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The Politics of Care: Unveiling the Dynamics of Chinese Medical Labour in Algeria, 1960s – 1980s

August 4, 2023

The Politics of Care: Unveiling the Dynamics of Chinese Medical Labour in Algeria, 1960s – 1980s

Dongxin Zou

Hospital of Ben Aknoun. Source: Dongxin Zou.

During my fieldwork in Algiers in the winter of 2015–16, I frequented the Chinese acupuncture clinic at the Hospital of Ben Aknoun, a university hospital known for its expertise in orthopaedics, neurology, and rehabilitation. Established in 1997, the clinic is attached to the hospital’s rehabilitation centre and at that time was managed by three doctors from Hubei and one Algerian woman physician. On a typical working day, they attended to approximately 100 patients every morning. The two treatment rooms, segregated for men and women, were always full, with five to six patients receiving a 20-minute session together in a room while the others waited in the hallway outside. There were no breaks between patients and the doctors could snatch only a few minutes before the next group was ushered in. They provided medical services in an orderly, time-controlled, and exhausting manner, as though working on a factory production line.

At the clinic I met Dr F, a man in his fifties who spoke with a Wuhan accent. He welcomed me warmly into his ‘workshop’ and treated me like his apprentice, always patient with my presence and curiosity. One day, while we were sandpapering blunt needles after work, he mentioned that both his parents had worked as aid doctors in Algeria. His father, a cardiologist, was posted in Saïda from 1968 to 1971, and his mother worked as an otolaryngologist in Guelma from 1984 to 1986. He did not see it as unusual that his entire family had been sent on a government-sponsored medical mission. As a former mission obstetrician whom I interviewed in Wuhan explained to me, everyone in her department would have to go abroad, willingly or not. It was just a matter of taking turns.

Chinese acupuncture clinic. Source: Dongxin Zou.
Patients waiting in the hallway. Source: Dongxin Zou.

Medical Humanitarianism, Past and Present

Driven by its geopolitical interests and inspired by revolutionary romanticism to provide care to the Third World, China has been sending medical missions to Africa since 1963. The first team was deployed to Saïda, a rural province in the Saharan Atlas region of northwestern Algeria. Their primary focus was delivering essential health care to rural and suburban communities. This pioneering mission set the pattern for China’s self-acclaimed tradition of extending healthcare assistance to other developing nations—a fact that remains relatively obscure in the Western world. Today, the Chinese aid program operates missions in 56 countries, with a significant concentration in Africa. In Algeria alone, 2,034 medical professionals and assistant staff were deployed in 15 hospitals between 1963 and 1992. Each stayed for an average of two years, with 157 returning to Algeria for a second stint, and six taking a third posting (Hubei Provincial Department of Health 1993: Appendix I).

Over the past two decades, as China expanded the scope and depth of its engagement in African lives, this medical aid program was brought to the forefront as a symbol of Chinese benevolence, embodying the spirit of Third World solidarity that was fostered during the Cold War. As I have written elsewhere (Zou 2021), the mechanisms of pairing a Chinese province with a foreign country and stationing medical teams overseas are maintained in the recent design of China’s ‘Health Silk Road’ (健康丝绸之路). The Chinese Government continues to prioritise health aid as a crucial factor in enhancing bilateral relations, often quoting the staggering numbers of patients treated by Chinese doctors as evidence of the effectiveness of its assistance. The construction of new hospitals and medical facilities, which was added to China’s health development package in the twenty-first century, provides another set of financial statistics that is often referred to by the Chinese authorities to further enhance the positive image of Chinese medical humanitarianism.

Medicine as a Labour Process

Medicine practised in ‘encounters’ is a prominent theme in discussions of Chinese overseas medical engagements. In this literature, medicine is viewed as knowledge that requires ‘glocalization’ (Hsu 2002), a commodity sold by entrepreneurial Chinese doctors (Zhan 2009; Hsu 2012), ‘an assemblage of values and expertise’ (Gong 2022: 480), and a site of situational power negotiated between doctors and patients (Zou 2022).

Acupuncture treatment room in the Hospital of Ben Aknoun. Source: Dongxin Zou.

