In the first decades of Communist Party rule, China saw life expectancy rise and maternal and infant mortality fall. The reason: a national effort to get basic health care to every village - free vaccinations, antibiotics, and instruction on sanitation, delivered by hastily trained health practitioners known as the "barefoot doctors." The rapid economic development brought by free-market reforms has ironically brought a collapse in the country's health care system. Under-funded hospitals now refuse treatment to the poor, and medical professionals leave impoverished rural areas. Millions are left without basic medical care. VOA's Luis Ramirez traveled to a remote village in China's far western province of Gansu.
A four-wheel drive vehicle lurches for hours along dirt roads and through shallow rivers to the village of Zhuangzi - 10 hours by train, bus, and car from the provincial capital of Lanzhou.
The mud houses, cave dwellings, and donkey carts on the parched landscape do not fit with the image of a China whose frantic development has catapulted its economy to the fourth largest in the world.
Alongside the road leading into the village a man, who asked to be identified only as Wang, swings a pick, repairing the road.
Self-trained and unlicensed, Wang is a 63-year-old retired hospital worker who serves as the village doctor. He shows his clinic, a bare room with a concrete floor and nothing more than a stethoscope, a chipped enamel tray with tweezers, and a jar with cotton. He proudly says he has never accepted money from villagers for medical treatment because, he says, no one in this village could afford to pay.
"Hundreds of villagers have come to me," said Wang. "I diagnose them and give them prescriptions. The medicine I have is just common medicine. It can only relieve symptoms. If it is anything serious, there is nothing I can do."
He says many sick villagers simply die, and their relatives sometimes never know what killed them. A man named Zhao Pingan comes to the door to see Wang. Wearing an old, blue communist-style worker suit, he is a frail man who appears to be in his 80s.
He says he is 58 years old but has been crippled by a respiratory infection that might have been easily cured with proper medical care.
Zhao says he has been sick for five years and he says it is quite serious. He feels weak and cannot move around much. He has never been to a hospital because, he says, his family is too poor.
The scene in Zhuangzi village is in sharp contrast to the gleaming hospitals of large eastern cities such as Shanghai and Beijing. There, advertisements tout the latest in expensive and often unnecessary procedures such as breast enlargement, eyelid reshaping and other cosmetic surgeries, as well as virginity restoration for women.
The disparity has been created in part by policies that encouraged hospitals and doctors to seek profits by selling drugs and expensive treatments to make up for the loss of subsidies that were eliminated as part of the country's transition to a free-market system.
With health insurance unaffordable for most people, international health experts estimate about half of China's rural population has no access to hospital services.
The numbers clearly spell out the disparities.
In recent years, the rural infant mortality rate has consistently been more than double what it is in urban areas - and it is rising. Some Western medical journals report the mortality rate among children under five in China's rural areas was 37 for every 1,000 in 1999, and climbed to 39 in 2002.
For years, China's communist leadership has been trying to close the health-care gap between cities and villages. Their ideas include a low-cost rural health insurance plan, which critics say has reached few people. Public health experts, however, see some hope as the central government has made health care a higher priority in recent months.
Henk Bekedam is the World Health Organization's representative in China.
"The government has already very clearly recognized that they need to so some re-thinking on how best to re-engage in health, and to re-invest in health," said Henk Bekedam.
At the close of the National People's Congress - China's parliament - in March, leaders vowed to spend billions of dollars on improving peasants' access to medical treatment.
However, none of that money appears to have yet reached places such as Zhuangzi village. There in his makeshift clinic, Wang says he will continue to provide free care as best he can, using the meager state pension that he receives every month.
"I was born in the countryside, and I understand how hard life is for farmers," he said. "I think treating patients who are poor is the moral thing to do."
Officials have warned that the health care system's failures could threaten stability at a time when China is already seeing a sharp increase in the number of civil disturbances.
However, there are no documented cases where health care issues have triggered major unrest. In Zhuangzi village, Wang says people died even when the barefoot doctors were there and so he asks, "Why should anyone expect change?"