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Journal of Asian American Studies 4.1 (2001) 57-75



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Medicine, Midwifery, And the State: Japanese Americans and Health Care in Hawai'i, 1885-1945 *

Susan L. Smith


One hundred years ago, a young Japanese man, Nitaro Kurisaki, came to Hawai'i to work as a contract laborer. He was assigned to a plantation where the luna, or plantation overseer, used a snake whip to keep the workers under control. One day he found himself in prison after beating up the luna who had falsely accused him of laziness and sneaking off to have a smoke. It was a Japanese physician, Dr. Iga Mori, who worked for the Bureau of Immigration, who investigated the case and secured the release of the twenty-year-old man. 1 In 1906 Junokichi Senda, a frightened teenager from Japan faced immigration officials in Honolulu. Although Senda was one of the few immigrants wearing a western-style suit, he still felt unsure of himself. More than fifty years later, he still remembered the comforting words of the Japanese interpreter and health inspector, Dr. Tomizo Katsunuma. An immigrant himself, Dr. Katsunuma was a welcome sight to the thousands of Japanese immigrants he helped inspect for the government of Hawai'i. 2

The stories of Japanese immigrants, known as the issei, suggest that the state recognized and helped to construct the cultural authority of issei doctors in Hawai'i. At the turn of the twentieth century medicine was a respected profession in both the U.S. and Japan. Doctors were able to mediate between the needs of the immigrants and the requirements of the state. The result was that although state intervention at times circumscribed issei doctors' work, the state maintained respect for and recognition of Japanese American medicine. [End Page 57]

However, the state did not respond to midwives in the same way. As the history of Japanese immigrant midwifery in Hawai'i demonstrates, the state viewed issei midwives as marginal figures. Midwives lacked occupational prestige and were subordinate to doctors in the American health care hierarchy. Although midwifery was an important female occupation in Japan in the early twentieth century, many Americans considered it a relic of bygone days and characterized the midwife as the birth attendant of the poor. Indeed, at times state action drove midwives out of practice, narrowing women's childbirth options and limiting employment opportunities for issei women. Therefore, even though the midwife, known in Japanese as sanba, was well respected in Japanese immigrant communities, state authorities in Hawai'i did not recognize her cultural authority and value.

The history of Japanese American medicine and midwifery in Hawai'i demonstrates that state actions had consequences well beyond the provision of health care or the extent of employment options in immigrant communities. State responses helped to shape the very nature of community leadership, with notable consequences in times of crisis. Because the state was invested in protecting medicine and not midwifery, state regulation came sooner and was stricter for issei physicians than issei midwives. However, state officials acknowledged the leadership of issei physicians, most of whom were men, while they did not take into account the parallel role played by issei midwives, all of whom were women.

Attention to Japanese American medicine and midwifery in Hawai'i has the potential to alter our conceptual framework for the history of health in the United States. It reveals the impact of racial politics and gender relations on public health policies and health care provisions. It illustrates the gendered consequences of racially motivated state intervention in health care.

Issei Medicine

The first Japanese immigrant physicians arrived in Hawai'i at the invitation of the kingdom of Hawai'i and the insistence of Japan. Japan generally sought to safeguard its immigrants who came as contract laborers for the sugar plantations beginning in 1885. The Hawaiian government, [End Page 58] through the Bureau of Immigration, needed Japanese doctors to assist as interpreters in the inspection of arrivals and care of the Japanese immigrants on plantations. The doctors were...

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