P103 – Ethics/aesthetics of Mobilisation for Health in Africa
8 July, 14:00 – 15:30

Manton John / University of Cambridge


Health care in Africa is entangled with developmental ideas and practices addressing global spatial inequalities, encoding ethical expectations, and embodying past and future hopes. Though often technocratic and instrumental, its projections are deeply affective, intimate and ephemeral: while consonant with nostalgia, community mobilization, and the persistence of structural inequality, the style, content, experiential dimensions and political-aesthetic exigencies of these projections remain underinvestigated. The panel aims to capture the sublime, grandiose, and quotidian nature of the medical enterprise, its undercurrents of anxiety and desire, and the uneasy ethics and aesthetics of mobilisation it fosters.
This panel interrogates the pasts, present, and futures of health care, medical research, governance and regulation as mobilising enterprises in Africa. It queries medical politics, science, promises, and fantasies in view of their conjoint ethical and aesthetic resonances, as compound artefacts conjoining State or liberatory politics with temporalities and spatialities of order, harmony and design. Papers resuscitate and reanimate the forlorn hopes of grandiose colonial development projects, counterpoint the arts of medical dreaming with unfolding public health catastrophe, and foreground remains of disrupted enterprises in care.

L’éthique et l’esthétique de la mobilisation sur la santé en Afrique
La santé en Afrique est empêtrée dans des idées et des pratiques de développement reflétant les inégalités spatiales mondiales, codant les attentes éthiques, et incarnant les espoirs passé et actuel. Bien que souvent technocratique et instrumentales, ces projections sont profondément affectives, intimes et éphémères: en harmonie avec la nostalgie, la mobilisation de la communauté et la persistance de l’inégalité structurelle, le style, le contenu, les dimensions de l’expérience et des exigences politiques et esthétiques de ces projections restent mal connus. Le panel vise à saisir la nature sublime, grandiose, et quotidienne de l’action médicale, ses courants sous-jacents, les anxiétés et désirs, l’éthique et l’esthétique de la mobilisation qu’elle favorise.
Ce panel interroge le passé, le présent, et l’avenir des soins de santé, la recherche médicale, la gouvernance et la réglementation en tant que mobilisation des actions de santé en Afrique. Il interroge les politiques médicales, les sciences, les promesses et fantasmes en vue de leurs résonances éthiques et esthétiques conjoints, entre politique étatiste ou libératrices et temporalités et spatialités de l’ordre, l’harmonie et le design. Nous réanimons les espoirs déçus de grandioses projets de développement coloniaux, en confrontant les idéaux médicaux aux processus de développement catastrophique de la santé publique, et en mettant en avant les séquelles des entreprises manquées.

Paper 1

Fagite Damilola / Obafemi Awolowo University, Ile-Ife, Nigeria

From Colonialism to Post-Colonialism: Historicizing the Nature and Development of the Nigerian Healthcare System

The Nigerian healthcare sector can be said to have witnessed tremendous transformation from the traditional health care system that predominated various Nigerian communities and ethnic groups in the pre-colonial period till date. The advent of Christian missionaries in Nigeria can be said to have marked the beginning of ‘modern’ healthcare system in Nigeria which served as an alternative to the existing indigenous systems of healthcare. This ‘modern’ healthcare system developed in the wake of British colonization of Nigeria and transformed to what it is today. The main thesis of this paper is to historicize the nature and paths of development in the healthcare system of Nigeria since amalgamation. The study also examines policies initiated by the colonial and post-colonial governments to improve the quality of healthcare delivery system, as well as government intervention programmes during the outbreak of diseases such as malaria, small pox, and influenza especially during the colonial period. This study will further investigate the developmental stage of the Nigerian healthcare system on the eve and after independence, and its contribution to national development

Paper 2

Zumthurm Tizian / University of Bern

Contradictions of Ethics and Aesthetics in Medical Practices at Albert Schweitzer’s Hospital in Lambarene, Gabon, 1913-65

