Training of personnel for the healthcare sector at the initial stage of development of the People's Republic of China (1949-1960)

Aktamov Innokentii Galimalaevich ORCID: 0000-0002-8646-1048 PhD in Pedagogy PhD, Head of the Centre for Oriental Languages Translation, Institute for Mongolian, Buddhist and Tibetan Studies of the Siberian Branch of the Russian Academy of Sciences; associate professor of the Department of History and Regional studies of Dorzhi Banzarov Buryat State University 670047, Russia, Republic of Buryatia, Ulan-Ude, Sakhyanova str., 6, office 305 aktamov13@gmail.com

Bodoev Aleksandr Vasil'evich PhD in Medicine PhD in Medicine associate professor of the Department of Faculty Surgery of Dorzhi Banzarov Buryat State University 670002, Russia, Republic of Buryatia, Ulan-Ude, Oktyabrskaya str., 36a bodoev@mail.ru

Historical foundations of cooperation. The healthcare system is one of the foundations of the socio-economic development of the country. The effective functioning of social institutions directly depends on the level of qualification of specialists. Professional training is of particular importance for the field of medical care and prevention. In this regard, the formation and development of the healthcare system in China in the middle of the twentieth century is of research interest. At that time, China was creating a new state, the country's leadership was defining strategic guidelines for its development, and there was active interaction with the Soviet Union. The period from 1949 to 1960 is characterized by many researchers as the "golden" decade ^{[1, p. 47]} of Soviet-Chinese interstate relations, during which projects in all spheres of public life were intensively developed. At the same time, the history of bilateral relations between the countries dates back to the time of the Russian Ecclesiastical Mission in Beijing (the end of the XVII century). This can be called the first stage of cooperation. The second stage can be considered the construction of the railway – the KVZhD, which stimulated the systematization of relations between Russian and Chinese subjects. The conditional third stage occurred during the events related to the revolution of 1917 and the great wave of migration, which peaked in the 1920s ^[2].  The next stage is connected with the activation of the Soviet Union's policy in China during the Second World War. Thus, the so-called "golden" stage in the development of bilateral relations is the fifth stage. During this period, the policy of the Chinese leadership in the field of personnel training for the healthcare sector is of interest. As many domestic researchers note, the historiography of Soviet-Chinese cooperation in the field of medicine is not so extensive, but in recent years the research of P.E. Ratmanov, O.S. Nagornykh, V.Y. Bashkuev, N.P. Shok, etc. has been devoted to these issues.     

After the proclamation of October 1 , 1949 After Mao Zedong created a new state – the People's Republic of China, the communist government began reforms in all spheres of society, including the process of modernizing the health care system.

On February 14, 1950, the "Treaty of Friendship, Alliance and Mutual Assistance" was signed between the USSR and the PRC. In addition to this agreement, a bilateral agreement was signed on the Soviet Union's assistance to China for the construction and reconstruction of large enterprises, including social facilities. Detailed information is presented in the collective work of N.L. Mamayeva, I.N. Sotnikova, A.L. Verchenko entitled "Participation of the USSR in the reconstruction and construction of "156 production facilities" in the PRC in the 1950s. New facts and circumstances of Soviet-Chinese cooperation" ^[3].

Training of personnel. A separate area of cooperation in the field of medicine was the training of qualified personnel. Cooperation in this direction between the countries began back in the 1930s, when the Soviet leadership began sending specialists to China to work in medical centers and outpatient clinics at Consulates General in the northwest of the country. Doctors' business trips, including military ones, continued during the Second World War ^{[4, p. 78]}.

A fundamentally important document defining the nature and basic principles of cooperation between the countries is the "Soviet-Chinese Agreement on the working conditions of Soviet specialists in China", which was signed on March 27, 1950 in Moscow. Within the framework of this agreement, the Soviet Union undertook to send specialists and advisers of various qualification areas to China, taking into account the requests of the Chinese side. A few years later, in 1954, an Agreement on cultural cooperation and Technical assistance was signed between the USSR and the People's Republic of China, which made it possible to significantly expand the volume of economic assistance from the Soviet Union, as well as to increase the number of specialists sent to China [Ibid.]. Within the framework of bilateral cooperation, representatives of Chinese youth were sent to study in the Soviet Union. According to statistics, in 1950, 400 students from China studied in the USSR, which was 6.4% of the total number of students from abroad; in 1960, 900 students were 9.7%. The People's education of the People's Republic of China from 1949 to the mid-1950s generally followed the same path as the socialist education system in the USSR ^{[5, p. 80]}.

At the initial stage of the development of the new Chinese state, the issue of training national personnel was of paramount importance. As I.N. Sotnikova notes, "... at the beginning of the 1950s, there were 164 thousand engineering and technical workers and 15.8 million workers and employees in the whole country, of which only 4.3 million industrial and transport workers employed mainly at small and minute enterprises. In 1953, China had only 78 design organizations, each of which employed, as a rule, less than 200 people" ^{[6, p. 607]}. The top leadership of the country understood that without the help of the Soviet Union it is impossible to systematically solve the personnel issue, so the Government of the People's Republic of China asked the USSR to assist in planning, developing and implementing projects in various industries, organizing administrative and managerial apparatus, creating research and design institutions [Ibid.]. In January 1955, Advisor to the President of the Chinese Academy of Sciences B.A. Kovda developed a draft of "Some measures for planning and organizing national research in the People's Republic of China", suggesting that the Chinese side organize and plan scientific research throughout the PRC. to develop a plan of scientific vision of development to address the most important issues set out in the five-year and fifteen-year plans of the national economy ^[7]. In the period from October 1954 to July 1955, he was the chief adviser to the President of the Chinese Academy of Sciences. Thus, it can be argued that consulting, technical and organizational assistance has affected all spheres of the economy and public life.

