Well, I did it! I turned in my final history paper today at PSU, and provided I didn't completely blow the assignment I have earned my bachelor's in History, a project that has lately taken on a "just do it and get it done and move on" feel. I love to read history, and my "History of Health and Healing in Africa" class at the university was both inspiring and tedious. The reading was a load, and not all of it was scintillating. But I liked it. I liked being there, sitting with a group of very bright kids (for the most part) who were engaged (for the most part) and serious and determined to learn. I had a great instructor, a young woman named Jennifer Tappan, who knows her stuff and communicates well and demanded that her students work and get as much out of the classroom and reading experiences as possible. All and all a great educational experience. I think I learned something. Glad I did it.
Here is my final paper, sans the footnotes. I've included a bibliography of sources.
There is Much to Be Done: Hegemony and the New Africanists--An Evaluation of the Past and Present
The focus of this paper will attempt to explore whether actual change has occurred in numerous African states since the Berlin Conference of 1871 set off the “Scramble for Africa.” In the context of a partial and fragmented historiography of health and healing, the contrasts and similarities of the West’s present vision of Africa with that of the colonizers’ will be evaluated from numerous angles, including biomedical and localized healing therapies, political economy and hegemonic control, individualized and group resistance to hegemony and biomedicine, migrant labor, gender considerations, and the scourge of AIDS. An interpretation of the historical and present reality of hegemony, gleaned from select texts, is the dominant theme of this effort.
A triumphalist narrative steeped in myth flourished in the colonial documents of the nineteenth century—the myth of a forbidden, dark, and disease-ridden continent inhabited by uncivilized “savages” who only needed to learn the foundations of a Westernized worldview and hygiene to pull themselves out of their culturally deprived and sickly lives (Prins 159-162, Ranger 256, Swanson 387, Marks 205). Coveted for its natural resources and a favorite target of Christian crusaders in the late nineteenth century, Africa was haphazardly partitioned, coerced, and at times brutally manipulated by European elites, who rarely suspected nor were overly concerned that the unintended consequences of their actions could and often would lead to unimaginable suffering among the African people. In the case of Congo, which Leopold claimed as his private dominion, a deliberate genocide coincided with colonization. In more recent times, in large swaths of Africa, a benign genocide could be said to have occurred vis-à-vis the West’s neglect of HIV/AIDS victims, a situation marked by mismanaged and underfunded attempts to eradicate the disease (Vaughan 56, Landau 262, Hunt 432, Nguyen 1-187).
The rise of African studies as a discipline in the academy has countered many of the lingering effects of colonialism as an intellectual barrier to our understanding of how African health and healing conundrums have evolved over time. By giving health and healing an historical foundation, Africanists have created new narratives that unfold in direct opposition to lingering colonial constructs and the presence of new, highly developed methods of surveillance and coercion, new technologies, and reorganized economies. The new history of health and healing in Africa is very much concerned with power—who held it during the colonial era, who holds it now, and who may hold it in the future (Feierman 75).
While the new historians are laudable, one worries that, like newly developed drugs with an unknown efficacy against AIDS in 1983, their impact will not (or cannot) translate into an antidote against those who would, in the context of health and healing issues, abuse the fundamental right of every human being to lead an optimal existence free of poverty and its associated diseases. It is also presumed that the new Africanists are not responsible for empowering Africa, though such an outcome would be welcomed. When many of the citizens of the richest countries in the world are severely limited by their own incapacity to evolve from racist and/or impoverished modalities, or unable to clearly enunciate the dilemmas confronting them while demanding change, the chances for a final victory over servitude are diminished. The chance of overcoming class constructs on a scale large enough to effect economic power and control is diminished in the face of elites’ business and governmental interests. Collusion on that level is necessarily confined to hierarchal structures that trample the individual economies of the majority while enriching the few. That is as true today as it was in the colonial era, when localized authority guarded the interests of European elites, because it is an aspect of capitalism that is non-negotiable and unlikely to ever change (Nguyen 1-187).
