Exploring the grim realities of daily life in a northeastern Sichuan rural community, Anna Lora-Wainwright's Fighting for Breath: Living Morally and Dying of Cancer in a Chinese Village examines how attributing blame for cancer and delivering care to those suffering from the disease materializes and reproduces local values. When evaluating potential causes of cancer that include water contamination, the long-term toll of manual labor, cigarettes, preserved vegetables, and alcohol consumption, villagers gravitate towards explanations that are “socially efficacious” in helping “to reconstitute a moral world” (p. 164). Drawing on lay understandings of Chinese medicine, aging cancer patients point to long-standing economic, gender, and generational differences to make sense of their bodily suffering. Negative emotions left over from divorces, hardship resulting from unfair division of labor, shifts in family structure, and bad tempers are understood to be somaticized through qi (breath or air) with deadly effects (pp. 126–32).
In the Langzhong villages where Lora-Wainwright conducted eighteen months of fieldwork, farmers pursue different strategies to limit the spread of cancer, which is most commonly seen in esophagus and stomach tumors. When and how to use pesticides have become particularly charged topics for village residents. Despite associations in the countryside with both suicide and cancer, commonly used farm chemicals are also widely recognized as contributing to rising living standards and market-linked growth in the post-Mao era. Given low domestic demand for organic produce and the absence of a romantic idealization of earlier modes of agricultural production (pp. 112–13), local farmers limit the use of pesticides on food grown for home consumption while continuing to spray products intended for sale outside their villages.
Depictions of the stark struggles of Chinese rural life are tempered by the author's descriptions of the new forms of care that this disease elicits. Lora-Wainwright draws extensively on her experiences in helping to care for Gandie, the father of her village host who was diagnosed with esophagus cancer just before she began her fieldwork. Wanting to avoid burdening his family with the cost of hospitalization, Gandie refuses to seek surgery in city hospitals. Lora-Wainwright comments that this one-time Maoist official's “disposition to avoid hospital treatment had outlived the conditions that produced it” (p. 220). But this pronouncement belies her own documentation of the high expenses, low perceived efficacy, and poor clinical outcomes for the rural poor who attempt to navigate urban hospitals in China's changing healthcare system. In the social world she so vividly describes, Gandie's decision to forgo biomedical treatment of late-stage cancer and accept an early death seems at once noble and sensible.
Caring for Gandie presents his relatives with an opportunity to come together even as it also brings up tensions in a rural community increasingly divided by growing economic inequality. Differently situated family members offer varying combinations of personal visits, gifts, services, and cash to the dying patriarch. In deciding how to care for and later commemorate Gandie, family members frequently disagree on how to value different forms of assistance (does sending remittances from afar make up for the fact that a grandson did not return to see his dying grandfather?) as well as the appropriateness of observing Christian rituals and “traditional customs” to honor the dead (p. 226). The importance of these disagreements comes to a head in a heated debate about the placement of Gandie's ancestral portrait, a photograph he had taken in preparation for his death. After a grandson expresses fear of the old man's roaming spirit, the image is removed from its position on the storage room altar, despite the bitter protests of certain relatives.
Drawing on data from a standardized questionnaire as well as extensive time spent living and farming with rural dwellers, Lora-Wainwright's study fits into a lineage of empirically grounded village studies in China. The author is most comfortable when mapping her informants’ positions, opinions, and reactions to specific events and in answering such questions as, “what kinds of costs are entailed (by caring for cancer sufferers) . . . and who shoulders them?” (p. 179). Villagers emerge as sympathetic agents in responding to the terrifying threat of cancer by actively shaping moral worlds that also continue to bear the influence of complex local histories.
Though attention to practice serves this study well, the author rarely discusses how conflicting desires and persisting ambiguities inflect the experience of the characters populating the text, including herself. Describing her own role in aiding a villager in a John Snow-inspired attempt to test local wells, Lora-Wainwright says she is “puzzled” (p. 96) when water tests she organizes fail to show evidence of elevated levels of known carcinogens in the water. She also declares that, due to difficulties in collecting and accessing quantitative, “hard” data, she must abstain from weighing in on whether her research site should be designated as a “cancer village” (pp. 3–4). To this reader, the author misses an opportunity to ask how encountering limitations of her own epistemological commitments might allow an exploration of the rationalist structure (“we” know, “they” believe) that implicitly undergirds many anthropological explorations of alternate belief systems, including, perhaps, her own view of her hosts' multiple, coexisting ways of identifying and responding to cancer etiologies.
Despite these minor shortcomings, this book succeeds not only in describing culturally specific ways of explaining and caring for cancer sufferers, but also in evoking the complex, dynamically shifting social context within which these responses are negotiated.
