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

Minghui Li

The promotion of modern medicine and the training of medical personnel in China witnessed substantial changes during the second Sino-Japanese war (1937-1945). On the one hand, as the Nationalist government moved to Chongqing in the western part of the country, numerous medical resources were relocated and medical training institutions were reconfigured in Southwest China, particularly in the province of Sichuan. On the other hand, Western missionaries’ dominant role in popularizing modern medicine was immensely impaired by the Japanese invasion, and the leadership in many missionary hospitals were gradually transferred to Chinese staff. These transformations had huge impacts on wartime Sichuan, and continued to affect local medical work from 1945 to the eve of the Communist’s seizing central power. Nursing was absolutely pivotal part of this historical process, and Nursing Shifts in Sichuan approaches this theme by examining the links between nursing education at two distinct but influential institutions from 1937 to 1951. In this book, Sonya Grypma identifies the establishment and development of nursing education associated with the Peking Union Medical College (PUMC), and the West China Union University (WCUU), and reveals the negotiations, cooperations and conflicts between the two institutions before, during, and after PUMC’s taking refuge in Chengdu. By doing so, Grypma demonstrates how class, religion, gender, and nationality catalyzed shifts of modern nursing in China during this period.

The book is based on a variety of materials, which include personal collections belonging to missionary relatives, interview transcripts of people in connection with relevant nursing institutions, and archives obtained from the USA, Canada, China, and UK (such as the Rockefeller Archive Center, the United Church of Canada Archives, and the PUMC Archives). These sources enable an elaborate description of the evolution of modern nursing in China, which involved multiple actors from diverse organizations and went beyond provincial and national borders. It compensates for the lack of transnational and global perspectives in the current Chinese historiography of nursing during the 1930s and 1940s. Grypma’s interest in China’s nursing dates back to her doctoral research twenty years ago. Her continued exploration of (Canadian) missionary nurses in China and her more than eight years’ collection of sources concerning Sichuan ensure the depth of the narration of this book. Her own experiences as a former dean of nursing at Trinity Western University kept her sensitive to problems such as power hierarchy and gendered differentiation in nursing that are found in the sources, and rendered her incisive insights.

The first part of the book (chapters 1-4) sketches out the historical background of nursing in China from the late 19th to the mid-20th century, and documents the evolution of the nursing education associated with the PUMC and WCUU in Beijing and Chengdu respectively, before PUMC’s being taken over by the Japanese in 1941 and its subsequent closure in 1942. The PUMC was an elite medical college in Beijing founded by the China Medical Board and partly sponsored by the Rockefeller Foundation. Its school of nursing created a university-level program which aimed to foster nursing leaders for the country. The WCUU was established by several Christian missions in Chengdu, with its nursing work and education mainly in the charge of Canadian missionary hospitals. The Canadian missionaries offered lower-grade nursing education, with a goal of providing the hospitals with ordinary nursing workforce. Though the two institutions headed forward in different paths, the war accidentally brought them to meet and cooperate. Part two (chapters 5-8) explores the preparations of the PUMC and WCUU for their cooperation in the nursing education, as well as the changes in their nursing work during and after the war. The fact that the PUMC helped the WCUU to initiate a baccalaureate nursing program and to lift its education standard was a significant attempt, yet the PUMC school of nurse returned to Beijing not long after the war ended, with the implementation of the program departing from its original design and incurring doubts subsequently. However, before university-level nursing education fully recovered in the PUMC and further matured in the WCUU, it was discontinued by the Communist government in 1950-1951. Likewise, missionary nursing in China came to an end. Apart from depicting the institutional and administrative reorganizations, Grypma also vividly shows the power relations between female nurses and male physicians, between Chinese and Westerners, and between institutional leaders who had different understanding of the purpose of nursing education.  

Nursing Shifts in Sichuan makes valuable contributions to the growing literature on medical missionary and nursing in modern China. Recent studies show that the competition between male and female medical professionals in Gynecology and Obstetrics in twentieth-century China was not fierce compared with many Western countries, mainly due to the entrenched gendered norms, the government’s approval of female obstetricians, and female doctors’ capability to create professional space for their female colleagues. Nursing was a highly feminine profession and became increasingly popular for women throughout the first half of the twentieth century, but little attention has been focused on how nurses obtained power in the male-dominant hospital environment. Grypma’s accounts on Gertrude Hodeman and Vera Nieh, deans of nursing at the PUMC before and during the war, remarkably present the harsh power struggle between female leaders in nursing and their male superiors. These cases illustrate how female agency played a role in guaranteeing the quality of nursing work and protecting the profits of the nurses, and how tough female leaders were vilified by their male colleagues. They are intriguing examples different from current research’s findings about Gynecology and Obstetrics, enhancing our understanding of the gendered role and hierarchies in the medical profession in modern China. In the meantime, though the current historiography has well recognized the historical process that the leadership in missionary hospitals was shifted from Westerners to Chinese during the war, empirical studies to verify it are lacking. Grypma’s micro study on the PUMC and WCUU fairly illuminates how the Western leadership in nursing institutions in different geographical settings was step by step weakened by government’s policies and the Japanese invasion. The two institutions were representative in different aspects and may speak for the general shifts of nursing leadership across the wartime China. Furthermore, the book is attached with informative tables and appendixes about the PUMC nursing faculty, Canadian missionary nurses who worked in China, and the interned foreign nurses during the war. These tables and appendixes not only strengthen the book’s argument, but also lay an important foundation for future research about Western/missionary nursing in modern China.

Though the book unfolds in an engaging and informative way, it is to be regretted that several issues are not further explored. Compared with East China, Sichuan was considered rather conservative as women’s status in the society was low during the Republican era. Even if modern medicine/nursing was introduced to Sichuan at the end of the 19th century, the majority of the population had little access to it and relied heavily on traditional and folk healing methods until the mid-20th century. In this sense, one wonders to what extent the West China Mission (WCM) stations in urban and rural Sichuan contributed to the increase of nursing students, and how Sichuan girls from non-Christian families were motivated to be involved in missionary nursing schools. These backgrounds are not clear in the book. It is also a bit odd that, while the title of the book highlights its main focus on nursing in Sichuan and Canadian missions, the book actually concentrates on the American elite and Canadian missionary institutions in Beijing and Sichuan equally. Another issue is about the impact of the PUMC nursing school on the WCUU’s nursing education. While the book details the administrative negotiations and institutional changes during the PUMC’s stay in Chengdu, it has not elaborated on how the PUMC assisted the WCUU in teaching or in dealing with hospital cases. Meanwhile, since the book argues that the WCUU failed to stick to the educational standard that the PUMC set up after the latter left, one may ask to what extent the elite PUMC helped uplift the WCUU’s nursing work and contributed to the shifts of modern nursing in Sichuan as the book’s title suggests. Moreover, I believe the book would be more comprehensive if it included a review of literature about the history of Western/missionary nursing in modern China. Despite these, this book, with the rich and fascinating materials and diverse perspectives, will be of great interest to anyone who seeks to understand medical missionary and modern nursing in Beijing, in Sichuan, and in China as a whole, in the first half of the twentieth century.