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Chapter 7 Perceived Efficacy, Social Identities, and the Rejection of Cancer Surgery When I met her, Grandma Chen was a lively seventy-two years old, although her life had been anything but easy. Born in 1931 in the village neighboring Baoma, in 1949 she married Grandfather Li and—as was customary—did not meet him until their wedding day. Grandma Chen gave birth to five sons and one daughter, but two sons were stillborn and the daughter died in 1959 at the age of one, at the start of the Great Leap Forward Famine. She recalled that from 1959 until 1961 there was practically no food, she stopped menstruating, her pregnancies were troubled, and she had no breast milk. Her father-in-law beat her often: “He beat me on the head with a stick when I was five months pregnant,” she told me. Her mother-in-law was also abusive to her: “Once, in the 1950s, I offered sweet potato to our guests, so she beat me. At that time life was hard, we had no food.” A month after her first son was born, in 1953, her husband joined the army to fight in Korea and returned in 1957. Once back, he was violent toward her and had an affair with a married woman who lived in the same production team. Her mother-in-law (not her husband’s mother but his father’s second wife) supported her at that time, and Grandma Chen remembered her fondly: “Nobody hung her picture after she died—only I have. She died in 1993 of ‘vomiting illness’—that is, stomach cancer. She couldn’t eat; she would eat and vomit straight away—she died of starvation.” In 2005 her three sons and their wives were all migrant workers, except for the eldest daughter-in-law, who was at home caring for her granddaughter and helping Grandma Chen with farming. She especially liked and missed her youngest daughter-in-law, who had been away since 1999 Perceived Efficacy, Social Identities, and the Rejection of Surgery     201 and whose parents “both died of the ‘spitting illness’ [esophagus cancer ]” ( July 10, 2005). Reflecting on her health, Grandma Chen claimed, “My health is good now, so I help others with farming. Once, a fortune-teller came to see my daughter-in-law. I asked him how long I would live, and he said I would die at sixty-two with ouqi bing [literally, “repressed anger illness ”]. It’s nonsense” ( July 10, 2005). The following spring (April 2006), at seventy-four, Grandma Chen was diagnosed with stomach cancer. Having nursed her mother-in-law through the same illness and watched her neighbor’s husband die of it three years previously, Grandma Chen killed herself by drinking pesticide. When I visited in July 2006, her neighbors surmised that she committed suicide to spare her sons the expense of hospital treatment that cancer would have incurred and to spare herself the pain she would have had to endure in the following months. Under what circumstances did Grandma Chen become convinced not only that treatment was unaffordable, but also that it was unreliable, inefficacious, and therefore not worth investing in? This chapter examines these two aspects in turn—financial barriers to access Figure 7.1 Grandma Chen treats her neighbor’s backache with a folk version of moxibustion to “expel damp” (2005). 202     Strategies of Care and Mourning and perceptions of efficacy—to trace the various factors influencing health care–seeking patterns. It illustrates how hospital treatment (and cancer surgery in particular) is understood by villagers, why, and with what effects. The first part of this chapter provides an account of the developments of health care provision since the founding of the People’s Republic (1949) at the national, provincial, county, and village level. This elucidates the ongoing health care disparities between rural and urban and wealthy and poor regions both in terms of quality and quantity of care available and the clear structural obstacles villagers face in accessing extortionately expensive care. It highlights villagers’ selfperception as second-class citizens, left behind by improvements that have benefited their urban counterparts. As cancer sufferer Uncle Wang stated, “When we [farmers] get ill, we can’t even afford treatment— we’re just left to die” (October 2004). This sentence was perhaps the one that recurred with the most frequency during my fieldwork. In this light, before the introduction of the new rural cooperative medical system (RCMS, a collective health insurance program...


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