Into Africa: A Transnational History of Catholic Medical Missions and Social Change

Into Africa

Into Africa

A Transnational History of Catholic Medical Missions and Social Change

BARBRA MANN WALL

RUTGERS UNIVERSITY PRESS

NEW BRUNSWICK, NEW JERSEY, AND LONDON

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Wall, Barbra Mann, author.

Into Africa : a transnational history of Catholic medical missions and social change / Barbra Mann Wall.

pages cm

Includes bibliographical references and index.

ISBN 978–0–8135–6622–1 (hardcover : alk. paper) — ISBN 978–0–8135–6623–8 (e-book (web pdf)) — ISBN 978–0–8135–7288–8 (e-book (epub))

1. Catholic Church—Missions—Africa, Sub-Saharan.   2. Missions, Medical—Africa, Sub-Saharan.   3. Medical personnel—Africa, Sub-Saharan.   4. Women missionaries—Africa, Sub-Saharan.   5. Medical care—Africa, Sub-Saharan.   I. Title.

RA390.A357W35      2015

610.690967—dc23

2015002727

A British Cataloging-in-Publication record for this book is available from the British Library.

Copyright © 2015 by Barbra Mann Wall

All rights reserved

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For Deb

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

Figures

2.1. Mother and baby with Sister Paula D’Errico, Berekum, Ghana, sometime in late 1950s or early 1960s

2.2. Anatomy class with Sister Alice Hanks, tutor, Berekum, Ghana, 1963

2.3. Hanging an IV drip in room with crucifix, Uganda, 1968

2.4. Holy Family Hospital, Berekum, Ghana, taken approximately 1959

2.5. Sister Maria Hornung with pharmacy assistants in Uganda hospital, 1966

3.1. Sister Joan Michel Kirsch with young boy, c. 1950s

4.1. Sister Joseph Therese Agbasiere, a Holy Rosary Sister, comforting a mother who had dusted her baby with chalk in an attempt to heal it. Taken during the Nigerian Civil War

5.1. Nutrition class, Berekum, Ghana, 1972

5.2. Sister Mary Ann Tregoning, Ghana, c. 1980

5.3. Sister Maria Hornung, phramacist, on medical safari in a Ugandan village, 1964

6.1. Medical Mission Sisters in front of the White House, Washington, DC, participating in a justice march, October 1998

6.2. A Catholic nun runs a stall advertising the use of condoms to prevent HIV/AIDS spreading in Pietermaritzburg, KwaZulu Natal, 2001

Tables

2.1. Statistics of Holy Family Hospital, Berekum, 1953–1985

2.2. Personnel and Procedures at Holy Family Hospital, Berekum, 1958–1966

2.3. Sample of Patients Treated at Holy Family Hospital, Berekum, January 1961

3.1. Monthly Statistics, Kowak Dispensary, 1951–1956

4.1. Income and Expenditures, St. Mary’s Hospital, Urua Akpan, 1953–1966

5.1. Topics in PRHETIH Program, 1979

Acknowledgments

I am indebted to the staffs and archivists of many repositories for their assistance in this project: Sister Jane Gates, MMS, Archives of the Medical Mission Sisters in Fox Chase, Pennsylvania; Annaig Boyer, Archives of the Medical Mission Sisters in Acton, United Kingdom; Sister Catherine Dwyer, MMM, and Sister Isabelle Smyth, MMM, from the archives of the Medical Missionaries of Mary in Drogheda, Ireland; Ellen D. Pierce, Archives of the Maryknoll Sisters, Ossining, New York; Lucy McCann, Archivist, Bodleian Library of Commonwealth & African Studies at Rhodes House, Oxford University, Oxford, United Kingdom; Ralph Bates, Oxford Center for Mission Studies Library, Oxford University, Oxford, United Kingdom; Belinda Michaelides, Secretary of the Wellcome Unit for the History of Medicine, Oxford, United Kingdom; Sister Mary Nesta, IHM, my contact for the Sisters of the Immaculate Heart of Mary, Mother of Christ, in Minneapolis, Minnesota; Sister Ursula Preusser, MMS, Archives of the Medical Mission Sisters in Berekum, Ghana; the Holy Rosary Sisters in Killeshandra, Ireland; and Susan Eason at the Catholic Archives of Texas in Austin, Texas.

