Medical Outreach in Rural Communities
While my hospital duties formed the core of my professional life, some of my most meaningful work occurred beyond the hospital walls. From the earliest days of my career, I recognized that many rural residents lacked access to even basic surgical care due to geographic, economic, and cultural barriers. Beginning in the mid-1960s, I established a regular program of surgical outreach, traveling to remote townships and villages to bring surgical care directly to underserved populations.
These outreach visits initially focused on minor procedures that could be performed safely in basic healthcare stations: draining abscesses, removing superficial tumors, repairing hernias, and treating simple fractures. Over time, as relationships with local healthcare workers strengthened and basic facilities improved, we gradually expanded to more complex interventions.
The challenges of practicing surgery in these settings were immense. Operating rooms, if they existed at all, were often converted classrooms or administrative offices. Sterilization relied on simple pressure cookers rather than autoclaves. Lighting came from whatever sources could be assembled—sometimes automobile headlights powered by portable generators when electricity failed. Anesthesia options were limited to local infiltration and occasionally rudimentary general anesthesia administered by minimally trained personnel.
Despite these constraints, we achieved remarkable results. Between 1965 and 1975, my team performed over 1,200 operations during these rural outreach visits with complication rates only marginally higher than those in our county hospital. More importantly, we brought surgical care to patients who would otherwise have suffered or died without intervention.
A particularly memorable outreach experience occurred during the spring of 1969 in a remote mountain village near the Anhui-Jiangxi border. A local epidemic of complicated appendicitis had overwhelmed the small township clinic. Over a period of five days, I performed 17 appendectomies in a makeshift operating room set up in the village school. Working with minimal equipment and assisted only by a local doctor and a nurse from our hospital, we successfully treated all patients without mortality.
These outreach efforts also served an educational purpose, as each visit included training for local health workers. I developed simplified protocols for identifying surgical emergencies, initial management of trauma, and post-operative care that could be implemented by personnel with limited training. Many of these healthcare workers later referred appropriate cases to our hospital and some eventually pursued formal medical education.
Military Medical Support
Another significant dimension of my extramural practice involved collaboration with military medical units, particularly during the period of heightened border tensions in the late 1960s and early 1970s. Although I never held a formal military appointment, I was repeatedly called upon to provide surgical consultation and assistance to military hospitals in our region that faced shortages of qualified surgeons.
In 1969, during a period of intense border confrontation, I was temporarily seconded to a military field hospital in northern Anhui. For three months, I worked alongside military doctors treating both combat injuries and routine surgical conditions among military personnel. This experience broadened my trauma surgery skills considerably and exposed me to military medical protocols that emphasized efficiency and resource conservation—approaches I later incorporated into my civilian practice.
The military work required adaptations in both technique and mindset. Operating under field conditions, often with the possibility of sudden relocation, demanded surgical approaches that prioritized speed, simplicity, and definitive intervention. The military emphasis on detailed protocols and standardized procedures contrasted with the more individualized approach typical in civilian settings, offering valuable lessons in systematizing surgical care.
My contributions were recognized with a special commendation from the regional military command, an unusual honor for a civilian physician during that politically sensitive period. More importantly, this experience forged lasting professional relationships with military medical personnel that would prove valuable throughout my career, particularly in obtaining medications and equipment during periods of severe shortages.
Disaster Response and Emergency Surgery
Natural disasters and industrial accidents repeatedly called me away from routine hospital duties throughout my career. The most significant of these events was the catastrophic Anhui flood of 1969, which devastated communities along the Yangtze River and its tributaries. As one of the few trained surgeons in our county, I was mobilized as part of the emergency medical response.
For nearly a month, I worked from a makeshift medical station established on higher ground, treating victims of the flooding. Traumatic injuries were common—lacerations, fractures, and crush injuries sustained during evacuation efforts or building collapses. Equally challenging were the infectious complications that emerged in the days following the initial disaster: wound infections, waterborne illnesses, and respiratory infections that spread rapidly through crowded evacuation centers.
Working under these conditions required improvisation and adaptation. Surgical supplies quickly ran short, forcing us to reuse sterile materials and employ unconventional substitutes. Local anesthetics were reserved for the most painful procedures, with many minor operations performed using only sedation and psychological support. Medical records were kept on whatever paper could be found, often school notebooks or administrative forms repurposed for clinical documentation.
Despite these hardships, our team maintained remarkably high standards of care. Of the 243 surgical procedures I performed during this disaster response, only 11 developed serious complications, and we lost only two patients—both of whom arrived with severe traumatic injuries and hypovolemic shock that proved irreversible despite our interventions.
