Conversionary Sites: Transforming Medical Aid and Global Christianity from Madagascar to Minnesota

Conversionary Sites: Transforming Medical Aid and Global Christianity from Madagascar to Minnesota

by Britt Halvorson

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Drawing on more than two years of participant observation in the American Midwest and in Madagascar among Lutheran clinicians, volunteer laborers, healers, evangelists, and former missionaries, Conversionary Sites investigates the role of religion in the globalization of medicine. Based on immersive research of a transnational Christian medical aid program, Britt Halvorson tells the story of a thirty-year-old initiative that aimed to professionalize and modernize colonial-era evangelism. Creatively blending perspectives on humanitarianism, global medicine, and the anthropology of Christianity, she argues that the cultural spaces created by these programs operate as multistranded “conversionary sites,” where questions of global inequality, transnational religious fellowship, and postcolonial cultural and economic forces are negotiated.
A nuanced critique of the ambivalent relationships among religion, capitalism, and humanitarian aid, Conversionary Sites draws important connections between religion and science, capitalism and charity, and the US and the Global South.

Product Details

ISBN-13: 9780226557434
Publisher: University of Chicago Press
Publication date: 06/28/2018
Sold by: Barnes & Noble
Format: NOOK Book
Pages: 288
File size: 3 MB

About the Author

Britt Halvorson is faculty fellow in anthropology at Colby College, in Maine.

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Remembering and Forgetting through Medical Aid Work

The storyteller is the figure in which the righteous man encounters himself.

— Walter Benjamin (1968, 109)

Madagascar has long held a prominent place in the geopolitical imagination and imperial projects of US Lutherans in the Midwest. (See figure 1.) Today these century-long ties between Lutherans in the US Midwest and in southern Madagascar have been revived through a medical aid program that sends shipments of U.S.-procured medical supplies to church-run clinics in Madagascar. The aid program thus builds on the history of US Lutheran ties to Madagascar but also seeks to establish a new kind of professional aid relationship that respects Malagasy sovereignty and national authority. Yet how do people involved with contemporary Christian aid arrangements that emerged from colonial foreign mission work, such as the Minnesota-Madagascar aid program, regard their own history? This chapter closely examines how Lutherans in Minneapolis–St. Paul and in the Malagasy capital Antananarivo apprehend the colonial mission past. It reveals that the past is a crucial, often overlooked, resource in the cultural process of becoming Christian humanitarians and in crafting the moral foundation of religiously-based aid.

In this chapter, I pursue a central question: How do certain connections and values of history come to matter in the present for Lutheran humanitarians, while other linkages are erased or muted? I understand the past as a relational value, intimately bound to a sense of the present and continually being made and remade in relation to "present" endeavors, rather than as a container or context for current aid work. I take inspiration here from critical postcolonial studies and, specifically, Ann Stoler's (2008) assertion that imperialist projects are never entirely new but take shape from the "ruins" of what came before. This approach to Christian aid alliances reveals the dynamism, variability, and political qualities of history making and its ongoing, vital role in shaping the dominant sensibilities of aid work. For former US Lutheran missionaries and their U.S.-based supporters, becoming humanitarians has meant reworking histories of mission involvement in Madagascar in particular ways that segment time and morally cleanse the late-colonial period, but not the early colonial past. In the process, former missionaries attenuate their ties to the early colonial past that, in fact, played a strong role in laying the groundwork for current medical humanitarian projects through the introduction of biomedicine in Madagascar. By contrast, Malagasy Lutherans working at SALFA's Antananarivo offices do not cleanse their contemporary aid work of colonial influences. Rather, they identify instances of colonial continuities in the foreign support they seek and the organizational structures they navigate to operate Lutheran medical institutions in Madagascar.

The Lutheran aid program emerged under specific political and economic conditions in Madagascar, as I described in the Introduction. As long-term US missionaries were leaving Madagascar in the late 1970s, the Malagasy economy collapsed after a period of state-endorsed socialism under President Didier Ratsiraka. In the midst of this "economic crisis" and subsequent austerity measures imposed by World Bank structural adjustment, Malagasy Lutheran doctors and former US medical missionaries established in 1979 the Malagasy Lutheran health care department or SALFA to coordinate medical and technical support for individual Lutheran clinics across the island. Many of these Lutheran hospitals had found it increasingly hard to obtain basic medical materials because of widespread commodity shortages, weak currency, and diminished international trade under Ratsiraka's administration. Former medical missionaries organized two NGOs in Minneapolis in the early-to-mid-1980s — IHM and Malagasy Partnership — to send medical relief to SALFA in Antananarivo. Since then, this humanitarian arrangement has continued. With increasing economic hardship during the intervening thirty years in Madagascar, the aid alliance has become part of the long-term functioning of SALFA, which today provides support to forty-eight clinics across the island. Many former US missionaries and their families now voluntarily work for or financially support the two Minneapolis-based NGOs.