Yet little has been made of medicine as a labour process in these cross-cultural encounters. While a wealth of scholarship has shed light on the migration of Chinese workers to developing countries, medical doctors are rarely seen as labourers. This is perhaps due to the absence of the capitalist mode of production in their services or the lack of monetary and social incentives that have galvanised other ‘Africa drifters’ (Driessen 2020). Nonetheless, just like other workers, these highly professional and salaried physicians have been constrained by a labour process that has long shaped the health care they provide on the ground. For instance, Dr F had to deal with a substantial patient load each day, and the workforce shortage compelled him to treat his patients in a way that mirrored the efficiency of an assembly line. Both Dr F and his parents were medical labourers, subject to the Chinese State’s ‘politics of life’ (Fassin 2007). Their career decisions and family lives were subordinate to the larger objective of medical missions to which the state assigned priority.

By examining medicine as a labour process, we are prompted to think about what kind of social relations of production enabled and regulated the practice of aid doctors. This labour-centric approach to understanding medical encounters highlights the various pressures experienced by Chinese doctors from both their superiors and their patients (Seim et al. 2022). It places the doctors’ medical production within the often contentious, if not antagonistic, relationships between their purposive medical activities, the patients on whom they perform those activities, and managerial control. This labour process was even more complicated in Algeria as it took place in the contact zone of two different sociomedical cultures. In what follows, I draw from my archival and field research to discuss the pressures inherent in the labour process of Chinese medical missions from the 1960s to the 1980s. Both desired and undesired by doctors, these pressures significantly influenced Chinese medical practice in local communities and had a direct impact on the care that was provided.


Pressures from ‘above’, embodied by the health administration in China, shaped the supply of medical labourers. China’s medical aid program was a manifestation of its health diplomacy written into bilateral agreements with recipient governments. In the case of Algeria, the Chinese Ministry of Health assigned quotas to the Hubei provincial health department, which was responsible for recruiting medical personnel with desired expertise. In the 1960s, before the program was made known in Chinese medical circles, mission members were selected without their knowledge and notified only shortly before being sent to training camps, which prepared them for assignments in locations that meant nothing to them.

The doctors possessed little autonomy to contest these top-down decisions because they were state employees. During the socialist period, doctors were categorised as state cadres and were tied to, and dependent on, their work units—public hospitals—for income, welfare, promotion, and pensions. Many welcomed the opportunity to work abroad. Participating in medical missions not only was recognition of their political credentials and technical expertise, but also rewarded them with additional stipends granted by the Chinese Government. However, this came at the cost of unexpectedly leaving their families behind. Doctor couples, such as Dr F’s parents, were not permitted to be assigned to the same mission. Individual concerns were deemed insignificant compared with the overarching state agenda of solidifying the Sino-Algerian alliance. What was acknowledged and celebrated publicly was the moral imperative with which the mission members were entrusted to alleviate the suffering of Algerians. While it would be unfair to disregard the humanitarian passion on the part of these doctors, it should be noted that they were not initially volunteers.

While in Algeria, the doctors were assigned to public hospitals and had to work within the confines of the local health system. During the 1960s and 1970s, however, they generally enjoyed significant professional autonomy. Most were posted to remote areas where health resources were scarce and local doctors were unwilling to relocate. They often served as the sole or primary medical specialists in these hospitals. The lack of competition from Algerian doctors gave them additional authority and spared them from negotiating job assignments with local colleagues. The mission’s inclusion of Chinese medicine, particularly acupuncture, and the adoption of the ‘barefoot’ (赤脚) healthcare model, wherein medical services were actively brought to patients’ doorsteps, exemplified the flexibility granted to them by the Algerian health authorities.

More considerable pressure on the missions came from their Chinese supervisors—a situation that, paradoxically, was particularly evident in the realms of acupuncture and barefoot healthcare delivery. Acupuncture was a Chinese healing technique that was revitalised through the Maoist call for the integration of Chinese and Western medicines (see also Baum’s essay in this issue). Strong efforts were made on the part of the state to promote acupuncture in Algeria, including posting at least one acupuncturist in every Chinese team and encouraging its use. Trained in biomedicine, Dr F’s father picked up acupuncture during the early period of politicised zeal for Chinese medicine in the Mao era. Despite prescribing Chinese patent medicines to his Algerian patients, he was hesitant to perform acupuncture on them. He was worried about potential adverse effects and feared that language barriers would complicate situations in which he would be unable to provide adequate explanations to patients.

