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

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 act.

Therefore, as the war came to an end in 1945 and the PUMC returned to its old campus in Beijing in the subsequent year, it seemed that the goals of public health nursing and university-level nursing education advocated by the PUMC were about to spread to other parts of the country and ultimately triumph at a national level. The high hopes, however, were abruptly dashed with the meteoric advancement of the Communist movement in mainland China. Even though the new regime did not impose serious restrictions on both the PUMC and the WCUU, academic freedom tangibly dissipated. Then, with the outbreak of the Korean War (1950–1953) and the resultant fanfare of anti-Western antagonism, both institutions, together with dozens of tertiary universities and colleges funded and/or run by foreigners, were taken over by the government. Thus, ended an era of Western influence in the history of modern nursing in China.

Drawing on a wide range of institutional archival materials and personal memoirs, Grypma's well-researched and richly documented book makes a significant contribution to the field of Chinese nursing studies. Most significantly, unlike previous scholarship that overwhelmingly emphasizes the one-way flow of modern nursing knowledge from West to East, this book demonstrates the multidirectional nature of knowledge movement in the modern era. In particular, it traces how ideas of public health nursing and tertiary education for nurses, which first emerged in America, deeply shaped the minds of Chinese nurses at the PUMC. They then brought their interpretation of the ideas to west China during wartime, which in turn transformed the local nursing practices performed by Canadian nurses and their Chinese students at the WCUU. In this narrative, China was not merely a passive recipient of Western scientific knowledge. Instead, she became an active participant in the transmission and creation of that knowledge. In other words, Grypma's work foregrounds the reciprocal, mutually constitutive interactions among Chinese nursing, Western nursing, and Chinese actors.

Given the richness of information the book provides, it is not possible to write a comprehensive review in the space allotted here. Grypma, for instance, devotes a significant chunk of the book to examine the intricate relationships among various groups of people (e.g., nurses and physicians, students and teachers, missionaries and civil servants, and people of different nationalities). By vividly tracing conflicts, disputes, but also cooperation and partnership among them, Grypma succeeds in unveiling a tension-ridden, complex, and tortuous process of how nursing practice and education were negotiated in modern China. Meanwhile, the nuanced analysis of the interpersonal drama creates a highly engaging reading experience, thereby rendering the book attractive to both lay reader and scholar alike.

Despite the book's tremendous contribution to the field, I do have a few qualms about Grypma's general approach to the subject. For one thing, even though the book focuses on nursing education, it often foregrounds the voices and experiences of school administrators and faculty at the expense of that of students. Students' perspectives, however, are crucial in understanding how nursing reforms advocated by PUMC administrators were interpreted and put into practice at the grassroots level. After all, it was those students who largely determined to what extent reformist nursing ideals had been implemented and fulfilled in their daily interaction with patients. In addition, as Grypma has pointed out that the field of nursing history has gradually moved "from an era of heroic biography" to one focusing on the "ordinary daily lives of subjects more possible and desirable" (p. 15). Ironically, in spite of the book's proclaimed effort to move beyond the dominance of prominent Western organizations and individuals in the study of Chinese nursing history, it ends up focusing on a select group of less prestigious but still influential figures such as the Kilborn family, who played a pivotal in running the WCUU for decades, and Vera Nieh (née Yuchan, 1905–1998) who was the nursing dean of the PUMC during the wartime and postwar periods. What is missing in the account is the views and life stories of ordinary nurses who constituted the great majority of the nursing population.

Overall, the book makes a major contribution to our understanding of the role that both Canadian missionaries and Chinese nurses played in transforming the meaning of nursing service and the provision of nursing education at a critical moment in modern Chinese history. Any serious scholars of Republican Chinese history and of nursing history should engage with this book seriously.