EASTS Advance Publication, published on July 5, 2017 East Asian Science, Technology and Society: An International Journal (2017) 11:1–20 DOI 10.1215/18752160-3817554 Placing Image and Practice in Tension: South Korean Nurses, Medical Pedagogy, and the Indiana University –Bloomington Nursing Program, 1958 –1962 John P. DiMoia Received: 13 April 2016 / Accepted: 7 November 2016 q 2017 Ministry of Science and Technology, Taiwan Abstract In the aftermath of the Korean War (1950 – 53), the symbolic and material reconstruction of South Korea began, with much of the relief work assumed under the broad banner of the United Nations and its various affiliates and with a wide range of international aid and relief organizations participating. With this dramatic increase in the areas of new medical infrastructure, training, and pedagogy, it remains surprising that much of the scholarship to date has focused largely on medical practitioners and their contributions to a rebuilding nation, that is, the Korean domestic context almost exclusively, suggesting a strong degree of continuity with the past. For South Korean nurses, this period (1954 to early 1960s) would see a radical reconfiguring of their professional practice, along with that of doctors, and, more important, their patterns of movement, as international migration to the United States and Europe was enhanced by changes to immigration law in and following 1965. Even before this change, however, Korean nurses began traveling abroad for further education and professional development, with the Korean War opening up numerous opportunities consistent with such aims. To borrow the language of historian Young-Sun Hong, medical per- sonnel were rapidly becoming mobilized as a critical part of a much larger “global humanitarian regime,” one consistent with the work of Catherine Cineza Choy on medical migration of Filipino nurses. Keywords nursingmedical aidSouth KoreaGermanyVietnamCold War migrationtechnical assistancefree-world assistance Acknowledgments The author thanks Howard Chiang, Warwick University, and Warwick’s conference center in Venice for hosting the workshop that initiated this special issue. He also thanks the National University of Singapore for additional travel assistance in 2014. J. P. DiMoia Independent Scholar e-mail:
[email protected]Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 2 J. P. DiMoia 1 The Korean War and Constructing “Free-World” Networks of Medical Expertise (1954 – 1960) In the aftermath of the Korean War, the symbolic and material reconstruction of South Korea began, with much of the relief work assumed under the broad banner of the United Nations and its various affiliates and with a wide range of international aid and relief organizations participating (United Nations 1956).1 The scale of devastation was such that some scholars have argued for using the Korean context as a lens through which to understand the formative practices of the United Nations, as this was one of the first major tests for the organization, its ideals, and more specifically the execu- tion of its broader designs.2 While international adoption has a lengthy history, for example, the roots of the practice (post-Korean War) follow specific patterns, taking a shape that has allowed the newer scholarship to make some penetrating observations about the developing US-Republic of Korea (ROK) relationship, as detailed in the work of anthropologist Eleana Kim (2010) and others (Oh 2015; Holt 1956).3 The volume of orphans and refugees associated with the conflict required the rapid crea- tion and implementation of new policy measures. Similarly, for medicine, and biomed- icine in particular, the Korean War proved to be a testing grounds for a wide range of emerging practices, including vascular surgery and the treatment of hanta virus infec- tion and hemorrhagic fever.4 For many Korean doctors and health professionals, the opportunity to work in the field offered a valuable immersion in clinical practice that had been denied to them in their previous training, especially those who had studied under the Japanese imperial system during the later stages of World War II and the Pacific War of the late 1930s and early 1940s (Kim 2014).5 For the ROK’s external partners, the transition to peacetime meant an opportunity to rethink their relationship to Korea, with many nations opting to continue their aid in some form, whether radically reconfigured or, in some cases, with little or no change in dynamics (Hong 2015).6 Medical services, which had seen the arrival of American and Norwegian Mobile Army Surgical Hospital (MASH) units, along with hospital facili- ties based near the Pusan perimeter, provided one such opportunity, with the UN Korea Reconstruction Agency (UNKRA) and the American-Korean Foundation over- seeing a range of activities, especially in terms of assisting with orphans, along with 1 Prominent among the participating organizations would be the UN Korea Reconstruction Agency and the UN Civil Assistance Command, Korea. 2 Many of the propaganda images from the Korean conflict can be found at the Hoover Institute, Stanford University, especially leaflets and pamphlets mobilizing biomedicine. These materials shaped the percep- tion of biomedicine as a benefit to be associated exclusively with the South Korean/Free World cause, especially through the participation of the United Nations. A similar argument might be made for the significance of international participation in postconflict housing; see Kwak 2015 and Park 2016. 3 Holt International Children’s Organization was among the most famous of the adoption agencies to direct Korean adoptees to “Christian” homes in the United States. 4 The hanta virus causing hemorrhagic fever was isolated in the 1970s by Ho-Wang Lee, among others, and Geun-bae Kim (2005) has written an account of the complex politics underlying this effort. 5 Graduates of the Japanese Imperial University Program in Medicine typically constituted at least half to two-thirds Japanese residents and had little opportunity to engage in clinical practice. 6 For West German medical aid to the ROK, especially concerning the German Red Cross Hospital in Pusan, see Hong 2015, chap. 3. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 3 the care and rehabilitation of wounded veterans (Rusk 1972).7 Two major projects were set in place to oversee the structural transformation of Korean medical education and health care at the tertiary level. The first of these, the Minnesota Project (1954 – 62), brought the University of Minnesota into a relationship of exchange with Seoul National University, with medicine forming one of the three core areas of emphasis (the others were agriculture and engineering).8 Several years later, a Scandinavian (Norway, Sweden, and Denmark) effort (1958 –68) transformed the Seoul City Hos- pital into the newly imagined National Medical Center, with doctors and nurses from Europe remaining until at least the late 1960s before handing over responsibility for the refurbished facility to their Korean students and trainees (National Medical Center in Korea 1971, esp. chap 7). With this dramatic increase in activity in the areas of new medical infrastructure, training, and pedagogy, it remains surprising that the scholarship to date has focused almost exclusively on these diverse contributions to a rebuilding nation as a form of continuity and, in corresponding fashion, a celebratory narrative of a refurbished domestic context, with little attention to the impact of accompanying regional and international factors. There remains a great deal to explore, therefore, in terms of at least one major question: the surrounding international context of medical migration within, to, and from Asia, a story that greatly complicates the convenient narrative of a restored domestic setting. For this issue, doctors and support personnel provide a means of tracking the patterns, especially Korean nurses, who performed most of the hands-on clinical work in the hospital and the clinic. With the coming of specialization in the following decades, the American system of clinical rounds and internships would be introduced at major hospitals like Seoul National and Yonsei, bringing some degree of resemblance to American/international models of practice, even while acknowledging room for local differences. Even if this change in pedagogy clearly did not cause outmigration per se, it contributed to a heightened awareness of a conflux of issues—better external sources of pay, more chances for professional growth, along with active encouragement from the Park Chung Hee government after 1961—resulting in a dramatic revaluing of these nurses and their place within the broader international labor market by the early 1960s. Specifically, this period (1954 to early 1960s) would see a radical reconfiguring of their professional practice and, more important, their patterns of movement, as inter- national migration to the United States and other sites was greatly enhanced by chang- es to immigration law in and following 1965. This year witnessed the breakdown of ethnic quotas dating to the 1920s, thereby potentially widening immigration to the 7 See also Howard Rusk’s personal papers, held at the Western Historical Manuscript Collection, Ellis Library, University of Missouri–Columbia. 8 Data from Edmund B. Flink, Report and Recommendations on Teaching and Research in Internal Medicine, 1 February 1958; and four reports at the University of Minnesota, Special Collections: William F. Maloney, Report of Observations as Adviser in Medicine, 1 July 1956; James H. Matthews, Final Report of Observations and Recommendations, 7 November 1958; E. P. Brown, Report of Observation and Activities as Adviser in Medicine, 24 January 1959; and Glenn R. Mitchell, Report on the Seoul National University Hospital,. In total, eleven Minnesota medical advisers spent time in Seoul. [ US] Agency for International Development, Historical Survey of United States Technical Assistance to Nursing: Part II—Far East, 1951– 1966, University of Minnesota Special Collections, http://pdf.usaid.gov/pdf_docs /Pdacs352.pdf (accessed 19 September 2014). Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 4 J. P. DiMoia United States and offering new opportunities to Asian migrants. Even before this change, however, Korean nurses began traveling abroad for further education and professional development, with the Korean War opening up numerous opportunities consistent with such aims. To use the language of Young-Sun Hong (2015: 3), Korean medical personnel were rapidly becoming mobilized, enrolled within a systemic “global humanitarian regime” (see also Bernad 1974).9 The Minnesota Project includ- ed a number of nurses in its scheme, with Korean nurses spending considerable time at the University of Minnesota before returning home to help with the implementation of the new clinical program (1957 – 59), having experienced the inner workings of the system firsthand. Marjory Low of the University of Minnesota was one of the nursing advisers who traveled in the other direction, spending time in Seoul as an adviser (1957 – 59), along with the medical advisers working at the physician level.10 This style of contact with external actors was nothing new for Korean nurses, dating to their working relationship with Western missionaries as far back as the late nine- teenth century. In this earlier form of contact, medicine represented a critical part of the package brought by Protestant missionaries, along with higher education, composing a core part of the mission informing such institutions as Ewha Womans University and Severance Hospital, later affiliated with Yonsei University. What was new, however, was the heated international Cold War context in which the renewed relationship had to bear the weight of additional material and symbolic overtones, with nurses challenged both personally and professionally to transform themselves and to work comfortably in a wide variety of new settings, both domestic and international. If Korean nurses and related health care professionals have received much less scholarly attention than their comparable Asian counterparts (e.g., the Philippines), it is not for a lack of accomplishment, as these two groups, collectively, formed part of a pattern of medical migration between Northeast Asia and a wide range of sites, with the United States and Western Europe (e.g., West Germany) dominating as favored destinations (Ishi 1988).11 For the Filipino case specifically, Catherine Ceniza Choy has written about an “empire of care,” examining the extent to which the combined force of American empire and the “special relationship” encouraged a path-dependent relationship that brought thousands of health care professionals to the United States in the decades following the Second World War (Choy 2003).12 The question remains as to why Korean nurses have yet to receive such attention, especially during this period when the changing material reality often stood in contrast to how external actors perceived and interacted with them. This article argues specifically that programs designed for interactions with Korean nurses frequently did not perceive them as international migrants and actively sought to train them almost exclusively within the Korean domestic context. In this sense, there was a conspicuous lack of fit between the new training programs and the needs, aims, and ambitions of these young nurses. 9 Koreans contributed medical aid to other nations as early as 1954, participating in Operation Brother- hood, offering medical assistance to “free world” Vietnam and Laos. 10 Historical Survey, 31. 11 For the West German story, see Hong 2015, chap. 8. 12 Arguably the attention devoted to the Philippines case, and the corresponding lack of attention to South Korea in contrast, says something about their very different developmental trajectories as nations and, equally important, their relative standing in the eyes of the West. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 5 1.1 Korean Nurses as Transnational Migrants (1948 –1965) The period following the Korean War (1954 –63) witnessed a dramatic transformation during which Korean nurses increasingly became transnational migrants, a special category of workers representing their nation in a variety of new settings and contexts, including West Germany, South Vietnam, and the United States (Schonwalder 2004).13 More specifically, this article uses the International Cooperation Adminis- tration (ICA)-sponsored nursing program led by Indiana University (IU)-Blooming- ton for approximately a decade (1958 – 66) following the Korean War as a lens through which to examine the dense, heated politics of the period.14 Lesser known than the comparable Minnesota and Scandinavian efforts, the IU-Bloomington project created a relationship between the flagship campus in Indiana and more than ten Korean universities and schools of nursing, aiming to upgrade the medical pedagogy and training of a new generation of nurse practitioners.15 Beginning with the understand- ing of a previous relationship formed through medicine and missionary activity, IU undertook its mission on the assumption that the Korean context in the late 1950s was best represented by continuity, meaning an ongoing heritage linked with pre- vious missionary activity, offering only a limited perspective on the challenges to be addressed. IU soon encountered a lack of fit between its stated aims and those of the targeted recipients, although this problem was not always articulated. In many ways, the IU program was distinct from comparable programs of the period, especially in terms of the patterns of exchange more typical for American and international educational institutions. The ICA established a one-to-one relation- ship with its partners, pairing an American university and a foreign partner institu- tion within a particular area of expertise (Kim 1982).16 First, perhaps motivated by the perceived need for widespread reform, IU sought to make contact with as many Korean schools of nursing as possible, holding numerous workshops and public events to emphasize its message of outreach. Second, the nursing program was largely staffed, run, and carried out by a core group of female professors of nursing at the university, chief among them Dotaline E. Allen and Mildred P. Adams, and this added gender dimension contributes to the complexity and appeal of this story. At least initially, IU mobilized a message of continuity in its publicity materials, the reestab- lishment or affirmation of an American medical mission started in the late nineteenth century.17 Similarly, Minnesota sought to accomplish this same type of work with its effort at Seoul National University, adding a healthy dose of free-world rhetoric to support its stance in the immediate aftermath of the Korean War. Arriving several years later, IU offered numerous pictures of Korean nurses in training, seeking to emphasize the 13 Nursing exchange with West Germany began in the early 1960s. 14 Data are from Indiana University School of Nursing Records, 1914–2002, Ruth Lilly Special Collections and Archives, University Library, Indiana University Purdue University Indianapolis. An inventory of the collection is available at https://www.ulib.iupui.edu/files/u51/ua025.pdf. 15 Korean universities participating in the IU public workshop program included nine in Seoul, two in Taegu, and one in Kwangju. 