By Emiy Rauhala / Dongzang
September 12, 2014

In the early hours of April 14, 2012, Zheng Yanliang cut off his right leg. Racked by pain from arterial thrombosis, but unable to pay for the surgical amputation he needed, the corn farmer severed his limb with a hacksaw and a fruit knife. It took 20 minutes to grind through the bone.

Much is astonishing about Zheng’s ordeal — not least that he survived. Zheng, then 46, had been suffering from excruciating leg pain, when a doctor at a local clinic diagnosed him and explained that blood was barely getting to his lower limbs. The right leg would need to be removed.

Zheng and his wife traveled from their dusty village of Dongzang, in China’s eastern Hebei province, to a public hospital in Beijing. There, they were told to produce about $48,000 in cash as a deposit. Zheng made about $400 in a good month, so he went home. Months passed. Maggots infested his dying limb. By the time he put sawtooth to skin, he says, the pain was so dreadful that he was happy to see his leg gone.

When Zheng’s story hit the headlines last fall, it turned the farmer into a folk hero. Like Zheng, ordinary Chinese are frustrated with China’s health care system: long waits, shoddy service, high costs. “The [Zheng] case epitomizes the sustained failure of the government to provide a solution to the problem of affordability and access,” says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, a U.S. think tank.

For the international editions of this week’s magazine, I wrote about China’s efforts to overhaul its ailing health care system (read the full story here). In 2009, Beijing pledged about $173 billion over three years for public health care. They say 95% of Chinese are now insured (and happily note they achieved this level of coverage before the U.S.). The state now reimburses more of each treatment — up to 70% for some serious illnesses.

But stop any person on the street, and they’ll tell you that the scope of the insurance is spotty and costs are too high. Dr. Bernhard Schwartländer, the World Health Organization’s representative in China, says people may be covered but “they need to work on what is covered and how much it costs.”

In a speech to China’s National People’s Congress, delegate Dr. Zhong Nanshan, a respected physician and veteran of the SARS outbreak, argued that China must do more. In less than 10 years, health spending has jumped from 3% to 5% of GDP — a “great effort,” he said, but still less, by GDP, than Afghanistan. Doctors are exhausted and disillusioned and the general public still finds it difficult and expensive to receive care.

Take farmer Zheng. When his local hospital couldn’t treat his leg pain, he went to the city. If he had the deposit, he could have been admitted and the rural insurance scheme may have reimbursed some of the costs of his care — an improvement over years past. But he did not have the deposit. So he took a hacksaw and fruit knife to his leg and risked his life.

For Zheng, help came only after he contacted a local reporter. When people heard his story, donations from party cadres and concerned citizens flooded in. A year and a half after the DIY amputation, his other leg, which was also affected, was removed in a hospital free of charge. He greeted reporters at his home in Dongzang village in the presence of local officials who, while declining to introduce themselves, made a point of reminding Zheng how much the authorities had done to help. Was Zheng satisfied with his treatment? “I’m just a farmer,” he said. “I don’t know about such things.”

When another blood clot landed Zheng in the hospital, reporters were forbidden from asking him questions. In a hallway patrolled by uniformed security personnel, Zheng’s wife told TIME that they need money for hospital bills, prosthetics and rehabilitation. “It’s a very bad situation,” she said. “We are running out of time.”

So is the rest of China.

— With reporting by Gu Yongqiang in Beijing and Changsha.

Write to Emily Rauhala at emily_rauhala@timeasia.com.

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