In all my work, I have valued the intellectual community of the University of Pennsylvania. Along with Joan Lynaugh, Julie Fairman, Patricia D’Antonio, and Cynthia Connolly, colleagues at the Barbara Bates Center for the Study of the History of Nursing were most generous with their expertise and encouragement. They read my work with sharp minds, always providing nuanced comments while providing a unique friendship. My thanks to Dean Afaf Meleis and other administrators at Penn who granted me a sabbatical to write the book. I also am grateful for the friendship and support of historians of nursing Arlene Keeling, Sandra Lewenson, and Barbara Brodie. And I acknowledge friends and colleagues who also study women religious and with whom I have traveled and presented papers: Susanne Malchau Dietz, Carmen Mangion, Carolyn Bowden, Sonya Grypma, and Helen Sweet. To all of these friends, I am grateful for their support.

I have benefited by attendance at several international conferences on colonial and African health and medicine where I learned from international and Africa-based scholars. These include: the International Conference on Nursing History in Berlin, Germany, May 12–14, 2011; History of Health Care in Africa Conference, Basel, Switzerland, September 14–15, 2011; Conference on Humanitarianism, Nursing and Missions: How to Study Knowledge Exchanges in a Historical, Transnational Perspective, Bergen, Norway, Sept. 22–23, 2011; the History of Women Religious in Britain and Ireland Conference, Dublin, Ireland, June 2012; Nursing History in a Global Perspective, International Nursing History Conference, Kolding, Denmark, August 9–11, 2012; New Directions in the Histories of Health, Healing, and Medicine in African Contexts Workshop, August 19–21, 2012, KwaZulu-Natal, South Africa; and the UK Association for the History of Nursing Colloquium, History of Colonial and Post-Colonial Nursing, July 4, 2013, Oxford, UK.

I also have used a number of oral histories for the book. I offer a special acknowledgment to my students, Madeline Reckart and Hillman Scholar Lauren Johnson at the University of Pennsylvania School of Nursing who interviewed the sisters with me. Thanks to the Sisters of the Immaculate Heart of Mary, Mother of Christ: Sisters Mary Nesta, Maria Chinweze Enujiofor; Maureen Bernardine Onovo; Nkiruka Okafor; Immaculata Uwanuakwa; and Maria Nkiru. I am grateful to the Medical Mission Sisters: Sisters Jane Gates, Joan Marie Doud, Margaret Moran, Mary Ann Tregoning, Catherine Shean, Alice Hanks, and Rose Kerschbaumer. And thanks to the many Medical Missionaries of Mary who asked that I not use their names.

I also want to express my thanks to the University of Pennsylvania for its generous support in funding this project through a University Research Foundation Grant; the Provost Undergraduate Research Mentorship (PURM) Award with my student Madeline Reckart; and the School of Nursing’s F(our)ULD Undergraduate Research Award that I received with my Hillman Scholar Lauren Johnson. Both Madeline and Lauren presented papers based on this research at the Southern Association for the History of Medicine and Science Conference, Charleston, South Carolina, February 21, 2013; and the Second Agnes Dillon Randolph International Nursing History Conference, University of Virginia, Charlottesville, Virginia, March 15–16, 2013.

Portions of the following have been used with permission of the publisher: Beyond the Imperial Narrative: Catholic Missionary Nursing, Medicine and Knowledge Translation in Sub-Saharan Africa, 1945–1980, in Transnational and Historical Perspectives on Global Health, Welfare, and Humanitarianism, edited by E. Fleischmann, S. Grypma, M. Marten, and I. M. Okkenhaug, 90–109 (Kristiansand, Norway: Portal Forlag, 2013).

At Rutgers University Press, Peter Mickulas, Rima Apple, Janet Golden, Carrie Hudak, Joy Stoffers, Allyson Fields, Marilyn Campbell, Margaret Case, and others have been dependable editors and have always been enthusiastic about the manuscript. They have encouraged me all along the way, and I thank them for their continued support.

Finally, I acknowledge the love and support from my husband of thirty-four years, Robyn Wall, who, as always, is my best editor and friend; my son Austin, who never ceases to delight me; my long-time friend Cynthia Cantwell whose support and love for fifty years has never ceased; and to my sister, Debra Mann, to whom I dedicate the book. Through my many years of research and writing, she has never lost faith in me. Her love and support has sustained me far beyond the life of this book.

