Into Africa

Barbra Mann Wall

• Publisher: Rutgers University Press
• Year: 2015
• ISBN:
  9780813572888
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Winner of the 2016 Lavinia Dock Award from the American Association for the History of Nursing  Awarded first place in the 2016 American Journal of Nursing Book of the Year Award in the History and Public Policy category The most dramatic growth of Christianity in the late twentieth century has occurred in Africa, where Catholic missions have played major roles. But these missions did more than simply convert Africans. Catholic sisters became heavily involved in the Church’s health services and eventually in relief and social justice efforts. In  Into Africa, Barbra Mann Wall offers a transnational history that reveals how Catholic medical and nursing sisters established relationships between local and international groups, sparking an exchange of ideas that crossed national, religious, gender, and political boundaries.
 
Both a nurse and a historian, Wall explores this intersection of religion, medicine, gender, race, and politics in sub-Saharan Africa, focusing on the years following World War II, a period when European colonial rule was ending and Africans were building new governments, health care institutions, and education systems. She focuses specifically on hospitals, clinics, and schools of nursing in Ghana and Uganda run by the Medical Mission Sisters of Philadelphia; in Nigeria and Uganda by the Irish Medical Missionaries of Mary; in Tanzania by the Maryknoll Sisters of New York; and in Nigeria by a local Nigerian congregation. Wall shows how, although initially somewhat ethnocentric, the sisters gradually developed a deeper understanding of the diverse populations they served. In the process, their medical and nursing work intersected with critical social, political, and cultural debates that continue in Africa today: debates about the role of women in their local societies, the relationship of women to the nursing and medical professions and to the Catholic Church, the obligations countries have to provide care for their citizens, and the role of women in human rights.
 
A groundbreaking contribution to the study of globalization and medicine, Into Africa highlights the importance of transnational partnerships, using the stories of these nuns to enhance the understanding of medical mission work and global change.

1

Medical Missions in Context

Following World War II, national identities and international alliances shifted rapidly, and many colonized nations found courage and opportunity to move toward independence. In sub-Saharan Africa, as the voices of independence grew louder, British and other colonizers came under international criticism and increasingly were unable to sustain their colonies. Within a decade, they began moving out in droves. Consequently, indigenous populations struggled to realign their countries and begin the arduous process of self-rule. Catholic women’s religious congregations, whose work in Africa had been hampered by the war, now saw themselves playing a supportive role in this transition process by expanding their medical missions. They did so in the context of an accelerating Catholic missionary movement; in the 1950s there were more foreign missionaries in Africa than ever before.¹ This book addresses an important but largely neglected aspect of medical mission work: its transnational character involving the mobilization of religious women, their ideas, and their institutions across national borders and continents; the groups with whom they aligned; the outcomes of their work; and how their organization and mission changed during the decolonization and independence periods.²

The most dramatic growth of Christianity in the late twentieth century has occurred in Africa, and Catholic missions have played major roles. According to the 2010 Symposium of Episcopal Conferences of Africa and Madagascar, “in 1900, there were two million Catholics in Africa; today, there are over 165 million. . . . 14 percent of Catholics worldwide now live there, nearly half of the children in Catholic elementary schools study there, and 43 percent of the world’s adult baptisms—over a million a year—take place there.” More Catholic hospitals are in Africa than in North and Central America collectively. In 1951, there were 4,437 African sisters working continent-wide, while currently the African continent is second only to Asia in religious vocations. “Between 1998 and 2007 . . . the number of women religious grew by over 10,000, from 51,304 to 61,886.”³ This current demographic shift can be viewed as a woman’s movement: even though men typically are the theologians, women are the most numerous practitioners.⁴

Indeed, women have been key players in the transformation of mission from one that expanded the Catholic Church and biomedical care to that of helping the poor to claim their rights and dignity within their own social systems. In the process, encounters between Africans and women from various religious congregations involved multiple negotiations that challenged a one-dimensional notion of a compliant indigenous population subjected to an overbearing Western presence. As Catholic sisters developed networks among those they served, they participated in various intercultural exchanges, and multidirectional movements of influence and ideas occurred.⁵ American, European, and indigenous healers eventually borrowed from each other as they fused different medical systems into their own. In addition, biomedically trained African nurses and auxiliaries played important roles in negotiations between Western-educated health care practitioners and local patients.⁶ By examining the lived reality of mission work on the ground where health care actually took place, one sees how American and European women’s encounters with people from different African countries intertwined with political movements, theological changes, and beliefs about medicine and nursing.

