A Man in Full: To Hell and Back in the Chinese Healthcare System
When a farmer and migrant worker got thrombosis in his legs, China failed him. In the end, he had to saw off his own rotting leg in order to survive. Zheng Yanliang's story is an allegory of the struggle to modernize the Chinese healthcare system.
His shroud had already been purchased when, on April 14, 2012, Zheng Yanliang, 48, a Chinese man from Hebei Province, summoned up the last of his strength to lean out of his bed and reach for his toolbox. He took out a hacksaw. Then he wrapped the handle of a backscratcher in a piece of material, which he stuck in his mouth so that he could bite on it. He did not hesitate. He had thought about his options and concluded that he had only one choice, this unthinkable, monstrous deed. He placed the saw against his right leg, a hand's breadth below his hip, and began to saw.
Zheng is sitting in his bed in a room in Beijing. He wants to get up, but he can't do it without the help of his wife, Zhonghong. "Zhonghong, give me the rag," he says. She hands him a thin piece of white gauze material. He pushes up the two trouser legs, looks at what is missing and feels what is still there. "The flesh is too soft," he says, "too little strength, too little muscle."
He sits on the material and wraps it tightly around the stump. Then he presses the stump into the cup of the prosthesis, and his wife screws it into place. He now has a leg made of plastic and metal, with a knee consisting of nine hydraulic joints in the middle, a lower leg and foot encased in an orange Nike shoe.
And now the left leg, which Zheng also lost, later on, when his name was already in Chinese newspapers and doctors could no longer turn him away, and which was then properly amputated. He ties a wide belt around his hips and stomach, to support his upper body. Then Zhonghong bends down, hugs her husband firmly and lifts him up. Zheng teeters for a moment, but then he stands up. Zheng Yanliang, undefeated, is standing up straight and smiling. "Give me the cane," he says to his wife.
It took Zheng seven months to learn how to stand up again. He spent seven months living with his wife in this small room on a deafeningly loud arterial road on the southern edge of Beijing, unable to sleep at night and spending torturous days with other physically disabled people in a rehabilitation center. Today is his last day in Beijing. It's the day he and his wife will travel back to their village, just a few hours to the southwest of the Chinese capital.
'Where Was Our Government?'
Zheng's martyrdom has shaken the Chinese. The story was reported in newspapers and shared thousands of times on the Internet. "What happened to this man, that he was forced to do something like this?" one blogger asked. "Where was our government? Where was the Red Cross?" another wanted to know. "All praise to socialism," a third blogger wrote with bitter irony. "Those who live in capitalism have no idea how good we have it here in China."
Many refused to believe Zheng's story at first. But it's true. And it can no longer be ignored. In the meantime, says one of Zheng's caretakers, even Xi Jinping, president of the People's Republic of China and general secretary of the Communist Party, has asked about the condition of this patient, this one man in a country of 1.3 billion people. The caretaker says: "Zheng Yanliang is a sensitive case." His is the story of a man who sawed off his own leg because he had no other choice. It signifies how the state abandons its citizens, and how the country's healthcare system leaves patients in the greatest possible distress to fend for themselves.
Zheng's trip home in a minivan passes through the suburbs of Beijing, along the city's fifth and sixth beltways and out into industrial Hebei Province. Trucks filled with coal and semis loaded with construction machinery roar past in the right lane while black sedans speed by in the left. And next to the highway, high-speed trains traveling three times as fast speed along, bound for other Chinese provinces.
Hebei is half the size of Germany, has a population of 70 million and produces twice as much steel as the United States. Those who live there are always in a hurry. Hebei's inhabitants are busy doing everything they can to increase the modest affluence they have managed to accumulate in the last 30 years. Many of them have no time to be sick, nor do they have any money to get well.
Zheng was 10 years old when Mao died and 15 when the Chinese economy embarked on its real Great Leap Forward. As the only boy of four children, he helped out in the wheat and corn fields the party had assigned to his father. But the farm did not produce enough income to feed the family, so Zheng began working on a construction site. "I know this area well," he says from the passenger seat, as he gazes at a sea of high-rise buildings on the outskirts of Beijing. "We poured foundations and built apartment buildings here for years." He says that he never went into the city at that time, and that he still has not seen Tiananmen Square.
For years, his life -- a life like that of millions of other Chinese -- consisted of working in construction for 10 months every year, followed by two months at home. When he married in 1998, the country's one-child policy had been in place for many years. Besides, he wouldn't have been able to support more than the one daughter Zhonghong gave birth to a year after they were married. Zheng later took a job in one of the brick factories in Hebei, where the sky is filled with hundreds of smokestacks. Zheng made, loaded and delivered the bricks that were used to urbanize China.
