Doctors within Borders: Ethnography Review

Introduction

“Become a human before you become a doctor” (Lo 2002: 58) is a quote from President Takagi. This quote has influenced the medical minds of many Taiwanese medical students in the early 20^th century to work for the society instead of wealth and fame. Including this quote, the respectful relationship between Japanese professors and Taiwanese medical students, and their struggle for equality in the medical field made me question what sort of challenges that the medical professions face today.

In Ming-cheng M. Lo’s ethnography, Doctors within Borders: Profession, Ethnicity, and Modernity, the author gathers the historical facts and personal interview to analyze the social relations and factors that shaped the identity of Taiwanese doctors under the rule of Japanese regime. I personally found this ethnography relatable at a few different degrees because I was able to connect to my own cultural background. Beyond my personal scope, this ethnography connects to several different subjects in global health such as medical colonialism, medical ethic problems, and social identities that relates to our class lectures, films, and class readings that we’ve discussed over the course. I also believe that Lo’s work was insightful because it provided in-depth historical analysis of specific group of people based on their profession in a certain time frame in relation to its colonizers. Lo’s work explores and analyzes the history of medical colonialism and relates it to present day problems.

Summary

Doctors within Borders: profession, ethnicity, and modernity in colonial Taiwan, analyzes the relation between professions and colonialism of Taiwanese doctors under Japanese rule. Lo presents her book in a chronological fashion that allows the readers to grasp the idea of historical development of identities of doctors during Japanese rule regime. Lo analyzes the relationship and factors that formed the complex identities of Taiwanese doctors during a specific period.

Lo’s main points are related to historical period of Taiwan, and Lo describes the state of identity of Taiwanese doctors as a whole group. Lo first describes the pre-Japanese Taiwan history, and examines how Japanese conquers their model colony, Taiwan, through implanting their theory of scientific colonialism. In this chapter, Lo main point is the development of Japanese scientific colonialism that will be implicated to Taiwan throughout their entire colonization. From 1920 to 1931, doctors formed an identity of “national physicians”. During this period Taiwanese doctors thought their main role was to serve their nation. The first structural contradiction that the Taiwanese doctors faced was that the Japanese government watched over Taiwan very closely, unlike other professions, physicians were able to have a certain degree of professional autonomy. Doctors were able to enjoy professional autonomy because medicine was an effective tool to colonial administrators to civilize colonial subjects. Therefore, improvement in the medical practices needed to be fulfilled, and this led the administrators to allowed more Taiwanese to medical schools. Gradually, the advancement of medical practice and education was put before state policies. Another structural contradiction that the medical community faced is the institutionalized ethnic inequalities between Japanese and Taiwanese in the medical community, while the professional culture challenged this inequality. The third contradiction that the Taiwanese physicians faced is that they shared cultural traditions and solidity with other Taiwanese, but sometimes they were distanced from their own ethnic group due to their professional culture and class position. From 1931 to 1936, the identity of national physicians decline due to the increasing state oppression and regulation, which suppressed political activism of Taiwanese physicians. This also led to weakened connection between culture and professional and ethnic communities. The new collective identity of Taiwanese doctors silenced, and weakened during this time. From 1937 to 1945, there was a period of “medical modernists”. Taiwanese doctors developed a collective identity from modernity that derived from their profession instead of their ethnicity. The elevating market position of their profession also played a role in weakening their relationship with their culture and ethnicity. This led them to build an identity based on their profession. The ethnography also compares the Dojinkai Projects in China to colonialism in Taiwan. Dojinkai project was Japan-funded hospitals and medical activities that took place in China. Unlike the environment in Taiwan, Japan had to compete with other imperial powers such as Europe and U.S. Due to dramatic differences between Taiwan and China, Japanese medical services failed to bring success. Overall, the Dojinkai Project was recorded as one of the failed attempts to spread Japanese regime in China, which taught the Japanese officials to revise their colonial plans.

Comparison to China

Japanese Empire’s plan to be a leading country in Asia against America and Europe also spread not only to Taiwan and Korea, but also to China. Although China was not one of colonies of Japan, Japanese government decided to initiate medical activities and open Japanese hospitals in China. However, China was more hostile towards Japan than Taiwan because of already existing western powers were already influencing Chinese culture. Japanese hospitals failed to attract patients to their hospitals because of the lack of the trust between the Chinese patients and Japanese doctors. After many failed attempts Japanese analyzed the factors that led to their issues lied in “technical issues, cultural barriers, economic barriers, as well as political considerations” (Lo 2002, 175), and this revealed conditions needed to be met for doctors to be more effective in other nations. Comparison to China reveals that Japan was not always successful in colonizing, and the complex requirements that needs to be met for a colony to adopt into colonizer’s regime.

In the article by Jovchelovitch, Social Representations of Health and Ilness: The Case of the Chinese Community in England, reports that the Chinese in England display strong ties to their culture, and these strong ties to their cultural traditions builds the base to health and illness.

I thought this article related to one of the main point the ethnography because in the early days of Japanese colonialism Taiwanese doctors also practiced their cultural tradition, and their identity was strongly tied to their ethnicity and culture just like the Chinese community in England. Collective identity can be formed by ethnicity and culture as shown by “national physician” idendity of Taiwanese doctors during the period of 1920 to 1931.