16 The ICA often failed to account for the external dynamics—regional, international—shaping the effects of its programs. 17 Korea Project, boxes 26–30, Indiana University School of Nursing Records. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 6 J. P. DiMoia relationships being established between the Americans and their Korean counterparts, a theme of university exchange essentially consistent with the earlier missionary activity dating to the late Joseon. At the same time, South Korea was undergoing enormous changes, and some of the inherent contradictions began to emerge during the program, producing conspicuous points of tension. When IU-Bloomington arrived in the late 1950s, President Syngman Rhee was in power, and the ROK stood as a staunch anticommunist ally of the United States, sustained largely by American aid packages. By the late 1960s, nearly a decade later, this same nation was deeply enmeshed in the war in Vietnam (for South Korea, its participation covered 1964– 73), and while remaining a close ally to the United States, South Korea was becoming much more explicit about its intentions to develop economically and militarily on its own terms. This changing relationship reflected not only the South Korea-US dynamic but also the reconfigured relationship with Japan, making in effect a triangular relationship for Northeast Asia, one that needed to be managed carefully. Economically, normaliza- tion with Japan in 1965 brought enormous benefits, even as postcolonial tensions between the two nations continued to produce strains, deriving in particular from the prior colonial relationship (1910 – 45) (Shin and Robinson 2001). If Korean doctors sought to cultivate a new image distinct from their Japanese training after 1945, there is little in the literature on how Korean nurses responded and what they might have done in handling this same issue, even as this topic presents itself as a potential line of inquiry. Moreover, the American presence introduced another actor with a claim to imperium, and the dynamics of that relationship have inspired a great deal of scholarly commentary (Brazinsky 2007). Certainly the United States remained the dominant partner for much of the period, and while South Korea pursued its own agenda, it did so within a set of constraints, recognizing the boundaries established by the powerful combination of American economic and military support. Both Minne- sota and IU experienced this dynamic in the form of a major disruption to their respective programs after 1962.18 For Korean nurses specifically, their lives changed dramatically by the mid- to late 1960s, both personally and professionally, as they became valued migrants traveling and working within a wider developing regional and international economy of medical exchange.19 This type of movement had not been possible previously, certainly not at this scale, and by the middle of the decade the ROK government had recognized the potential of this group of highly trained, specialized workers as a form of human capital, as representatives of national pride, as migrants, and especially as a source of revenue. These women, when placed in their new positions, whether in West Germany, the United States, or any of several other favored destinations, served as a much needed source of foreign exchange, with remittances to Korea functioning as a 18 The year 1962 represented the renewal point for ICA contracts in both cases. Moreover, this was the first time that the renewal fell under a new Korean government (Park Chung Hee), resulting in a disruption to the two programs. 19 Along with ROK Army forces, Korean medical personnel were among the earliest groups to be sent to South Vietnam in September 1964. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 7 valuable form of economic subsidy to their families and, by extension, the nation.20 In some cases, the ROK actively promoted the migration patterns, as was the case with West Germany, using this highly select population to further enhance the relationship between the two nations (Chosun Ilbo 2008). With these circumstances, it is fair to consider the issue of how to frame the activities of these nurses, increasingly embedded within emerging regional and inter- national networks of labor migration. At the personal level, their motivations for going abroad were quite diverse, including economic motives, the opportunity for pro- fessional and educational enhancement, and perhaps even a certain amount of national pride in being among the first Koreans to have such a chance. At the same time, the patterns of movement took place within a set of constraints bounded by immigration law, international labor markets, and especially the political and economic relation- ships shared among certain groups of like-minded nations during the Cold War, a grouping sometimes characterized as the “free world.” In this last sense, the US-ROK relationship has been scrutinized and labeled in a variety of ways; certainly it was a relationship of partial dependency, with a clear and palpable difference in power. The question remains, then, of whether it is appropriate to label this program “neocolonial” or perhaps even “subimperial,” taking place within a set of boundaries shaped and informed by American empire. At the same time, IU clearly did not perceive itself in these pejorative terms, choosing to frame its mission instead as one of a relationship between two groups of women, with emphasis placed on restoring the domestic setting and its public health. 2 Forming New Links: Indiana University, the International Cooperation Administration, and the US Federal Research Economy How did IU end up with its significant presence in Asia? Beginning in the late 1940s, the US federal government created numerous incentives for American universities to act as contractors on its behalf, beginning with the Mutual Security Administration under President Truman and continuing this impulse enthusiastically under President Eisenhower with the subsequent formation of the Foreign Operations Administration and the ICA.21 Large midwestern state universities with a regional focus frequently used these federal contracts to transform themselves into much larger research uni- versities, and the legacy of John Hannah at Michigan State University—famous for its relationship with South Vietnam—serves as a representative case of a technical/agri- cultural school undergoing such an expansion (Ernst 1998). For IU, it was President Herman B. Wells (1938 – 62) who saw the potential for the university to grow by moving abroad and participating in these international programs (Capshew 2012). IU became known not only for its program in South Korea but also for its lengthy 20 The Korea Overseas Development Corporation was state owned and oversaw the placement of these workers, seeking to regulate and control the migration process, focusing on its financial rewards. For an account of the corporation’s methods, see Chira 1987. 21 President Truman’s “Point Four” address of January 1949 is often considered the starting point for this American style of technical diplomacy (1949–61), later to be subsumed by the US Agency for International Development (USAID). Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 8 J. P. DiMoia relationship with Thailand in the 1950s, developing an extensive program in public administration at Thammasat University in conjunction with the Southeast Asian partner nation (Thailand Public Administration Program 1965; Sutton 1962). If the program made sense from the standpoint of building up the reputation of the university, along with offering considerable financial incentives, it made equal sense to the faculty members responsible for running it. At this early stage in the post-Korean War era, the opportunity to work and teach abroad often enhanced the careers of those who took the chance, frequently in ways that they might not have anticipated. For IU, Allen and Adams were already well established at the nursing school, and the move to Korea offered the opportunity to expand their teaching agenda and the scope of their program. Unlike Minnesota, with its exclusive relationship with Seoul National University, IU had the ambition of contacting and working with as many schools of nursing as possible. This strategy may have derived from the question of numbers— with small clusters of nurses scattered at a range of institutions, especially outside of Seoul in rural areas—and it offered the possibility of effecting substantive change with a real impact.22 For Allen and Adams, the Korea program also represented a logical extension of their prior work in nursing. Allen, acting director of the Division of Nursing Education at IU from 1950 (full director from 1951), had worked her way through the ranks, acquiring her EdD at the university (1955) along the way. An Indiana native, she spent time in Colorado during the 1930s before turning to Columbia University and then IU, beginning her affiliation with IU from the early 1940s as a teacher.23 Adams, the junior to her colleague, completed her EdD in 1964 and was much more explicitly involved in expanding the international ambitions of the nursing program. For the Korea pro- gram, she served as onsite acting head for much of the time, while Allen made only two supervisory visits conducted at intervals, remaining in Bloomington most of the time. Following her Korea work, Adams was later involved in expanding IU’s nursing outreach efforts to Latin America, work that carried her through the latter stages of her university career.24 As “IU’s nursing ambassador abroad,” Adams, along with the accompanying frame of her participation in the Korea program, raises an issue implicit for much of the period, although one frequently not addressed: migration.25 The ultimate destination of nurse trainees was often not specified, and for Latin America and the IU relation- ship, the goal was one of increasing diversity in nursing education and within the profession at large. Clearly, if IU was recruiting these students, it was not yet speci- fying where the final destination for their future working lives should be. To revisit the precedent set in South Korea, the National Medical Center had considered this issue, with the three European partner nations agreeing that Korean nurses would be regarded as “ hands off ”: they would be ineligible for recruitment to fill positions in 22 Estimates for nursing in Korea came to about five thousand to six thousand nurses by the early 1960s. 23 Frances Orgain, Memorial Resolution for Emeritus Professor Dotaline E. Allen, Circular B05-1970, Bloomington Faculty Counsel Minutes, Indiana University, http://webapp1.dlib.indiana.edu/bfc/view? docId¼B05-1970&chunk.id¼ d1e87&toc.id¼ &brand¼ bfc (accessed 19 September 2014). 24 Honoree Mildred P. Adams, University Honors and Awards, Indiana University, https://honorsandawards .iu.edu/search-awards/honoree.shtml?honoreeID¼4004 (accessed 19 September 2014). 25 The issue of migration remains implicit within the IU materials but is seldom addressed. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 9 Europe, recognizing their high value to a recovering Korea (National Medical Center in Korea 1971: 61). Similarly, Minnesota urged its recruits to return to Seoul after completing their field experience in Minneapolis and, with few exceptions, was suc- cessful in asserting its authority on this point. At the same time, both of these accounts derive from the external portion of the story, leaving ample room to consider the Korean viewpoint within a growing international labor market. This also leaves the question of where IU stood on this critical issue. According to at least one alternative version, published several years into the venture (1964), the IU – Korea program owed it origins to a combination of domestic actors, with these situated in the Korean context rather than the United States (Allen and Adams 1964: 104 –6). Following the conclusion of the war, Korean nurses sought assistance from the ROK Ministry of Education, seeking advice in terms of improving access to better forms of pedagogy and the latest in medical training. According to this revised version of events, the Ministry of Education then approached the American ICA with a request for assistance, with IU identified as providing the best fit to meet this need. Although this version does not radically alter our understanding of the circumstances, it grants a much higher degree of agency to the Korean nurses as the primary actors and, in particular, cites their desire to professionalize and to upgrade their status. As this account was reported by the IU side, it also underscores a desire to portray the working relationship in the best possible light, with the American presence solicited from the outside rather than simply intervening without a context. Still, this version appears to limit the intended effects to the domestic, emphasizing the tension between the contrasting accounts. 2.1 On the Ground: Translating Korean Concerns and Addressing Practical Issues To begin with a generalization, IU was typical of many of the ICA’s efforts in that IU did not possess area-specific expertise (for East Asia or South Korea), even as it brought great enthusiasm and energy to the project. Arriving in the late 1950s, Adams would coordinate efforts on the ground, with her senior colleague, Allen, remaining behind in Bloomington, visiting at intervals to check in. Certainly IU knew about prior missionary efforts in Korean nursing education and higher edu- cation, and two specific sites (Ewha, Yonsei) provided the links to establish contacts and get under way. As for nursing specifically, the ICA program did not specify any explicit goal other than a general aim of raising the standard of South Korean public health and assisting a recovering nation in the aftermath of war. Again, this request fits a pattern of aid and relief very common for the period. IU also held a comparative advantage with its late arrival in that several other programs had established a presence and a system of working in close cooperation with the South Korean government. In 1954 even simple tasks had been difficult, as much of the governing apparatus was still in the process of moving from the wartime location of Pusan. By the late 1950s, in contrast, there was a considerable expatriate population in place, even as conditions in South Korea remained clearly affected by the privations of war. More important, health care professionals arriving from differ- ent national contexts were able to interact easily and to share new ideas, results, and surplus materials across projects. For the Minnesota and Scandinavian efforts, there are numerous accounts of doctors meeting during their off-hours, using one another as Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 10 J. P. DiMoia sounding boards and as resources to understand the Korean context. For nursing, the IU program arrived with much of the initial bureaucratic work already in place, at least insofar as other parties had started to shape the path. Precisely on this point of liaising with their Korean counterparts, IU worked through the Ministry of Health and Social Welfare and the Ministry of Education, the two bodies responsible for dealing with the necessities of public health. For this time period, this meant dealing with disease problems such as tuberculosis and lep- rosy, two of the most common public health issues, as well as the problem of parasites, although this second issue was not addressed at the national level until about a decade later (late 1960s).26 More than these disease-specific points, the issue in the late 1950s was one of increasing the visibility, image, and appeal of Korean public health, par- ticularly with the lingering effects of the war. Biomedicine was not necessarily the preferred choice of many Koreans, and even persuading patients to visit a hospital was sometimes a victory, as it familiarized them with a wider range of health choices.27 Working within these constraints, IU had to negotiate a careful path, responding as both generous and yet critical at the same time, seeking to effect change without raising concerns about the pace of change. 