Breaks or vacations were not part of this life. Zheng was a hard worker, a strong and healthy man. He smoked and drank, but only as much as he could afford, and when he had a few extra yuan he played poker with his neighbors, and he went out to eat with them once a month. Hebei's cuisine is simple, fatty and unmistakable: donkey soup, cured donkey in gelatin, and donkey meat, and Baijiu, a strong distilled spirit made with sorghum and with an alcohol content of about 50 percent. Before leaving Beijing, Zheng bought a few bottles of Baijiu, which he intends to drink with his friends.
A Journey of Agonies
The minivan bumps along dirt roads and past empty fields to his village, Dongzang, where the streets are empty. His wife unlocks the iron gate. A pile of corncobs are spread out to dry in the courtyard. "I put the leg in that clay jar at the time," she says, pointing to a corner. On the day Zheng sawed off his leg, he called out to his wife and instructed her to keep the dead flesh in a jar in the courtyard. He said he wanted to be buried with it when he dies. The second leg is also in the jar now.
While he was in Beijing, a neighbor built a concrete ramp in front of the main door, and now his wife pushes him up it in his wheelchair. Then Zheng rolls into the room where his calamity began three years ago. From there, he embarked on a journey of agonies through the Chinese healthcare system, an odyssey that involved traveling hundreds of kilometers, and in which he was examined in several hospitals by a number of doctors, all of whom recognized the danger but did not take the steps needed for him to heal. And it was to this room that he eventually returned, after receiving no treatment, to die.
"It was the sixth day after the Chinese New Year's festival, Jan. 28, 2012," Zheng recalls. "I was sitting on this green sofa here, playing poker with a few friends. When I stood up, I suddenly felt a terrible pain right here." He touches his groin.
Half an hour later, he could hardly move his leg. There is no doctor in the village, only an infirmary with a paramedic, Zheng Kexin, who examined him that day. The same paramedic is on duty today, three years later. The open pickup trucks farmers and workers use to bring their sick and injured to the infirmary, wrapped in blankets, are standing outside the building. As the paramedic speaks, people are constantly knocking on the door -- fathers and mothers asking him to go to the room where their sick children are moaning in pain. Of course he remembers patient Zheng, the paramedic says.
"I gave him some painkillers and sent him back home. I didn't like the way he looked. But I have 20 to 30 patients every afternoon. When my wife isn't there, I am responsible for almost 3,000 patients. The cell phone rings day and night."
Zheng was taken back home, but when his leg became cold and pale, he began to lose sensation and his toes started to turn blue, his friends loaded him into a car and rushed him to Baoding, a provincial city. There is no ambulance service in rural areas. Zheng's wife took along all the money she could find. The Chinese give each other money for the New Year's festival, and the couple had 3,000 yuan, or about 400 ($436), in the house.
The Hebei University Hospital is one of three large hospitals in Baoding, with 1,500 beds and more than 20,000 surgeries a year. The building is slightly dilapidated and houses many more patients than it should. In the General Surgery on the 11th floor, where Zheng ended up that night, there are patients lying in beds in the hallways and on mats in the stairwell. It smells of cigarettes and urine.
At 11:10 p.m., an emergency room doctor examined Zheng and referred him to the surgeons. According to his medical record, Zheng had strong pain in both legs and had had his appendix removed three months earlier. "No other abnormalities," the record reads. Blood work was done and he was given painkillers.
'Complicated and Critical'
During that night, Zhonghong watched as her husband's lower legs became more and more discolored and his feet began turning outward in a grotesque way. She dragged her husband to the toilet several times. The next morning, he was given an ultrasound and an MRI, and then, finally, a diagnosis was prepared. Arterial thrombosis had formed in both of the patient's legs, wrote Dr. Li Riheng, and Zheng's condition was "complicated and critical." Nevertheless, the university hospital discharged the patient and transferred him to Military Hospital 301 in Beijing.
The blood vessels supplying blood to Zheng's legs were clogged, in a condition called acute arterial occlusion. If treated early, the prospects of recovery are good. "But if surgery is delayed by more than 12 hours," reads the professional literature, "there is a risk of loss of the extremity."
Zheng couldn't understand why the doctors did not operate on their patient, despite the obvious diagnosis, and why, 20 hours after the initial onset of symptoms, they transferred him to Beijing, 160 kilometers (100 miles) away. And there is no explanation for it. Two years later, he approached the hospital complaint department with the same question, but his complaint was denied.
"Why do you ask about that?" asks Dr. Zhang Aimin, 50, the chief resident in the General Surgery department, when SPIEGEL confronts him with the same question. Yes, he says, he does remember this patient. "The man is morally deficient," he explains. "He is just telling people his story to make money."
In a waking moment Zheng, who was in so much pain that he kept fainting, instructed his wife to borrow 10,000 yuan, or about 1,500, from friends. Zhonghong then traveled with her husband to Beijing, a journey that lasted four hours.