The social and political transformations I have described are not limited to Lutheran Christian ties between Madagascar and the United States but form part of a much broader phenomenon that occurred across African states in the 1980s and 1990s. Scholars have documented the rise of a neoliberal order at this time that shifted political power away from centralized states to NGOs and religiously-based organizations (Bornstein 2005; Ferguson 2006). By neoliberal order, scholars refer partly to World Bank and International Monetary Fund structural adjustment plans in postindependence states like Madagascar that favored market liberalization and required austerity in government spending on public services like health care in exchange for high-interest loans (Peterson 2014). Such structural reforms created a greater role for NGOs and other transnational alliances in the provision of social services like health care. Though neoliberalism is an umbrella term with widely varying meanings that can sometimes obscure as much as they reveal (Ganti 2014), I use the term in this chapter to draw attention to how preexisting religious organizations in Madagascar responded to state-based market reforms and, in subsequent chapters, explore the ambivalent cultural relationship of Lutheran aid participants with individualist discourses of accountability "conducive to neoliberalism" (Rudnyckyj 2009, 130). Building on the idea that neoliberalism encompasses shifting techniques and relationships of governing, rather than only market reform in a limited or state-based structural sense, some writers have characterized these loose, horizontally organized, transnational configurations as new political alliances in African nations that, after the 1990s, have increasingly displaced prior, colonialist orientations to citizenship and sovereignty (Nguyen 2010; Piot 2010, 8).

The Minnesota-Madagascar aid alliance offers some interesting qualifications to this thesis. Although Lutherans' aid interventions took the shape of NGO alliances that were fostered under the rising neoliberal order of the 1980s and 1990s, their partnership emerged directly from the structures and encounters of colonial evangelism. In addition, in various ways, colonial pasts still come to matter for both Americans and Malagasy from within these "newer" NGO-based alliances. This evidence suggests the existence of hybrid configurations in African states that are neither rooted only in colonial structures of political rule nor emerging merely from neoliberal transformations in governance but complexly cut of the cloth of both. Also, as Wacquant (2012) has argued, neoliberalism is not characterized by the total evisceration of the state but the reconstitution of it through a variety of market reforms that support the interests of a political elite. This reengineering process can be visible in market liberalization programs in Madagascar since the 1980s that have, in turn, sustained the Minnesota-Madagascar aid program; these state-based market reforms are, as Wacquant (2012, 73) writes, a "space of ... struggles over the very ... priorities of public authority," a subject with a contentious and multistranded postindependence history in Madagascar. Together, the Lutheran aid initiative calls for ethnographic techniques attuned to how people perceive such programs as continuous and discontinuous with what came before them.

Anthropologists have argued that a proliferation of late-twentieth-century cultural experiences of discontinuity and rupture, ranging from migration to the rise of an international aid regime, can be traced to market liberalization and its widespread effects (Comaroff and Comaroff 2000; Ong 2006). I build in this chapter on these far-reaching conversations on late-twentieth-century cultural experiences of displacement amid shifting forms of affiliation and increasingly powerful transnational structures of governance. I am particularly interested, however, in how, even in cultural practices that emphasize disjunctures with what came before them, such as the Lutheran aid alliance, discontinuity is, in some ways, an ideological position that is never perfectly realized and requires ongoing practice. That is, the claim of newness and difference itself forms part of the political power of these transnational alliances. Therefore, I explore how the relationship between cultural continuity and discontinuity is perceived by individual actors themselves — in this case, between the current aid alliance and the colonial history of Lutheran involvement in Madagascar — and examine what kind of cultural work this selective recognition of affinity and disjuncture with the past enables in the medical aid program, and for whom.

