From the first Western nurse arriving in China in 1884 to the last missionary nurse departing China in around 1952, nursing in China underwent tremendous changes during the long twentieth century. The role of nurses moved from assisting Christian medical physicians to becoming a modern profession and a new way for Chinese women to contribute to the nation-building project. Sonya Grypma's book Nursing Shifts in Sichuan traces a critical time in the history of nursing in modern China, outlining how nursing programs went from being low grade to university level in West China. When the only elite nursing school, the Peking Union Medical College (PUMC), sheltered on the campus of the West China Union University (WCUU) from 1943 to 1946 because of the Japanese takeover of its campus in Beijing, it unsettled the notion of nursing in West China. At the time, a few other nursing schools were either hosted by or affiliated with the WCUU. The reopening of the PUMC on the WCUU campus pushed forward a higher standard in Sichuan—a baccalaureate degree in nursing education.
This book is divided into eight chapters plus an introduction and a conclusion. Grypma begins by depicting the nurses waiting at the United Church of Canada West China Mission (WCM) for the arrival of the refugee PUMC. Grypma introduces readers to the intriguing situation in which the low-grade nursing training offered by the Canadian WCM in Sichuan was about to encounter the elite PUMC School of Nursing in the context of wartime. She continues with a history of modern nursing in China that can be categorized into four stages: “introduction [1884–1914], professionalization [1914–27], nationalization [1927–37], and fragmentation [1937–51]” (p. 7). The wartime period, which was full of chaos and uncertainty, set the stage for the shifts in nursing programs in West China.
The first four chapters focus on the period before the exodus of the PUMC to West China. Chapter 1 details the history of modern nursing and introduces key figures and institutions that feature in the primary discussion of the book. Chapter 2 explores how the Chinese nurse leaders responded to wartime challenges (1932–40), which, in turn, provided “opportunities for a new cadre of Chinese nurses to prepare to step into the looming leadership gap” (p. 79). In parallel with chapter 2, chapter 3 examines how missionary nursing in West China responded to the changing sociopolitical context from 1936 to 1940. It shows “how war-related phenomena such as mass migration, relentless air raids, and diminishing resources contributed to the erosion of missionary nursing in West China” (p. 82). Chapter 4 demonstrates how members of the WCM and PUMC continued nursing education at a time when the Japanese had declared war on the Allies.
In the second half of the book, chapters 5–8 provide insights into the internal conflicts in the reopening of the PUMC in Sichuan and the promotion of the baccalaureate program in the Nursing School of the WCUU College of Medicine. When the refugee PUMC arrived in Sichuan in May or June 1943, the nursing faculty was all Chinese under the leadership of PUMC alumnus Vera Nieh. The small PUMC faculty, as Grypma shows in chapter 5 (1943–45), insisted on a high standard of nursing education that was taught in English and required six years of training, including one pre-nursing year at the university level, three years in a hospital, and two more years at university. Nieh envisioned running the PUMC School of Nursing in the same way it had been run in Beijing, where the dean of the Nursing School “held much of the decision-making authority (including related to the budget)” (p. 208). However, chapter 6 reveals that this provoked an antagonistic attitude from the primarily male administrators of the China Medical Board of the Rockefeller Foundation, which supported the PUMC. Despite the conflict, Nieh stayed on as the dean of the nursing school.
When the PUMC returned to Beijing in 1946, as chapter 7 (1946–49) shows, a similar baccalaureate nursing program came into existence at the WCUU under the leadership of Canadian missionary Cora Kilborn. Students of the WCUU, nevertheless, desired a baccalaureate program that was not undergirded by the traditional view of nursing as service advocated by Canadian missionary nurses. Chapter 8 (1949–51) discusses “the place of nursing as a patriotic profession in a postwar world” (p. 260). Grypma shows the continuous efforts to promote a high-quality nursing education by the PUMC Nursing School faculty and traces the most recent years of modern nursing in China.
Grypma's book is a vigorously researched study based on rich archival materials that assesses multiple perspectives on the topic and institutions. This book convincingly shows “how modern nursing is a social construct with beginnings, evolutions, and endings” (p. 6). It adopts a critical approach in the emerging scholarship of nursing that “uses constructs of identity (race, gender, class) as a lens through which to understand how power imbalances have shaped nursing work” (p. 15). It also incorporates the lens of nationality in examining nursing history in modern China. It is an indispensable addition to the scholarly work on the history of nursing that “grants historical agency to both Western and Chinese nurses” (p. 6). While the book sheds light on the struggles and thoughts of Chinese nursing leaders in the making of modern nursing during the wartime period, the reliance on English sources may disproportionately overrepresent the engagement of Western figures in a series of key discussions. This issue aside, Nursing Shifts in Sichuan is a thoroughly researched work that will interest readers, particularly scholars of the social history of nursing, religion, and mission, with a fascinating transnational history unfolding in wartime China.
