Margaret Humphreys on
Teaching American Medical History in China, Summer 2017
In the fall of 2016 my colleague in the Duke History Department, Nicole Barnes, called my attention to a teaching fellowship supported by the Organization of American Historians (and the Ford Foundation). This fellowship is awarded each summer for three American faculty members to go teach a seminar on an American history topic to graduate students in China. Each year the three themes are different; in the 2016 competition one theme was “The Social History of American Medicine.” That’s my field, so I applied. In December I learned that I’d been accepted. For me, it was a leap in the dark—I’d never been to China, knew no Chinese, and had little concept about what teaching this seminar would be like. These were students who majored in American or world history at their Chinese universities, and who had at least some proficiency in English. Amidst a busy spring semester I took a very introductory Chinese language course at my son’s school, and off I went to Shanghai in July knowing how to say hello, thank you, and little else.
This residency seminar ran from July 18 through July 22, hosted by Prof. Yong-An Zhang at Shanghai University. I arrived in Shanghai on July 15. My secondary invitation was to Shaanxi Normal University in Xi’an, hosted by Professor Hua Cheng Li, head of the Research Center for the Social History of Medicine, at SNU. I traveled there by train on July 24, and lectured in the mornings of July 25, 26, 27. I returned by train to Shanghai on July 30 and flew home on July 31. Graduate students were assigned to assist me in both places. They accompanied me on transfers from station to hotel, and were charming escorts to meals and a variety of historical sites.
The seminar was well funded. All the students had rooms at the same hotel as I did, although they shared double rooms. The students all had cards that allowed them to eat in the cafeteria. We all met the first night for a group dinner at a local restaurant. Thirty-six students are listed the seminar program booklet. The Chinese government funded this side of the experience quite generously.
When I applied for the residency I described a seminar based on five questions in the social history of medicine, with a day devoted to each. The questions were: 1) what is the understanding of health & disease, and the basis of medical practice?; 2) who is sick and why? 3) what is the government’s responsibility for health? 4)how does regional ecology determine health? 5) who practices medicine? As I began to prepare the course for this setting I realized that the topical structure would not work well. Instead I fell back on a chronological structure and embedded the questions in each historical period, arbitrarily designated as European arrival to 1800, 1800-1860, 1860-1900, 1900-1950, 1950-present.
This allowed me to draw on the few available “surveys” of the topic (Gerald Grob, The Deadly Truth; James Cassedy, Medicine in America, and John Burnham, Health Care in America). These works are chronological, matching the course structure fairly well. This in turn made the choice of 50 pages of reading per day feasible.
The schedule called for five days of lectures, nine to five. I knew my voice, even bolstered as it was by water, coffee, Ricolas, could not sustain such persistent use. Nor, I suspected, could their capacity for paying attention. So I structured the days as follows. Began at 9 AM; lectured until 10:15. Break (students brought in fruit, cookies, other treats; there was instant coffee, and bottled water). Then I showed a video clip, and we discussed it. Lunch break was 12-2. After the first day I went with the students to the student cafeteria. Then lecture again until 3:15, break, and a final hour for questions. Shortly before I arrived I learned that the third day would be cut in half, with an afternoon trip to a museum of traditional Chinese medicine. This had nothing to do with my topic, but was fascinating none the less.
The students became more relaxed with me as the seminar went on, and the discussions loosened a bit. My video clips helped this—day 1 was the smallpox inoculation scene from the HBO John Adams series; day 2 an excerpt from the LT Ulrich, Midwife’s Tale movie showing Martha Ballard’s role as a practitioner; day 3 a clip from an American Experience documentary on yellow fever; day 4 a silent educational film about hookworm produced by the Rockefeller Foundation in the 1920s, and day 5 a government film about the power of DDT (1945) to fight insect-borne disease. I also showed some malaria fighting cartoons on the last day. As is the case in my lectures at my home institution, these movie clips sparked lively conversation. Even if the students hadn’t done the reading, and perhaps had trouble understanding my English, they had the images in front of them that spoke volumes.
I presented all of my lectures with powerpoints. I put much more language on the powerpoints than I would do usually, in the hope that students might be better readers of English than hearers of it. Still, there were obvious language barriers. Some students came up afterwards and asked me questions about topics that had been explicitly covered in lecture, as if they had heard none of it. This was frustrating all around. Other students were clearly proficient, and asked challenging questions that revealed assumptions about American history that had to be reconciled to my own experience.
