Providence, R.I. [ Brown University] - PSTC Faculty Assistant Katherine Mason, an Assistant Professor of Anthropology, whose book Infectious Change: Reinventing Chinese Public Health after an Epidemic won the 2019 Foundation for the Sociology of Health and Illness Book Prize, reflects upon her ethnographic fieldwork in China, how the outbreak of influenza-like virus SARS changed the Chinese public health system, and her latest project on maternal mental health in China. Infectious Change was published by Stanford University Press.

Q&A:

1. In Infectious Change, you claim the Chinese government’s efforts to contain the SARS virus were motivated by international pressure. Can you speak a little about how political pressure plays into public health campaigns? How do governments balance appeasing the international community and meeting the individual needs of their constituents?

Political considerations almost always play into public health campaigns – no matter where or what they are. This is not necessarily a bad thing! Consider the current political pressure in the US demanding government action to reduce access to vaping devices, or to address opioid addiction, or to increase vaccination rates for measles. Most of us who work on population health issues would agree that in these cases, political pressure can be very productive. The problem that I highlight in Infectious Change has to do with when political priorities don’t match up with public health need. In the places where I did my fieldwork, the years after SARS saw a huge increase in funding and support for public health infrastructure and disease control at the local level in China, but the money was disproportionately going toward global priorities motivated by fear, rather than toward local priorities motivated by need. I think this likely happens more than we realize. There is no one way to address it, but regularly reassessing where money and resources are going, and making sure that the most urgent needs of local communities are addressed first, would be a good start.

2. Infectious Change is based on your ethnographic fieldwork and personal communications with individual public health workers in Tianmai (pseudonym), China. As a medical anthropologist, how do the personal experiences of these individuals help you understand larger population health phenomena?

This question really gets at the heart of why I wanted to do this project. Ultimately, all public health policies and actions are conceived and implemented by actual people. It is easy to forget this when you are only looking at the effects of those policies, or on the policies themselves, or the larger political dynamics behind them. In China, the role of personal relationships is particularly important for implementing, measuring and tracking population health interventions. Because China has a single-party, authoritarian government structure, a lot of people assume that whatever the leaders decree at the national level will automatically come to pass at the local level. This is simply not true. Very little happens at the local level unless the local bureaucrats are willing to let it happen, and local bureaucrats are rarely willing to let it happen unless they have a good personal relationship with the person asking them to cooperate. The power structures at the local level are incredibly complex and dependent upon individual personalities. It was those local processes that I was trying to understand. Without understanding this, you can’t understand the bigger picture of population health in China.

3. In addition to spending over a year in China conducting fieldwork for Infectious Change, China is also the site for your latest field project on perinatal mood and anxiety disorders. How did your interest in China come about? How has your understanding of the country’s health and healthcare system evolved through each of these distinct projects?

Like most things in life, my interest in China started by happenstance. As a junior in college, I overheard a classmate talking about an interesting summer internship he had done in Taiwan. I didn’t know much about Taiwan, but it sounded like a fun adventure, so I decided to apply. I spent the summer in Taiwan, got interested in Taiwan’s relationship with Mainland China, and then applied for and got a fellowship to spend the first two years after college teaching English in the Mainland. I spent almost two years in Guangzhou, China but got evacuated in April 2003 during the height of the SARS epidemic, which started near this city. This is what first sparked my interest in medical anthropology, and in writing this book.

My new project provides such a different perspective! I’m working with a local hospital rather than local public health institutions and am talking directly to affected patients. I’m also doing my research in a different part of China, in a small city in Sichuan province. Postpartum depression and anxiety are underrecognized and undertreated disorders, especially in China, but they are so common, and the suffering can be quite severe. In addition to learning much more about the mental health system in China, the new project is also giving me a greater understanding of the incredibly difficult work that clinicians do. The OB/GYNs in the hospital that I am collaborating with can see upwards of 60 to 100 patients a day. There isn’t a lot of time for caring for individual patients, but they really do their best. I have so much respect for them.

4. In Infectious Change, you discuss how workers in Tianmai expressed great reverence for former leader Deng Xiaoping, coupled with bitterness towards his predecessor Chairman Mao. Can you speak a bit more about the role of politics in your research and findings?

It’s huge, and yet it’s so hard to talk about. This is a project that I definitely could not have done in a place like Beijing, and that I definitely could not do in 2019. I was in the right place at the right time. Outside of Beijing, the booming cities of coastal China are very open places, especially the further south you go. Technically, certain aspects of the disease control processes that I observed and discussed during my fieldwork could be considered “state secrets.” And yet people spoke pretty openly about these “secrets” with me, and they rarely seemed very nervous about my presence, even at government functions. Unfortunately, things have gotten a lot more difficult for both foreign and Chinese scholars now, under the leadership of Xi Jinping. Xi is doing his best to clamp down on a lot of that openness. There’s no way I would have gotten away with doing this project now – I simply wouldn’t have been allowed to observe the things I observed, or ask the questions I asked. I counsel my current graduate students who are doing research in China to be much more careful than I was when investigating anything that could be considered political.

5. Finally, how did maintaining such close contact with public health workers who were so deeply affected by the SARS epidemic impact you? Were there any particular moments or anecdotes that stood out, or helped strengthen your connection to the individuals whose lives you followed?

The thing that’s sort of unique about ethnographic methods is that most ethnographers become good friends with at least some of their interlocutors. You just can’t spend that much time deeply embedded in people’s lives without coming to care about them. I am still in contact with some of the people I met there, and I treasure my friendships with them.

I tell a lot of anecdotes in the book, but I think one of the most moving friendships I had was with the woman I call Dr. Gong (a pseudonym). Dr. Gong appeared on the surface to be a sort of stereotypically calculating bureaucrat who a lot of people thought was just using people to get ahead. She was widely disliked. Even though she had friends in high places, and was always going out and working her connections, she was really one of the loneliest people I have ever met. She was also a really good person when you got to know her. We became good friends, and she took care of me when I got really sick partway through my fieldwork. I think our friendship started out rather instrumentally – I needed her help, and she thought that I could help get her son into an elite school he was trying to get into. But even when it became clear that I wasn’t going to be much use to her in that way, she was always there for me. I think about her a lot.

Kitri Sundaram, PSTC writer