The PhD-Thesis, on which this contribution is based, is part of a bigger ongoing research project and focuses on medical practices. This includes a variety of questions on power and the organisation of daily routines, on the arrival of innovations and the development of expertise, on questions of cultural adaptations and compliance by patients and staff alike, on the role of middle figures, and on the problem of the African patients’ view.
This paper explores the contradiction between Schweitzer’s famous ethics Reverence for Life (after which every living being has the same value) and the practical and discursive realities in and around the hospital: it was a segregated space and Schweitzer was accused of a paternalistic, or even racist, management philosophy. Still, the hospital achieved local and global fame and admiration. Public discourse was largely controlled by Schweitzer himself by highlighting his ethics and civilising mission. In this sense, aesthetics seem to have been important to Schweitzer: he was a careful and skilful narrator and writer and an enthusiast of Bach. However, he also was a deeply practical, if somewhat conservative, person, which is shown in his architectural preferences and in the ways medicine was practised in the hospital. Nevertheless, it has been suggested that Schweitzer was not so much interested in curing Africans, but in “making his life an argument”, as he put it himself, which can be seen as both, an ethical and aesthetic act.

Paper 3

Mohamed Deika / University of Toronto

Colonial Health Services and International Humanitarian Medicine in British Somaliland

My paper traces the proliferation of British imperial health programs with the separate but intertwined evolution of international health and humanitarian activities in the increasingly termed “underdeveloped world.” Specifically, I will discuss the development of colonial public health services in British Somaliland and how Britain responded to international humanitarian organizations, namely the Red Cross and Save the Children Fund, which adopted new global agendas in the late-colonial period.
In essence, I seek to answer a simple question fairly undocumented in the literature on colonial medicine in Africa: why was there a sudden shift in the colonies from little to several forms of colonial health services beginning in the 1930s? Indeed, Britain (like other imperial powers) demonstrated an urgency to maintain their empire in the face of decolonization and a devastated post-war economy. Still, the public health changes in the colonies were not directly affiliated with empire; rather, they were a product of a changing international scene. My research challenges historians of imperial medicine in Africa to greater account for the role of transnational actors and the interplay between decolonization and the emergence of global humanitarianism and development.

Paper 4

Mulemi Benson / Catholic University of Eastern Africa

“Standing in the gap”: Cancer treatment uncertainty and religious coping in a Kenyan hospital

Cancer care and treatment advances in developed countries have not yet materialized in low income countries. The fact that not all cancers can be treated in spite of recent improvements in oncology even in developed countries contributes to disillusion and uncertainty about management of the disease. Drawing on twelve months hospital ethnography, this paper examines the relationship between Christian religious discourse and biomedical treatment of cancer in a large public hospital in the Kenya. Hospital staff, patients and informal care givers cling to religious coping as a way of bridging the gap between unabated agony and hope or trust in oncology as a techno-medical quest with the potential of extending life and alleviating suffering in Africa. The paper uses the case of management of cancer in the Kenyan clinical setting to contribute to the debate on uncertainty, intuition, trust and biomedical limitations in cancer care. Cancer creates uncertainty about the power of bio-medicine to cure, heal and sustainably restore well-being and points to ever increasing global healthcare inequalities. The lived experience of cancer management often contradicts trust in medical construction of successful therapy. Religious ideas and discourse are thus intuitive initiatives that patients, their relatives and professional carers draw on to re-shape the meaning of their experience of cancer management, and resilience during biomedical treatment.

Paper 5

Diener Tara Dosumu / University of Michigan

Weapons of the Ward: Performing Knowledge, Practicing Authority in a West African Hospital

This paper considers state power as it is articulated through the actions of one group of civil employees: nurses working at a government hospital. Princess Christian Maternity Hospital in Freetown, Sierra Leone, has long been a locus of state power. From gathering demographic data, to physically surveilling subjects, administering vaccines as part of global health campaigns, monitoring disease rates, and distributing and promoting contraceptives, nurses at Princess Christian have been actively engaged in performing colonial and post-colonial state power while reaping the benefits of guaranteed work and retirement income. They have also become adept at resisting, undermining, and transforming that power, as ties to the state are cross-cut by other factors such as professional status and rank, gender, and age.
The ability to effectively mobilize affinities and negotiate the web of competing alliances impacts access to resources of all kinds within the hospital, raising many ethical dilemmas. Nurses are gatekeepers guarding and supervising the distribution of state-provisioned resources. This paper argues that in this intensely plural clinical context, with an institutional memory spanning generations, their insider knowledge – that which can only be gained through practical experience within this state-administered hospital – can become the most valuable currency of all: a power whose legitimacy is rooted beyond the boundaries of state control.

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