Saturday, January 05, 2008

Proletarian Doctors Redux

Bethune led the way. And Canada quietly has produced a model for creating doctors faster than the monopoly guild that is the College of Physicians and Surgeons would like to admit to.

As I have pointed out here before the way to create more doctors and reform the medicare system is to break the haughty power of the monopoly the doctors guild has on its profession. And it appears that such a possibility has been in place for forty years but nobody bothered to admit it existed.

Add to this a program of nurse practitioners, free tuition and a commitment to work in rural areas, as well as community based health clinics with doctors on salary we would well be on our way to ending the health care crisis. And it would cost far less than any other reform.

Canada could produce a lot more doctors at a lower cost, and medical students would save thousands in tuition if most of its medical schools moved to a three-year program, the Canadian Medical Association Journal suggests.

Such three-year programs have existed for decades at McMaster University in Hamilton, Ont., and at the University of Calgary.

Dr. Paul H├ębert, editor-in-chief of the Canadian Medical Association Journal and a professor of medicine at the University of Ottawa, wants to know how they measure up against the four-year programs at the rest of the country's medical schools.

"We've had a 40-year experiment go on, and no one's looked at that data as far as I know in a very cogent and detailed manner," he told CBC Radio's Ottawa Morning Friday, the same week he published an editorial titled "Is it time for another medical curriculum revolution?" in the bi-weekly journal.

Dr. Norman Bethune, assisted by Henning Sorensen,
performing a transfusion during the Spanish Civil War

Norman Bethune (1890-1939) was a Canadian thoracic surgeon.
During the 1930s he became a convinced communist, and this led him to Spain, where he joined the anti-Fascist struggle. On the Spanish battle fields he became aware that 75% of serious battle casualties would survive if operated on immediately. In early 1938, he arrived in China, and proceeded to Yan'an, the revolutionary base area of the Chinese Communist Party. Mao Zedong commissioned him to organize a mobile operating unit in the interior of North China. Although he was forced to work under extreme circumstances, sometimes operating for forty hours straight without sleep, and within minutes of the front lines, he saved the lives of many Chinese party members and soldiers. He died of septicemia, contracted when he cut himself while operating under great pressure from advancing Japanese forces.

Norman Bethune (1890-1939)

  • born in Gravenhurst, Ontario
  • served as a stretcher bearer in a field ambulance unit of the Canadian army in France in 1915
  • a bout of tuberculosis inspired his interest in thoracic surgery
  • joined the surgical team at Montreal's Royal Victoria Hospital
  • produced over a dozen new surgical instruments
  • became disillusioned with medical practice because often patients who were saved by surgery became sick again when they returned to squalid living conditions
  • visited the Soviet Union, and secretly joined the communist party in 1935
  • opened a health clinic for the unemployed
  • promoted reform of the health care system
  • fought the fascists in Spain in 1936
  • in Madrid he organized the first mobile blood-transfusion unit
  • in 1938 he went to aid the Chinese against the Japanese invasion
  • in China he formed the first mobile medical unit, which could be carried on two mules
  • died of an infection due to the lack of penicillin, the infection ocurred during surgery due to a lack of surgical gloves
  • Bethune is regarded as a martyr in China and is referred to as "Pai-ch'iu-en" which means "white weeks grace"
  • next to his tomb in China there is a statue, a pavillion, a museum, and a hospital dedicated to him
  • the family home in Gravenhurst is now a museum
  • played by Donald Sutherland in the biographical film: "Bethune: Making of a Hero"
  • biography: The Scalpel, The Sword by Ted Allen and Sydney Gordon
  • for more information see Canada firsts (1992) by Ralph Nader, Nadia Milleron, and Duff Conacher

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History of the Norman Bethune Tapestry

by William C. Gibson, MD, DPhil

One day when I had just arrived back in Vancouver from World Health Organization meetings in Geneva I dropped in to see H.R. MacMillan at his home. As usual he began: "What is the best thing you saw while away?" I told him of a very fine tapestry which was in a travelling exhibition, showing Norman Bethune in the Chinese countryside. "Find it," he said.

After months of correspondence with Chinese and Geneva sources, I had to report failure. So H.R. said: "Get one made in China and send me the bill." So I sent off to Shanghai a colour photo to be reproduced, giving the approximate size which we could accommodate.

Six months later the Bethune tapestry arrived, almost buried in mothballs! We placed it in the Sherrington Room, where many came to study it.*

The setting depicts a former Buddhist temple, which Bethune had converted to his operating room for the Eighth Route Army in Hopei Province in the north.

Bethune had sailed on a CPR Empress liner from Vancouver soon after Japan attacked China, because he was at that time in Salmon Arm, B.C. on a fundraising mission for his blood transfusion service in the Spanish Civil War. On hearing of the invasion of China, he gave up his efforts for Spain, where he had done yeoman service for the legal government of Spain despite the Department of External Affairs in Ottawa, which threw no end of roadblocks in his way.

With a Canadian nurse he set off for China, accompanied, alas, by an American Red Cross surgeon who turned out to be a chronic alcoholic (as I believe he had been in Newfoundland). In 18 months Bethune became a legend. After his death at age 49 of an infected finger, cut while operating, Mao wrote a eulogy which was memorized by every schoolchild in China. When I first visited China in 1973, with the Bethune Foundation, every stop we made was highlighted by children reciting it.

* One visitor was Dr. Wong, who was Bethune's anesthetist, shown in the tapestry. Bethune is doing a rib resection to get at a lung damaged by a bullet. You can see him bending over the wedged-open chest of the soldier.


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