3 Indiana University: Establishing Relationships and Crafting an Approach to Clinical Practice through Workshops (1958 –1962) Granted a mandate to improve the quality (and presumably quantity) of South Korean nursing education, the IU program began its work in Korea with a series of site visits in 1958, seeking to establish contact with a range of partners. According to IU’s records, its initial contact with Ewha Womans University established the pattern for many subsequent encounters, with the relationship serving as a model and as a point of entry into the Korean context. Although IU was aware of a history of Western medicine in Korea since the nineteenth century, many of IU’s reports tended to prioritize what it defined as the midcentury equivalent to professionalism, in other words, the creation of an autonomous or independent Korean medical community after 1945. In addition, IU was aware that many of the medical resources in Korea had relocated to the Pusan perimeter during the preceding period (1950 – 54), seeking to avoid the combat occu- pying the middle of the peninsula. With this set of assumptions, IU was openly disappointed with the quality of Korean nursing education and, equally, with the caliber of the candidates it tended to receive at the point of intake.28 Many of the young women entering nursing did so with the equivalent of an eighth-grade education or less, and the profession was not 26 Aya Homei is now working on the relationship between nutrition, parasites, and birth control in the postwar Japan context through the Japan Organization for International Cooperation in Family Planning. For a recent example of her work, see Homei 2015. 27 This trope appears in any number of projects from the period, including the University of Minnesota, Scandinavian projects, and IU. 28 W. W. Wright, Improvement of Nursing Education in Korea, Korea Project Reports, box 27, Indiana University School of Nursing Records. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 11 necessarily of high status, meaning that it did not attract a select demographic.29 As for the first point, IU made it a priority to upgrade the requirements for entry, asking for better-quality candidates in possession of more credentials, preferably a high school education. Understandable as that goal may have been, the effect of raising the bar to entry at a time of shortage was risky, holding the potential for reducing overall num- bers. Moreover, the gesture indicated that IU needed some time to become familiar with the Korean context and its realities, as the aftermath of war affected material conditions at nearly every level.30 In this sense, IU’s attitude was more than a bit paternalistic, judging the Korean context according to its own metrics. The call for an upgrade to credentials did not mean, however, that IU was unaware of the major point of emphasis, clinical practice, which had been frequently unavail- able to Korean practitioners during the preceding period.31 To a great extent, Korean families assumed responsibility for caring for a sick or ailing family member, even while that person was in the hospital. With a need for professionals to take over these duties, and with the story of Korean nurses reaching out to the Ministry of Education, IU sought to find a means of outreach, incorporating the diverse views of nurses. Along with the relationships established with schools of nursing, therefore, IU included a critical component devoted to large-scale public workshops, traveling to three urban sites—Seoul, Taegu, and Kwangju—to encourage as much regional participation as possible. Traditionally, institutions of higher education have been densely concentrat- ed in Seoul, and IU was one of the few programs to address this issue head-on, even while others most certainly were aware of it. With this approach, IU recognized the problem of the relative abundance of resources in the Seoul metropolitan area and the corresponding lack for much of the remainder, rural South Korea. This development has historical roots dating prior to the arrival of Western medicine, when some form of a quarantine system was put in place during Joseon to limit the spread of epidemic disease.32 In any case, this form of outreach at mid-twentieth century saw nurses from the surrounding communities attending each of the three major workshops, meaning that audience numbers sur- passed expectations, even from the first workshop. Moreover, IU participants noted that, in a few cases, Korean nurses attending one workshop took the time to travel to the next at their own expense, allowing for the accumulation of familiarity and exper- tise, an incremental building of a larger community. This unintended development helped later when it came time to turn the project over to the Koreans, who would need to continue the effort on their own. What took place at these workshops was an attempt to break down and reconfigure an existing system based almost exclusively on lecture and demonstration. In other 29 However, in the German case, Hong (2015) argues that Korean nurses often felt that their professional training was not respected in the new work context in Germany. Clearly there were quite different percep- tions concerning the level of nurse training when comparing South Korea, the United States, and Europe for the early 1960s. 30 In other words, IU’s perceptions reflected a combination of reality and construction, as the construction of a weakness in a developing country (thereby justifying intervention) is a common trope of development. 31 This theme appeared frequently in the Minnesota Project as well, especially for 1957– 59. 32 This quarantine system involved providing temporary housing outside a city or village where those suspected to be sick were placed, rather than permitting them to enter a city. For the reformation and construction of a “modern” health system at the end of the nineteenth century, see Shin 2015. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 12 J. P. DiMoia words, Korean nurses tended not to gain a lot of hands-on experience until they were actually in their jobs and given responsibility for patient care. The same was true for Korean doctors, and there is a growing literature on how this style of medical peda- gogy links to the German model of academic medicine prevailing during the colonial period (Kim 2014). For this context, IU set up small group discussions and hands-on tasks, exercises that would help to encourage dialogue and allow the participants to ask questions.33 The issue of translation was significant, as few materials were available and most documents and items to be used had to be newly rendered in Hangul script.34 Even acknowledging these issues, the IU supervisors were happy with the develop- ment of rapport with their workshop participants. In these public workshops, and in their ongoing relationships working directly with Korean schools of nursing, IU had an agenda of breaking down perceived hierarchies within Korean medicine, another lingering perception from the colonial period. Still, as much of the burden of clinical care already fell to these personnel, what specifically had to change to achieve results? For their counterparts, Minnesota and the Scandi- navian consortium, the answer to this question came in the form of increased special- ization and the introduction of a system of clinical rotation requiring familiarization with a wide range of common medical problems and skill areas.35 For nurses as well, specialization offered considerable challenges, but it also held the promise of increas- ing prestige and the opportunity to professionalize upon the mastery of specific skill sets. The IU teaching materials for nursing therefore outlined a range of highly specific areas, indicating the desire to get nurses to specialize as early as possible or to be acquainted with a number of emerging subspecialties. The population with which IU was working on this ambitious set of goals was more diverse than it might appear, as the term Korean nurse covered a set of actors employed in very different settings as of 1960, even within a small nation. The schools of nursing specifically associated with the public workshops numbered slightly more than ten, but in building its long-term relationships with nursing IU conducted a baseline survey that included more than thirty sites nationwide.36 Many of these programs were not based at the elite universities (more visible to Western donors) and were instead associated with technical high schools in the provinces.37 This explains a great deal of the concern about class issues and the need to introduce an upgrade to the level of education required for admission, as previously mentioned. It also hints at some of the tensions present within the nursing community, where the hierarchies prevalent in Korean society likely influenced (and limited) the types of career opportunities available to those from outside the relatively well-off base of metropolitan networks. The prevailing urban-rural divide within Korean medicine was not the only concern facing IU, as the university also chose to engage with nursing as a set consisting of 33 Nursing Workshop, 24– 27 January 1961, box 27, Indiana University School of Nursing Records. 34 Historical Survey. 35 Minnesota made clinical practice the core of its effort (1957–59) as it implemented a clerk-residency system of rotations in the late 1950s. 36 These materials are in box 26 of the Indiana University School of Nursing Records, and the individual files for Korean institutions/departments number more than thirty. In some cases, IU held two or more workshops at the same institution (e.g., two different departments at the same school). 37 Historical Survey. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 13 many distinct subcommunities, establishing as many new relationships as possible. If the first of these was the community within universities and technical high schools, IU sought engagement with the ROK military as well, and with the comparable programs run by other aid programs.38 The ROK Army materials appear in a number of the IU files, indicating a depth of engagement, and here, too, clinical practice remained a central concern, especially with the recent experience of the Korean War. To make a generalization, the intent was to introduce a number of routines or scripts, habitual ways of approaching the most common clinical tasks, to enforce discipline and good habits among the nurses who would serve. Arguably, military medicine played a role as critical as that of aid programs in offering an entire generation of Korean prac- titioners the opportunity to work alongside their international colleagues, to learn new techniques and practices, and to introduce these back into Korean medicine. Moreover, at the national level, IU eagerly sought to make contact with the Korean Nurses Association, adding an additional bond that conceivably cut across all of the other bureaucratic and institutional layers. Dating to the early twentieth century, the association was linked with the earlier missionary legacy, but for IU its real appeal lay in the potential to achieve further outreach. The association’s in-house journal, Night- ingale, provided a forum for reaching any number of readers unable to travel to the public workshops, offering the latest in information about new approaches to health care. IU publicized its mission in this fashion and thus reached a level of public engagement surpassing that of many other relief programs. If the university can be criticized for spreading its resources thin and perhaps failing to concentrate on a particular specialty, the breadth and scope of its ambition were nonetheless valuable. At the same time, the IU program was filled with palpable tensions, contradictions implicit to its mission to bring a revised version of medical pedagogy to Korean nurses while also urging them to remain within the domestic context, continuing their work in Korea. In many other national contexts, one of the driving factors motivating the outmigration of health professionals has been tied to the use of licensing exams, standardized tests used as a metric to set standards in a particular profession.39 The use of these exams in international contexts frequently enables (and actively encour- ages) new professionals to begin expanding their ambitions, especially as they have demonstrated competence in a particular skill area and may reside in a market where their skills may not be adequately compensated. For the IU program, there is no evidence at this early point of the use of such evaluative criteria, but Korean nurses were beginning to be recognized as a valuable commodity, even as their migration patterns would not attract significant scholarly attention until later. At this point in the early 1960s, the major effect of the IU presence, and indeed the related medical programs running concurrently, was likely experienced in two ways. First, the general push toward professionalization simultaneously widened and reduced the scope of the nascent profession, encouraging these women to purse greater ambitions for career development and growth while also raising the bar to entry to a significant degree. Second, the patterns of migration were still confined primarily within the boundaries of South Korea as a domestic space, and this by itself was by 38 Republic of Korea Army (book), 1958, box 28, Indiana University School of Nursing Records. 39 The obvious example here would be the Philippines, but other developing countries serve as well. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 14 J. P. DiMoia no means a minor development. The call for travel to participate in workshops, the dissemination of new information through journals and professional publications, and an enhanced role within the hospital setting were developments that collectively encouraged the sense of a national community. Again, international actors noticed the value of Korean nurses from early in the decade, and it is fair to consider the extent to which members of the profession began to develop an awareness of their value on their own. If IU did not act as a cause for this development, it nonetheless appeared at a time when the change was coming: IU’s program goals not only failed to anticipate this dynamic but sometimes actively worked against it, again leading to unexpected tensions. 4 Emerging Regional and International Migration: The International Context and the Free World Network (1966 –) The typical patterns for scholarly and professional exchange in Korea prior to 1945 were shaped heavily by the Japanese colonial experience, with most of those going abroad traveling within an East Asian system, with Taisho/Showa Japan serving as a favored destination, along with Republican China (Moon and Kim 2004; Kim 2005).40 There were exceptions to this pattern, of course, but the possibility of move- ment to other locations, such as Europe and North America, did not become a reality for most Korean students until sometime well after 1945. For medicine specifically, this observation holds with respect to clinical practice, with models of practice deriv- ing largely from interactions shaped by the colonizer.41 Newer forms of intervention through American and international actors during and following the Korean War therefore represented a form of disruption, one that would create new possibilities for both practice and migration. At the same time, these professional developments also proved useful to the state, motivated to resell itself to the population in the aftermath of war. To restate this last observation, the transformation of Korean nursing pedagogy took place within a political context, domestically and regionally, and this setting inevitably influenced the process. Starting in the last portion of President Syngman Rhee’s rule (1958), the IU nursing program adopted a stance similar to that of other relief programs, mobilizing the post – Korean War context as the explanatory frame for undertaking its relief work. Certainly few would question the need for medical relief only a few years after the close of the war, when the nation remained in recovery mode. A few years later, however, the situation became more complicated, with the coup in May 1961 and the arrival of the new Park Chung Hee government. Even after the junta removed its military garb in favor of civilian elections held in 1963, the formative 40 For nursing specifically, see Yi 2006. 