Denial at an Elite Hospital
Military Hospital 301 is administered by the People's Liberation Army and is one of the country's biggest and best hospitals. It has more than 4,000 beds and provides outpatient care to 3.8 million people and treats 110,000 hospitalized patients a year. According to its website, the hospital is "responsible for the medical care of the leaders of the Central Committee of the Communist Party, the Central Military Commission, the General Staff of the People's Liberation Army and the troops stationed in Beijing." If the Chinese president were to suffer from arterial occlusion in the legs or even a less serious condition that required inpatient treatment, he would be taken to Hospital 301.
High-ranking officials are treated in the VIP wing, which has military security, while outpatients enter the hospital through a marble, glass and chrome steel lobby, which could double as the departure hall of a major airport. Zheng Yanliang was an emergency patient, and the vascular surgeon who treated him sent him directly to the Orthopedics Department. He noted that the patient's right leg could no longer be saved through vascular surgery and asked his colleagues in orthopedics to review the conditions for amputation. Zheng spent the night either being examined or lying on a stretcher in the hallway of the emergency room. A doctor took his wife aside and explained to her that an amputation was only the first step in a lengthy course of treatment, which, all told, would cost about 300,000 yuan, or 40,000 -- a sum the couple could not even have raised if they had sold everything they owned.
Besides, said the doctor, an amputation was not possible at that time, because it would require a "clear line" in Zheng's tissue to develop. According to the doctor, this "clear line" would indicate the point at which the leg could be amputated. If they wanted to have the operation done in Beijing, the doctor said, they would have to increase their deposit. The couple's 10,000 yuan had already been used up on the previous evening, he explained.
Zheng didn't want to leave Military Hospital 301, and he didn't want to die. But he had no choice. He had reached the end of what the healthcare system had to offer him, a man with a potentially fatal condition.
Left to Fend for Themselves
At 8 a.m. the next morning, one of China's leading hospitals discharged patient Zheng Yanliang. The patient was aware of his situation, the doctor on duty wrote in the file, and yet he refused to remain in the hospital. According to the file, Zheng was "informed that he would be responsible for the consequences if treatment were delayed." Zheng paid 11,000 yuan for his night in Beijing, and another 1,800 for the ambulance that took him back to Baoding.
The party concerns itself with prosperity and housing, jobs, roads and security. But booming China has long ignored the health of its citizens. The Communist healthcare system collapsed when it was privatized at the beginning of China's economic reforms. That healthcare system had almost doubled Chinese life expectancy from 35 to 68 and reduced child mortality by 80 percent -- one of the few remarkable achievements of the Mao years.
Then came Deng Xiaoping, and the Chinese became more affluent, but their health did not improve significantly. Only civil servants and government employees remained insured and continued to receive medical care, while farmers and migrant workers were left to fend for themselves.
Families and relatives were left to fill the gap left by the government. For Zhonghong, it was a question of who could help and which of their friends and relatives had connections. She thought of a nephew who was a medical student, and she called him. The nephew knew a surgeon in Baoding, and they went to see him.
Dr. Li, the surgeon, met the couple at Hospital No. 252 in Baoding, but as a private citizen, not as a doctor. He did them a favor. There is no record of this encounter, merely the version told by Zheng and his wife. When SPIEGEL contacted Dr. Li by telephone, he said he had never heard of a patient named Zheng Yanliang.
"He told us that he was only familiar with Yanliang's illness from the literature," says Zheng's wife, "but that he had never encountered anything like it in practice." The doctors in Beijing were right, he said: It was still too early for amputation. Zhonghong asked if the blood clot could somehow be dissolved, but the doctor said that it couldn't, that it was too late for that. If nothing were done, he said, Zheng might have one or two weeks left to live. But if the clots were dissolved and fragments reached the heart, he would die immediately.
The End of the Line
"I hadn't slept for two days," says Zhonghong. "We had used up all our money. We had gone into debt. And still the money wasn't enough for an operation. I had to make a decision. I told my husband: 'We'll go home, and you'll get better.'" She thought she was taking him home to die.
It was February 2012, and Zheng was lying in his bed. He was being given Tramadol, a painkiller, by injection every 12 hours, but then the intervals were reduced to four hours and finally two. After three days he began to hallucinate and saw ghosts flying around the room. His leg was getting blacker and blacker every day. Zhonghong was changing his adult diapers, but they were soon unnecessary because he had stopped eating. He would still drink water when his wife poured it down his throat, but he couldn't tolerate his mother or his mother-in-law at his bedside. Zhonghong sat with her husband, waiting for him to die. His sister came to visit him and said that she had bought the shroud. This was where Zheng's story could have and ought to have ended.
But Zheng didn't die.
