Fighting for Breath: Living Morally and Dying of Cancer in a Chinese Village

Chapter 1: Cancer and Contending Forms of Morality

Chapter 1 Cancer and Contending Forms of Morality The worst thing about esophagus cancer is you can’t eat, not even drink, you feel dry, you want to drink but you can’t. I know, my mum and dad died of it, too. And having an operation has only limited temporary effects; you’re left without any flesh. It’s the worst; with other kinds of cancer you can still eat, even with stomach cancer—the food comes out in half an hour, but at least you can eat. And the people who die of it, they are not that old, they are healthy people, who never had to take many medicines. There’s just no way to know it’s coming; it feels like a sore throat at first, and then when you start wondering, it’s far too late. —Doctor Wang, village doctor, July 15, 2005 This book offers an account of how families strive to make sense of cancer and care for sufferers in one locality in contemporary rural China. Here I situate the study vis-à-vis the two broad fields of the anthropology of health and suffering and the ethnography of rural China. Villagers’ multifaceted and situationally contingent narratives about cancer causality and practices of care serve as a prism to explore what is at stake in the contemporary reform era. I argue that we might best understand these narratives and practices as embedded in a larger moral economy discourse on the part of Chinese villagers, regarding both their social relations with their families and fellow villagers and their shifting relationship with the Chinese state. In contrast to many ethnographies of China that see the present as lacking in morality, I show that villagers make an incessant effort to inhabit moral worlds and claim to act in a moral fashion. Through these engagements they also redefine morality’s parameters. 18 Foundations Suffering and inequality Critical medical anthropology is largely defined by its interest in health inequalities. Leading exponents of this trend Merrill Singer and Hans Baer see its focus to be on “the importance of political and economic forces, including the exercise of power, in shaping health, disease, illness experience, and healthcare” (1995, 5). Paul Farmer, a prominent voice in this field, has strived to highlight the effects of global political and economic forces on the distribution of suffering. Through the concept of “structural violence” (1997, 2003), he argued that illness is often precipitated and worsened for those situated at the bottom of the social ladder. He cautioned against confusing “structural violence with cultural difference” (1997, 277) and resorting to culture to justify suffering (torture, for instance) as otherness. Similarly, he opposed the tendency to account for failures in public health projects with reference to cultural barriers to their implementation (1999). This literature undermines the epidemiological inclination to blame AIDS and other infectious diseases on individual behavior and suggests instead that the burden of disease is increased by the marginality and poverty of populations particularly affected by it (see also Whyte 2009). The concept of “syndemics”—that is, “the synergistic interaction of two or more coexistent diseases and resultant excess burden of disease” (Singer and Clair 2003, 423; Singer 2009)—was put forward to highlight the connection between disease and “noxious social conditions and social relationships” (Singer and Clair 2003, 434). A study of maternal mortality in Mongolia by Craig Janes and Oyuntsetseg Chuluundorj (2004) offers an example of how changes in the socioeconomic and political setting affected health in general and maternal health in particular. In the wake of the demise of the Soviet Union, Mongolia was affected by economic reforms similar to those that took place in China following Mao’s death. Such reforms precipitated economic insecurity among households rendered more vulnerable to market and climate fluctuations, widespread unemployment and outmigration in search of work, food insecurity and malnutrition, and a collapse of public health and health care. As women became economically and socially marginal and yet subject to heavy labor demands and the health care system suffered a lack of investment, maternal health declined sharply (251–252). As we shall see, health care for rural Cancer and Contending Forms of Morality 19 Chinese experienced a similar decline in the aftermath of reforms, as secondary and tertiary care became more reliant on fee-for-service and grew unaffordable for many rural households. The cost of tests to diagnose cancer can amount to...