41 A number of projects are currently in progress concerning the colonial legacy of medicine in Korea. Theodore Jun Yoo has recently published It’s Madness (2016) on colonial psychiatry, while Jin-Kyung Park (2008) works on gynecology and the treatment of Korean women in colonial-era prisons. Jennifer Yum’s 2014 PhD dissertation addresses postwar psychiatry, and Jane Kim (2012) has written on leprosy. Sonja Kim’s PhD dissertation (2008) addresses mothering and care in colonial Korea. Kyung Moon Hwang’s Rationalizing Korea (2016) has generous sections on public health and demography for late Joseon. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 15 US-ROK relationship took time to renegotiate, as this was a more confident South Korea, and matters in Southeast Asia were accelerating in the lead-up to Vietnam. In 1962, therefore, the formal portion of the IU-ROK relationship came to an abrupt end, with the contract terminating as those on the Korean end encouraged it to lapse. This move was not without precedent, as the Minnesota Project, similarly, was allowed to lapse, with Seoul National University simply choosing not to renew its exchange arrangement as of June 1962. In this second case, Minnesota persisted through the late 1960s in seeking a renegotiation of the relationship, with little response on the Korean end. For IU, although the result was disappointing, there had been few formal institutional relationships, so the work in Korea could continue, albeit on somewhat different terms. The IU nursing team stayed in touch with a number of Korean schools of nursing and, moreover, spread the word about its ongo- ing series of workshops. Materials in the IU files indicate an ongoing relationship through at least 1966, even if the intensity and frequency of contact from the earlier period were lacking. The motivations informing this gesture of deferral remain unclear and may have been as simple as the desire to have a clean slate, one free of the numerous partnerships established during the Syngman Rhee era. For its part, the ICA appeared confused about how to respond, and for IU, the initial reaction was very much one of surprise. In its subsequent report for the period, the US Agency for International Development (USAID) lamented that “the contract was terminated one year earlier than had been anticipated or less than 20 months after the first nurse advisor of the Indiana team” had arrived to begin work in-country.42 In effect, USAID regarded the program as some- thing of a lost opportunity, one where much more could have been accomplished. Even with the relationships established with Ewha and Yonsei, this activity represented only a portion of the American ambitions for nursing in a domestic setting. The profession still held great symbolic significance at this level, and the USAID report continued to cite the damages to the profession deriving from the Korean War in seeking to justify its mission. In brief, USAID and its representatives from IU failed to recognize how their essentially static vision was very different from that of their Korean counterparts who were moving ahead rapidly. 4.1 Changing Priorities (1962 –) If the Syngman Rhee government sought to establish relationships with numerous partner nations, looking for financial and logistic support wherever possible, the suc- ceeding Park government had similar priorities, with one major difference. Rhee was primarily motivated in bringing resources to South Korea, getting as much as he could from the challenging circumstances of recovery in the aftermath of the Korean War. Park, on the other hand, was motivated by a desire to renegotiate exchange on terms favorable to South Korea. In particular, he sought new forms of knowledge, along with technology and infrastructure, things that could transform the nation rapidly and raise it from its status of a developing country. In this respect, the termination of the relationship with IU appears less surprising. Even if the program had yet to run its 42 Historical Survey. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 16 J. P. DiMoia course, it tended to reinforce a relationship of dependency, certainly not the style of practice desirable in the long run. By the early 1960s, in direct contrast to the advice offered by the Scandinavian consortium, along with other parties, South Korea began sending its nurses abroad, using them as a powerful symbol of the nation’s growing ambitions. By this, I do not refer to just the pattern of migration that would soon begin with changes to American immigration law in 1965—in other words, self-selection by individual migrants—but, rather, the active promotion of outgoing migration by the state within an international system. Estimates for the numbers of nurses nationwide tended to be on the low side, reaching a figure of about ten thousand, and generally emphasized the need for more trained personnel.43 Moreover, the IU program, as we have seen, regarded these nurses as hardworking and enthusiastic but wanted to upgrade significantly their clinical training and the education credentials required to enter the profession. Why, then, did the ROK state begin to promote its nurses as a symbol of the nation, and with what specific aims in mind? The most conspicuous part of this new trend involved migration to West Germany, with Park Chung Hee admiring his frequent trade partner and seeking to emulate its success in several ways.44 In the early 1960s, West Germany, along with the United States and Japan, was one of South Korea’s major trade partners, and the rhetoric of the “free world” (implying these nations, and also suggesting Hong Kong, South Vietnam, Thailand, and Taiwan) associated with this group had to be taken seriously. As a gesture of his friendship, therefore, Park sent a group of Korean miners and nurses to West Germany beginning in 1962. The gesture was more than symbolic, however, as these workers served as a valuable source of foreign currency, with their remittances going back to Korea regularly. For nurses specifically, the program began with a small group of roughly twenty nursing students and would rapidly expand over the next ten to fifteen years. Between 1966 and 1976, an estimated thirteen thousand Korean nurses served in West Germany in some capacity, creating and reinforcing a pattern of eco- nomic migration, with a large number of these women ultimately choosing to marry and settle in Europe (Chosun Ilbo 2008).45 Even as many of these nurses ultimately returned to Korea, the pattern of “export- ing” a set of valued health practitioners for a variety of economic and political reasons had begun, and this ROK – West Germany relationship was soon followed by several related gestures. Specifically, the US-ROK relationship already involved a pattern of education exchange following the Korean War, but changes to US immigration law in 1965 rapidly made long-term migration and resettlement much easier for those seek- ing a move. Moreover, the South Korean engagement with South Vietnam took on added significance with the expansion of the war in 1965, and again, ROK military medicine had a vital role to play.46 In simple terms, Korean nurses were now traveling 43 This figure includes midwives; nurses, counted alone, numbered about fifty-five hundred. 44 Park also admired the Autobahn and, following his December 1964 visit, is alleged to have taken this for the model for the Gyeongbu Expressway. 45 In Cold War Germany (2015), Hong seeks to link the movements of Korean nurses in the early 1960s to the earlier German Red Cross Hospital in Pusan (1954) and the operations of the German Red Cross in late 1950s South Korea. 46 The Vietnam War, like the Korean War, provided a rich context in which ROK medicine received extensive field/clinical experience. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 17 abroad in much greater numbers and frequently going to sites beyond the East Asian region, to seek higher levels of education, greater professional opportunities, and in some cases long-term resettlement. 4.2 Looking to the Vietnam Context (1964 –) What is surprising is not so much the dramatic pace of these changes but the extent to which this emerging free world relationship of medical exchange has gone largely unnoticed in the literature, certainly in contrast to more celebrated cases like that of the Philippines. In part, this is because of the economic disparities governing the Amer- ican relationship with the Philippines, in which Filipino doctors and nurses are seen as leaving the country primarily to seek better economic circumstances. For South Korea, the economic growth that followed in the 1970s and 1980s made for a much “happier” narrative, one in which their migratory patterns are typically seen as tem- porary rather than permanent. Moreover, the ROK’s rise to the status of a relatively wealthy country bridged a portion of the gap with the United States and other allies, meaning that the power differential is perceived as less of a factor in drawing these professionals. In any event, there was never a conspicuous fear of a Korean “brain drain” to the United States, even as scholars have noted the significance of American postgraduate education as a lure. At the very least, it is fair to say that the transfor- mation of Korean medical pedagogy took place within a relationship characterized by a conspicuous power difference and this changed once more as South Korea began to redefine itself. Programs like that of IU in some sense served to mask or even obscure the reality from the American viewpoint. If it is unfair to place the weight of this transformation upon ROK participation in the Vietnam conflict exclusively, we should nonetheless recognize the dramatic impact of the war on South Korean medicine, whether referring to its domestic activi- ties (blood drives) or those conducted abroad. Again, the participation of Korean doctors and nurses in the field served as an intensive introduction to clinical practice, handling many of the same issues approached in the Minnesota Project just a few years previously. At the same time, blood drives conducted on Korean college campuses brought the war home, and the return of wounded and injured soldiers, along with the deceased, gave war a material, palpable presence. Moreover, the medical personnel supporting the ROK military were not just treating their own soldiers, as a significant part of their mission was one of cultural outreach, or “civic action,” bringing biomed- icine directly to the Vietnamese population as an ideological exercise.47 This second theme has received very little attention in English to date and underscores the extent to which the nation sought not only sought to change its own medical pedagogy and practice but also wanted a significant upgrade to its own international image and prestige. The materials and images circulated in support of this mobilization were typically produced by the ROK’s Ministry of Public Information, and as they were published in 47 See Korean Forces in Vietnam: Three Years in Vietnam, 1968, http://www.vietvet.or.kr/hwabo/pawol3 /js3x000.htm (accessed 25 September 2016). Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 18 J. P. DiMoia English and Korean, they were likely intended for wide distribution.48 In fact, even prior to engaging with Vietnam in a military fashion, South Korea sent a mobile medical team overseas in 1964 as part of the initial point of contact (based at Vung Tau), and this fact receives conspicuous mention in a number of the ministry’s pub- lications (Korean Ministry of Public Information 1966). In simple terms, South Kore- an medicine, mobilized under the broad umbrella of Cold War interests, has to be reevaluated from the standpoint of intersecting ideology and practice, with Korean nurses and doctors representing the idealized face of an emerging free world partner with its own set of ambitions. Like the Korean soldiers participating in the combat phases of the war, these doctors, nurses, and support personnel functioned within a dense network of interests: in effect, Asians providing medical treatment to other Asians but within a set of bounded constraints. To return to the main focus of this article, the IU nursing program, the link with the Vietnam context is an indirect one, as IU personnel could not possibly have anticipated the direction South Korea would take by the late 1960s. If the university chose to portray its relationship with its Korean partners as initially one of continuity, essen- tially a resumption of earlier missionary activity, this characterization cannot explain the obvious contradictions of a nursing community with rapidly changing interests. As Korean nurses began to migrate, whether on their own or highly encouraged, as was the case with West Germany, they became a set of highly valued migrants, prized for their skills and labor. Moreover, they embodied the paradox of a nation still recovering from the effects of war, and yet one eager to depict itself as an emerging power through these transnational agents. By the close of the IU program, Korean nurses were already on the way to becoming integrated within an international system of migration in which their skills would lead to better pay and in some cases professional opportu- nities, while arguably constrained by the broader contours of American imperium. The irony, as emphasized here, lies in these late 1950s training programs interacting close- ly with Koreans, while almost completely failing to recognize the rapidly changing dynamics. References Allen, Dotaline E., and Mildred P. Adams (1964). “Workshops Work in Korea.” American Journal of Nursing 64, no. 8: 104–6. Bernad, Miguel A. (1974). Adventure in Vietnam: The Story of Operation Brotherhood. Manila: Operation Brotherhood International. Brazinsky, Gregg (2007). Nation-Building in South Korea: Koreans, Americans, and the Making of a Democracy. Chapel Hill, NC: University of North Carolina Press. Capshew, James (2012). Herman B. Wells: The Promise of the American University. Bloomington: Indiana University Press. Chira, Susan (1987). “Seoul Makes It Easy to Say Goodbye.” New York Times, 31 March 1987. http://www .nytimes.com/1987/03/31/world/seoul-makes-it-easy-to-say-goodbye.html. Chosun Ilbo (2008). “Sixty Years of the Republic: Koreans Go to Work in West Germany.” 8 July. Choy, Catherine Ceniza (2003). Empire of Care: Nursing and Migration in Filipino American History. Durham, NC: Duke University Press. 48 These volumes appeared the most frequently during 1966–68, although they cover as late as 1973, coinciding with the Korean presence. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 Placing Image and Practice in Tension 19 Ernst, John (1998). Forging a Fateful Alliance: Michigan State University and the Vietnam War. Lansing: Michigan State University Press. Holt, Berta (1956). Seed from the East. With David Wisner and Harry Albus. Creswell, OR: Holt Inter- national Children’s Organization. Homei, Aya (2015). “The Science of Population and Birth Control in Postwar Japan.” In Crossing Bound- aries, Crossing Cultures: Science, Technology, and Medicine in the Emergence of Modern Japan, edited by D. G. Wittner and P. Brown. London: Routledge. Hong, Young-Sun (2015). Cold War Germany, the Third World, and the Global Humanitarian Regime. London: Cambridge University Press. Hwang, Kyung Moon (2016). Rationalizing Korea: The Rise of the Modern State, 1894–1945. Berkeley: University of California Press. Ishi, Tomojo (1988). “International Linkage and National Class Conflict: The Migration of Korean Nurses to the United States.” Amerasia Journal 14, no. 1: 23–50. Kim, Eleana (2010). Adopted Territory: Transnational Korean Adoptees and the Politics of Belonging. Durham, NC: Duke University Press. Kim, Geun-bae (2005). 