When workers left the merafe in post-World War II Bechuanaland to work in South Africa’s mines for wages, they lost a crucial part of themselves, a part that could be reclaimed only by an adjustment of their “moral imaginations,” an adaptive survival mechanism. Workers were literally changed by the newness in their lives as old paradigms of culture and ritual eroded. The phenomenon demanded resolution and a direct confrontation with new realities. Money (madi) gained import to Batswana because its meaning was forced upon them in an atmosphere of colonial control and increasingly forced dependence upon it. By the same token, the discovery of madi’s liberating qualities appealed to many workers, as did the hard work itself, which gave them new insights into their lives. Strength and individualism emerged as valued assets for many workers in the mines, but the dangers of the job could also create apprehension about the future as Batswana witnessed an onslaught of debility and the toxic effects of unsafe hard labor, as well as the damaged ecology of the merafe, where jobs grew scarcer and scarcer and the Batswana way of life changed (Livingston 107-141).
In Bechuanaland and elsewhere in Africa in the colonial era, the social cost of debility was borne by the workers, just as it is in much of Africa and other parts of the world today. This narrative argues that control within the ongoing economic hegemony of the West comes with profound costs. As “developing nations,” states such as Cote d’Ivoire, which gained Independence in 1960 and at first flourished before growing increasingly dependent on foreign loans to compete amidst nascent globalization, the crush of hegemony is crucial to understanding the new Africanists’ point of view. The neoliberalism of political policies best exemplified by Reaganomics and Thatcherism in the 1980s tied Cote d’Ivoire to its debt and caused the state’s educational system and other institutions to collapse. The newest shibboleths of the West’s economy in the 1980s precluded anything like a reasonable effort to fairly and equitably distribute social costs. The neoliberal model of doing business carried over in the initial fight against AIDS in the mid-nineties, when the known efficacy of ARV therapies should have given the West a better opportunity to do the right thing, but was rather squandered by a reliance on non-governmental organizations (NGOs) and the pharmaceutical industry to carry the fight in a poorly designed and underfunded model of therapeutics. Today Cote d’Ivoire is struggling to pull itself out of the ravages of a recent civil war, in no small part created by the effects of hegemony (Thomas, Livingston, Nguyen 187).
Like Bechuanaland after World War II and the Meru district of Kenya, in Cote d’Ivoire during the early days of the AIDS crisis, and in other colonies throughout the colonial era, individuals became entangled in colonial systems of surveillance and control and were forced into relationships with governing entities from faraway lands. Bodies, formerly conjoined to cultures guided by vastly different cosmological views, fell under the hegemonic spell of the colonizers in ways that suggest pure hubris on the part of the European powers. In Meru, the British seemed unable to settle on a clear direction of influence; several times creating laws that contradicted former policies in what a modern politician would call a “flip-flop.” It is fair to suggest that elements of individualized resistance (see footnote) came into play in some cultures. Meru’s girls, exemplified by some of their reactions against the ban on circumcision, grew entangled with colonial rule. Some girls circumcised each other and themselves, or at least attempted or pretended to as a show of solidarity against patriarchy, Christian objection, and London’s at-the-time small but noisy feminist movement in the mid-twentieth century (Thomas 1-186).
The history of Africa is a history of political struggle even within the highly nuanced, micro historical discussion of health and healing which the new Africanists favor in the texts under scrutiny here. In the conflation between missionary work and therapeutics that developed under colonialism in Congo, emerging methods of mobility (bicycles) and communications (letter writing) were designed to aid and abet Belgian companies in the control and dissemination of health care to maximize business interests. Where concern for the health of the Congolese was elucidated and carried out, it was conflated with business interests, patriotism, and attempts to keep and promote a ready-made system of forced labor and servitude, aspects of the genocides alluded to above. Health care systems as political and hegemonic exercises took precedence over purely humanitarian reasons for organizing bodies and placing medical dispensaries in key population zones throughout Congo in the colonial era (Hunt 160-195).