Official protocols also required that doctors provide mobile healthcare services to reach rural populations who faced difficulties accessing hospitals in towns. Dr F’s father recalled his visits to remote rural clinics three to four times a week. Although well-intentioned to serve a larger population, these services added burdens on the doctors by expanding the scope of their duties and squeezing them to produce more with less. The doctors faced even scarcer resources during those patrol rounds, which hampered their ability to provide adequate care. In the mid 1980s, Chinese health authorities recognised that sending doctors on patrols was an inefficient use of medical labour, not only in terms of quality of care but also considering the sparsely populated nature of rural Algeria.

A Chinese doctor provides mobile medical services, Saïda, 1970. Source: Dr F’s father’s private collection.

The provision of Chinese medicines, included as part of the aid package, was a significant aspect of the material conditions with which the doctors grappled during their labour process. While doctors on earlier missions were generously supplied with requested medicines and equipment, the financial strains resulting from China’s expanding foreign aid necessitated a shift in priorities by the mid 1970s. Health officials began to emphasise the efficient use of supplies and the Health Ministry issued orders to restrict the use of expensive Chinese patent medicines. This constraint compelled doctors to manage their medical resources more carefully and eventually transition from prescribing familiar medicines used in China to utilising locally available options. They also had to be creative in improvising methods and using makeshift devices in their practice.

Administratively, the medical teams reported to the Chinese Embassy. Closely monitoring the dispersed teams throughout Algeria proved unfeasible; nor were supervisors back home able to exercise hands-on disciplinary measures with the missions. Nonetheless, the Chinese authorities did exert pressure on the doctors by selecting their workplace colleagues, defining the scope of their medical practice, and regulating the availability of medical supplies. The government remunerated them for their labour while maintaining control over their practice and, through material provisions, dictating the specific skills and expertise they could apply in their patient care.


Another primary source of pressure on Chinese doctors came from ‘below’. A paternalistic model of health care prevails in Algeria, and the aid doctors I have met unanimously expressed their contentment with the compliant and subservient attitude of Algerian patients. They took pleasure in the considerable authority they wielded during patient encounters and often found it effortless to obtain patients’ consent for their decisions. This sentiment was present in mission memoirs from the period before the 1980s when paternalism in the doctor–patient relationship was presumably entirely unquestioned. Hence, the pressures from patients came primarily not from defiance of doctors’ authority but from other, more particular challenges, which led to an overall feeling of frustration among the Chinese doctors.

One significant pressure stemmed from a workforce shortage, which forced the doctors to work long hours without appropriate pay. As I have demonstrated elsewhere (Zou 2022), women obstetricians were particularly vulnerable given the nature of their speciality. The sheer number of patients and gruelling schedule often led to exhaustion and burnout. While the higher salaries provided by the Chinese Government may have served as compensation in earlier periods, the marketisation of domestic health care and rapidly rising income levels for medical professionals who stayed home from 1985 meant the aid doctors’ labour was increasingly proletarianised. Financial incentives alone became progressively less influential in motivating doctors to participate in the mission.

While it is true that doctors derived satisfaction from the authority and parental role they wielded in patient encounters, they were frequently frustrated by their patients’ limited health knowledge, which influenced health outcomes and could not be addressed solely through medical expertise. Obstetricians often encountered patients in a critical condition that could have been prevented had they possessed basic reproductive knowledge. Equally exasperating was the realisation that although patients would listen to the doctors during emergencies, they would not necessarily submit completely to expert advice. Obstetricians had to repair wombs that had been repeatedly cut open for caesarean deliveries, despite their personal belief that the best health protection for women in their fertile years was contraception. Multiple childbirths without prenatal examinations placed Algerian mothers at a higher risk of complications that put significant pressure on the doctors to provide prompt and effective treatment to save lives. Lacking the cultural authority to enact meaningful changes in the social dimensions of women’s health, the doctors experienced a sense of powerlessness and frustration in the face of suboptimal health outcomes.

