I: Welcome everyone to the APAMSA AANHPI Health Issues Interview series, where we’ll be interviewing researchers, policymakers, community-based organizations, and other experts on health-related topics that affect the AANHPI community. My name is Grant Wen and I’m the health advocacy director at APAMSA National. 

For our first interview in this series, I would like to welcome our guest Dr. Nicole Barnes. Dr. Barnes is a professor of history at Duke University with co-appointments in the global health department and the program in gender, sexuality, and feminist studies. Dr. Barnes holds a place very near to my heart because she was my thesis advisor back in my undergraduate years, so without further ado, let’s welcome Dr. Barnes.

B: Thank you for that introduction, Grant. So yes, like you said, I’m an assistant professor at Duke. I teach the history of Chinese medicine, history of global health, and general courses in history of China as well as global history of medicine. The history of medicine is my greatest passion, so I’m delighted to bring those insights to bear on the questions of the day.

Yeah, the story really goes back to my childhood. I moved with my family in second grade to Logan, Utah and it was a small town where almost everybody was Mormon but I was not, and so in seeking out the non-Mormon friends, I found the Asian-American community and just from a very early age, became very comfortable with my Asian friends and their grandparents who didn’t speak English and ate different foods. I just kind of fell in love with Asian cultures and gained a sense of comfort in those spaces, something that really helped me later on as a college student, as I pursued deeper interests in foreign languages and cultures. I was actually a French and Spanish major but then I became a dual minor in Chinese language and Asian studies. I spent some time in Guiling, in Guangxi Province in mainland China as well. My Chinese teacher at the time, Chiumi Lei, who is now at Rice University, encouraged me to go into graduate school and wrote stellar letters of recommendations so I got funding, which was really important because I came from a family of low economic means, so that funding to continue my studies was essential for me. That’s something that I try to continue to do as a professor now—-to continue to mentor, sponsor, and assist students to pursue their lifelong passions, even if they don’t have the economic needs to do so personally.

So that’s one aspect. And then the history of medicine just came out of my own interests. That’s also kind of an autobiographical story. My maternal grandmother became a nurse because she was trained by the United States military during World War II and my paternal grandmother lost five of her siblings to disease. From my own family history I see very much the impact of medicine both in terms of loss of dear family members and in terms of the professionalization of women and the granting of new professional opportunities. It just so happens that my first book, which is an open-access free downloadable ePub online, is about the history of women’s place in the medical professions in China during the war with Japan. It’s called Intimate Communities: Wartime Healthcare and the Birth of Modern China. If any readers are interested you can just google “Nicole Barnes” and “intimate communities” and you’ll find your free download.

Currently, I’m starting research on the social, political, and cultural history of the use of night soil as farming fertilizer in China over the course of the late nineteenth and twentieth centuries. This is partly out of an interest in environmental degradation and the ongoing social prejudice against farming peoples and migrant workers in China today—-both of which are dire situations as I’m sure you know—- but also out of respect of the centuries of profound knowledge about how to combine animal husbandry and stewardship of the land to produce a dramatically productive agricultural output from a limited space of arable land. This is what Chinese farmers did for centuries—-they were the envy of farmers around the world for a long long time and the switch from the night soil economy to sewerage and disposal has actually been a source of deep environmental degradation, so I’m interested in the environmental humanities, medical hygiene, and sanitation aspects of that story as well as the social impact in terms of the treatment of rural people in whether we see them as a source of dirt or is a source of illustrious knowledge that has been held in Chinese culture for a long time. So it’s a project that has many strands.

That’s a great question and there’s two main ways I’d like to respond. First, it’s important to learn the specificity of medicalized racism against Asian Americans on U.S. soil, but also specifically Chinese immigrants back in the beginning of the twentieth century during a bubonic plague pandemic that began in southwestern China and made its way to Hong Kong. Because Hong Kong at the time was the primary port out of China due to its status as a British colony, the plague then made its way around the world and came to the Americas in the very late 19th century and led to the ultimate burning of San Francisco and Hawaiian Honolulu Chinatowns, demonstrating the deep prejudice against Chinese in the United States.

So that was like a flashpoint, if you will, the literal use of fire to supposedly purify these neighborhoods, but also an illustration of just how profound the racism against the Chinese has been since their arrival here in the United States. So for those of us who understand the history, when we started hearing about the conversation and the language that previous President Donald Trump was using, the recent spike in violence, and the horrible murders in Atlanta, they were deeply disturbing but not surprising because this anti-Chinese racism is so deep. Anti-Asian racism in general in the United States tends to ebb and flow, but I would argue that it never goes away despite these model minority conversations and the idea of Asians as an exception to U.S. racism. That sentiment is always present. The xenophobia and the average American’s fear / exoticization / obsession / attraction to things Asian and seeing them as exotic, strange, foreign and weird—-that has just always been a really profound part of U.S. culture and there’s a lot of lack of understanding that can come out into the open at times when a major Asian country is no longer the close friend but now is perceived as an enemy.