Comparison to Korea

The ethnography mainly emphasizes the integration of scientific colonialism in Taiwan and China. I thought the comparison of Japanese colonialism in Taiwan and Korea might provide more insight into how the character and condition of the colony plays role in adaptation to colonizer’s regime, because Korea shares similar background to Taiwan. If China provides weak comparison because of dramatic difference of their environment and influences, and also China was not one of Japan’s colonies. Korea is more suitable comparison to Taiwan because Taiwan and Korea share similar historical background in terms of their colonization under Japan, and their geographical size is similar which may play a role in colonization. Both countries were under Japanese regime, and under the Japanese rule they experienced rapid economic and infrastructural development. However, what differs Korea from Taiwan is that Korea was more reluctant to Japanese regime than Taiwan, which was easier in terms of adapting them into Japanese regime (Lo 2002). From my personal experience, I was taught in school and by the society that Koreans were very reluctant to Japanese rule, and it resulted in several uprisings. This resulted in negative feelings towards Japanese government until today. Since Lo does not mention much about the reluctance of Taiwan to Japan I cannot say that they weren’t reluctant, but it seems most of Taiwanese adapted to colonial life in a short period of time. I think if Lo explored and analyzed more about the annexation of Korea by Japan in terms of medical field, it might have brought up interesting comparison even more than China.

Research Ethics

Japan did not just use medical technology to colonize bordering countries, but they also utilized the medical field to develop new weapons that will give them the upper hand during war. Unfortunately, this research to more powerful weapon has lead to death or disability to those who were not Japanese. I agree with Lo’s analysis of Japanese doctors legitimizing their choices to destroying countless lives to benefit lives of other by doubling their roles as “humanist life-savers and accomplices of the war” (Lo 2002:165). To justify their actions and choices, the doctors formed contradicting identities that allowed themselves to be both humanists and tools for war simultaneously, even at the cost of people’s lives. It is appalling to see how group of highly educated people whose jobs are to help people can change under the power of authority and nationalism.  I’ve known before that when Korea was annexed by Japan, Japanese soldiers kidnapped and killed many Koreans, and among them there were those who were killed for medical researches. However, I never knew about how these doctors or scientists justified themselves to carry on with these dangerous researches.

Regardless of how advanced the modern medicine and science is, the abuse of research ethics in medicine still occurs today throughout the world especially in underdeveloped countries. The video that was shown in class, Fault Lines: Outsourced: Clinical Trials Overseas, demonstrates how an American pharmaceutical company uses people who lack knowledge in the areas of medicine and disease to continue their research even at the chances of death. Companies handle these issues by not providing people information, and neglecting their fault. It seems as these companies and researchers is motivated by money and gaining knowledge. Similar to the Japanese, the modern medical researchers and directors from the company also justified themselves to abuse medical ethics through a reason that the knowledge gained from these studies might provide better medical care to their own people at the cost of people in underdeveloped countries whose lives’ aren’t as valuable to them. However, the only difference between Japanese doctors and American researchers is that Japanese were pressured mainly by their nation and role as doctors to serve their own nation, while American researchers are pressured by the monetary constraints that are put on by pharmaceutical companies.

I would have liked the author to explore more about the effect of other Taiwanese on Taiwanese doctors. The author didn’t really give much detail about how people other than the wealthy Taiwanese felt about Japanese regime. There must have been some sort of tension between doctors and people who were not as wealthy. I think this was one of the author’s weaknesses in this ethnography because Lo only included the effect of Japanese government and Japanese medical professors. The author does not include the full set of environment that the doctors lived outside the hospital as a doctor. However, focusing deeply on few items in the writing gave in-depth analysis of relationship between Japanese regime and Taiwanese doctors during the colonial times. If the author explored more on the relationship between Taiwanese doctors and Taiwanese of other classes, it would have further expanded the analysis of Taiwanese doctor’s identity in different settings. In the book, the author mentions the nationalism of Taiwanese doctors, but does not expand on how and how much they were involved in their ethnic communities.

Conclusion

Overall, the work of this ethnography that the author has done still relates to current issues of today. The information in this book is practical since it gives deeper understanding to the readers about the effect of colonialism in the medical field. Even today colonialism still exists, but in a different form. Powerful countries, such as U.S., spreads medical practices and sends medical professionals to educate and help people in under-developed countries. This is similar to Japanese scientific colonialism in a sense that U.S. is delivering new technology to a foreign culture that lacks such knowledge. As discussed above, the effect of colonialism to a specific group is very complex, and even under the same authoritarian power the results are different for different colonies. Therefore, it is hard to determine how the community will react to foreign technology incorporated into their daily lives. Moreover, this ethnography shows how culture and environment affects the identity and ethics of medical professionals. This can also imply not only to medical professionals, but also to different communities. We need to consider how much culture affects the identity of individuals and collective identities. Identity is an important part of aspect in global health because it affects the decisions that people make about their health and medical ethics. 

Bibliography

  Fault Lines : Outsourced: Clinical Trials Overseas. Al Jazeera, 2011. Youtube. Web. 7 Nov. 2012. <http://www.youtube.com/watch?v=g_p0kmrFi_o>.

  Jovchelovitch, Sandra, and Marie-Claude Gervais. "Social Representations of Health and Illness: The Case of the Chinese Community in England." Journal of Community & Applied Social Psychology 9.4 (1999): 247-60. Print.

  Lo, Ming-cheng Miriam. Doctors within Borders: Profession, Ethnicity, and Modernity in Colonial Taiwan. Berkeley, CA: University of California, 2002. Print.