한국 근대 과학 기술 인력의 출인 (The Origins of Korean Scientific Manpower). Seoul: Moonji. Kim, Hoi-eun (2014). Doctors of Empire: Medical and Cultural Encounters between Imperial Germany and Meiji Japan. Toronto: University of Toronto Press. Kim, Jane (2012). “Leprosy in Korea: A Global History.” PhD diss., UCLA. Kim, Sonja (2008). “Contesting bodies: Managing Population, Birthing, and Medicine in Korea, 1876–1945.” PhD diss., UCLA. Kim, Sooyong (1982). “Outflow of Contract Migrant Workers during the 1960s.” In Contract Migration in the Republic of Korea. (http://staging.ilo.org/public/libdoc/ilo/1982/82B09_192_engl.pdf ). Korean Ministry of Public Information (1966). ROK Forces in Vietnam. Korea Information Series, no. 10. Seoul: Ministry of Public Information. Kwak, Nancy (2015). A World of Homeowners: American Power and the Politics of Housing Aid. Chicago: University of Chicago Press. Moon, Manyong, and Kim Young-Sik (2004). 한국 근대과학 형성과정 자료 (The Formation of Modern Korean Science). Seoul: Seoul National University Press. National Medical Center in Korea: A Scandinavian Contribution to Medical Training and Health Devel- opment, 1958–1968 (1971). Oslo: Universitetsforlaget. Oh, Arissa (2015). To Save the Children of Korea: The Cold War Origins of International Adoption. Stanford, CA: Stanford University Press. Park, Dongmin (2016). “Free World, Cheap Housing: U.S. Hegemony and the Origins of Modern Archi- tecture in South Korea, 1953–1960.” PhD diss., University of California, Berkeley. Park, Jin-Kyung (2008). “Corporeal Colonialism: Medicine, Reproduction, and Race in Colonial Korea. PhD diss., University of Illinois. Rusk, Howard (1972). A World to Care For. New York: Random House. Schonwalder, Karen (2004). “Why Germany’s Guestworkers Were Largely Europeans: The Selective Principles of Post-war Labour Recruitment Policy.” Ethnic and Racial Studies 27, no. 2: 248–65. Shin, Dong Won (2015). 동의보감과 동아시아 의학사 / (Donguibogam and East Asian Medicine). Paju, South Korea: Dulnyuk Publishing. Shin, Gi-wook, and Michael Robinson (2001). Colonial Modernity in Korea. Cambridge, MA: Harvard University Press. Sutton, Joseph L., ed. (1962). Problems of Politics and Administration in Thailand. Bloomington: Institute of Training for Public Service, Department of Government, Indiana University. Thailand Public Administration Program: Thammasat University, Bangkok–Indiana University, Bloom- ington (1965). Bloomington: Indiana University Press. United Nations (1956). UNKRA in Action. New York: United Nations. Yi, Ggodme (2006). “한신광 (韓晨光) : 한국 근대의 산파이자 간호부로서의 삶” (The Life and Works of Han Shin Gwang: A Midwife and Nurse of Korean Modern Times). Korean Journal of Medical History, no. 15: 107– 19. Yoo, Theodore Jun (2016). It’s Madness: The Politics of Mental Illness in Colonial Korea. Berkeley: University of California Press. Yum, Jennifer (2014). “In Sickness and in Health: Americans and Psychiatry in Korea, 1950–1962.” PhD diss., Harvard University. Published by Duke University Press EASTS Advance Publication, published on July 5, 2017 20 J. P. DiMoia John P. DiMoia is associate professor of history at the National University of Singapore (NUS), where he teaches classes focusing on the broader history of technology (esp. in East Asia, eighteenth century to the present), the history of medicine (tropical, global, eighteenth century to the present), and modern Korea (mid-nineteenth century to the present). He is also an associate fellow at Tembusu College (NUS), a member of the STS cluster, and an affiliate with the Centre for Family and Population Research. He is working on two new projects: a book on energy issues in Northeast Asia and the Korean Peninsula and a collection titled “Engineering Asia,” coedited with Hiromi Mizuno and Aaron S. Moore. Published by Duke University Press
1 Placing Image and Practice in Tension: From Domestic Agents of Care to International Practitioners: South Korean Nurses, Medical Pedagogy, and the IU-Bloomington Nursing Program, 1958-1962 I. The Korean War and Constructing d Emerging “Free World” Networks of Medical Expertise (1954-1960) In the aftermath of the Korean War, the symbolic and material reconstruction of South Korea began, with much of the relief work assumed under the broad banner of the United Nations and its various affiliates, and with a wide range of international aid and relief organizations also participating (UNKRA in Action).1 TThe scale of the devastation was such that some scholars have argued for using the Korean context as a lens through which to understand the formative practices of the United Nations, as this was one of the first major tests for the organization, its ideals, and more specifically, the execution of its broader designs.2 While international adoption has a lengthy history, for example, the roots of the practice (post-Korean War) follow specific patterns, taking a shape that has allowed the newer scholarship to make some penetrating observations about the developing US-ROK (Republic of Korea) relationship, as detailed in the work of UC Irvine anthropologist Eleana Kim, among others (Kim 2010, Oh 2015, Holt 1956). 3 Similarly, for medicine, and biomedicine in particular, the Korean War proved to be a testing 1 Prominent among the participating international relief organizations would be UNKRA (United Nations Korea Reconstruction Agency) and UNCACK (United Nations Civil Assistance Command, Korea). 2 Many of the propaganda images from the Korean conflict can be found at the Hoover Institute, Stanford University, especially leaflets and pamphlets mobilizing biomedicine and distributed during the war. A similar argument might be made for the significance of international participation in post-conflict housing: see Nancy Kwak’s A World of Homeowners: American Power and the Politics of Housing Aid, Chicago: University of Chicago Press (2015) and Dongmin Park’s recent U.C. Berkeley dissertation (2016), “Free World, Cheap Buildings”: U. S. Hegemony and the Origins of Modern Architecture in South Korea, 1953-1960. 3 Holt International Children’s Organization was among the most famous of the adoption agencies to direct Korean adoptees to “Christian” homes in the US. 2 grounds for a wide range of emerging practices, including vascular surgery and the treatment of the hanta virus and hemorrhagic fever.4 For many Korean doctors and health professionals, the opportunity to work in the field offered a valuable immersion in clinical practice that had been denied to them in their previous training, especially those who had studied under the Japanese imperial system during the later stages of World War Two / the Pacific War (late 1930s, early1940s, Kim 2014).5 For the ROK’s external partners, the transition to peacetime meant an opportunity to rethink their relationship to Korea, with many nations opting to continue their aid in some form, whether radically reconfigured, or in some cases, with little or no change in its dynamics (Hong 2015). 6 Medicine, which had seen the arrival of American and Norwegian MASH (Mobile Army Surgical Hospital) units, along with hospital facilities based near the Pusan perimeter, provided one such opportunity, with UNKRA (United Nations Korea Reconstruction Agency) and the AKF (American-Korean Foundation) overseeing a range of activities, especially in terms of assisting with orphans, along and with the care and rehabilitation of wounded veterans (Rusk 1972).7 Two major projects were set in place to oversee the the structural transformation of Korean medical education and health care at the tertiary level. The first of these, the Minnesota 4 The hanta virus causing hemorrhagic fever was isolated in the 1970s by Dr. Ho-Wang Lee, among others, and Dr. Geun-bae Kim of Chonbuk National University has written an account of the complex politics underlying this effort. 5 Graduates of the Imperial university program in Medicine typically included a class composed of at least half to two-thirds Japanese residents, and generally had little opportunity to engage in clinical practice. 6 See Hong’s Chapter Three, “Mission Impossible,” for West German medical aid to the ROK, especially concerning the German Red Cross Hospital in Pusan. 7 See also Dr. Rusk’s personal papers, held at the Western Historical Manuscript Collection (WHMC) at the University of Missouri-Columbia. 3 Project (1954-1962), brought the University of Minnesota into a relationship of exchange with Seoul National University, with medicine forming one of the three core areas of emphasis (Medicine, Agriculture, and Engineering) (Maloney 1956, Flink 1958, Brown 1959, Mitchell, Matthews 1958).8 Several years later, a Scandinavian (Norway, Sweden, and Denmark) effort (1958-1968) transformed the Seoul City Hospital into the newly imagined “National Medical Center,” with doctors and nurses from Europe remaining until at least the late 1960s, before handing over responsibility for the refurbished facility to their Korean students and trainees (The National Medical Center in Korea).9 With this dramatic increase in activity in the areas of new medical infrastructure, training, and pedagogy, it remains surprising that the scholarship to date has focused almost exclusively on Korean medical doctors and their these diverse contributions to a rebuilding nation as a form of continuity, and in corresponding fashion, a celebratory narrative of a refurbished domestic context, with little attention to the impact of accompanying regional and international factors. There remains a great deal still to explore, therefore, in terms of at least one major questiontwo major questions: first, the issue of continuity with previous forms of practice; and second,, n of the surrounding international context of medical migration within, as well as, to and from Asia, a story which greatly complicates the convenient narrative of a restored domestic setting. For this issue, the growing pool of support personnel, including the figure of the chogyo ( 조 교 , or assistant),doctors and support personnel provide a means of tracking the patterns, especially and Korean nurses, those who performed the majority of the hands-on clinical work in the hospital and the clinic as settings. Of these two figures, the chogyo often gets listed as being present 8 In total, eleven Minnesota medical advisers spent time in Seoul. University of Minnesota, Special Collections. 9 See Chapter Seven of the NMC volume, “Epilogue.” 4 during surgery or some similar exercise, but there is generally little detail about the specific clinical duties required of such an individual. With the coming of specialization in the following decades, the American system of clinical rounds and internships would be introduced at major hospitals like Seoul National and Yonsei, bringing some degree of resemblance to American / international models of practice, even while acknowledging room for local differences. Even if this change in pedagogy clearly did not cause out migration per se, it contributed to a heightened awareness of a conflux of issues—better external sources of pay, more chances for professional growth, along with active encouragement from the Park Chung Hee government after 1961— resulting in a dramatic revaluing of these nurses and their place within the broader international labor market by the early 1960s. As for South Korean nursesSpecifically, this period (1954-early 1960s) would see a radical reconfiguring of their professional practice, and more importantly, their patterns of movement, as international migration to the United States and other sites was greatly enhancedabled by changes to immigration law in and following 1965. Even before this change, however, Korean nurses began traveling abroad for further education and professional development, with the Korean War opening up numerous opportunities consistent with such aims. To use the language of Young-Sun Hong, Korean medical personnel were rapidly becoming mobilized, enrolled within athe systemic “global humanitarian regime.” (Hong 2015, Bernad 1974).10 The Minnesota Project included a number of nurses in its scheme, with Korean nurses spending considerable time at the University of Minnesota, before returning home to help with the implementation of the new clinical program (1957-1959), having experienced the inner workings of the system firsthand. Marjory Low of the University of Minnesota was one of the nursing 10 Koreans contributed medical aid to other nations as early as 1954, participating in Operation Brotherhood, offering medical assistance to “Free World” Vietnam and Laos. 5 advisers who traveled in the other direction, spending time in Seoul as an advisor (1957-1959), along with the medical advisors working at the physician level (“Historical Survey,” p. 31).11 This style of contact / contact with external actors was nothing new for Korean nurses, dating back to their working relationship with Western missionaries as far back as the late nineteenth century. In this earlier form of contactfact, medicine representede had formed a critical part of the package brought by Protestant missionaries, along with higher education, composing a core part of the mission informing g emerging institutions such as Ewha Women’s University and Severance Hospital, later to be affiliated with Yonsei University. What was new, however, was the heated international Cold War context in which theis renewed relationship had to bear the weight of additional material and symbolic overtones, with nurses challenged both personally and professionally to transform themselves and to work comfortably in a wide variety of new settings, both domestic and international. If Korean nurses and related health care professionals have received much less scholarly attention than their comparable AsianFilipino counterparts (e.g., the Philippines), it is not for a lack of accomplishment, as these two groups, collectively, formed part of a pattern of medical migration between Northeast Asia and a wide range of sites, with the United States and Western Europe (e.g., West Germany) dominating as the favored destinations (Ishi 1988).12 For the Filipino case specifically, Catherine Choy scholars of U.C. Berkeley has ve written about an “Empire of Care,” examining the extent to which the combined force of American Empire and the “special relationship” encouraged a path-dependent relationship that brought thousands of health care professionals to the United States in the decades following the Second World War 11 Marjory Low was part of the Minnesota Project for two years (1957-1959), along with two other nursing advisers from Minnesota. 1212 For the West German story, see Hong, Chapter Eight, “Far Away, But Yet So Close.” 6 (Choy 2003).13 The question remains as to why Korean nurses have yet to receive such attention, especially for this period where the changing material reality often stood in contrast to how external actors perceived and interacted with them.. This article argues specifically that programs designed for interactions with Korean nurses frequently did not perceive them as international migrants, and actively sought to train them almost exclusively within the Korean domestic context. In this sense, there was a conspicuous lack of fit between the new training programs and the needs, aims, and ambitions of these young nurses. Korean Nurses as Transnational Migrants (1948-1965) In fact, for the Korean case as well, the period following the Korean War (1954-1963) witnessed a dramatic transformation during which Korean nurses increasingly became transnational migrants, a special category of workers representing their nation in a variety of new settings and contexts, including West Germany, South Vietnam, and the United States (Schonwalder 2004).14 More specifically, this chapter examines uses the ICA-sponsored (International Cooperation Administration) nursing program led by Indiana University- Bloomington for approximately a decade (1958-1962, 1962-1966) following the Korean War (Indiana University, School of Nursing Records) as a lens through which to examine the dense, heated politics of the period.15 Lesser-known than the comparable Minnesota and Scandinavian efforts, the IU-Bloomington project created a relationship between the flagship campus in 13 Arguably the great deal of attention devoted to the Philippines case, and the correspondingomparable lack of attention to South Korea in contrast, likely says something about their very different developmental trajectories as nations, and equally important, their relative standing in the eyes of the West. 14 The Nnursing exchange with West Germany began in the early 1960s. 15 The IU collection for its nursing program is held at IUPUI (Indiana University / Purdue University- Indianapolis, where the medical campus is based, and the holdings for medicine are housed. 7 Indiana and more than ten Korean universities and schools of nursing, aiming at upgrading the medical pedagogy and training of a new generation of nurse practitioners. 