Barefoot Doctors Spreading Hepatitis in China with Reused Needles - Editorial

Townsend Letter for Doctors and Patients,  Jan, 2002  

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In a story which seems more fitting for the National Enquirer than the New York Times (8/20/01), we are told of rural doctors injecting children for upper respiratory infections using dirty needles. We expect this sort of thing in the Third World developing nations, even in Eastern Europe. The pitiful situation in bankrupt Romania and Albania with no funding for medical care for the poor and the chronically ill children has made for many television newsmagazine shows. What we wouldn't expect is that a nation which is not bankrupt and which is arguably becoming the world's leading manufacturing exporter, China, is allowing an underground market of used syringes, needles, IV solution bags, and other medical supplies. All of this would be nothing more than the horrors of the illicit drug trade, heroin abuse, and similar street drugs, except that it isn't streetside drug shooting galleries, it is the typical medical practice of contemporary China in rural provinces.

The so-called "barefoot doctor" of the '80's who received perhaps 2 years of education is now the main practitioner in much of rural China. These barefoot doctors didn't learn about Western medicine when they trained, but now make a specialty of treating upper respiratory infections with antibiotics and corticosteroids, only they do so with an injection, not the prescription pad. Of course, there is an economic incentive to administer such injections. The doctor appointment only allows for pennies to be collected on the appointment time, but a good fee can be collected for an injection of antibiotics.

Some physicians attempt to be scrupulous about their medical practices. There are some who will only use a "clean" syringe and needle from a paper package. Too bad that the underground economy is cleaning up many used syringes and needles with improper cleaning techniques and many of these needles, previously used for injections, turn up as "new" syringes and medical supplies. Of course, a far greater number of practitioners do not have the funds or do not wish to spend their funds on obtaining clean injection supplies. Instead they reuse syringes and needles as long as no blood is spotted on the needle. When there is blood, a quick wash under the faucet will do. Still this would not mean much if these were only injections for truly sick and debilitated patients. Unfortunately this is not the case. Many rural farmers bring their infants into these doctor's offices complaining of sore throat and fever, wanting Western-style antibiotic therapy. A typical "cocktail" for many of these youngsters includes 2 very p owerful antibiotics, one anti-viral agent, and a steroid. None of these treatments would be necessary for a typical cold or low-grade upper respiratory infection. But like their American counterparts, these Chinese doctors like prescribing antibiotics. However, instead of whipping out a prescription, they grab a syringe of drugs and inject the sick child.

The net result is that China is experiencing a rampant incidence of Hepatitis-B. Because Chinese children are not vaccinated for Hepatitis, they have no defense for exposure to it. It is not uncommon for a youngster to see a doctor three to six times a year with a cold and to receive 6 injections or more. With so many doctors reusing their syringes and needles there is likely blood contamination spreading Hepatitis from child to child. Of course, the possibility is high that HIV might be spreading in a similar fashion. However, the epidemiologists in Beijing have been able to track Hepatitis spreading in this alarming fashion, but not HIV. Still it is quite likely that HIV is spreading in a similar fashion. Epidemiological estimates are that 60% of Chinese have Hepatitis B, compared to only 1% in the US.

Economic forces play strongly in this outrageous scenario of disease spread by dirty needles. Many used medical supplies are simply packaged up and removed from clinics and hospitals. The supplies first make their way to dumpsites and landfills, but much of the medical supplies get removed by freelancing parties and taken to recycling centers. Some of the medical plastic gets crushed and broken apart for making recycled plastic bags. But large quantities get delivered to backyard cleaning operations where syringes and needles are simply washed and put into paper containers for reuse. Chinese authorities have attempted to crack down on these operations but with little success.

It is ironic that these practitioners feel that they do not have the funds to spend on clean syringes and needles, yet they willingly obtain and administer powerful antibiotics, anti-virals, and corticosteroids for injection. True, medicines are cheaper in China than in the US. Yet, money is spent to get the drug and none is spent on preventing blood contamination. These Chinese doctors are instructed in barefoot medicine on the use of herbs and acupuncture, yet forsake traditional herbal Chinese medicine for Western antibiotics. One can hardly blame the practitioner, given the love for antibiotics in our culture. Still it is ironic that these Chinese toddlers are being denied herbal treatment to receive antibiotics and steroids with an extra measure of Hepatitis.