Wang Xiulan, a retired medical professor in her 60s, was surprised that a nod from the most powerful man in her home village could not make her planned clinic a reality.

Wu Liutun, secretary of the Duqiao Village Committee of the Communist Party of China, told her that his signature did not count as it had before.

Wu asked Wang to get permission for the clinic from eight village deputies from the No 7 Group, one of the seven subsidiary units of Duqiao village.