Review: Charles M. Good, The Steamer Parish, 2004
Reviewed by: Marcel Dreier,
Good, Charles M. The Steamer Parish: The Rise and Fall of Missionary Medicine on an African Frontier.
Cloth $80.00sc ISBN 0-226-30281-4; Paper $30.00sp ISBN 0-226-30282-2
With “The Steamer Parish“ Charles M. Good presents a history of the Universities ’
„Steamer Parish” broadly splits into three sections: Chapters 1 and 2 are essentially introductory in character. Chapters 3 to 5 look at the frontier of the mission organisation and at environment from the perspective of historical geography. These chapters focus on the role of steamer technology in the development of the UMCA. Chapters 6 to 10 discuss what the book suggests in its subtitle: “The rise and fall of missionary medicine on an African frontier”.
The book starts with an introductory chapter which lays out debates about the impact of medical missions in
Chapters 3 to 5 describe the "spatial concepts of the mission”. Good, who is a historical geographer, makes a notable point in studying the "geographies of imperialism" and a valuable input by proving that "where and why the mission located its hospitals and dispensaries created important issues of space management that ultimately influenced this medical outreach and effectiveness.” (p. xv)
The arrival of the UMCA is the theme of Chapter 3. It describes the efforts to establish a mission field from about 1875. The chapter explains the idea of importing the first steamboat for its qualities as a mission-transport (both fast and with a wide range) and a mission-base which facilitated the “opening up” of the mission field in as much independence from local chiefs as possible (p. 82). The chapter goes on to portray the mounting of the UMCA’s main mission station on
Chapter 4 shows – rich in material - how the steamer technology was fundamental to the way the mission field was organised and how it enabled transport and communication. But steamers and their services were subject to disruption: The facets of steamer technology in the Malawian ecological and economic environment are detailed in chapter 5.
The second half of the book is concerned with mission medicine. It starts with a chapter that discusses health on the eve of colonization. This section discusses the ”cultural ecology of diseases” oriented on the diverse diseases. The chapter is mainly about disease prevalence with only a short excursus into African healing and coping strategies (pp. 256-259). How the specific infrastructure was erected and by whom it was served is described in chapter 7. This is a detailed account on medical stations and personnel The background is that by 1900, “building up and staffing an infrastructure of hospitals, clinics, and medical outreach had become essential to the UMCA’s perception and performance of its overall mandate.” (p. 261). Here Good also discusses the conception and the management of medical services delivery and its heavy restrictions by shortages of resources, staff and so on (pp. 293-308). This part of the “Steamer Parish” is interesting to those studying the needs to build strong health-systems in
Chapter 8 is the most promising chapter of all the chapters on medicine but also somewhat of a disappointment. Entitled “gauging change” the chapter aims at compiling and balancing “positive gains” and “consequences of significant failures of practice and policy, of omission and commission” of UMCA medical services (p. 311). Based on the incomplete hospital and dispensary statistics and on written reports and assessments by mission exponents the ‘gauging’ remains vague. Good shows growth in numbers of in- and outpatients, but with this data he does neither shed much light on the “(cultural) ecology of disease” which he described in chapter 6, nor on the successes of treatments or the development of diseases treated (in fact there is more on this in chapter 9). In the end, we do have two main statements relating to the actual service delivery of the UMCA’s medical enterprise: First, the statistics on treatments in hospitals and dispensaries “underscore the reality that […] the UMCA’s doctors, nurses and dispensers could reach but a mere fraction of the population that obviously needed care.” (p. 320). And secondly that there are fields of special interest for mission medical engagement: Good provides illustrative materials concerning the development of leper treatment and mother and child health. Despite massive collaboration with government health offices in these fields, Good states that there was not much medical success in the treatment of lepers all through the era of the UMCA in
Chapter 9 actually continues the discussion on ‘gauging change’. It looks at treatment of specific diseases and hints at some of the changes in prevalence and susceptibility. But this chapter is also dedicated to highlighting how the UMCA medical personnel applied and added on medical know-how (pp. 398-405). The chapter ends with listing the failures of the UMCA’s medical enterprise from the 1950s when it showed that UMCA was unable to modernise its infrastructure to level with the current needs and the state of the art in medical techniques (p .406f).
