Yi’s more earthly protégés is Gray, a young man from Yun Village. He’s a promising herbalist; unfortunately, he doesn’t like interacting with other people, least of all his patients. So Mrs. Yi and her husband are pleased when Gray starts following them in the night, remarking: “He’s observing us, trying to learn how to care about his neighbors.” If Mrs. Yi has challenged Gray with technical training akin to the clinical intensives of the Cultural Revolution’s program, we don’t see that on the page. Instead, Can Xue focuses on the socio-psychological education that global health policy professor Chi-Man (Winnie) Yip celebrates as key to universal healthcare: “Barefoot doctors were part of the community, understood the community, cared about the community, and were trusted by the community.” For Mrs. Yi, the barefoot doctor pedagogy isn’t so much a crash course as a series of trust exercises. Relating to the needs of others is not a lesson she can impart to Gray overnight.

Though most people in Yun Village are very poor, Mrs. Yi observes a gift for contentment: “The concept of the village’s vitality was hard to define, as mist is, but it was definitely a fact.” The villagers don’t bother to track their exact age or worry too much about sickness, death, and the voices they hear in the night. They are more curious about their local chickens, who seem to be in a spiritual tug-of-war with a phantom weasel. Eventually the weasel shows up dead, its body stretched out perfectly intact beside an equally unmarked dead chicken. The mystery is, if not solved, temporarily laid to rest.

Happiest of all are the old people dying of cancer. Mrs. Yi’s herbs ease her patients’ discomfort and her constant care brings equanimity, even ecstasy. The elderly Mr. Tauber, in his last days, stoops to kiss a daisy and lies on the ground to enjoy the warmth of the dirt. In between spasms of pain, the dying Mrs. Yossi tells Mrs. Yi, “I’m overjoyed.” These elderly villagers, Mrs. Yi observes, have the wisdom of “ancient saints.” They have spent every day of their lives in active contemplation; now, at the end, they’ve reached true understanding of what Mrs. Yi refers to as “that thing.”

In Barefoot Doctor, “that thing” is understanding that a grassy field grabs at your passing feet because it adores you, and that the history of a mountain village can be observed in the spotted leaves of a local herb. Such interconnectedness can lead to waves of intense emotion. “It must be exhausting to live as a barefoot doctor in a Chinese village if Can Xue’s latest novel is anything to go by,” snipped the Spectator:  “Not because of your work as curer-in-chief, but because all your patients are either nauseatingly happy or prone to near-constant weeping.” Yes, it does take a little while to adjust to the “rosy cloud” the characters experience. A few chapters in, the reader might wonder, is an author allowed so many scenes featuring tears of joy? As if winking at this inclination to enforce of quota on happiness, Can Xue has slyly seeded the book with a few skeptics, prey to the familiar worldly concerns of social status and economic security: of the inhabitants of Yun Village, I relate most to Ginger, a “difficult daughter-in-law” and outsider. Ginger is untrusting, volatile, and frightened of death. She even goes so far as to fret that the kindly Mrs. Yi has designs on her impoverished family’s lean-to as a storage shed.

To look for detailed character studies, bravura phrase-making, or intricate plot developments in Barefoot Doctor is to misunderstand Can Xue’s interest in fiction. The novel’s sentences drift in and out of linear sense; its narrative sequences accrete their surrealism slowly, in a structure of repetitions and variations more raga than epic. In “A Short Piece on Experimental Fiction” published in BOMB, the author describes her process as akin to that of blind, burrowing, subterranean animals:

These animals, who have never before appeared on the surface, eat the soil. The orientation of their plowing is vertical, only they do not see the direction they are going with their eyes, eyes atrophied long ago. Their vertical motion is in tune with the rhythm of the earth. They use their bodies and minds to conform to this rhythm of nature.

In her writing, Can Xue is digging not upwards toward the surface but down into the core. She asks her readers to do the same. As she explains in the interview that accompanies the BOMB essay, once we dispense with our fixation on literal meanings and the “diverse confusion of human affairs,” we can approach “literature of the soul.” It’s an assignment that is both inward and interpersonal: delve into that deep place, Can Xue promises, and we’ll find that “contact between souls is possible.” Look to Yun Village not for entertaining anecdotes, then, but for reverie.

Over the course of the novel, Barefoot Doctor’s odd, fable-like logic becomes more insistent, and more persuasive, as if Mrs. Yi herself is in charge of the reader’s treatment plan and slowly upping our dose of “cheerful” herbs. Notions of selfhood, agency, and temporality start to smudge. Gray follows the guidance of omnipresent Grandpa Onion; Mrs. Yi takes instruction from her patients. In a particularly vivid passage that exemplifies Can Xue’s ability to turn disorientation into a kind of enlightenment, a young woman named Angelica travels to Blue Mountain, with the hope of training with dying Dr. Lin in the remote Blue Village. She is greeted first by a disembodied male voice in the night, then by a hospitable woodsman in the morning. Are they the same person? Angelica seems unconcerned. She asks:

“What’s your name, sir? Why did you bring me firewood?”

“My surname is Firewood. Please call me Uncle Firewood. Why did I bring you firewood? Because Dr. Lin’s cause is mine as well. That’s what I think anyway. Good-bye now. I’ll come again tomorrow.”

Uncle Firewood’s neighbors include Blue, who says she lives in Blue Village, and Wind, who demonstrates he has the ability to disappear “like a gust of wind.” Dr. Lin’s name (林) means “forest.” Blue’s husband, whose gut is swollen with acute liver disease, gets at the crux of local nomenclature with a terse greeting: “I am Blue Village. Couldn’t you recognize me?”