All of the participants were at least graduate level students working on either American history or world history. A few were faculty members at other universities. But the room was full of good will. At the end nearly every one of them wanted to take a selfie with me. They were interested in learning about the OAH, and I put up the web page and told them that they were all welcome to join, that they didn’t need a faculty sponsor or some kind of letter to do so.
The Shaanxi Normal lectures were on historiography and method, at their request. This was harder to convey than the general overview that I had offered in Shanghai, and the English proficiency of the group was not as high. Still, I did my best. I drew on my experience as a journal editor to particularly emphasize what it takes to get published in a history of medicine journal in the US and Europe. When the Shanghai professor learned what I was to say in Xi’an, he regretted that I did not do this for his students as well. To my mind the most important questions about method involved access to resources beyond the “Great Fire Wall.” Foucault et al. had little to say about the digital revolution and its importance.
Still, it is obvious that for these Chinese grad students and junior faculty scholars, time in the US is essential. Perhaps the OAH already helps facilitate such fellowships; this whole question is new to me. Professors Zhang and Li made it clear that students or junior faculty might be able to come to the US with their own money if they could find university sponsors. This is something I plan to explore at my own university and perhaps OAH is already facilitating this elsewhere.
Often with my Duke students I try to draw out their experiences of developing countries to illuminate what life in, for example, a nineteenth city urban slum was like. The central role of human waste disposal was key then, and many students have seen this first hand in their foreign travels. I asked several scholars in China whether they thought the country was developed or developing. All hedged, qualified, said “yes and no.” Much of the history of American medicine is about the modernization of biomedicine, in terms of ideas, education, technology, and infrastructure. While I avoided a grand progress narrative—and emphasized the persistent health disparities in the U.S.—I have little sense about their personal experiences of health care in China were. There were two doctors in the class, and I tried to learn from them but it was hard to get a clear picture. My vague image is of a hierarchy of facilities, from the “international hospitals” for businessmen (and foreigners) in the big cities to more modest but sufficient middle class care, to minimal health coverage available in villages.
Perhaps the most vibrant discussion came when I showed the film on hookworm and talked about the ways in which this campaign expected participants to observe their stool for worms, and bring in samples. I made comparisons to the schistosomiasis campaign in China, where the issue involved the use of human excrement as fertilizer, and the need to separate the egg-laden feces from the water supply. The class took off, but all in Chinese so I’m not sure what was said. I began to wonder how much these 20-30ish year old students had been exposed to rural life; was this use of so-called “night soil” new to them if they were raised in an urban area? Was it shameful to discuss in front of an American professor? I didn’t know, but I was pleased at least that the topic had clearly sparked an animated conversation.
The question of modern or still developing also emerged with regard to classroom infrastructure. The classrooms had the latest in electronic gear—flat screen wall monitors, laptops (Dell, Lenovo), and microphones. At both campuses the buildings were multi-storied, shiny, white, and no more than 10 years old. These externally modern structures, however, lacked central air-conditioning. Instead, there were free-standing AC units that were turned on at the start of the speaking day. It topped 100F every day I lectured in China. Being covered in sweat just became the new normal. In Shanghai were we were on the first floor; at Shaanxi the center’s seminar room was on the sixth. There was no elevator.
As I traveled by train from Shanghai to Xi’an I saw no fewer than 6 nuclear power plants visible from the tracks. Solar energy panels were common on top of buildings tall and small, and at times arrayed in a field. I’m not expert on Chinese energy policy, but clearly the drive for modernization has created a huge power hunger. And the decisions to not put central air conditioning (or elevators) in an otherwise “modern” building may strike this overly warm American as odd, but may be a rational choice in the Chinese path to modernization. This observation challenged my naïve self to awareness that the American model of modern life does not a world standard make. We all may need to learn to live without the thermostat set at 72F in the not too distant future.
My tourist excursions to historical sites set off all sorts of questions not only about the history of the country but also about how it is being portrayed. Presumably the government has “approved this message.” The Tang dynasty (618-907 CE), whose capital was at Xi’an, appears as a golden age of brocade, beauty, pomp and power. Contact with the west over the Silk Road is glorified. A live show at the “Tang Fantasy” theme park includes men riding live camels and horses, wearing period garb and looking grand. The messages are mixed. Strong central power invested in an emperor is good? Hierarchical, obedient society is likewise? Connection to the west is more equivocal. There were camel silhouettes decorating the walls at the grocery store.