16 Beginning with the understanding of a previous relationship formed through medicine and missionary activity, Indiana undertook its mission on the assumption that the Korean context in the late 1950s was best represented by continuity, meaning an ongoing heritage linked with previous missionary activity, offering only a limited perspective on the challenges to be addressed. Indiana soon encountered a lack of fit between its stated aims and those of the targeted recipients, even as this problem was not always articulated. In many ways, the Indiana program was distinct from comparable programs of the period, especially in terms of the patterns of exchange more typical for American and international educational institutions. at this time. ICA typically established a one to one relationships with its partners, pairing an American university and a foreign partner institution within a particular area of expertise (Kim 1982)..17 First, perhaps motivated by the perceived need for widespread reform, Indiana sought to make contact with as many Korean schools of nursing as possible, holding numerous workshops and public events to emphasize its message of outreach. Second, the nursing program was largely staffed, run by, and carried out by a core group of female professors of nursing at the university, chief among them, Drs. Dotaline E. Allen and Mildred P. Adams, and this added gender dimension at the height of the Cold War contributes to the complexity and appeal of this story. At least initially, Indiana mobilized a message of continuity 16 Korean universities participating in the IU public workshop program included nine in Seoul, two in Taegu, and one in Kwangju. 17 ICA often failed to account for the external dynamics—regional, international—shaping the effects of its programs. 8 in its publicity materials, the re-establishment or affirmation of an American medical mission started in the late nineteenth century (“Korea Project”). Similarly, Minnesota sought to accomplish this same type of work with its effort at Seoul National University, adding a healthy dose of “Free World” rhetoric to support its stance in the immediate aftermath of the Korean War. Arriving several years later, Indiana offered numerous pictures of Korean nurses in training, seeking to emphasize the relationships being established between the Americans and their Korean counterparts, a theme of university exchange essentially consistent with the earlier missionary activity dating to late Joseon. At the same time, South Korea was undergoing enormous changes, and some of the inherent contradictions began to express themselves over the course of the program, producing conspicuous points of tension. When IU-Bloomington arrived in the late 1950s, President Syngman Rhee was in power, and the ROK stood as a staunch anti-Communist ally of the United States, sustained largely by American aid packages. By the late 1960s, nearly a decade later, this same nation was deeply enmeshed in the war in Vietnam (for South Korea, its participation covered its participation covered the period 19645-1973), and while remaining a close ally to the United States, South Korea was becoming much more explicit about its intentions to develop economically and militarily on its own terms. This changing relationship reflected not just the South -Korea-US dynamic, but also, the reconfigured relationship with Japan, making it, in effect, a triangular relationship for Northeast Asia, and one that needed to be managed carefully. Economically, normalization with Japan in 1965 brought enormous benefits, even as post-colonial tensions between the two nations continued to produce strains, deriving in particular from the lengthy prior colonial relationship (1910-1945) (Shin and Robinson 2001). If Korean doctors soughthad to cultivate a new image distinct from their Japanese training after 1945, there is very little in the literature on how 9 Korean nurses responded, and what they might have done in handling handled this same issue, even as this topic presentsoffers itself as a potential line of inquiry. Moreover, the American presence introduced another actor with a claim to imperium, and the dynamics of that relationship have inspired a great deal of scholarly commentary (Brazinsky 2007). Certainly the U.S. remained the dominant partner for much of the period, and while South Korea pursued its own agenda, it did so within a set of constraints, recognizing the boundaries established by the powerful combination of American economic and military support. Both Minnesota and Indiana experienced this dynamic in the form of a major disruption to their respective programs after 1962.18 For Korean nurses specifically, their lives soon changed dramatically by the mid- to late 1960s, both personally and professionally, as they became valued migrants traveling and working within a wider developing regional and international economy of medical exchange. 19 This type of movement had not been possible previously, or certainly not at this scale, and by the middle of the decade, the ROK government had recognized the potential of this group of highly trained, specialized workers as a form of human capital, as representatives of national pride, as migrants, and especially as a source of revenue. These women, when placed in their new positions, whether in West Germany, the United States, or several other favored destinations, served as a much needed source of foreign exchange, with remissions to Korea functioning as a valuable form of economic subsidy to their families, and by extension, to the nation.20 In some cases, the ROK actively promoted the migration patterns, as was the case with West Germany, using this 18 1962 represented the renewal point for ICA contracts in both cases. Moreover, this was the first time that the renewal fell under a new Korean government (Park Chung Hee), thereby resulting in a disruption to the two programs. 19 Along with ROKA forces, Korean medical personnel were among the earliest groups to be sent to South Vietnam in September 1964. 10 highly select population to further enhance the developing relationship between the two nations (“60 Years of the Republic”). With these circumstances, it is fair to consider the issue of how to frame the activities of these nurses, increasingly embedded within emerging regional and international networks of labor migration. At the personal level, their motivations for going abroad were quite diverse, ranging from economic motives, the opportunity for professional and educational enhancement, and perhaps even a certain amount of national pride in being among the first Koreans to have such a chance. At the same time, the patterns of movement took place within a set of constraints bounded by immigration law, international labor markets, and especially, the political and economic relationships shared among certain groups of like-minded nations during the Cold War, a grouping sometimes characterized as the “Free World.” In this last sense, the US-ROK relationship has been scrutinized and labelled in a variety of ways: certainly it was a relationship of partial dependency, with a clear and palpable difference in power. The question remains then as to whether it is appropriate to label this program as “neocolonial” or perhaps even as “sub- imperial,” taking place within a set of boundaries shaped and informed by American Empire. At the same time, Indiana University clearly did not perceive itself in these pejorative terms, choosing to frame its mission instead as one of a relationship between two groups of women, with emphasis placed on restoring the domestic setting and its public health. II. FormingEstablishing New Links: Indiana University, ICA, and the U.S. Federal Research Economy 20 KODCO, or Korea Overseas Development Corporation, was state-owned, and oversaw the placement of these workers, seeking to regulate and control the migration process, focusing on its financial rewards. For an account of KODCO’s methods, see http://www.nytimes.com/1987/03/31/world/seoul-makes-it-easy-to-say-goodbye.html. Accessed as of September 23, 2016. 11 How did Indiana University end up with itsa significant presence in Asia during this period? While the precise dynamics are difficult to pinpoint, Beginning in the late 1940s, the US federal government created numerous incentives for American universities to act as contractors on its behalf, beginning with the MSA (Mutual Security Administration) under President Truman, and then continuing this impulse enthusiastically under President Eisenhower with the subsequent formation of FOA (Foreign Operations Administration) and ICA.21 Large, Midwestern state universities with a regional focus frequently used these federal contracts to transform themselves into much larger, research universities, and the legacy of John Hannah at Michigan State University—famous for its relationship with South Vietnam—serves as a representative case (Ernst 1998) of a technical / agricultural school undergoing such an expansion. For Indiana, it was President Herman B. Wells (1938-1962) who saw the potential for the university to grow by moving abroad and participating in these international programs (Capshew 2012). Indiana became known not only for its program in South Korea, but also for its lengthy relationship with Thailand in the 1950s, developing an extensive program in Public Administration at Thammasat University in conjunction with the Southeast Asian partner nation from the late 1950s (Thailand 1965, Sutton 1962). If the program made sense from the standpoint of building up the reputation of the university, along with offering considerable financial incentives, it made equal sense to the faculty members responsible for running it. At this early stage in the post-Korean War era, the opportunity to work and teach abroad often enhanced the careers of those who took the chance, frequently in ways that they might not have anticipated. For Indiana, Professors Dotaline E. Allen and Mildred P. Adams were already well-established at the IU Nursing School, and the move to 21 President Truman’s “Point Four” address of January 1949 is often considered the starting point for this American style of technical diplomacy (1949-1961), later to be subsumed by USAID. 12 Korea offered the opportunity to expand their teaching agenda and the scope of their program. Unlike Minnesota, with its exclusive relationship to Seoul National University, Indiana had the ambition of contacting and working with as many schools of nursing as possible. This strategy may have derived from the question of numbers—with small clusters of nurses scattered at a range of institutions, especially outside of Seoul in rural areas—and in any case, it offered the possibility of effecting substantive change with a real impact.22 For Drs. Allen and Adams, the Korea program also represented a logical extension of their prior work in nursing. Allen, acting director of the Division of Nursing Education at Indiana from 1950 (Full Director from 1951), had worked her way up through the ranks, acquiring the Ed. D. at the university (1955) along the way. An Indiana native, she spent time in Colorado during the 1930s, before turning to Columbia University and then Indiana, beginning her affiliation with IU from the early 1940s as a teacher (“Memorial Resolution”). Adams, the junior to her colleague, completed her Ed. D. in 1964, and was much more explicitly involved in expanding the international ambitionsdimensions of the nursing program. For the Korea program, she served as became the on-site, acting as head for much of the time, while Allen made only two supervisory visits conducted at intervals, remaining in Bloomington Indiana for the majority of the time. Following Korea, Adams was later involved in expanding Indiana’s nursing outreach efforts to Latin America, work that carried her through the latter stages of her university career (“Honors and Awards”). As “IU’s nursing ambassador abroad,” Dr. Adams, along with the accompanying frame of her participation in the Korea program, raises an issue implicit for much of the period, although one 22 Estimates for nursing in Korea came to about 5,000-6-000 nurses by the early 1960s. 13 frequently not not always addressed.23 The ultimate destination of nurse trainees was often frequently not specified, and for the Latin America and the IU relationship, the goal mobilized was one of increasing diversity in nursing education and within the profession at large. Clearly, if IU was recruiting these students, it was not yetnecessarily specifying where they should be thinking of as their final or ultimate destination for their future working and professional lives. To revisit the precedent set in South Korea, the National Medical Center had considered thought about this issue a great deal, with the three European partner nations agreeing that Korean nurses would have to be regarded treated as “hands off,”: that is, they would not be ineligible for recruitment recruited to fill positions in Europe, recognizing that their their high value toin a recovering Korea was critical (The National Medical Center in Korea, p. 61). Similarly, Minnesota urged its recruits to return to Seoul after completing their field experience in Minneapolis, and with few exceptions, was generally successful in asserting its authority on this point. At the same time, both of these accounts derive from the external portion of the story, leaving ample room to consider the Korean viewpoint within a growing international labor market. This also leaves the question as to where Indiana stood on this critical issue According to at least one alternate version account, published several years into the venture (1964), the IU–Korea program owed it origins to a combination of domestic actors, with these situated in the Korean context, rather than the US (Allen, Adams, pp. 104-106). Following the conclusion of the war, Korean nurses sought assistance from the Ministry of Education, seeking advice in terms of improving their access to better forms of pedagogy and the latest in medical training. According to this revised version of events, the ROK Ministry of Education then approached the American ICA with a request for such assistance, with Indiana University 23 The issue of migration remains implicit within the Indiana materials, but is seldom addressed.Ibid. 14 identified as providing the best fit to meet this need. Although this version does not radically alter our understanding of the circumstances, it does grants a much higher degree of agency to the Korean nurses as the primary actors, and in particular, cites their desire to professionalize and to upgrade their status. As this account was reported by the Indiana side, it also underscores a desire to portray the working relationship in the best possible light, with the American presence solicited from the outside, rather than simply intervening without a context. Still, this version appear to limit the intended effects to the domestic, emphasizing the tension between the contrasting accounts. On the Ground: Translating Korean Concerns and Addressing Practical Issues To begin with a generalization, IU was typical of many of the ICA’s post-Korean War efforts in that the university did not possess area-specific (for East Asia or South Korea) expertise, even as it brought great enthusiasm and energy to the project. Arriving in the late 1950s, Dr. Adams would coordinate efforts on the ground, with her senior colleague, Allen, remaining behind in Bloomington, visiting at intervals to check in. Certainly Indiana knew about prior missionary efforts in Korean nursing education and higher education, and two specific sites (Ewha, Yonsei) provided the initial links to get started with in terms of making establishing contacts and getting underway. As for nursing specifically, the ICA program did not specify any explicit goal other than a general aim of raising the standard of South Korean public health, and assisting a recovering nation in the aftermath of war. Again, this request fits a pattern of aid and relief very common for the period. Indiana also held a comparative advantage with its “late” arrival, so to speak, in that several other programs had established a presence and a system of working in close cooperation with the South Korean government. In 1954, even simple tasks had been difficult as much of the 15 governing apparatus was still in the process of relocating from the wartime locale of Pusan (returning back to Seoul). By the late 1950s, in contrast, there was a considerable expatriate population in place, even as conditions in South Korea remained basic and clearly affected by the privations of war. More importantly, health care professionals arriving from different national contexts were able to interact easily, and to share new ideas, results, and surplus materials across projects. For the Minnesota and Scandinavian efforts, there are numerous accounts of doctors meeting during their off hours, using each other as a sounding board and as a resource in order to understand the Korean context. For nursing, Indiana arrived with much of the initial bureaucratic work already set in place, at least in so far as others parties had started to shape the path. Precisely on this point of liaising with their Korean counterparts, Indiana typically worked through the Ministry of Health and Social Welfare and the Ministry of Education, the two bodies responsible for dealing with the necessities of Public Health. For this time period, this meant dealing with disease problems such as tuberculosis and leprosy, two of the most common public health issues, as well as the problem of parasites, although this second issue was not addressed at the national level until about a decade later (late 1960s).24 More than these disease-specific points, the issue in the late 1950s was one of increasing the visibility, image, and appeal of Korean public health, particularly with the lingering effects of the war. Biomedicine was not necessarily the preferred choice of many Koreans, and even persuading patients to visit a the hospital was sometimes a victory, as it familiarized them with a wider range of health choices. 