Nursing Shifts in Sichuan illuminates modern nursing as one of the most consequential additions to early-twentieth-century health care in China. In 1943, members of the elite Peking Union Medical College (PUMC) were forced to evacuate to the "backwater" province of Sichuan, landing at the West China Union University campus in Chengdu. As part of an extraordinary mass migration of students and professors to Free China during the Japanese occupation, the refugee PUMC was hosted by the Canadian West China Mission for the next three years. Nursing Shifts in Sichuan traces the tumultuous final days of twentieth-century relations between China and the West. The PUMC had been so successful in its attempts to develop a Chinese nursing elite that alumnae held most of the key nursing positions in the country. While under evacuation, PUMC transformed nursing at the Canadian mission, initiating the second university program in China. Both programs were closed by the new Communist government in 1951; degree programs lay dormant for the next thirty-five years. In the contemporary era of exponential increases in East–West educational exchanges, Sonya Grypma offers both a cautionary tale about the fragility of transnational relations and a testament to the resilience of educated women.