In her 1945 publication, Mission for Samaritans, Anna Dengel, founder of the Society of Catholic Medical Missionaries, or the Medical Mission Sisters (MMS), invited her readers to contemplate a particular framework for mission work that combined religious commitment and medical science. She saw it as a “branch of missionary work through which skilled medical care is given to the sick and poor of mission countries, as a means of relieving their physical suffering and bringing to them a knowledge and appreciation of our Faith.” Yet the sisters would care for “all whom we see sick and suffering, even if we know that they will not therefore accept our Faith.”⁷ Although Mother Anna recognized that missionary priests and sisters had worked for centuries in relieving the sick, what was new for her religious community was “organized, systematic medical care by people . . . who have been trained in the medical field as doctors, nurses, or technicians.”⁸ She was convinced of the superiority of scientific knowledge, and she wanted to make it available to others. Founded in 1925, the MMS were the first group of its kind in the medical field in being both professional and religious, and the first Catholic congregation of women to work as physicians, surgeons, and obstetricians.⁹

To Mother Anna, the MMS would be “good Samaritans” who would minister to the ill and to those who fell victim to superstition; most important, science and expert knowledge were essential. She also laid the groundwork for social justice when she wrote, “It is the tremendous debt which we, the white race, owe to the peoples subjected and exploited by our forefathers.”¹⁰ Even if a “utopia of medical care were established, the problems would not be solved. For the roots of the conditions we have just examined lie far deeper than in a mere lack of medical care.”¹¹ Although she did not question the expansion of missionary authority outside Europe and the United States, she framed her medical mission in direct opposition to imperialism driven by selfish greed by calling for a revision of social and economic conditions. Even though the term “social justice” was not in common usage at the time, and it would not enter sisters’ regular vernacular until the 1960s, her emphasis was still very much in that mold.

Transnational Processes

In this book, I explore transformations in the Catholic medical mission movement in sub-Saharan Africa from 1945 to 1985 by situating the study of Catholic sisters in a transnational framework. I recognize that global, world, transnational, and international histories are contested terms.¹² This book is framed within what Lynn Hunt describes as “micro-historical” transnational processes at work when “histories of diverse places become connected and interdependent.”¹³ It follows guidelines set by C. A. Bayly, who sees transnational history as a “range of connections that transcend politically bounded territories and connect various parts of the world to one another. Networks, institutions, ideas, and processes constitute these connections.”¹⁴

In this respect, Catholic medical and nursing mission history is one that witnessed sisters’ practices continually shaped and reshaped by their interactions with indigenous people, government agencies, global networks, wars, famines, and the structures and demands of the Catholic Church. As a transnational organization, the Roman Catholic Church’s influence emanates from the Vatican in Rome to national churches in countries all over the world to dioceses at the local level. Despite the Church’s classic patriarchy, women have had access to resources and status through entrance into religious orders to become sisters, or nuns.¹⁵ The Catholic sisters represented in this book are part of multinational religious congregations and orders with members from Europe, Asia, Africa, South America, and North America. Case studies of their work are used to examine how women in a transnational church became potent actors in health care both at the local and global levels.