The historical analysis under scrutiny here repeatedly draws comparisons between the efficacy of biomedicine and “traditional” or localized forms of therapy. Implicit in discussions of that duality has been the recognition that an historical bias regarding Westernized medicine has dominated the general discourse, particularly in the political and economic realm, from the colonial era through the present. Yet, repeated instances of the efficacy of localized therapies are known. The new Africanists seek to integrate biomedicine and known herbal and cosmological remedies among Africans in their understanding of the history of health and healing in Africa (Whyte 289).
It is important to understand that the persistence of the faith in biomedicine in some circles is a product of the medical hegemony of the West—an understandable but limited result of the undisputed efficacy of certain biomedical therapies worldwide. Since the 1970s, the new Africanists have focused on “medical pluralism,” a conjoining of Westernized and local therapies, as a way to understand the history of disease and healing in Africa. The recognition of this phenomenon, mined out of deep ethnographic and anthropological studies in a multi-disciplinarian effort to locate knowledge, creates testimonials of individualized native resistance to colonialism in a medical context. But the new Africanists succinctly note that medical pluralism also generated new ideas about disease and the efficacy of localized therapies among healers and tribal leaders in parts of the continent. Pluralism was a good thing if allowed to be explored outside the fold of biomedical biases, in other words (Whyte 291).
As First World Africanists and their cohorts in Africa explored new techniques of gathering and disseminating knowledge, they made a remarkable discovery—the locals, these supposedly backward and afflicted citizens of the world, were doing the same thing! Scholars discovered that networks of information-based knowledge in many forms were an aspect of the historiography of Africa long overlooked. Recognition emerged—the history of Africa was a living thing. Notions of African existence being static rather than an amalgam of heterogeneous groupings of people who had created and organized their cultures, were just plain wrong-headed. It was time to take Africa and its diverse people, cultures and many languages (750 to 1000) seriously. The Africanists looked to the medical and cultural anthropologists, interpreting their data flow, and developing a vocabulary suitable to the tasks of scientific and medical exploration. Disease no longer was something that simply happened in the historical narrative of Africa. Rather the Africanists, shaping the shared discoveries of other scholars into medical narratives, gleaned meaning from associated disciplines. One example—it helped to thoroughly understand the historical and scientific differences between rinderpest and schistosomiasis, their causations, cultural significance, and historical markers. It also helped to learn the language of the people one communicated with, particularly as it applied to gathering oral histories and using that material to forage theses which revealed what people actually think and believe about health and healing, about their pasts, their present lives, and what the future may hold for their families and cultures (Kodesh 208, White 1381, Feierman 73-131).
Much of the textual evidence examined herein is concerned with the tension wrought between individuals suffering debility and powerlessness against both state-run and localized hierarchies organized to control populations through two centuries of highly sophisticated and evolved monetary and social design. What is the difference between colonial era bans on circumcision and controversies over perinatal drug trials in Africa today? The answer to the question suggests that power is regenerative; methods of subjugation and control are reissued and updated in new forms of surveillance aligned with the moral sponsorship of social, cultural and economic hegemony. Historically, abused bodies, discipline, and evolving apparatuses of control are constants in the evidence gathered by the new Africanists since their discoveries soared into consciousness in a not-too-distant past and continue to move ahead. Not coincidently, those barriers to actual freedom from abusive power, or what Nguyen refers to as the “therapeutic recolonization” of Africa, are with us as much today as they were in the nineteenth century (Wendland 4, Nguyen 185).
Given the complexity of their exercise, what are the new Africanists capable of offering the world? The argument herein is that hegemony and a persistent method of social, cultural and economic control organized and disseminated by the West, have conspired, whether deliberately or through a pattern of unintended harmful consequences, to give the academy much to stress about. While a new vision of what has happened and continues to happen in Africa has been elucidated, the gap between knowledge and the enactment of strategies to eradicate debility in Africa remains large. The business of creating a link between the histories of health and healing in Africa and the present quandary of Africa is unfinished. African nations remain among the poorest in the world. One is inclined to ask, what is the purpose and intent of the gathering of the knowledge the new Africanists have produced in recent decades? The scholarly disciplines have merged and been hashed out, with plenty of opportunities ahead to make discoveries, but what will be their effects? Can hegemony and the “disease of capitalism” be eradicated from the world? Will capital ever reconcile itself to the earth’s suffering and provide enough to help rather than hinder progress in the field of health and healing? These are difficult questions to answer at this time, and may never be answerable (Malowany 325).
