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

In Nursing Shifts in Sichuan, Sonya Grypma delivers an important, well-documented assessment of “the last sustained period of transnational relationships (and knowledge flows) between China, Canada, and the United States, as the Rockefellers, through the Peking Union Medical College (PUMC) aimed to develop a Chinese nursing elite” (5) until the Communist government terminated degree-based nursing programs in 1951. Equally, it makes a valuable contribution to understanding the pivotal but conflicted role of nursing as a conveyor of knowledge and cultural broker within the wider context of global health networks. Given that there would be a thirty-five-year hiatus before the alumnae helped relaunch degree programs in China, Nursing Shifts is both “a cautionary tale of the transient nature of transnational relations and a treatise on the resilience of educated women” (5).The book is organized into eight thematic chapters covering four stages of the transition of modern nursing in China from Western to Chinese actors: introduction (1884–1914), professionalization (1914–1927), nationalization (1927–1937), and fragmentation (1937–1951). The first four chapters set the stage for the conflict of personalities, values, and visions of nursing education. The final four appraise the collision of two worlds of nursing, as the refugee PUMC was hosted by the Canadian West China Mission until its return to Beijing after the war.Nursing Shifts has many strengths. Its introduction sets a clear road map of what will be examined: the study’s importance in expanding nursing as a critical actor in global health and the methodology used. Grypma contends that “despite the Rockefellers’ notoriety,” Nursing Shifts engages with contemporary scholarship that forefronts “ordinary women and lives of lesser-known figures.” The deans of nursing “emerge as the actors with both the most prestige and the most conflicted relations.” Gertrude Hodgman, Vera Nieh, and Cora Kilborn “were constantly embroiled in power struggles, particularly in relation to their relatively low status within their respective organizations—as women” (15). It forefronts both Chinese and Western nurses, who view nursing education as a steppingstone for women’s liberation and leadership in the healthcare landscape. Moreover, her study illuminates how “class, gender, and nationality” shaped exchanges between nurses and physicians, states and administrators, missionaries and civil servants, and Canadians, Americans, and Chinese” (6). Grypma, former dean of a private Canadian Christian–based nursing school, judiciously acknowledges her own vantage point: “I am sensitive to ways in which missionaries positioned themselves in relation to the PUMC” (17).This study reassesses the resilience of two complementary but competing transnational epistemic communities, or knowledge-based networks. A central tenet underpinning Nursing Shifts’ storyline is the distinction that Grypma draws between missionary nurses and PUMC alumnae. Characterized by their shared duty to care and belief that their actions benefited the welfare of the Chinese people, they differed on how each re-envisaged nursing identity and education while geopolitical conditions devastated health care in war-torn China. Although missionary nursing became less evangelistic as Christian churches embraced the social gospel, “it still provided a tangible opportunity to emulate Christ and serve God by serving others” through work, in close collaboration with physicians, and in instructing students in Western-styled hospitals (57). In contrast, right from the beginning PUMC nurses strove to create an autonomous “cutting edge” institution geared toward developing nursing leaders and public health. For them, missionaries’ view of themselves as “virtuous carriers of Christian culture” was simply a remnant of a bygone era (12).Gypma carefully avoids any hagiographic treatment of Chinese and Western nursing leaders. Instead, she offers a sensitive but critical assessment of their lived experiences as she builds her case in support of PUMC’s greater resilience during and after the war, which left a more enduring legacy. Despite the shift from evangelism to a social construct of religion drawn from the social gospel, she argues, “War-related phenomena such as mass migration, relentless air raids, and diminishing resources contributed to the erosion of missionary nursing in West China well before Canada and the United States declared war on Japan,” thereby setting the stage in 1943 for the PUMC’s entrance into the narrative arc of Canadian missionary nursing (80–81). Western nurses began to disengage from missionary work, and Chinese nurses stepped into leadership positions. Gypma provides a striking account of the tenacious and courageous efforts of the PUMC to carry on their nursing responsibilities as educators and leaders as Western institutions in China were taken over by the Japanese with lightning speed in the wake of Pearl Harbor on December 7, 1941. In 1943, PUMC nursing faculty evacuated to the “backwater” province of Sichuan in Free China; they not only re-established an elite nursing education program at the West China Union Campus in Chengdu but also helped to transform missionary nursing by launching the second university-based nursing program in China. Vera Nieh emerges as a ‘“fighter’ driven by patriotism and capable of adhering to and fighting for her own deeply held principles—and supporting women’s leadership at the same time” (204). Grypma’s account is noteworthy for its reappraisal of Nieh’s ascribed leadership role here: “Indeed, the actual decisions regarding the opening of the school did not involve Nieh at all. . . . Thus, the refugee PUMC story is really one of a remarkably committed and engaged group of PUMC alumnae—approximately twelve in all—who firmly believed that the PUMC had something critical to offer in the war effort in China.” (202)China-born “mishkid” Cora Kilborn and Vera Nieh provide apt foils for two competing visions of nursing identify and education. The West China Mission university-based nursing program opened, but Cora Kilborn’s leadership was challenged by Chinese PUMC alumnae and the first group of baccalaureate students, who vehemently disagreed with her approach to university-level education. The West China Mission under Kilborn’s leadership adhered to the curative rather than preventive model of health, which became difficult to maintain as prices soared and human and other resources faded away over the course of the war. As Grypma later noted, “One cannot imagine a more disappointing ending to her life’s work in China than a literal slap in the face by a Chinese nursing colleague” (284). In contrast, the PUMC School of Nursing offered “an innovative model that challenged medical authority, privileged nursing priorities, separated nursing education from practice, prioritized advanced education, and modelled nursing leadership. . . . The PUMC unsettled traditional nursing (and medical) norms, positioning nursing as a liberating movement for women—in Chengdu, as in Beijing” (258).Nursing Shifts is rich fuel for rethinking Chinese and Western nurses’ controversial place in historiography of health care in China. Like Grypma, I found that the transnational knowledge networks were far more complex, contested, and mutually transformative than previously acknowledged. However, I was struck by the differences between the Chinese nurses’ and Western nurses’ real-world experiences as members of the Quaker-sponsored Friends Ambulance Unit in this era. As pacifists, these Westerners came not to convert but alleviate wartime suffering and thereby forge the bonds of international friendship. Chinese nurses played pivotal roles in their individual humanitarian odysseys that not only empowered them as women but also forced them to rethink their professional identities as Western nurses. As Grypma recognized, her study is part of a much larger story yet to be told by Western and Chinese historians. Good global nursing history unsettles assumptions, exposes the lacunae in the scholarly literature, and sets the future direction of nursing within global health networks. Nursing Shifts does all three.

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