As for its own health care and training system, China began its creation in the Western manner after 1912. This was due to the epidemic of pneumonic plague in Manchuria in 1910-1911 . The government in 1912 created the Beijing Medical School (now the Center of Medical Sciences of Peking University) as a leading professional medical organization according to the Western model. The first set of the school was 72 people. Over the first fifty years, this institution has trained about 200 thousand specialists. However, given the vast territory and the number of the population, medical workers was clearly not enough. The country's leadership, represented by the Kuomintang, understood that traditional Chinese medicine could not effectively combat diseases, and in the 1920s tried to make every effort to create a modernized public health service and medical education on the Western model. The Department of Public Health was established in the Ministry of Internal Affairs in 1927. In 1945, it was reorganized into the Ministry of Health.

In the early 1950s, China introduced the Soviet model of epidemic prevention and education, created a sanitary and anti-epidemic public health system at medical universities. In addition, the basic principles of the functioning of the health care system were formed: compliance with occupational hygiene, healthy nutrition, environmental hygiene, sanitary standards in general education institutions and compliance with radiation hygiene standards ^[1].

The Soviet model of healthcare in the People's Republic of China quickly showed its effectiveness. For example, infectious diseases that potentially pose a high risk to public health, such as smallpox, cholera, plague, typhus, etc., have either been completely eradicated or have been effectively combated. Thanks to nationwide routine immunization programs, infectious diseases such as polio, diphtheria, whooping cough, and measles began to be prevented in a timely manner. In addition, most types of endemic and parasitic diseases are generally quite effectively controlled. Despite natural disasters, such as floods and earthquakes, which are a natural source of infectious diseases, there are much fewer cases of outbreaks of epidemics. This indicates that the public health and hygiene situation has improved significantly. The evidence of high quality changes can be assessments and official letters from the leadership of the PRC. For example, on July 21, 1956, Minister of Health Li De Qian sent a letter of gratitude to the leadership of the Soviet Union, in which he noted: "Your advanced medical theory and rich clinical experience in the field of therapy have greatly helped in improving the work of medical institutions and medical practice, also helped to train teachers and reform higher medical educational institutions in China, which promotes the development of public health" ^{[8, pp. 171-172]}.

The interest in the development of the national health care system on the part of the country's top party leadership was expressed in full support of the USSR's initiatives in this area. In 1960 , an agreement on scientific cooperation on the most important issues of medicine was signed between the Academy of Medical Sciences of the USSR and established in 1957 . By the Academy of Medical Sciences of the People's Republic of China [Ibid.].

The creation of institutions for training personnel for the health care system was carried out at an accelerated pace. Already by 1965, there were more than 230 educational institutions in the country that trained specialist doctors. The total number of such medical workers exceeded 200,000 people. The leadership of the People's Republic of China, following the model of the Soviet Union, began to create multidisciplinary hospitals in provinces and counties, and mobile outpatient clinics began to function in rural areas. All this made it possible to create a unified healthcare system throughout the country in a relatively short time. Of course, the functioning of both individual institutions and the entire system as a whole failed, the problem with logistics was not solved, the problem of personnel shortage remained urgent. This even caused concern on the part of the country's top leadership. At the same time, it should be recognized that the foundations laid in the middle of the twentieth century made it possible to create an effective model of disease prevention and treatment of the population of one of the largest countries in the world.   

According to statistics, the total mortality of the population in China decreased from 20 per 1,000 people in 1949 to 6.43 per 1,000 people in 2001. The infant mortality rate decreased from 200 per 1,000 in 1949 to 28.4 per 1,000 in 2000. Maternal mortality decreased from 150 per 10,000 in 1949 to 50.2 per 100,000 in 2001. The average life expectancy increased from 35 years in 1949 to 71.4 years in 2000 ^[16].

Conclusion. Summing up, it should be noted that in the first years of its existence, the People's Republic of China faced a number of acute social problems that required urgent solutions. Along with the solution of food security issues, the elimination of illiteracy, it was necessary to provide the population with medical care. As with the implementation of the modernization of the agricultural sector, the development of industry, the New China in the field of healthcare fully relied on the assistance of the Soviet Union. The 1949-1960-ies are particularly significant and effective from the point of view of cooperation between the countries, both from the point of view of political and ideological aspects, and in terms of the implementation of specific projects in various sectors of the economy and the social sphere. An invaluable contribution to the development of the personnel training system for the People's Republic of China was made by Soviet specialists who were sent by the country's leadership to fraternally help the Chinese people. These were highly qualified personnel who conducted their activities both at the highest level in the rank of advisers to industry ministers, heads of enterprises, state institutions, and employees directly employed in the real sector. Despite a relatively short period of active cooperation lasting only 10 years, the Chinese state was able to adopt the Soviet model and integrate it into its national health system. Further development of this sphere has shown that the basic foundations of the Soviet model have not lost their significance in modern conditions, including in the fight against the COVID-19 pandemic. In the future, it is planned to expand the study and trace the evolution of the healthcare system of the People's Republic of China in different periods of state development.