The unique focus of the Chinese mission resulted in an unexpected form of pressure on the doctors: a discrepancy between patient needs and the doctors’ desire to enhance their specialised skills. Critically ill expectant mothers did not typically present a novel challenge in terms of medical knowledge or technical expertise. Generally, most patients the doctors encountered required and could afford only basic care, as the Chinese mission was largely designed to address primary healthcare needs in less developed regions. Complex health issues that necessitated advanced diagnostic and treatment equipment were referred to hospitals in urban centres, leaving the mission doctors primarily responsible for basic health care. Nonetheless, the political significance of the aid program pushed Chinese health officials to select specialists who were overqualified for their assigned roles. Dr F’s father, while acknowledging that ‘doctors always learn something by seeing patients’, expressed disappointment in the limited learning opportunities during his assignment in the late 1960s in Algeria. This sentiment was shared strongly by contemporary aid doctors who face increasing pressure to produce research output for career advancement. An orthopaedic surgeon whom I met in 2016 expressed anxiety about having only simple cases on which to work, given the small patient population in a less developed area of Algeria. He did not want to avoid labour: he wanted to work cases that were more ‘valuable’ for improving his skills and more fulfilling to his specialist identity.

Collectively, the pressures experienced by Chinese mission doctors in patient encounters were representative of the overall medical landscape in rural and suburban healthcare settings in Algeria. Of course, labour dystocia, cardiac arrests, bone fractures, and other genuine emergencies were critical. Their frequency strained the limited workforce and inevitably affected the quality of care. Adding to the doctors’ frustration was a multitude of medical issues that they perceived as trivial, preventable, or not aligned with their level of expertise, which negatively impacted their morale in delivering healthcare services.

Making the Labour Visible

This essay has focused on the labour process of the Chinese Government–sponsored medical mission in Algeria from the 1960s to the 1980s. The mission itself has outlived the socialist system and the geopolitical competition of the Cold War. Today, the Chinese media continues to highlight these doctors’ dedication to their profession and humanitarian passion for patients in distant lands. It is not my intention to negate the mission’s contribution to the wellbeing of the host communities. However, it is important to underscore that beneath the altruism and empathy, there existed a culture of discipline and enforced sacrifice that permeated the mission’s caregiving efforts yet remained largely unnoticed in common perceptions about their care.

Only by examining the mission’s healthcare service as a labour process can we better understand how the aid doctors were caught among myriad pressures, coming from both the health authorities and the patients for whom they cared. These pressures shaped how their medical labour power was transformed into medical practice. The Chinese health authorities exerted significant pressure on the doctors, influencing every aspect of their work, from their enlistment and assignment of posts to their remuneration and the determination of the scope, methods, and evaluation of their services. These pressures were enforced through administrative and material means. Simultaneously, the patients placed demands on the doctors, requiring services that were not only physically exhausting and repetitive but also led to the ‘deskilling’ of the medical specialists. Adding to their frustration, the doctors faced inadequate facilities that hampered their efforts to restore patients’ health. As such, the doctors found themselves constantly negotiating with their supervisors and the objects of medical production, that is, the patients. The labour process in which they engaged was about seeking a balance between autonomy and subservience, navigating their professional commitment and managerial discipline, and striving for efficiency and productivity, while managing the mundane aspects of their work and increasing their expertise.

The labour process of the socialist period continues in the current practices of Chinese medical aid to Algeria. Although certain pressures may have changed over time—such as the discontinuation of the barefoot doctor model of health delivery—the mission doctors’ labour process remains embedded in complex relations of production and care among themselves, health authorities, and patients. The enlistment of Dr F and his colleagues was not entirely voluntary, and they ran an acupuncture workshop in a demanding environment with limited equipment—something the media often portrayed as an indication of the doctors’ selflessness and commitment to improving humanity. What is often overlooked is the impact of these pressures—which could be at once detrimental or constructive—on the care they were tasked to provide. Ultimately, viewing medicine as a productive labour process can encourage a re-evaluation of the ethics and politics of Chinese medical humanitarianism.



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Zou, Dongxin. 2021. ‘PRC Medical Internationalism: From Cold War to Covid-19.’ ARIscope, 21 January.

Zou, Dongxin. 2022. ‘Orientalism without Power? Chinese Female Ob-Gyns in Rural Algeria and Morocco in the Post-Mao Era.’ Journal of Middle East Women’s Studies 18(1): 105–33.

Dongxin Zou is an Assistant Professor in History of Science at the Hong Kong Polytechnic University who specialises in modern Chinese history. Her research focuses on the history of medicine, health technology, and the transnational networks of material circulation and knowledge production in the Global South. She is currently writing a book that explores the history of Chinese medical missions to postcolonial Algeria, focusing on the exchange of technologies, drugs, and medical practices.
Hong Kong Polytechnic University


Volume 2, Issue 1, 2023