His leg, however, was already dead. When he woke up one morning, after 11 weeks in a semiconscious state, he no longer felt any pain in his right leg. It was April 12, 2012. But the leg smelled, because the process of decay had already begun. Zheng couldn't stand the sight of it. Two days later, he asked his wife to hand him the saw in a toolbox under his bed. "Help me saw off the leg," he said. Zhonghong refused. They argued and she stormed out of the room, leaving him alone. He took the saw and began cutting, but there was hardly any blood. The bones were brittle and the tissue was infested with maggots. Zheng bit so hard on the piece of wood between his teeth that he broke a molar. When his wife returned to the room and saw what he had done, she collapsed.
Doctors in Despair
To this day, a serious illness like Zheng's can ruin a family financially. After the turn of the millennium, nine out of 10 Chinese had no health insurance, and even as the urban elites became more prosperous, doctors' salaries remained low. Underpaid, overworked and repeatedly exposed to attacks by helpless and aggressive patients, China's doctors are in despair over their profession. One in four doctors suffers from depression.
The party is trying to correct the problem. In early 2003, China began introducing health insurance for the rural population. It aims to increase the number of doctors from 1.5 to 2 per 1,000 residents by 2020 (the ratio in Germany is 3.8). Officially, almost all Chinese now have health insurance, an achievement recognized by the World Health Organization. But it's a staggered system. Patients who visit a local infirmary receive 70 to 80 percent of their expenses reimbursed. The reimbursement drops to 60 percent in district hospitals, and in modern facilities like Hospital 301 in Beijing, the average reimbursement is only 30 percent. And no matter where a patient is treated, the costs must be paid in advance.
Now that he had sawed off his leg, Zheng was suddenly no longer at death's door.
He began to eat again. Zhonghong poured iodine on the wound. The neighbors, who hadn't entered the house in weeks, began visiting again. Zheng began to recover.
Zheng's story could have ended here, too, and the world would not have found out about it. It could have continued as it did in the months that followed. A Chinese farmer and migrant worker lives in a village as a severely disabled person, his family cares for him as well as it can, his sister buys a wheelchair, and the government approves a disability pension of 129 yuan a month, or about 20. Instead of going to college, his daughter takes a job in a shoe factory, but the money still isn't enough. He could have continued living in poverty like this, from one day to the next, for years to come. Perhaps he would have died soon of the thrombosis in his other leg, of his damaged kidneys or of an infection. The fact that it didn't end this way is yet another miracle in a life at the very bottom in China.
A Tragic Story Goes Global
Zheng didn't give up, and he was also lucky. In the summer of 2013, after more than a year had passed since his self-amputation, he hit upon the idea of telling his story to a newspaper. He hardly knew anything about newspapers, not even their names. He called information to obtain the titles and contact numbers of newspapers in Beijing. He spoke with journalists there, but they didn't believe him. One of them suggested he contact a local paper, the Baoding Evening News. It sent a reporter to Dongzang, who took photos and wrote a report.
"Now they were all coming to see me," says Zheng.
One of his visitors was Dr. Han Bin, the head of Hospital No. 2 in Baoding. He looked at Zheng's left leg and said that he wanted to take him to the hospital immediately. Zheng told him that he couldn't afford the operation. But the doctor reassured him and said: "We'll take care of that." His left leg was amputated. Zhonghong had it wrapped up and placed it with the other leg in the clay jar in the courtyard.
One of the journalists posted Zheng's account number on the Internet. Some 320,000 yuan in donations were paid within a few days.
In the spring of 2014, the Baoding invalids' association found a rehab center in Beijing that admitted Zheng and had two prosthetic legs made for him. Zheng shared the costs with the association and the rehab center. Of the 320,000 yuan in donations, he still had 18,000 left over in the end.
'There Is Something Wrong with Our System'
Asked if he thinks there's a villain in this story, Zheng shrugs his shoulders. He can only think of a hero. His wife. "I was poor when we met," he says. "And I'm still poor today. She helped me. I think she is very fond of me."
Li Zhang, the village mayor, says: "We provided Zheng with his disability pension. What else could we have done?"
Dr. Xu Yongle, a vascular surgeon at Hospital 301 in Beijing, who examined Zheng three years ago, classified him as an emergency case and sent him to the orthopedics department, says: "If a patient ends up lying in his bed at home and saws off his own leg, there is something wrong with our system."
Zheng, supported by his crutches, is now standing in his house, looking out the window at the courtyard and the clay jar that holds his dead legs, or what is left of them -- dust and bones, relics of himself. Zheng's legs have preceded him into the afterlife, to a place where he refused to follow them and doesn't intend to go for a long time. Zheng Yanliang is standing in his living room, alive, a man in full.
Translated from the German by Christopher Sultan
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