25 24 Aya Homei of Manchester University is now working on the relationship between nutrition, parasites, and birth control in the post-war Japan context through JOICFP (Japan Organization for International Cooperation in Family Planning). 25 This trope appears in any number of projects from the period, including Minnesota, Scandinavia, and Indiana. 16 Working within these constraints, Indiana had to negotiate a careful path, responding as both generous and yet critical at the same time, seeking to effect change without raising causing any concerns about the pace of change. III. Indiana University: Establishing Relationships and Crafting an Approach to Clinical Practice through Workshops Public Outreach and Reaching a Diverse Population (1958-1962) Granted a mandate to improve the quality (and presumably quantity) of South Korean nursing education, the IU program began its work in Korea with a series of site visits in 1958, seeking to establish contact with a wide range of possible partners. According to Indiana’s records, its initial contact with Ewha Women’s University established the basic pattern for many subsequent encounters, with the relationship serving as a model and as a point of entry into the Korean context. Although aware of a history of Western medicine in Korea since the 19 th century, many of Indiana’s reports tended to prioritize what it definedregarded as the mid-century equivalent to “professional,” in other words, the creation of an autonomous or independent Korean medical community after 1945. In addition, Indiana was aware that many of the medical resources in Korea had relocated to the Pusan perimeter during the preceding period (1950-1954), seeking to avoid the combat occupying the middle of the peninsula. With this set of assumptions, Indiana was openlyvery disappointed with the quality of Korean nursing education, and equally, with the caliber of the candidates it tended to receive see on the at the point of intake end (“Improvement of Nursing Care in Korea”). Many of the young women entering nursing did so with the equivalent of about an eighth grade education or less, and the profession was not necessarily of high status, meaning that it did not attract a particularly 17 select demographic.26 As for this first point, Indiana made it a priority to upgrade the requirements for entry, asking for a better quality of candidate in possession of more credentials, preferably a high school education. Understandable as that goal may have been to the American actors, the effect of raising the bar to entry at a time of shortage was risky, holding the potential for reducing the overall numbers. Moreover, the gesture indicated that Indiana needed some time to become familiar with the Korean context and its realities, as the aftermath of war affected material conditions at nearly every level.27 In this sense, Indiana’s attitude was more than a bit paternalistic, judging the Korean context according to its own metrics. The call for an upgrade to credentials did not mean, however, that Indiana was unaware of the major point of emphasis, clinical practice, which had been frequently unavailable to Koreans practitioners during the preceding period.28 To a great extent, Korean families assumed responsibility for caring for a sick or ailing family member, even while that person was in the hospital. With a need for professionals to take over these duties, and with the story of Korean nurses reaching out to the Ministry of Education, Indiana sought to find a means of outreach, incorporating the diverse views of nurses. Along with the relationships established with schools of nursing, therefore, the university included a critical component devoted to large-scale public workshops, traveling to three urban sites—to be held in Seoul, Taegu, and Kwangju—to 26 However, in the German case, Hong argues that Korean nurses often felt that their professional training was not respected in the new work context. Clearly there were quite different perceptions concerning the level of nurse training when comparing South Korea, the US, and Europe for the early 1960s. 27 In other words, Indiana’s perceptions reflected a combination of reality and construction, as the construction of a weakness in a developing country (thereby justifying the intervention) is a common trope of development. 28 This theme appeared frequently in the Minnesota Project as well, especially for the 1957-1959 period. 18 encourage as much regional participation as possible. Traditionally, institutions of higher education have been densely concentrated in Seoul, and Indiana was one of the few programs to address this issue head-on, even while others most certainly were had to be aware of it. With this approach, Indiana recognized the problem of the relative abundance of resources in the Seoul metropolitan area, and the corresponding lack for much of the remainder, rural South Korea. This development has its historical roots dating prior to the arrival of Western medicine, when some form of a quarantine system was put in place during JoseonChŏson to limit the spread of epidemic disease.29 In any case, this form of outreach at mid-twentieth century saw nurses attending from the surrounding communities at each of the three major workshops, meaning that the audience numbers surpassed expectations, even from the first workshop. Moreover, Indiana participants noted that in a few cases, Korean nurses attending one workshop took the time to travel to the next at their own expense, allowing for the accumulation of familiarity and expertise, an incremental building of a larger community. This unintended development helped greatly when it came time later to turn the project over to the Koreans, who would need to continue the effort on their own. What took place at these workshops was an attempt to break down and reconfigure an existing system based almost exclusively on lecture and demonstration. In other words, Korean nurses tended not to gain a lot of hands-on experience until they were actually in their jobs, and given responsibility for of the task of patient care. The same was true for Korean doctors, and there is a growing literature on how this style of medical pedagogy links to the German model of academic medicine prevailing during the colonial period (Kim 2014). For this context, Indiana 29 This quarantine system involved providing a set of temporary housing outside a city or village where those suspected to be sick were placed, rather than permitting them to enter a city. For the reformation and construction of a “modern” health system at the end of the nineteenth century, see the work of Shin Dong-won of Chonbuk National University. 19 set up small group discussions and hands-on tasks, exercises that would help to encourage dialogue and allow the participants to ask questions (“Nursing Workshop”). The issue of translation was a significant one, as there were few materials available, and the majority of documents and items to be used had to newly rendered in hangul script (“Historical Survey”). Even acknowledging these issues, the Indiana supervisors were happy with the gradual development of rapport with their workshop participants. In these public workshops, and in their ongoing relationships working directly with schools of nursing, Indiana had an agenda of breaking down the perceived hierarchies within Korean medicine, another lingering perception from the colonial period. Still, as much of the burden of clinical care already fell to these personnel, what specifically had to change in order to achieve results? For their counterparts, Minnesota and the Scandinavian consortium, the answer to this question came in the form of increased specialization, the introduction of a system of clinical rotation requiring familiarization with a wide range of common medical problems and skill areas.30 For nurses as well, specialization offered considerable challengess, but it also held the promise of increasing prestige and the opportunity to professionalize upon the mastery of specific skill sets. The Indiana teaching materials for nursing therefore outlined a range of highly specific areas, indicating the desire to get nurses to specialize as early as possible, or to at least be acquainted with a number of emerging sub-specialties. The population with which Indiana was working on this ambitious set of goals was more diverse than it might appear, as the term “Korean nurse” covered a set of actors employed in very different settings as of 1960, even within a small nation. The schools of nursing specifically associated with the public workshops numbered slightly more than ten, but in building its long- 30 Minnesota made clinical practice the core of its effort (1957-1959) as it implemented a clerk- residency system of rotations in the late 1950s. 20 term relationships with nursing, Indiana conducted a baseline survey that included more than thirty sites nation-wide.31 Many of these programs were not based at the elite universities (more visible to Western donors), in Seoul, and were instead associated with technical high schools in the provinces (“Historical Survey”). This last remark explains a great deal of the concern about class issues and the need to introduce an upgrade to the level of education required for admission, as previously already mentioned. It also hints at some of the tensions present within the larger nursing community, where some of the hierarchies prevalent in Korean society likely influenced (and limited) the types of career opportunities available to those starting from outside the relatively well-off base of metropolitan networks. The prevailing urban / rural divide within Korean medicine was not the only concern facing Indiana, as the university also chose to engage with nursing as a set consisting of many distinct sub-communities, taking advantage to establish as many new relationships as possible. If the first of these to this point whas been the community as it existed within universities and technical high schools, IU sought some engagement with the ROK military as well, and with the comparable programs run by other aid programs (“Republic of Korea Army” 1958). The ROKA (Republic of Korea Army) materials appear in a number of the Indiana files, indicating a depth of engagement; and here, too, clinical practice remained a central concern, especially with the recent experience of the Korean War. To make a generalization, the intent was to introduce a number of routines or scripts, habitual routinized ways of approaching the most common clinical tasks, to enforce discipline and good habits among the nurses who would serve. Arguably, military medicine played a role as critical as that of aid programs in offering an entire generation 31 These materials are in Box 26, and the individual files for Korean institutions / departments number more than thirty. In some cases, Indiana held two or more workshops at the same institution (e.g., to two different departments at the same school). 21 of Korean practitioners the opportunity to work alongside their international colleagues, to learn new techniques and practices, and to introduce these back into Korean medicine. Moreover, at the national level, Indiana eagerly sought to make contact with the Korean Nurses Association (KNA), adding an additional bond that conceivably cut across all of the other bureaucratic and institutional layers. Dating to the early twentieth century, the KNA held associations with the earlier missionary legacy, but for Indiana, its real appeal lay in the potential to achieve further outreach. The association’s in-house journal, Nightingale, provided a forum for reaching any number of readers unable to travel to the public workshops, offering the latest in information about new approaches to health care. Indiana sought to publicize its mission in this fashion, and in this respect, reached a level of public engagement surpassing that of many other relief programs. If the university can be criticized for spreading its resources thin, and perhaps failing to concentrate on a particular specialty, the breadth and scope of its ambition was nonetheless valuable. At the same time, the Indiana program was filled with palpable tensions, contradictions implicit to its mission to bring a revised version of medical pedagogy to Korean nurses, while also urging them to remain within the domestic context, continuing their work in Korea. In many other national contexts, one of the driving factors motivating the out-migration of health professionals has been tied to the use of licensing exams, standardized tests used as a metric to set standards in a particular profession. 32 As the argument goes, Tthe use of these exams in international contexts frequently enablesd (and actively encouraged) new professionals to begin expanding their ambitions, especially as they have demonstrated competence in a particular skill area, and may reside in a market where their skills may not be adequately compensated. For the 32 The obvious example here would be the Philippines, but other developing countries serve as well for this period. 