Health > Intergovernmental conference of Far-Eastern countries on rural hygiene : report by the Preparatory Committee

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It may, however, be asked whether, on the contrary, treatment
by western-trained doctors should not be insisted upon even
in the villages. The economic structure of the village in all
Eastern countries is extremely rudimentary and provision
for treatment by a fully trained doctor is out of the question,
at the moment, for financial reasons.
In several countries, attempts have been made to pay doctors
settling in villages a minimum salary to which they can add
by taking private patients. This system does not, however,
appear to have met with much success, for the reason that
this minimum salary was not adequately supplemented by
their private earnings. (In the Punjab, for instance, out of
359 doctors in charge of the rural dispensaries, only two received
grants of this kind. In Annam, this system worked successfully
in only four cases.) Moreover, the difficulties of inducing a
doctor to settle in a village are not only financial but individual
as well. A man whose whole youth has been spent in a town,
who has studied at a university or followed the courses of a
medical school, will be reluctant to spend the greater part
of his life in a village where the houses are built on piles or
have mud walls, amidst a population that is so ignorant that
it does not even desire his presence.
The question therefore arose whether these economic and
social objections could not be met by the training of “ semi-
qualified ” doctors—that is to say, young men who had
undergone a short four-year course and would be content to
work for lower fees in the village community. It was thought
that this kind of doctor would be able to work in much closer
contact with the people. This principle has been applied in
some countries, most intensively in British India.
In Japan, a beginning was made by setting up a relatively
large number of simple medical schools, but these were very
soon converted into medical faculties giving a full course.
At first sight, it seems very natural and desirable to develop
this system of assistant doctors, but the objections and difficulties
should be considered.
For this form of training, young people are required who
have not had a complete secondary education, otherwise they
would expect too much. They should be given a very short