Chairman Mao – Public Health Extraordinaire, Schistosomiasis

A propaganda poster decreeing that
Schistosomiasis must be eliminated

Poor Chairman Mao is incredibly easy to badmouth. As westerners who are proud of our freedom, the oppression of civil rights under people like Stalin and Mao makes us cringe. Add some of the craziness that Chairman Mao did in the “Great Leap Forward” (commanding all the peasants to make steal -> less farmers -> crappy, unusable steal got made -> millions die from starvation) and the “Cultural Revolution” (persecute anyone with an education, destroy the past) and it becomes laughable in a sad, sick way.

For all of Chairman Mao’s shortcomings, however, he did some impressive things. Two surprising areas that he succeeded pretty well at are in public health. Two diseases that used to be huge problems in China are Schistosomiasis and Lymphatic filariasis. He basically eradicated one of them and brought the other down considerably. This was and might still be an unparalleled achievement for a developing country. One of the cons of having someone with ultimate power rule a country is the inevitable abuse and poor decision making that eventually results. On the other hand, it eliminates the red tape to getting things done, and Mao stepped up to the plate and effectively went to war against some diseases.

Mao’s battle with Schistosomiasis

Mao first encountered Schistosomiasis very early on in his reign as China’s emperor (oops, I mean chairman). For interesting reading about this encounter, I recommend this story that Harper Magazine did about the experience.

I will summarize briefly: after Chairman Mao won the civil war in China in 1949 and the opposing group led by Chiang Kai-shek fled to Taiwan, Mao was eager for closure. He wanted to invade Taiwan to take it back and destroy the opposition once and for all. Taiwan is an island on the southern tip of China by Fujian province, so Mao positioned all of his best troops there to prepare for invasion. He did not have very good ships, and landing on Taiwan would likely require his troops to swim a significant distance. So, he had them take swimming lessons. Several weeks later, however, most of his army came down with a strange illness. By the time he got reinforcements, the United States had their navy in the area and Mao had lost his hope of ever invading Taiwan. Thus, Schistosomiasis became the "fluke" that saved Taiwan. This is clever because a fluke is the type of bug that schistosomiasis is classified as.

About 6 years later, Mao started a public health campaign in 1956 to eradicate Schistosomiasis. Mao was reportedly advised that one of the greatest obstacles to growth in agriculture was Schistosomiasis, so he took a renewed interest in the bug and was determined to conquer it see the article Mao Zedong's fight against Schistosomiasis by Fan and Lai for more details.

Schistosomiasis is a bug that spends a portion of its life cycle in a particular snail. The parasite goes from living in the snail to swimming around in the water to burrowing into the skin of a human to eventually being excreted out through feces back into the water where it can find a snail. Many of these contaminated waterways were irrigation canals. Eradicating the snails would be a key way to get rid of the disease, and stopping pollution of waterways with sewage would also be a necessity. Chairman Mao went after both of these ideas.

As Chairman, there was no limit to what Mao could do. He coined a slogan called “Schistosomiasis must be eliminated” (the Chinese, 一定要消灭血吸虫病, is equally not very catchy) and put millions of peasants to work. He flooded China with propaganda and educational materials about the bug and even had movies made that featured Schistosomiasis.

This picture is fascinating to me. The Chinese signs declare Mao's command
that "Schistosomiasis must be eliminated” (一定要消灭血吸虫病)   

At the most primitive level of the campaign, Chairman Mao went directly after the snails. Millions of peasants gathered up the snails and burned, buried, or killed them with drugs. In an effort that was probably more effective, many of the irrigation canals were blocked off and dried up as new, non-contaminated canals were made.

Thousands of Chinese peasants collecting the offending snails

It seems a bit radical, but it worked. Some accounts place an overall decrease from 10 million cases of Schistosomiasis per year to 1 million cases per year after just 2 years. Not only this, but China saw record harvests in 1958. In a very characteristic move by Chairman Mao, when he was informed about the success of his campaign in 1958 he was so excited that he wrote a poem about the erradication of Schistosomiasis.

Farewell to the God of a Plague, by Chairman Mao 

绿水青山枉自多，华佗无奈小虫何！ 千村薜荔人遗矢，万户萧疏鬼唱歌。 坐地日行八万里，巡天遥看一千河。 牛郎欲问瘟神事，一样悲欢逐逝波。 春风杨柳万千条，六亿神州尽舜尧。 红雨随心翻作浪，青山着意化为桥。 天连五岭银锄落，地动三河铁臂摇。 借问瘟君欲何往，纸船明烛照天烧。

So many green and blue hills, but to what avail? This tiny creature left Hua Tuo powerless! Hundreds of villages choked with weeds, men wasted away; Thousands of homes deserted, ghosts chanted mournfully. Motionless, by earth I travel eighty thousand li a day, Surveying the sky I see a myriad Milky Ways from afar. Should the Cowherd ask tidings of the Plague Spirit, Say the same griefs flow down the stream of time. The spring wind blows amid profuse of willow wands, Six hundred million in this land all equal Yao and Shun. Crimson rain swirls in waves under our will, Green mountains turn to bridges at our wish. Gleaming mattocks fall on the Five Ridges heaven-high; Mighty arms move to rock the earth round the Three Rivers. May we ask Mr. Plague: "Where do you want to go?" Paper barges aflame and candle-light illuminate the sky.

The four pests campaign of 1958 消灭四害

Chairman Mao's success emboldened him to try other ventures, and in 1958 he intiated the four pests campaign to kill mosquitoes, rats, flies, and sparrows.This campaign wasn't as well founded as the previous campaign, and destruction of the sparrows actually caused crop-destroying pests to proliferate.

Some cite this as the start of the craziness that became the great leap forward, and throughout China's dark ages of the 60's, 70's, and 80's Schistosomiasis made a come back. It is now a very relevant health concern in China and it's impact might be made more severe by the 3 gorges dam.

Nonetheless, Chairman Mao's success here actually shines as an example of the great advances in public health that can be accomplished with relatively simple means when there is unity and support from the government.

Coming up: Mao's battle with lymphatic filariasis

I am a medical student at BCM and all thoughts are my own. I am not a doctor. Please read the disclaimer.
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