The concluding chapter 10 assesses the shortcomings of mission medicine (both in relation to what was possible and what was needed) in more general terms (pp. 426-431). The book ends describing how – in the early 1960’s – a new generation of medical practitioners employed by the UMCA brought about “a belated effort to shift away from old medical mission habits to create a more comprehensive system of health.” (p. 440). However, by then the UMCA was in deep (financial) crisis and it was too late for the mission to be able to contribute to the health system in independent
If this study had set out to prove the “that, collectively, medical missions laid the essential foundations and ‘spearheaded’ the future development of biomedical services and public health” (p. 2) it cannot show how this foundation was transported and transformed into the framework of the independent state. This is out of Good’s reach: the case of the UMCA in
Good primarily wants to prove that research on the role of missionary medicine must be based on historical evidence - not ideological statements (p. 2). And he argues by way of presenting a huge amount of material from archives and contemporary publications. Good profits from a long background in fieldwork in eastern and central
In his endeavour to prove the importance of historical facts, this book seems to be designed as a case-study. Engagements with scholarly debates about conversion, the cultural hegemonic function of modern medicine or individual contributions to the study of missionary medicine are interspersed, but producing theory is not the aim of a case study. Therefore, we have essentially a collection of material which describes the specific case of the UMCA in
As such “The Steamer Parish” touches many an important subject for such debates: First amongst these is the question of building a modern social services infrastructure, the role played by state-mission collaboration, and the results of specific cultural values of these institutions in the process of the ‘opening up’ of Africa. Good informs on other important topics as questions of gender or encounters with the Muslim population. Not least, “The Steamer Parish” discusses the limitations of the modernizing enterprise and the “substandard” medical infrastructure erected by the UMCA, although there are no definite judgements about the repercussion of this fact.
And there can be neither judgement nor answer, because the heavily felt shortcomings of “Steamer Parish” are concentrated in the absence of African voices. Good acknowledges this fact (“Until more African sources are found and heard, at least half of the story of how the introduction of biomedical services and foreign technologies affected colonial African’s daily lives, social space, and cultures will remain in obscurity.” p. 29). He even provides a glimpse by entering a short part of chapter 7 that builds mainly on oral testimonies “(“Go Ask the old men”, pp. 287-293.) This can not deter from the fact that we want to know more about Africans’ perceptions of the UMCA’s (medical) enterprise and motivations for using it. It is a pity, that – in a book with so much valuable material for further discussion and study – Good does not show where further fields and methods for investigating African agency and responses lie. It certainly would also be rewarding to go into a thicker description of some of the most telling events – even if only mission sources are consulted.
All criticism voiced shall not distract from the value of “The Steamer Parish” in studying the role mission societies played in the establishment of social welfare in rural Africa. Good makes his point, that historical research into the development of health provision in
Marcel Dreier, PhD student at the
This conference explores new trends and debates in the role of missionaries in the production of knowledge on
Convenors: Prof. Patrick Harries, Department of History,
Location: Basler Afrika Bibliographien, Klosterberg 23, CH-4051 Basel.
Die Ziele des Projektes sind
a) Forschungsebene: Einen wichtigen Beitrag zur Kenntnis über die Entstehung, den Charakter und das Leistungsvermögen von Gesundheitssystemen in Afrika zu leisten. Grundlage ist eine vergleichende Perspektive die auf Fallstudien basiert. Die Fallstudien sind in Ghana, Südafrika und Tanzania auf der Basis von schweizerischen missionsmedizinischen Interventionen entstandene Spitäler im ländlichen Raum. Während die Fallstudien detaillierte und lokal verankerte Sachlagen darstellen, kann der Vergleich weitergehende Kenntnisse über Faktoren für Erfolge und Misserfolge der Entwicklung von Gesundheitsstrukturen liefern.
b) Forschungsplatz Basel: Das Projekt leistet auch einen wichtigen Beitrag bei der Vernetzung und Stärkung der Afrikaforschung und -Lehre in Basel. Das Projekt ist zentral am Schnittpunkt verschiedener etablierter Forschungsinteressen und Forschungskapazitäten angesiedelt (Gesundheitsfragen und Entwicklung, Wissenschaftsstudien, Wissensproduktion, Missionsgeschichte, Medizingeschichte). Es ist darauf ausgelegt, in der Lehre- und Forschung einen längerfristigen Schwerpunkt bilden zu können.
c) Internationale Ebene: Das Thema ist international anschlussfähig. Es bestehen einige anerkannte Institutionen mit verwandten Interessen (Wellcome Foundation, WHO). Insbesondere aber kann ein solches Projekt auch einen Beitrag an die Forschung und Ausbildung im Süden leisten, indem es den Austausch mit afrikanischen Universitäten sucht und AkademikerInnen und StudentInnen mit der Universität Basel vernetzt und zum Teil integriert.
d) Das Projekt bringt HistorikerInnen, SpezialistInnen in ‚medical anthropology’ und EpidemiologInnen zusammen. Es ist multidisziplinär, indem es einen historischen Blickwinkel in Zusammenarbeit und kritischem Mitwirken anderer Disziplinen erarbeitet.