Reports of cancer villages have been available for a decade. However, this anthropological study takes us into an analysis of the culture of a cancer village and the feelings of those dying there. The study village, Baoma (500 residents) in Langzhong County, eastern Sichuan was the author's home in 2004–05 and she made annual return visits up to roughly 2012. Giving us this thorough picture through a family in a particular village provides in-depth insight into how a village adapts culturally to a new grim reality.
The theoretical introduction sticks well to the issue at hand – describing concepts relevant to how people react culturally to cancer in a typical Chinese village. The author is looking for an understanding of how guilt for the disease is assigned, the cultural understanding of the causes for cancer, and how the ethics of payment for care play out. She uses the term “moral economy” to describe the way in which relatives and the patient react in the face of a somewhat corrupt health care system that demands more money for services than rural people are able to pay.
Attention is paid to local history and the idea of moral order. We are told the perception in the village is that local leaders are more corrupt than higher-level leaders. This concept is widely accepted amongst China scholars as a generalization for all of rural China. It comes as no surprise that we also see a generation gap with the elderly more able to “eat bitterness,” having experienced the difficult times of the 1950s and the 1960s when there was little mobility. In contrast, the younger generation faces difficulties caused by a largely marketized economy, which continues to discriminate against rural residents – including those that out-migrate to urban areas. The family often lives divided with the young children and sometimes the wife remaining in the village with the grandparents while the husband and/or the wife migrate to urban locations in search of work. This situation puts an extra strain on the elderly who must help care for the grandchildren and continue to farm when they might have expected to relax in their old age. The wives that remain often take on the task of care for their husband's parents as well as the children, the farm labour, and even their own parents. Pollution-induced disease and lack of health care add to these burdens.
In some so-called cancer villages air pollution is the culprit, but in Baoma water pollution and agricultural chemicals play major roles. The author notes that blame for farm-chemical use can be assigned to the government, enterprise or individual farmer. When it comes to assigning explanations for cancer in the village, however, hard work, stress and temper, alcohol, smoking and also eating pickled vegetables are seen as causes. As for smoking and alcohol, men often are excused as these things are seen as essential for maintaining relationships (guanxi). The author notes that seeing hard work and stress as causes can be taken as a way to make the elderly cancer sufferer appear to have sacrificed their lives for the community rather than putting the blame on the powers that be or the habits of the individual.
In contrast, we see the tendency for wives, daughter-in-laws and sons to be blamed for stressing men and thus causing their cancer in what remains a male and elderly-dominated social hierarchy. Sons, daughters and their spouses can be blamed for not meeting their obligations even though in many cases their financial situations make that very difficult.
Lora-Wainwright frequently mentions the lack of ability to eat as a main symptom of cancer. In other words it would seem that if people can eat then they must not have cancer. By the time people cannot keep down food, it is too late to get effective medical cure. Moreover, the high costs of diagnosis and surgery give the rural poor a differing view on whether it is even moral to have surgery. Once someone cannot eat they will often opt not to see a doctor. Villagers see this behaviour as taking the moral high ground: the ill person does not want to impoverish the family. In order to combat such rural financial stress, the national government implemented a Rural Cooperative Medical Scheme in 2003. The scheme was not well received when first introduced in Baoma, with many thinking this was just another way for the local government to extract money. By 2007, many people had joined the scheme but remained suspicious and felt the system treated them unfairly compared to people with urban registrations.
The book also addresses contesting religious morality at death largely through a case in the family with whom the author lived. Local spiritual female mediums (shiniangzi), folk religion and Christianity play roles in the view of death. Local government sometimes takes a more tolerant view than the national government towards folk religion since it can have touristic value and “the emperor is far away.” Christians often refuse to fund or participate in traditional ceremonies such as burning paper money at burials. This leads to conflict between the Christians and believers of folk religion. The spiritual mediums, however, can cross the traditional and modern line as they are seen to be effective where medicine is not and are able to make claims to being “scientific” in a Chinese sense.
This excellent work has the feel of an academic dissertation that has been turned into a book. That said, I think the book is good for a general readership. They would learn a lot about the stress of a changing ecology and political culture in rural China. Just as the author mentions other works on dying and the culture of guilt from Brazil, Haiti and elsewhere, this book provides a good reference for those outside China studies who are interested in comparative aspects of such topics as well as general insights into recent social transitions in rural China.