22 IU program, there is no evidence at this early point of the use of such evaluative criteria, but Korean nurses were beginning to be recognized as a valuable commodity, even as their migration patterns would not attract significant scholarly attention until later. At this point in the early 1960s, the major effect of the Indiana presence, and indeed the related medical programs running concurrently, was likely experienced in two ways. First, the general push towards professionalization simultaneously widened and reduced the scope of the nascent profession, encouraging these women to purse greater ambitions for career development and growth, while also raising the bar to entry to a significant degree. Second, the patterns of migration, as such, were still confined primarily within the boundaries of South Korea as a domestic space, and this by itself was by no means a minor development. The call for travel to participate in workshops, the dissemination of new information through journals and professional publications, and an enhanced role within the hospital setting were developments that collectively encouraged the sense of a national community, and perhaps even some notion of a national community, although this has to remain speculative. Again, external actors noticed the value of Korean nurses from early in the decade, and it is fair to considerspeculate about the extent to which members of the profession began to develop an conscious awareness on their own. If Indiana did not act as a cause for this development, it nonetheless appeared at a time when the change was coming: IU’s program goals not only failed to anticipate this dynamic, but sometimes actively worked against it, again leading to unexpected tensions. IV. Emerging Tracking Regional and International Migration Patterns: the International Context and the Introduction of“Free World” Sub-imperialism, Network (1966- ) To offer a generalization, Tthe typical patterns for scholarly and professional exchange in Korea prior to 1945 were shaped heavily by the Japanese colonial experience, with the majority 23 of those going abroad traveling within an East Asian system, with Taisho / Showa Japan serving as a favored destination, along with Republican China prior to the outbreak of war in the 1930s (Moon and Kim 2004, Kim 2005).33 There were exceptions to this pattern, of course, but the possibility of movement to other locations, such as Europe and North America, did not become a reality for most Korean students until sometime well after 1945. For medicine specifically, this observation holds with respect to clinical practice, with models of practice deriving largely from interactions with shaped by the colonizer.34 Newer forms of intervention through American and international actors during and following the Korean War therefore represented a major form of change / disruption, one that would create new possibilities for both practice and migration. At the same time, these professional developments also proved useful to the state, motivated to re- sell itself to the population in the aftermath of war. To restate this last observation in other terms, the transformation of Korean nursing pedagogy took place within a political context, domestically and regionally, and this setting inevitably influenced the process. Starting in the last portion of President Syngman Rhee’s rule (1958), the IU nursing program adopted a stance similar to that of other relief programs, mobilizing the post- Korean War context as the explanatory frame for undertaking much of its relief work. Certainly few would question the need for medical relief only a few short years after the close of the war, 33 For nursing specifically, see the work of 이꽃매. 34 There are a number of projects currently in progress concerning the colonial legacy of medicine in Korea. Theodore Jun Yoo of Yonsei University has recently published It’s Madness (2016) on colonial psychiatry, while Jin-Kyung Park of Hankuk University of Foreign Studies (HUFS) works on gynecology and the treatment of Korean women in colonial–era prisons. Jennifer Yum recently completed a thesis on post-war psychiatry at Harvard, and Jane Kim has written on leprosy, having finished her doctorate at UCLA. Sonja Kim is completing a book on mothering and care in colonial Korea. Kyung Moon Hwang’s Rationalizing Korea (2016) has generous sections on public health and demography for late Joseon. 24 when the nation remained in recovery mode. A few years later, however, the situation became more complicated, with the coup in May 1961, and the arrival of the new Park Chung Hee government. Even after the junta removed its military garb in favor of civilian elections held in 1963, the formative US-ROK relationship took time to renegotiate, as this was a more confident South Korea, and matters in Southeast Asia were accelerating in the lead-up to Vietnam. In 1962, therefore, the formal portion of the IU-ROK relationship came to an abrupt end, with the contract terminating as those on the Korean end encouraged allowed it to lapse. This move was not without precedent, as the Minnesota Project, similarly, was allowed to lapse, with Seoul National University simply choosing not to renew itsthe exchange arrangement as of June 1962. In this second case, Minnesota persisted through the late 1960s in seeking a renegotiation of the relationship, with little response on the Korean end. For Indiana, although the result was disappointing, there had been few formal institutional relationships, so the work in Korea could continue, albeit to be conducted on somewhat different terms. That is, Tthe Indiana nursing team stayed in touch with a number of Korean schools of nursing, and moreover, spread the word about its ongoing series of workshops. The Mmaterials in the IU files indicate an ongoing relationship through at least 1966, even if the intensity and frequency of contact from the earlier period was lacking. The motivations informing this gesture of deferral remain unclear, and may have been as simple as the desire to havecreate a clean slate, one free of the numerous partnerships established during the Syngman Rhee era. For its part, ICA appeared confused about how to respond, and for Indiana, the initial reaction was very much one of surprise. In its subsequent report for the period, USAID lamented that “the contract was terminated one year earlier than had been anticipated or less than 20 months after the first nurse advisor of the Indiana team” had arrived to 25 begin work in-country (“Historical Survey”). In effect, USAID regarded the program as something of a lost opportunity, one where much more could have been accomplished. Even with the relationships established with Ewha and Yonsei, this activity represented only a portion of the American ambitions for nursing in a domestic setting. The profession still held great symbolic significance at this level, and the USAID report continued to cite the damages to the profession deriving from the Korean War in seeking to justify its mission. In brief, the American aid organization, and its representatives from Indiana, failed to recognize how their essentially static vision was very different from that of their Korean counterparts who were moving ahead rapidly. Changing Priorities (1962- ) If the Syngman Rhee government sought to establish relationships with numerous partner nations, looking for financial and logistic support wherever possible, the succeeding Park government had similar priorities, with one major difference. Rhee was primarily motivated in bringing resources to South Korea, getting as much as he could from the challenging circumstances of recovery in the aftermath of the Korean War. Park, on the other hand, was motivated by a desire to renegotiate exchange on terms favorable to South Korea. In particular, he sought new forms of knowledge, along with technology and infrastructure, things that could transform the nation rapidly and raise it from its circumstances as a developing country. In this respect, the termination of the relationship with Indiana appears less surprising. Even if the program had yet to run its course, it tended to reinforce a relationship of dependency, certainly not the style of practice desirable in the long run from the Korean standpoint. By the early 1960s, in direct contrast to the advice offered by the Scandinavian consortium, along with other parties, South Korea began sending its nurses abroad, using them as a powerful 26 symbol of the nation’s growing ambitions. By this, I do not refer to just the pattern of migration that would soon begin with changes to American immigration law in 1965—in other words, self- selection by individual migrants—but rather, the active promotion of outgoing migration by the state within an international system. Estimates for the numbers of nurses nationwide tended to be on the low side, reaching a figure of about ten thousand, and generally emphasized the need for more trained personnel.35 Moreover, the IU program, as we have seen, regarded these nurses as hardworking and enthusiastic but wanted to upgrade significantly their clinical training, and the education credentials required to enter the profession. Why then did the ROK state begin to promote its nurses as a symbol of the nation, and with what specific aims in mind? The most conspicuous part of this new trend involved migration to West Germany, with Park Chung Hee admiring his frequent trade partner, and seeking to emulate its success in at least several ways.36 In the early 1960s, West Germany, along with the United States and Japan, was one of South Korea’s major trade partners, and the “Free World” (implying these nations, and also suggesting Hong Kong, South Vietnam, Thailand, and Taiwan) rhetoric associated with this group had to be taken seriously. As a gesture of his friendship, therefore, Park sent a group of Korean miners and nurses to his neighbor beginning in 1962. The gesture was more than symbolic, however, as these workers served as a valuable source of foreign currency, with their remittances going back to Korea regularly. For nurses specifically, the program began with a small group of roughly 20 nursing students, and would rapidly expand over the next ten to fifteen years. Between 1966 and 1976, an estimated 13,000 Korean nurses served in West Germany in 35 This figure includes midwives; nurses, counted alone, number about 5,500. 36 Park also admired the autobahn, and following his December 1964 visit, is alleged to have taken this for the model for the GyeongbuKyongbu expressway. 27 some capacity, creating and reinforcing a pattern of economic migration, with a large number of these women ultimately choosing to marry and settle in Europe (“60 Years of the Republic”).37 Even as many of these nurses ultimately returned to Korea, the pattern of “exporting” a set of valued health practitioners for a variety of economic and political reasons had begun, and this ROK-West Germany relationship was soon followed by several related gestures. links. Specifically, the US-ROK relationship already involved a pattern of education exchange following the Korean War, but changes to US immigration law in 1965 rapidly made long-term migration and resettlement much easier for those seeking a move. Moreover, the South Korean engagement with South Vietnam took on added significance with the expansion of the war in 1965, and again, ROK military medicine had a vital role to play.38 In simple terms, Korean nurses were now traveling abroad in much greater numbers, and frequently going to sites beyond the East Asian region, to seek higher levels of education, greater professional opportunities, and in some cases, long-term resettlement. Arguably, none of this could have taken place without the specific context of the mid-century engagement with the United States and its partners. Looking to the Vietnam Context (1964- ) What is surprising is not so much the dramatic pace of these changes, but the extent to which this emerging e US-ROK “Free World” relationship of medical exchange has gone largely unnoticed in the literature, certainly in contrast to a more celebrated case, like that of the Philippines. In part, this is because of the economic disparities governing the American relationship with the Philippines, in which Filipino doctors and nurses are seen as leaving the 37 In Cold War Germany, Hong seeks to link the movements of Korean nurses in the early 1960s to the earlier German Red Cross Hospital in Pusan (1954) and the operations of the German Red Cross in late 1950s South Korea. 38 The Vietnam context, like the Korean War, provided a rich context in which ROK medicine received extensive field / clinical experience. 28 country primarily to seek better economic circumstances. For South Korea, the economic growth that followed in the 1970s and 1980s made for a much “happier” narrative, one in which their migratory patterns are typically seen as temporary, rather than permanent. Moreover, the ROK’s rise to the status of a relatively wealthy country bridged a portion of the gap with the United States and other allies, meaning that the power differential is perceived as less of a factor in drawing these professionals. In any event, there was never a conspicuous fear of a Korean “brain drain” to the US, even as scholars have noted the significance of American post-graduate education as a lure. At the very least, it is fair to say that the transformation of Korean medical pedagogy took place within a relationship characterized by a conspicuous power difference, and this changed once more as South Korea began to redefine itself. Program like that of Indiana in some sense served to mask or even obscure the reality from the American viewpoint. If it is unfair to place the weight of this transformation upon ROK participation in the Vietnam conflict exclusively, we should, nonetheless, recognize the dramatic impact of the war upon South Korean medicine, whether referring to its domestic activities (blood drives) or those conducted abroad. Again, the participation of Korean doctors and nurses in the field served as an intensive introduction to clinical practice, handling many of the same issues approached in the Minnesota Project just a few years previously. At the same time, blood drives conducted on Korean college campuses brought the war home, and the return of wounded and injured soldiers, along with the deceased, gave war a material, palpable presence. Moreover, the medical personnel serving to support the ROK military were not just treating their own soldiers, as a significant part of their mission was one of cultural outreach, or “Civic Actions,” bringing biomedicine directly to the Vietnamese population as an ideological exercise. 39 This second 39 See Pictorial War History of ROK Forces to Vietnam, September 1964 to June 1970, available at http://www.vietvet.or.kr/hwabo/pawol3/js3x000.htm. Accessed as of September 25, 2016. 29 theme has received very little attention in English to date, and underscores the extent to which the nation sought not only sought to change to its own medical pedagogy and practice, but also wanted a significant upgrade to its own international image and prestige. The materials and images circulated in support of this mobilization were typically produced by the ROK’s Ministry of Public Information, and as they were published in English and Korean, it is fair to speculate that they were likely intended for wide distribution.40 In fact, even prior to engaging with Vietnam in a military fashion, a mobile medical team from Korea was sent overseas in 1964 as part of the initial point of contact (based at Vung Tau), and this fact receives conspicuous mention in a number of the Ministry’s publications (ROK Forces In Vietnam). In simple terms, South Korean medicine, mobilized under the broad umbrella of American Cold War interests, has to be re-evaluated from the standpoint of intersecting ideology and practice, with Korean nurses and doctors representing the idealized face of an emerging “Free World” partner with its own set of ambitions. Like the Korean soldiers participating in the combat phases of the war, these doctors, nurses, and support personnel functioned within a dense network of interests: in effect, Asians providing treating medical treatment to other Asians, but only within a set of bounded constraints. To return to our main focus, the Indiana nursing program, the link with the Vietnam context has to be a weak,n indirect one, as IU personnel could not possibly have anticipated the direction South Korea would take by the late 1960s. However, Indiana was very active in promoting the professionalization of Korean nursing culture in a way that encouraged both the adoption of new career ambitions and also emerging forms of (domestic) labor migration. If the university chose to portray its relationship with its Korean partners as initially one of continuity, essentially a 40 These volumes appeared the most frequently during the 1966-1968 period, although they cover as late as 1973, coinciding with the Korean presence. 30 resumption of earlier missionary activity, this characterization cannotcould not explain the obvious contradictions of a nursing community with rapidly changing interests. As Korean nurses began to migrate, whether on their own, or highly encouraged, as was the case with West Germany, they became a set of highly valued migrants, prized for their skills and labor. Moreover, they embodied the paradox of a nation still recovering from the effects of war, and yet one eager to depict itself as an emerging power through these transnational agents. By the close of the Indiana program, Korean nurses were already on the way to becoming integrated within an international system of migration in which their skills would lead to better pay and professional opportunities (in some cases), while arguably constrainedby the broader contours of American imperium. The irony, as emphasized here, lies in these late 1950s training programs interacting closely with Koreans, while almost completely failing to recognize the rapidly changing dynamics. 31 Bibliography Dotaline E. Allen, Mildred P Adams, “Workshops Wwork in Korea,” The American Journal of Nursing, Volume 64, Number 8 (August 1964), pp. 104-106. Miguel A. Bernad, Adventure in Vietnam: The Story of Operation Brotherhood. Manila: Operation Brotherhood International, 1974. Gregg Brazinsky, Nation-building in South Korea: Koreans, Americans, and the Making of a Democracy. Chapel Hill, NC: University of North Carolina Press, 2007. E. P. 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