A Little History #13: Architects of China's Community Health Care and The Shijiazhuang Agreement by Tom McDermott

This article tells the story of the Shijiazhuang Agreement of August 1948 and UNICEF's first attempt to switch from distribution of relief supplies to capacity building through training of community health workers and village midwives.

The Idea Had History

The idea was certainly not new.

For more than twenty years, Chinese and foreign public-health pioneers had been experimenting with ways of bringing basic health services to China's enormous rural population.

Eloesser had also learned from war. Like Marcel Junod, he had witnessed the carnage of the Spanish Civil War; unlike Junod, Eloesser and Norman Bethune had worked as surgeons on the Republican side. Both had learned the value of simple techniques and the rapid training of nurses, orderlies and others when doctors and conventional medical facilities were scarce.

Early in his China assignment, Eloesser went north on a WHO teaching assignment and spent five months at a small village hospital named for Bethune. With virtually no outside communications, he used the experience not only to teach but to learn—studying the methods used to train local health workers and improving his Mandarin.

The experience reinforced his conviction that doctors alone could never meet the needs of rural China. What was needed were large numbers of ordinary people who could be trained relatively quickly in vaccination, sanitation and hygiene, control of common infectious diseases, first aid, childbirth and infant care.

Some Architects of China's Community Health System

Dr. John B. Grant — Jim Grant's father, born and raised in China. After medical studies in Canada and the United States, he returned to China in 1919 with a Rockefeller Foundation-sponsored study of hookworm control. Two years later the Foundation appointed him its representative in China. He helped establish Beijing's First Health Demonstration Station in 1925, serving a population of nearly 100,000. In 1929 he extended the approach to rural Dingxian through James Yen's Mass Education Movement, where his students established a health station and trained village health workers. Grant also developed a close relationship with Ludwik Rajchman and the League of Nations Health Organization. In a remarkable historical footnote, his son Jim, then 15, was camping with his Boy Scout troop only half a mile from the Marco Polo Bridge when fighting broke out between Japanese and Chinese forces on 7 July 1937. Jim and his mother left China soon afterward.

Dr. C. C. Chen — From 1931 onward expanded the Dingxian model, proving that village health workers with relatively little formal education could be trained inexpensively to provide effective basic care. Had a major influence on China's later systems of community-based rural health care.

Dr. Andrija Štampar — Croatian/Yugoslav pioneer of social medicine who helped develop Yugoslavia's community-health approach and established the School of Public Health in Zagreb, including its innovative "Peasants University" for rural health education. As a League of Nations adviser in China from 1933 to 1936, he travelled widely and promoted rural health protection services. After the war he played an important role in the creation of WHO and became President of the First World Health Assembly in 1948.

Dr. Berislav Borčić— Croatian/Yugoslav physician who worked in China during the 1930s under the League of Nations Health Organization. He returned in 1946 to direct UNRRA's health work and in 1947 established and headed the WHO mission in China. Borčić was Eloesser's supervisor and later became a senior health adviser and Deputy Executive Director at UNICEF. He and Eloesser later played important roles in developing UNICEF's standard midwifery kit.

Dr. Norman Bethune — Canadian thoracic surgeon who, like Eloesser and Junod, had served in the Spanish Civil War. He went to China in 1938 and worked with Mao's Eighth Route Army, combining mobile field surgery with rapid practical training of nurses, orderlies and other medical workers. Mao's famous eulogy made Bethune an enduring symbol of internationalism in China. His importance is still marked by monuments in Shijiazhuang and at Wanping in Beijing, where a large statue of Bethune stands at the Museum of the War of the Chinese People's Resistance Against Japanese Aggression, near the Marco Polo Bridge where the fighting of July 1937 helped trigger the full-scale war between China and Japan.

Dr. Leo Eloesser — Internationally known Stanford professor and thoracic surgeon whose innovations included the "Eloesser flap." After joining UNRRA in China, he worked under Borčić and spent five months on a WHO teaching assignment at a small village hospital named for Norman Bethune. While in the village he studied the methods used to train local health workers.   At Shijiazhuang in 1948, he finally had the opportunity to put that idea into practice through UNICEF.

The Journey North: July 1948

Leo Eloesser's TA

In July 1948, Dr. Leo Eloesser and Perry Hanson set out on a journey that would define the next phase of UNICEF's work in China — a training programme for community health workers and midwives in rural areas under Communist control.  

Junod left that same month for Korea, where Maurice Pate had asked him to explore the possibilities for a UNICEF country programme.

Eloesser and Hanson travelled alone, driving an old US Army truck, its sides covered with banners reading "United Nations International Emergency Children's Fund" in both English and Chinese.

US Army truck passed to UNRRA then passed to UNICEF

The journey took five days. Roads were flooded and they averaged only about fifty miles a day. They crossed and recrossed the shifting lines of the civil war.