Abbreviations

Into Africa

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, Ireland; and the Maryknoll Sisters from Ossining, New York.²⁵ This book concentrates largely on the MMS in Ghana and Uganda; the MMM in Nigeria and Uganda; and the Maryknolls in Tanzania. It also examines the Missionary Sisters of the Holy Rosary from Ireland in Nigeria; and the Sisters of the Immaculate Heart of Mary, Mother of Christ (IHM), in Nigeria. This latter group is a congregation from eastern Nigeria where there is a strong Catholic enclave.²⁶ By including them in the analysis, I begin to address the problem of the scarcity of African sisters’ voices. Today the IHMs have an international presence in, among other countries, the United States. The MMS and the MMM were established as multinational congregations from the beginning. The Maryknoll Sisters began with a distinctly American identity, although their membership soon internationalized. All the orders are similar in that their mission activities carried the women to many parts of the world. To differentiate their work from that of non-Catholic missionaries, the Maryknolls referred to themselves as missioners, and, with their permission, this term will be used for all the sisters represented in this book.

Ghana, Tanzania, Nigeria, and Uganda obviously do not represent the whole continent of Africa. My focus on these areas reflects my concern with religious and medical change rather than different colonizing projects. Thus, although broad patterns emerge among the women’s religious congregations, the contexts of their work are different; and their influences on health care reveal diverse missionary experiences. Because North Africa represents quite different patterns from sub-Saharan Africa in terms of religion and development, it is not discussed here.

Catholic sisters take vows of poverty, chastity, and obedience, and Catholic tradition views them as ideal missionaries, although a lay mission movement also occurred. For the Catholic Church, marriage is acceptable but celibacy is considered a higher quality. Whereas Protestants were initially reluctant to hire women for missions, eventually Protestant women joined the mission field in great numbers as wives or as single women with professional skills such as teaching, nursing, or evangelism.²⁷ They especially worked for women and children, which allowed them to carve out a niche and power base to participate in ministry. Catholic missioners worked with women and children as well. Influenced by the Church’s emphasis on home and family, women religious ran hospitals and clinics, operated maternal and child care clinics, recruited women for religious congregations, and educated women in schools of nursing.²⁸ A distinction from Protestant women, however, was that, as vowed, unmarried women, nuns had flexibility to be assigned anyplace in the world, and their vow of obedience assured their service wherever their superiors deemed necessary. Missions provided opportunities for leadership and adventure. In both Europe and the United States, a large number of women joined religious congregations, so that by 1920, 90,000 women, many of them from Ireland and Germany, had joined American orders. These groups peaked in the United States in 1965 with 179,954 sisters.²⁹ At the same time, missionary life was risky, and it could serve as a means of redemption.³⁰ In Africa, known as the white man’s grave, sisters’ work in health care could be a sacrificial act in which nuns prepared to die to further their Christian message.³¹

Competing Interpretations

The struggle to reconcile mission work and colonialism has become a key focus of academic study. Distinct shifts in historiography of missionaries have moved from celebratory encomiums to imperialistic interpretations to more nuanced analyses. To be sure, much scholarship has denounced missions for being connected to imperialism and for trying to change cultures. Academic historians of the 1960s and early 1970s were especially critical in linking missionaries with paternalism rather than any humanitarian motives. Postcolonial discourse in the 1970s created yet a different analysis: missions played a central role in creating the stereotype of the non-Westerner as uncivilized and in need of control.³² Appraisals extending into the 1990s, such as the highly influential work by Jean and John Comaroff, provided powerful critiques of missions as cultural imperialists.³³ The title of William R. Hutchison and Torbin Christensen’s book, Missionary Ideologies in the Imperialist Era: 1880–1920, demonstrates this assertion that missionaries used Christianity as a tool of European colonial empires.³⁴ In 2002, Andrew Orta analytically positioned missionaries as oppositions between local and global, indigenous and foreign.³⁵ Many of these scholars were reacting to hagiographic mission historiography that represented missionaries in heroic terms.³⁶ Megan Vaughan’s Curing Their Ills, for example, analyzes British Protestant medical missionary discourse during the colonial era and its representations of Africans. Rhetoric revealed that missions used their medical work as part of a program of social and moral engineering through which ‘Africa’ would be saved. Vaughan is sensitive to the limitations of using missionary language as evidence for actual encounters on the ground, yet her work has held command over academic audiences for years.³⁷

When they first went to sub-Saharan Africa, Catholic missioners participated in both evangelistic and civilizing discourse, with their hospitals serving as