The Private Practice Heirs of China’s Socialist Aid Program
Take a stroll around Lusaka, the capital of Zambia, and you’ll almost certainly come across buildings adorned with Chinese-language signs. There are the usual Chinese restaurant markers, of course, but many are for Chinese-run medical clinics, often bearing the surname of their head doctor. Similar sights can be found in two of the country’s largest mining towns, Kitwe and Chingola, where Chinese clinics dot the towns’ more well-off neighborhoods.
This year marks the 60th anniversary of the first Chinese medical team (CMT) to arrive in Africa. Invited by the newly formed Algerian government in July 1962, the team touched down in Algiers in January of the following year and helped kick off decades of close medical cooperation between China and countries on the African continent.
After the famed TAZARA railway in East Africa, CMTs are probably the most important and longest-lasting legacy of Mao Zedong’s emphasis on “Third World” solidarity. During the Korean War, China sent numerous doctors and nurses to the front lines. In the context of the Cold War, medicine and public health became battlefields for the ideological struggle between the Eastern and Western blocs. In the late 1950s and the early 1960s, China signed health cooperation agreements with all Eastern Bloc countries except Cuba. Africa was an area of particular focus: Over the past 60 years, more than 20,000 trained Chinese medical professionals have been sent to 51 African countries, where they have provided life-saving care to 270 million locals, according to an official tally.
Initially centered on communist states or other countries friendly to the Eastern Bloc, Chinese medical aid diversified beginning in the early 1980s. China’s market reforms meant new opportunities, and the CMT program, although initiated and developed during the Mao era, has continued into the post-socialist period in some unexpected ways. While conventional CMTs continue to be dispatched to various African countries, a growing number of former CMT members have opted to stay in their assigned countries and enter into private practice after the completion of their official missions.
What led these doctors to stay, and how did that decision affect their lives and careers? I conducted fieldwork in Zambia and Kenya between 2015 and 2019, as part of my research on the historical relations between Africa and China, interviewing numerous health practitioners and conducting participant observations in several hospitals and clinics in the region.
When China dispatched its first CMT to Zambia in 1978, the group comprised 20 members, including 16 doctors and four support staff. The team was split between the mining towns of Kabwe and Luanshya, which were struggling to provide health services to mineworkers and their families.
Yu Huizhen, who first arrived in Zambia in 1990 as part of a CMT from the central Chinese province of Henan, recalled that this policy of providing healthcare to the “masses” failed to move the diplomatic needle. “It now appears that the closer you are to cities, the easier you get access to high level officials,” Yu told me in an interview. Yu returned as a CMT captain for a five-year tour in 1996; this time, his team was sent to the capital. “We moved to the University Teaching Hospital in Lusaka, as well as hospitals in the cities of Ndola and Livingstone,” he said.
After wrapping up his second tour, Yu decided to stay in Zambia and open a private clinic. Although there are no exact statistics on how many former CMT members have opened private practices in the country, there were a number of reasons why Chinese medical professionals might find Zambia appealing. Compared to their peers at central hospitals in Beijing, most CMT doctors hail from less-developed regions in China and their jobs back home pay poorly. Running a private business in Zambia not only offers a chance to improve their living standards, it also allows them to take their family overseas, where their kids can be educated at international schools.
Another “Old Zambian,” local slang for a longtime migrant, is Gao Ke’an. Originally from Beijing, where she worked at a military hospital, Gao first arrived in Zambia as an aid doctor in 1988. After her service was over, she stayed and opened the now-nationally renowned KG Dental Clinic in Lusaka in 1994.
Despite the clear-cut official distinction between CMTs and Chinese doctors in private practice, the two are often perceived by locals in a blurred, collective way: Yu, for example, is still widely referred to as “Captain,” a relic of his CMT days. But while the presence of CMTs can be helpful to aspiring Chinese private practitioners, they are not a prerequisite to success. In Kenya, which never received Chinese medical aid due to its alignment with the “capitalist” bloc, former CMT doctors have managed to carve a foothold for themselves. Li Chuan, a native of China’s eastern Shandong province, served on a CMT at Dodoma Regional Hospital in Tanzania from 1989 to 1991. In 1992, he followed the then-Chinese ambassador to Kenya, and two years later he opened a traditional Chinese medicine (TCM) clinic in Kenya’s capital of Nairobi.
Li’s clinic is essentially a monument to the potential of TCM outside China. The walls are covered in photos of him standing next to prominent Tanzanian leaders, as well as a framed recommendation from former Tanzanian Minister for Health P.M. Sarungi. The clinic’s guest book was likewise filled with glowing testimonials, including a photo of a baby conceived after a round of treatment at the clinic.
Although mainly targeted at the region’s sizeable Chinese community, Chinese clinics in East Africa have also become increasingly popular among local urbanites who can afford their services. The financial rewards can be great for doctors from poorer parts of China, where doctors are often paid little. Li, for instance, was quite open about the fact that he had decided to stay in Africa for primarily economic reasons.
Chinese medical practices, and especially TCM, are not always welcomed by local regulators, however. The first specialist in Chinese acupuncture ever dispatched to Tanzania, Li complained to me that “Africans don’t understand traditional Chinese medicine.” As evidence, he pointed to the fact that, until recently, it was the Kenyan cultural authorities, rather than the Ministry of Health, which regulated acupuncture.
Combining herbal medicines with various mind and body practices, such as acupuncture and tai chi, traditional Chinese medicine (TCM) is primarily used as a form of complementary medicine outside China. Li’s daughter, who took a job in his clinic after completing her medical training in the United Kingdom, explained that there is no clear distinction between conventional and complementary medicine in Kenya: “In the end, it all depends on whether the relevant government officials believe you are legal or not.”
Nevertheless, historically contingent factors such as interpersonal connections between Chinese and African elites, though often dismissed as “anecdotal,” have played a critical role in fostering closer Sino-African ties over the past 60 years. During my interview with Yu, he mentioned how his personal relationship with a former politician’s relative had helped the team win official acceptance. The man, who operated a hotel and a farm in Kabwe, regularly visited the nearby CMT for a heart problem. Sometimes, he would invite the medical team to his farm, developing close relations with them as a result. According to Yu, the man’s relative, a politician, eventually became familiar with the CMTs and later summoned Yu’s team to help when he was injured in a traffic accident.
That may seem like a minor achievement, but it’s a testament to the ways health diplomacy has brought China closer to the rest of the world. Now, in the aftermath of the COVID-19 pandemic, China is doubling down on health initiatives on the continent, with vaccine cooperation topping the agenda at the latest Forum on China-Africa Cooperation meeting in Shanghai.
This article draws on research from the author’s new book, “Kenya’s and Zambia’s Relations with China 1949-2019.”
Editor: Cai Yiwen; portrait artist: Wang Zhenhao.
(Header image: A Chinese pediatrician treats a girl in Equatorial Guinea, June 18, 2023. Dong Jianghui/Xinhua)