At a Caltex fuel station, they purchased petrol for what seemed an enormous sum: one billion Chinese dollars. By the following morning, when they cashed a bank cheque to reimburse the expense, the price had doubled.

1 Yuan 1948

The currency was evaporating almost as quickly as they could spend it.

They were headed for Shijiazhuang in Hebei Province. The city had considerable symbolic as well as strategic importance. Captured by Communist forces in November 1947, it was the first major city taken by the People's Liberation Army and an important railway junction. The Communist Party's national leadership was based nearby at Xibaipo, from where Mao and his colleagues were directing the final campaigns of the civil war.

For UNICEF, however, the attraction of Shijiazhuang was more practical. It offered access to the Communist-controlled areas where Eloesser hoped to test his ideas about training large numbers of ordinary rural people in basic health care.

Leo Eloesser was 67 when he made the five-day journey north. Readers are already familiar with his colorful career as a brilliant and internationally known thoracic surgeon..

Perry Hanson's family at home in Tai'an, Shandong Province.  Perry bottom right age 11

Perry Hanson, at 32, was from a very different generation. He had been born and raised in a missionary family in North China and spoke Chinese fluently. He attended the North China American School and Yenching University before completing his studies in the United States and becoming a Methodist minister. During World War II he served as a Chinese-language translator with the US Army in western China. After the war he joined UNRRA as a field officer and then UNICEF in 1948.

The two therefore made an unusual pair: a senior surgeon approaching 67 and a much younger field officer who had spent much of his life in China. Both had worked for UNRRA before joining the still very young UNICEF.

Meanwhile, the War Was Moving South 

Communist forces enter Beijing January 1949

During the months following Eloesser and Hanson's arrival, Communist armies continued their advance across China. Beijing would fall without a battle in January 1949, and in March the Communist leadership would move there from Xibaipo.

For the moment, however, Eloesser and Hanson were in Shijiazhuang. Their first task was to find somewhere to train the health workers.

A Monastery with a Tragic History

Dr. Su Chin Kwan, CLARA's senior health official, suggested an abandoned monastery outside the city.

Though they did know the history, It was not simply an empty building.   

The Monastery's Tragic History

The Ben Hu monastery near Shijiazhuang, known in English as Our Lady of Joy, had already been caught in China's wars. During the war against Japan, Japanese forces seized the monastery, imprisoned the monks and killed several of them.

The violence continued during the civil war. Our Lady of Joy was a daughter house of the older Trappist monastery, Our Lady of Consolation at Yangjiaping. In 1947 Communist forces took control of the mother house. The community was put on trial, some monks were executed, and survivors were forced on a brutal march carrying military supplies. Many died from hunger, disease, exhaustion and mistreatment.

Father Benedict Chao dies at age 108

The monks of Our Lady of Joy also fled. Among them was Father Benedict Chao, who had entered the monastery in 1941 and would eventually help rebuild the Trappist community in Hong Kong. He died there very recently on 31 July 2026 at the remarkable age of 108 — the last surviving link with that generation of Chinese Trappists.

So it is not enough to describe the site of UNICEF's first training course simply as “an abandoned Trappist monastery.” Its community had already been scattered by war and persecution. Perhaps, despite all they had suffered, the monks would have been pleased to know that their abandoned buildings were now being used to train people to save lives.

 The Shijiazhuang Agreement — 1 August 1948

The negotiations moved quickly.

On 1 August 1948, Eloesser reached agreement with CLARA and the health authorities. The agreement took the form of an exchange of letters between the UNICEF representatives and CLARA. The exchange took place at a former Japanese officers' club in Shijiazhuang.

Only a few months earlier, on 21 May 1948, Marcel Junod had signed UNICEF's programme agreement with the Nationalist Government in Nanjing. UNICEF now had a separate working agreement with the Communist authorities controlling much of North China — apparently the first formal programme agreement between a United Nations body and the Chinese Communists.

The agreement opened the way for Eloesser and Su to turn the ideas they had been discussing into an actual training programme.

The First Training Course Begins

Leo Eloesser teaching in the first course - small groups for translation and discussion

The first training course began in November 1948 and lasted three months. Twenty trainees were selected from the surrounding rural areas—described at the time as “peasants”—who would return to work in their own communities.

Classroom instruction continued into January 1949, after which the trainees went into villages to conduct surveys and provide preventive health care.

The course covered sanitation and communicable-disease control, first aid and treatment of injuries, and maternal and child health. Midwifery would be added to the second course. Eloesser wanted trainees to know enough to prevent common illnesses and deal with basic health problems at village level.

But he also wanted the system to multiply itself. The strongest trainees could become teachers for the next group. Eloesser later described the principle neatly: the number of trained workers could increase “geometrically rather than arithmetically.”

Anti-TB poster promotes BCG, Hebei Province 1950

Next: A Little History #14 — Things Fall Apart: A Tragedy in Three Acts