Nursing Shifts in Sichuan: Canadian Missions and Wartime China, 1937–1951 by Sonya Grypma (review)

The central message of Sonya Grypma's Nursing Shifts in Sichuan: Canadian Missions and Wartime China, 1937–1951 is that the Sino-Japanese War (1937–1945) fundamentally changed the dominant approach to modern nursing and nursing education in China. To illustrate the watershed shift, Grypma focuses on nursing programs offered at two distinct but influential institutions, the West China Union University (WCUU) and the Peking Union Medical College (PUMC). Until the outbreak of the war, the WCUU, founded by the United Church of Canada West China Mission in Chengdu in 1910, represented the then-prevalent model of nursing education. Missionary-run medical schools like the WCUU instilled in students a notion of nursing as a hospital-based vocation imbued with Christian significance, that is, nursing offered an opportunity to fulfill the religious imperative to alleviate the suffering of strangers. By contrast, the PUMC epitomized a more secular alternative. First established in Beijing in 1906 and later lavishly sponsored by the prestigious Rockefeller Foundation, the PUMC was an avid recipient and transmitter of nursing and nursing education ideas that first emerged in early twentieth-century America. To the PUMC, nursing was not merely a method to provide symptomatic relief from disease and soothe the individual patient's pain. Instead, it was "a scientifically based means toward a population-based end: a health citizenry" (p. 14). It meant that the primary task of nursing was to offer preventative measures that would help improve the overall health of the entire population. To achieve this ambitious goal, the PUMC required its students to go through a rigorous collegiate nursing program. Whereas WCUU graduates only received a nursing diploma, their PUMC counterparts received both a diploma and a baccalaureate degree. Overall, the PUMC aimed to train not simply rank-and-file nurses, but nursing leaders who would direct the future development of nursing in China.

For decades, there was little interaction between the two institutions, and the two approaches to nursing and nursing education barely overlapped. The situation, however, drastically changed after the outbreak of the Sino-Japanese War (1937–1945). As the Japanese overran east China, a substantial group of medical professionals joined millions of others to seek refuge in west China. Most significantly, after the Japanese takeover of the PUMC campus in 1943, its faculty and students took pains to relocate to Free China and reopened the school on the WCUU campus. Over the following three years, PUMC nurses changed how nursing was taught and practiced in Sichuan. By the end of the war, even WCUU students began to challenge the long-established missionary model and embrace ideals (e.g., public health nursing and university-level nursing education) trailblazed by the PUMC. From Grypma's perspective, the war had thus helped transform modern nursing in China from one heavily dictated by Westerns to one controlled by Chinese nurses and defined on Chinese terms, thereby completing the decades-long process of the "Sinofication" of nursing.

To understand this paradigmatic transformation, Grypma underscores the apparently conflicting role of the destructive and constructive nature of war. On the one hand, the war significantly weakened the position of Western medical missionaries in China. Even in west China which often did not suffer the direct impact of the war on its territory, wartime difficulties such as periodic air raids, shortage of material, and rampant inflation forced numerous missionary nurses to leave China. The exodus of foreign missionaries consequently created a leadership void only to be filled by Chinese nurses, the majority of whom were PUMC alumnae. On the other hand, at a more general level, the war had fundamentally undermined the legitimacy of the foreign imperialist presence in China and sparked growing nationalism. These changes thus further whittled away the time-honored missionary view of nursing as a form of altruistic vocation and elevated the competing understanding of public health nursing as a patriotic...