So you know, it really began not even with COVID, but with Trump’s trade war with China. I frequently traveled to China prior to COVID to do teaching for the Fuqua School of Business here at Duke. I did a trip to China during that time with business students, and the ones living and working in China at the time said as soon as the trade war started, they had a different feeling with their Chinese colleagues, and that the politics between the Xi and Trump administrations immediately entered their interpersonal relationships. I would say over the long-term, Sino-U.S. relations are always on this dime—- this tiny thin dime and it flips from friend to foe back and forth—- and it actually does enter interpersonal relationships in deeply troubling ways, so that thread is always there. So that’s one thing that we can use to respond to the most recent exacerbation of that kind of animosity—- with deeper awareness and knowledge of history.

And of course, early on in Asian American immigration history, there were a lot of Caucasians who would go see Chinese herbalists. That was not only a space of animosity but also of friendship and mutual understanding and respect so that’s another trend and another aspect of that history that bears attention.

What history and the humanities can bring to this event and to the problems of today is more global. It does not have to do with the specificity of the history of medicine, but more with the skills that a historian brings to bear on the world. When you are trying to do your historical analysis and recount histories, you have to do everything in your power to enter into the actual mindset and the way of being of a historical personage in order to understand their world, recreate their reality, and interpret and understand the sources that they leave behind—- the written records of court cases, personal letters, government documents, or newspaper accounts. That ability to practice entering in and stepping into the shoes of another individual is a profound skill that you can use in any other life setting because if you are constantly exercising your ability to think about something not from an egoistic, “me”-centric space, but from a position of trying to understand the other, that will make you much more empathetic, much more able to analyze any given situation from a variety of viewpoints, and therefore more flexible in responding to any kind of challenge. And that’s really what I think history as an academic discipline brings to the world.

Given the very long history of medicalized racism against the Chinese and Asians here in this country, any kind of hesitancy to accept a state-issued vaccine is something that I think should be understandable on the part of Asians in the U.S, even if they are U.S. citizens. Another thing that I think is important to bear in mind is that Chinese medicine and Chinese medical theories and ideas about health and illness in the body are distinct from a biomedical vaccine-centric and technology-centric approach, and we should really preserve respect for Chinese medical ways of being when we consider the issue of vaccine hesitancy.

I’m also just very glad to hear you use that language of hesitancy, because the most important and fundamental thing to keep in mind is that we will not be able to walk someone from vaccine hesitancy to acceptance if we don’t enter those conversations with an open mind and a willingness to listen much more than speak—-to listen and be receptive rather than coming in with a judgemental mindset.

In terms of access, in the field of Asian American history and Asian American studies, most recently in the last 5-10 years, there’s been a shift toward questioning the discourse of the model minority and challenging the ways that this image of Asian-Americans solidifies this idea that all Asian immigrants in the U.S. are upper-middle-class, people of wealth, means, and higher education. It also allows us to rewrite the history and the current realities in more complex ways that give attention to people of lower socioeconomic status, people who immigrated to other parts of the Americas and other parts of the world. After we put all of that into conversation, when we see that in a more complex light, then we can understand that in the Asian American community there are problems of access. Where are the poor and working-class Asian Americans? Where are the ones who have not had access to education to learn more English in order to understand all of the attributes of this foreign government and the public health information that is out there?

Even speaking as a historian of medicine who would self-describe as pro-vaccine and was very willing to get the vaccine, even I have had hesitancy after hearing the news about AstraZeneca, so I can completely understand how someone who is only hearing snippets here and there from some news sources or only hearing through word of mouth about resistance and hesitancy versus any kind of pro-vaccine sentiment.

It’s natural to understand that people would be hesitant. And then do they have a local vaccine center that they can access and can get to outside of their working hours? Or do they have an employer that’s going to give them some time off work to go to the vaccine center? All of these are really important questions. And I’ll just put a footnote there as well, that this is another place where the humanities and social sciences have something very important to offer, because we’re learning right now in a very poignant and powerful way, that it’s not just a matter of having the vaccine available. Being able to do all of that rapid scientific work was unbelievable and really unprecedented in all of human history—-to have multiple vaccines in such a short time period. It is phenomenally amazing and yet it’s still not enough, because if we cannot get the public information out there, if we cannot help convince people to be willing to have this put into their bodies, we are not going to be able to actually put that vaccine to use. So we need a broadband approach, if you will, that includes all kinds of sources of intelligence and ways of dealing with human beings to make this really work.

In traditional Chinese medicine, the core of it is really self care and preventative medicine. It’s making sure that you don’t get sick by keeping your own internal body very strong and your qi (life force) very strong. Qi is really just life force—- it’s that which expires or moves out of your physical body at the point of death and moves into your body at the point of conception. Keeping qi strong and keeping your whole body in balance through a good balanced diet, eating in accordance to the seasons at the right time, keeping your sleep schedule in accordance with the movements of the heavenly bodies like the sun and the moon, and of course sufficient sleep but also at the right time. Times are very important in Chinese medicine—- that’s a whole ‘nother topic that we don’t have time to go into—-but timing of illness onset, symptom presentation, and of self-care according your body to the times of the cosmos, all of that is essential and the core of Chinese medicine.

