The devil they knew

Wife of Lai Guofeng holds her baby in arms on August 5, 2013. The newborn baby who was allegedly sold to human traffickers by an obstetrician in northwest China's Shaanxi province was returned to his parents on Monday, and DNA tests confirmed the baby is Lai's son, local police said. (CNS Photo/Zhang Yichen)

When the media reports began coming, one after the other, revealing that respected local doctor Zhang Shuxia had been arrested on August 2 on suspicion of child trafficking, the residents of Fuping county of Shaanxi Province were first shocked - and then they were furious.

Zhang, a renowned obstetrician at the Maternal and Child Health Care Hospital in Fuping, had allegedly been targeting her acquaintances since 2006 - tricking them into thinking their newborn babies were dead or afflicted with serious health problems, and then taking the children to sell them. Her latest prey had been the baby boy of her school classmate. The sale of the boy netted her 21,600 yuan ($3,529).

Zhang, together with nine other suspects involved in the illegal business, has been put in criminal detention. According to the National Health and Family Planning Commission, Zhang's license has been revoked and three top executives of the hospitals have been sacked.

The commission also vowed to impose stricter management of medical services and implement stronger ethics training across the country to prevent similar cases.

Ten regulations concerning newborns were released by the Shaanxi health department on Monday, officially banning the doctors from transferring babies without the presence of the family and prohibiting obstetricians from making diagnoses.

Unhealthy lies

Zhang's final victim was returned to his home on August 5. He had been transferred to neighboring Henan Province right after his birth.

Lai Guofeng, the baby's father, recalled how he was bombarded with dire news from Zhang.

He was first informed that his wife was diagnosed with syphilis and hepatitis B and that this had affected their son, and he was then warned that the baby could not be cured even if the family could afford the high medical expenses. He was told that even then, the baby would not survive his 30s.

Hearing this, the frustrated father fell into Zhang's trap and signed the consent form to give up the baby.

Five days after the reunion of Lai's family, another family welcomed the return of their twins, after the two baby girls were taken away on May 31 by Zhang, who described them as physically deformed. Similarly, the twins had been "voluntarily" abandoned by the family.

Zhang's case was different than other similar kidnapping cases reported in media, insofar as doctors or family planning officials have typically used family planning policies to persuade families to give up their child rather than claiming health problems.

But an anonymous obstetrician at the Beijing Jishuitan Hospital told the Global Times that there are occasions when parents give up their newborns when they learn about potential health problems. "We need to tell them the potential difficulties, like how much money they might spend on future treatment. But we are never allowed to give any suggestions about whether to keep the baby or not. The final decision is totally up to the parents themselves. Usually, if they abandon the child, it happens due to economic concerns," the obstetrician said, adding that the doctors should still offer basic rescue assistance for humanitarian reasons, and in cases where the child has died, remains must be sent to the morgue.

Deng Liqiang, director of the legal affairs department at the Chinese Medical Doctor Association, said that abandoned babies are reported to hospital executives who then contact the police. "The police contact the civil affairs department who arrange for the children to be raised in welfare homes," Deng said.

Loopholes to kidnapping

According to regulations, when a baby is born, the midwives must show the baby to its mother to allow her to see the gender. If the baby is healthy, the mother can breast-feed it, and then the hospital will keep the baby in an incubator for about two hours in the

delivery room before the two will be accompanied to the ward by midwives. When babies are born with health problems they are sent to a neonatal intensive care unit where pediatricians make a diagnosis.

Deng said that not only Zhang, but the whole hospital had violated regulations. "In this case, the midwives obviously did not take the baby and the mother to the ward and even if the baby was confirmed dead, the head nurse did not fulfill her duties by registering their birth and death certificates," Deng said.

Deng also admitted that there is a hierarchy in hospitals and Zhang had an important role as the deputy director of obstetrics.

"It is natural to follow the orders of the directors or deputy directors," the obstetrician from Beijing added. "The midwives with Zhang did not acquiesce in the incident. Rather, they were not able to overrule their leader." However, Deng noted that healthcare providers must hold themselves responsible for patients and hospital staff should only follow orders in line with regulations.

Exploiting relationships

Zhang's alleged crimes were made possible by loopholes in hospital management, but they also relied on Zhang's relationships with the victims' families. This was possible because of the sheer number of people who seek medical help through connections via friends and family.

In one example, a mother-to-be surnamed Zhi, who is expecting her baby by the end of this year, said that she sought help from her friend who works at a hospital in Weihai, Shandong. "It feels safer, compared with hospitalization through complete strangers," she said.

Fang Shaowei, a sociologist residing in the US, said that such crimes usually happen when the acquaintances are made upon indirect contact. "The excessive trust of acquaintances and the paranoia against strangers can mutually reinforce each other, while criminals can use this mentality to carry out their plans," Fang said.

Meanwhile, local culture also plays a role, as parents who give birth to an unhealthy baby are often judged harshly. This reluctance to accept unhealthy children provided a smokescreen for Zhang's alleged activities.

Customs relating to dead babies also allegedly helped Zhang, as it is tradition to invite an elderly person to bury the child and the parents should not see. "In Zhang's case, the patients might have considered her to be like a family member. That's why they accepted her suggestions that she find an old cleaner at the hospital to do it," said An Guanglu, a writer from Shaanxi who is familiar with local customs.