Despite the recognition of the difficulties that lie ahead, new collaborative models are being dreamed of in some circles. James Pfeiffer asks that the policymakers and the researchers and the heads of the foundations and the workers in the NGOs and the rest of the health industry finally admit that current models have to a large degree failed. He lists a number of advisable systemic changes to the bureaucratic nightmare that accompanies programs of disease eradication in Mozambique. These changes make sense for health systems throughout Africa. Pfeiffer is an anthropologist and his ideas deserve consideration, as the twenty-first century is quickly speeding along and there is much to be done in Africa and elsewhere (Pfeiffer 736).
Sources and Bibliography
Articles and Book Chapters
Steven Feierman, “Struggles for Control: The Social Roots of Health and Healing in Modern Africa,” African Studies Review 28:2/3 (1985), 73-147.
Gwyn Prins, “But What Was the Disease? The Present State of Health and Healing in African Studies,” Past and Present 124 (1989), 159-179.
Shula Marks, “What is Colonial about Colonial Medicine? And What has Happened to Imperialism and Health?” Social History of Medicine 10:2 (1997), 205-219.
Maureen Malowany, “Unfinished Agendas: Writing the History of Medicine of Sub-Saharan Africa,” African Affairs 99 (2000): 325-349.
Susan Whyte, “Anthropological Approaches to African Misfortune, from Religion to Medicine,” in Anita Jacobsen-Widding and David Westerlund (eds.), Culture, Experience, and Pluralism: Essays on African Ideas of Illness and Healing (1989).
Neil Kodesh, “Networks of Knowledge: Clanship and Collective Well‐Being in Buganda,” The Journal of African History 49:2 (2008): 197-216.
Megan Vaughan, “The Great Dispensary in the Sky: Mission Medicine,” in Curing their Ills: Colonial Power and African Illness, 55-76.
Paul Landau, “Explaining Surgical Evangelism in Colonial Southern Africa: Teeth, Pain and Faith,” Journal of African History 37:2 (1996), 261-281.
Luise White, “They Could Make their Victims Dull: Genders and Genres, Fantasies and Cures in Colonial Southern Uganda,“ American Historical Review 100:5 (1995), 1379-1402.
Terence Ranger, “Godly Medicine: The Ambiguities of Medical Missions in Southeastern Tanzania,” in Steven Feierman and John Janzen, eds., The Social Basis of Health and Healing in Africa (1992), 256-282.
Nancy Rose Hunt, “Nurses and Bicycles,” in A Colonial Lexicon of Birth, Medicalization and Mobility in the Congo (1999), ch. 4.
Nancy Rose Hunt, “Le Bebe en Brusse”: European Women, African Birth Spacing and Colonial Intervention in Breast Feeding in the Belgian Congo,” International Journal of African Historical Studies 21:3 (1988), 401-432.
Maynard W. Swanson, “The Sanitation Syndrome: Bubonic Plague and Urban Native Policy in the Cape Colony, 1900-1909,” The Journal of African History, 18:3 (1977): 387-410.
James Pfeiffer, “International NGOs and Primary Health Care in Mozambique: The Need for a New Model of Collaboration,” Social Science and Medicine 56:4 (2003): 725-738.
Claire Wendland, “Research, Therapy, and Bioethical Hegemony: The Controversy Over Perinatal HIV Research in Africa,” African Studies Review 51:3 (2008): 1-23.
Textbooks
Lynn Thomas, Politics of the Womb: Women, Reproduction, and the State in Kenya (University of California Press, 2003).
Julie Livingston, Debility and the Moral Imagination in Botswana (University of Indiana Press, 2005).
Vinh-Kim Nguyen, The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS (Duke University Press, 2010).
TS
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