The experience reinforced my belief in the resilience of basic surgical principles even under the most challenging circumstances. It also highlighted the critical importance of preventive measures and early intervention in disaster settings, lessons I would later incorporate into emergency preparation protocols at both hospitals where I served as department head.
Consulting and Advisory Roles
As my reputation grew within the regional medical community, I increasingly served in consulting and advisory capacities beyond my home institutions. Beginning in the early 1980s, following the restoration of professional activities after the Cultural Revolution, I was frequently called upon to provide second opinions on complex surgical cases at smaller hospitals throughout southern Anhui Province.
These consultations typically involved patients with unusual presentations, complications following surgery, or conditions requiring specialized procedures. While sometimes I would perform the necessary operations myself, more often my role was to advise local surgeons, helping them develop the skills and confidence to handle such cases independently in the future.
This consultative work evolved into a more formal arrangement in 1985 when the Provincial Health Bureau appointed me to a rotating surgical advisory team that visited county-level hospitals quarterly. As part of this program, I conducted case reviews, performed demonstration surgeries, and led teaching sessions for local surgical staff. This initiative significantly improved surgical capabilities across our region, gradually reducing the need to transfer patients to distant urban centers for standard procedures.
In addition to clinical consultation, I served on various advisory committees addressing regional healthcare planning and resource allocation. My practical experience with rural surgical care provided valuable perspective in these forums, where I consistently advocated for approaches that would extend basic surgical services to underserved communities rather than concentrating all resources in urban centers.
Research and Documentation Outside Traditional Academic Settings
Without formal academic affiliations, my research activities developed along unconventional paths. Much of my investigative work focused on pragmatic questions arising from daily practice: How could standard surgical techniques be modified to accommodate resource limitations? Which approaches yielded the best outcomes in our specific patient population? What local materials could substitute for expensive imported surgical supplies?
I meticulously documented my findings in handwritten journals long before publishing became possible. These records—filled with technical observations, modified surgical approaches, and patient outcomes—formed a valuable resource when academic publishing resumed in the late 1970s. Between 1979 and 1995, I published 37 papers in various medical journals, most addressing practical aspects of surgery in resource-limited settings.
One notable research project involved the development of a modified approach to managing complicated appendicitis with localized peritonitis. Using a combination of limited resection, careful drainage, and locally developed antibiotic protocols, we achieved outcomes comparable to those reported from major urban hospitals despite our resource constraints. This work, published in 1983, was cited in national surgical guidelines and adopted by numerous county hospitals throughout central China.
Another significant contribution involved the documentation of indigenous medical practices I encountered during rural outreach work. While maintaining scientific skepticism, I cataloged traditional treatments that appeared to have genuine therapeutic value, particularly herbal preparations used to prevent wound infections. Several of these traditional remedies were later subjected to laboratory analysis, with some shown to contain compounds with antimicrobial properties. This work represented an early example of the integration of traditional and modern medicine that would later become a national healthcare priority.
Building International Connections
Despite geographical isolation and political constraints, I maintained a persistent interest in international surgical developments throughout my career. Beginning in the late 1970s, as China's contacts with the outside world expanded, I sought out whatever international medical literature became available, often relying on colleagues in provincial centers to share journals and textbooks that reached their institutions.
In 1982, I had my first opportunity for direct international exchange when a visiting surgical team from Japan conducted a week-long teaching seminar at Wuhu Central Hospital. Despite language barriers—communication occurred through interpreters and anatomical drawings—this interaction provided valuable exposure to alternative surgical approaches and contemporary technologies not yet available in our setting.
This initial exposure to international surgery spurred me to greater efforts in self-education. I began studying English medical terminology, eventually gaining sufficient proficiency to read international journals with the aid of a medical dictionary. This linguistic effort opened access to a wealth of surgical literature that dramatically influenced my practice during the latter half of my career.
A particularly significant international connection developed in 1990 when a former student, now working at a provincial teaching hospital, arranged for me to observe visiting American surgeons performing laparoscopic procedures. Although our hospital would not acquire laparoscopic equipment for several more years, this early exposure prepared me to implement these techniques as soon as the technology became available to us.
While never having the opportunity for formal international training or observation common among later generations of Chinese surgeons, I nevertheless managed to incorporate international surgical standards and innovations into my practice through persistent self-education and these limited but valuable cross-border professional exchanges.