“I—oh, I kind of get it now,” replies the intrepid Angelica. “I love you, mister.”

Angelica walks in circles trying to find the doctor. Pecking ravens unlace her shoes; when she bends to re-tie them, she’s overwhelmed by the sight of a crystal stone with a dark hole at its center.

By this point in the book, circularity makes sense. Blue Mountain and the black hole of Blue Village absorb Angelica: she can’t locate her new community without already belonging to it. Angelica accepts this calmly. Blue Mountain will handle her fate from here; once she is assimilated, she will arrive. The young doctor has fulfilled her destiny and become her own best teacher. It seems fair to assume that Angelica’s first step in treating Blue’s ailing husband will be to harvest some of the mountain’s wild bai zhi (白芷): the herb is known in English as angelica.

The lessons of Barefoot Doctor’s vignettes are, like those of folklore, more or less repetitive. Be patient. Be kind. Receptive. Diligent. Allow for a love that extends to one’s emotionally needy chickens, to a sleepy acacia tree. Stop asking petty questions like “Whose ghost is chanting an herbal spell in the night?” or “Did Spoon literally elope with a tiger?” Perhaps above all else, take heed of dreams.

Other critics have in fact compared reading Can Xue to the act of dreaming. I’d add that to read too much Barefoot Doctor in a sitting is akin to oversleeping, indulging semi-lucid dreams until your unconscious is stretched so thin you wake up feeling hungover. Sometimes the up-and-coming barefoot doctors experience a similar fatigue—but it’s usually excessive consciousness that is the problem. When Mia, another young doctor, rapidly excels in her work, she experiences a fear of failure so great that she cannot see the moon in the night sky. Then she dreams of filling prescriptions and wakes restored.

In the same BOMB article, Can Xue describes her fiction as “an experiment without an escape route,” which helps explain why the soothing dreams experienced by the characters of Barefoot Doctor don’t necessarily make for a restorative reading experience. Her stories, she explains, “take place in a region that borders on death, revealing a resolve to stake everything on this one attempt without turning back. What my stories suggest is that people can live inside of art.”

The author is pointing, in part, to the vulnerability of her unadorned sentences: the writing has nothing to hide behind. That alone can make a reader nervous. What’s even more nerve-rending is the prospect of living inside an artistic experiment when its creator has warned you there’s no trapdoor. As scholar Megan Walsh writes of Can Xue, “Her work is totally detached from surface reality.” Instead, Can Xue’s prose pushes the reader to burrow further and further inward, until the surface text of the so-called story is almost immaterial. Growing closer to the book in detaching from its text is a little like Angelica’s pursuit of Blue Village: accepting the paradox of intangible proximity offers a revelatory release from self-consciousness. As with Angelica’s quest, the prose style of Barefoot Doctor asks us to relearn what we thought we knew. After suspending selfhood for several chapters, the discombobulated reader might very much like to wake up.

Before Can Xue was a celebrated author, she was a barefoot doctor named Deng Xiaohua. (She was also a temporary teacher, a worker in a small factory, and a tailor.) The Maoist regime that launched the medical program had also sentenced her journalist parents to “reeducation” through hard labor in the countryside; she and her seven siblings were left with their grandmother. At times, the impoverished and stigmatized family were so hungry they resorted to eating their clothes. It’s tempting to read Barefoot Doctor as a utopian corrective to both the author’s life experiences and the complicated mess of history.

In the 1970s, foreign scholars were dazzled by the success of the barefoot doctor program, but their access to data and research sites was limited to government propaganda. Even today, with the archives open, the Cultural Revolution rebuffs inquiry. Miriam Gross, professor of Chinese history, writes: “Bottom-level campaign reports devolve to extensive quotes from Mao and large numbers of greatly exaggerated statistics, making them of somewhat limited utility. Likewise, oral histories can involve government intervention, censorship within the interview process, and danger for the participants.”

But in the fictional Yun Village, the principle of revolutionary rural healthcare is all that remains of the Maoist state. Here, the patients are trusting, the medicine is effective, the countryside adoring, and the barefoot doctor so central to her community it’s impossible to imagine her office could ever be abolished (as the role in fact was, in 1985). It’s a system with no paperwork and no political agenda. People are poor (one courting lover offers sweet potatoes to his darling), but somehow, in Barefoot Doctor, it doesn’t seem to matter. Can Xue’s characters weep joyfully and resist degradation. They even resist hunger.

In this light, the audacious crying of Mrs. Yi’s patients can be taken as an clue that the genres of historical commentary and autofiction aren’t big or wild enough to encapsulate this ambitious, mystical novel. Where history might be devastating, the soul is sublimely strange—and Barefoot Doctor is nothing if not a tale of miraculous, full-circle bafflement. At the end of the book, that mysterious weasel shows up again, apparently alive and still “elusive, solitary, beautiful, and arrogant,” despite the new bald patch on its belly. The skeptical Ginger will have the great pleasure of falling in love with it. In the final pages of Barefoot Doctor, her heart pounds as she watches the weasel make out with a sunflower. This is a happy ending.

Evangeline Riddiford Graham is the author of poetry chapbooks La belle dame avec les mains vertes and Ginesthoi. Her recent writing can be found in Los Angeles Review of Books, Art News Aotearoa, Divagations, and Landfall. She hosts and produces the poetry podcast Multi-Verse.