If you do all of these things, you cultivate your body and care for yourself, then ideally you have a lot of strength and resistance to any kind of pathogens or xie qi (pathogenic qi) that could attack your body. I could easily see some person who adheres very closely to a traditional Chinese medicine approach to health and illness feeling like the COVID virus is a form of xie qi and can attack my body, but if I strengthen my own body’s defenses and take herbal remedies that strengthen my respiratory system, then I am less worried about this virus because I know that I am going out into the world with this protection. Maybe I would also be willing to wear a face mask—-let’s not forget that face mask usage across China, and across Asia in general, is much more common and normalized than here in the United States. People do it for air quality issues, you know, if you’re riding a moped through polluted city streets, if you yourself are ill and you’re trying to prevent viruses and bacteria from invading, or just in response to the SARS epidemic of 2003. 

Mask wearing has been normalized, so if people are willing to wear a face mask and they’re taking herbal remedies to strengthen their respiratory system and doing everything else in the suite of things that they know how to do, learned generally from parents, grandparents, and wider culture, to care for their bodies, I could completely understand someone who says “No, I don’t need to take the vaccine.” 

There’s also another kind of aspect to this, which is that the vaccine could be conceived as the nuclear arsenal version of responding to this virus, whereas self-care, diet, sleep, and moderating everything about your body and its environment is a more gentle approach. That is often a point of contention between a Chinese medical etiology and a biomedical etiology. The other common way of thinking about that is antibiotics. A Chinese doctor might say, “Stop taking this antibiotic when you feel better because we know that the antibiotic destroys not only the bad bacteria but also the good ones, so we don’t want you to keep destroying yourself with that,” and of course that leads to antibiotic resistance and is an anathema in the biomedical community.

This really just comes from the different understandings of what health is about. In one world, it’s about balance and you don’t want to attack your body too much, and then in the other, it’s about bringing out the biggest arsenal against this danger.

From what I know sitting here in the U.S, I think in general I am very impressed and happy with what the mainland Chinese government has done with COVID to control it. Of course I am aware of and also concerned about the ways in which the Xi administration has used it as a pretext to advance and promote using artificial intelligence to track people’s movements and getting complete biopolitical control of people across the country. That is very much an issue of deep and profound concern.

But I think overall, if we’re going to talk about public health in general, China has done a remarkable job of controlling this pandemic. Yes, of course it did originate from Wuhan and now most recently even the Biden administration gave a nod to this theory that maybe it was something created in a laboratory and deliberately released or deliberately created in the laboratory and accidentally released.

I don’t personally give much credence to that. That, to me currently with the absence of real information, lives in the world of conspiracy theory, but a respiratory illness was bound to get out of a massive city, but I would challenge one to imagine a situation where in the city of such population density, any other country or governmental system would not have been able to control it as well and as efficiently as China did.

There were a lot of ways that they did that very cleverly. The universal enforcement of masking and quarantine, and yes, the tracking of people who tested positive, to ensure that they were observing quarantine and not moving out and infecting others. The use of forehead scanning for temperature, observation on busy street corners and making sure everyone had the face mask on, and now most recently not allowing people who have not received the vaccine to buy train tickets and move about freely. I mean I actually would like it if the U.S. government did some of these things to actually force people to show proof of vaccination, not just say “Ok, the CDC says we can stop wearing facemasks.” So now I, a US citizen, don’t know if the people who are unmasked and moving about have actually gotten the vaccine or if it’s just because they never wanted to wear masks. I think that’s going to lead to a long-term challenge here in the United States, whereas in China they have much deeper control. And then of course, as I previously mentioned, the normalization of face masks, but also other things that are less talked about like the building of large quarantine hospitals. Positive COVID cases in Wuhan early on were put into these hospitals, but they were with other COVID patients, so they were not forced into isolation. In the U.S., it’s all been isolation, stay-at-home, early on they were saying don’t even talk to people in your family. If someone gets sick, you isolate them in one single room. This is when we thought that maybe it could be transmitted by fomites, so anything a sick person touched could be a source of disease. Just having your spouse or your child serve food to you at the door and leave—-that is extreme isolation and that’s not good for a person’s sense of overall health. Again, going back to the Chinese medical idea of health as an overall holistic kind of health.

What I’ve seen reported about these group COVID isolation hospitals, is that the people there were happy to be able to do little activities with each other and not be in complete isolation. Yes, they might have been away from their family members, but they were interacting with other COVID patients and able to live a social life throughout that period as well, which I think is a distinctive Chinese approach to it that makes a lot of sense. 

I: Thank you so much again for all your time Dr. Barnes. This has been such a productive conversation. I think that there’s a lot to unpack from what you’ve shared with us today regarding not only what’s been going on here in the States but also what has happened in China with COVID-19. You’ve demonstrated the value of history and the humanistic disciplines in contributing to understanding of the world and how we approach the problems and issues that we face in our modern society and I wanted to thank you again for providing such valuable knowledge and sharing that with all of us.

B: Thank you for having me, it’s my pleasure!

I: Thanks everyone again for tuning in!