Catholic women’s religious organizations involved practices with many groups of women and men as they built acute and primary health care delivery systems in sub-Saharan Africa. While this can be seen as an aspect of nation building, nuns’ work transcended traditional nation/state boundaries: they were bound by stronger ties of gender and religion even as they challenged gendered conventions. At the same time, they worked in different kinds of relationships with transnational actors: sometimes they competed, sometimes they collaborated, and other times they integrated their resources.¹⁶

Colonial and Mission Medical Services

Colonial medical services in sub-Saharan Africa began as a means to care for the health of whites who lived in large cities. In contrast, it was Christian missions that provided the majority of medical and nursing care to rural Africans.¹⁷ Missionaries also provided most of the care to persons with leprosy. In Catholic hospitals and clinics today, indigenous workers constitute the majority of personnel. Yet expatriate sisters were the ones who opened, managed, financed, and taught in hospitals, rural clinics, schools of nursing and midwifery, and programs for auxiliary workers. They either established Catholic hospitals themselves or administered them for the local diocese. One way to secure acceptance of their religious and medical ideas was to train African nurses and midwives to replace the European and American sisters. As they carried out their health care missions, nuns were critical vehicles for knowledge construction and translation not only of Christianity but also of biomedical knowledge to African populations. They also produced knowledge about Africans that they shared with their home societies. This enterprise involved communication through books, pamphlets, and teaching materials sisters wrote for African students; magazines written for their religious orders and Catholic mission boards and donors in their home societies; and correspondence to sisters across the world. In doing so, missionaries initially used their own Western understandings to create an image of the “Other,” or “foreigner.” Over time, however, this changed as nuns identified more with the people with whom they lived and worked, which affected their policy advocacy.¹⁸ This happened in the twentieth century, when much of the mission movement peaked as secularization increased in the missionaries’ home societies.¹⁹ Secularization theory asserts that religion and religious ideals lose their influence with the modernization of society. Thus, many scholars have disregarded the significance of religion as an explanatory factor in twentieth-century history.²⁰ Others, however, have noted that there has been little decline in individual religiosity; and at the societal level, many religions are seeking to reclaim authority in the public arena.²¹ Furthermore, when studying women in the twentieth century, the secularization thesis is even more problematic. As Mary Jo Neitz asserts, “women in many places fought for access to the very religious roles that men supposedly were leaving.” Indeed, “women use religion as a resource for acting in their own behalf.”²² This certainly occurred in sub-Saharan Africa over the last half of the twentieth century.

As the Catholic Church faced increasingly secularizing societies at the local and national levels during decolonization and independence, Church leaders were deeply concerned about how to continue their influence. For the women in this study, “mission” meant conversion and the establishment of churches in territories where Catholicism had not yet developed. Beneath the surface, however, mission goals were being transformed.²³

Transnational cooperation was evident from the start of Catholic missions in sub-Saharan Africa. Although sisters worked in both Francophone and Anglophone Africa, this book centers on those who went to British colonies whose colonial leaders wanted English speakers. The British had established a policy of “indirect rule,” whereby they governed through traditional chiefs, and this gave African communities some say in the management of their affairs. Colonial policy was particularly advantageous for missionaries because Christianity was the religion of the colonial powers, and the missionaries had a privileged position.²⁴

The main focus of the book is from 1945 through the decolonization and independence periods to 1985, when another key transformation in health care occurred, one resulting from the HIV/AIDS epidemic (a book in itself). It should be particularly noted that the sisters in this study did not focus on caring for white settlers or families of white missionaries. With the end of colonization, a fuller account of the encounters among religious sisters, volunteer and trained community health workers, indigenous healers, international agencies, and biomedicine becomes possible.

Among the women’s religious congregations that sent the largest number of sisters overseas are the MMS from Fox Chase, Pennsylvania; the Medical Missionaries of Mary (MMM) from Drogheda,...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• List of Figures
• List of Tables
• Acknowledgments
• Abbreviations
• 1. Medical Missions in Context
• 2. Nursing, Medicine, and Mission in Ghana
• 3. Shifting Mission in Rural Tanzania
• 4. Catholic Medical Missions and Transnational Engagement in Nigeria
• 5. Transnational Collaboration in Primary Health Care
• 6. Appraising Women Religious and Their Mission Work
• Note on Sources
• Notes
• Index
• About the Author