In what follows, I organize the chapter as a multilayered dialogue between individuals' contemporary reflections and the colonial history of US-Malagasy interactions. In this process, I aim to show how contemporary reflections serve or critique particular narratives of the past and feature specific forgettings. My approach endeavors to shed light on how "humanitarian sensibilities" take root in global religious communities (Haskell 1985). They are social formations that shape and require a variety of cultural values and practices for their existence, including in this case specific narratives of the past. In turn, my use of the term humanitarian is meant to signal how, through these practices, Lutherans take part in the culturally pervasive process of making their actions, narrated views, and selfhood compatible with the moral order of the broader aid world. Not all of my Lutheran informants adopt the term humanitarian as an identifier for themselves, since some view it as too secular a label to adequately characterize their biblically inspired aid work. Nevertheless, I suggest here and in subsequent chapters that, through their medical relief organizations, they exhibit a humanitarian sensibility and draw heavily from the bureaucratic protocols, technocratic measures, ethical standards, discourse, forms of subjectivity, and funding sources of the broader aid world.

Among these activities, recognizing how Christian aid workers place their own work in time is a crucial part of understanding the cultural and moral logic of Christian aid arrangements. At strategic moments in the chapter, I draw in "forgotten" histories of colonial involvement using archival documents to provide critical alternatives to current US notions of the colonial past. Forgetting here is a culturally patterned, rather than necessarily individual, process that supports the formation of a humanitarian identity in the present time; forgetting thus plays a culturally productive role and is not simply an omission (Connerton 2008, 63). Bringing together these dissonant views mirrors the way that various versions of the past continually erupt, rather unpredictably, in contemporary aid efforts, as I will show throughout this book. To begin, I briefly situate the Minnesota-Madagascar aid program in the early colonial biomedical encounter in southern Madagascar. Given the immense scope of this subject, my aim is to provide a selective portrait of American and Malagasy medical interactions in southern Madagascar to show the colonial and cultural conditions through which Lutheran medicine was introduced, often in sharp contrast to the practices of Malagasy medicine (fanafody-gasy). This medical infrastructure, as it has been enculturated, refused, and reworked in diverse ways across Malagasy communities, constitutes part of the foundation of SALFA's current operation and the aid program.

Revisiting the Role of Colonial Missions in the Globalization of Medicine

Today, the Minnesota-Madagascar aid relationship builds on a century of interaction between Malagasy and Americans in southern Madagascar. Since 1888, US Lutherans have sent about 385 missionaries from Minnesota and the Upper Midwest to southern Madagascar. Norwegian American Lutherans were already well aware of Madagascar when they migrated to the Midwest United States, primarily from 1860 to 1900(Gjerde and Qualey 2002, 2). Along with South Africa, Madagascar had been one of two primary "mission fields" of the Norwegians (Nyhagen Predelli 2003). The Norwegian Missionary Society began evangelism programs in highland Madagascar in 1866, as had other European church societies. Merina Malagasy Queen Ranavalona II opened the country's borders to missionaries and other foreigners in 1861. Ranavalona II went on to make Protestantism a state religion in 1869, a move that strategically aligned the Merina state with the British Protestants of the London Missionary Society and other international societies in reaction to increasing French attempts to annex Madagascar (Nyhagen Predelli 2003, 21).

Following the Norwegians, Norwegian American Lutheran churches dispatched missionaries in 1888 to the region in Madagascar south of the Tropic of Capricorn, or south of Anantsono–St. Augustine in the west and Manantenina in the east, in the land primarily of Mahafaly, Tandroy, and Tanosy people. In the ensuing decades of French colonial occupation (1896–1960), Lutherans built outposts, churches, dispensaries, and schools in the southwest and southeast; when combined with institutions built under the auspices of the Norwegian Lutheran mission in the southern highlands, these became part of the institutional foundation in 1950 for the national Malagasy Lutheran Church or FLM (Fiangonana Loterana Malagasy). Today, the FLM counts nearly three million members and forms one of the island's four largest Protestant churches in a national population estimated to be about 50 percent Christian (Feeley-Harnik 1997, 87; Keller 2005, 40).

Medicine was a substantial component of early mission work in Madagascar, but Americans faced specific French colonial restrictions on how it could be pursued. After French colonial occupation of Madagascar in 1896, US medical doctors and other foreigners were prohibited by the French from practicing medicine in Madagascar without training in "tropical medicine" in France, a policy that increased French administrative control of colonial welfare institutions. Only one American Lutheran Free Church missionary doctor, J. O. Dyrnes, completed this requirement in 1899 and established a dispensary in Manasoa in southwest Madagascar.

Yet even amid French colonial prohibitions, Americans followed the institutional rise of medicine in the United States and the broader movement among European and US foreign mission societies in making medicine an "all but universal" component of mission work by World War I (Walls 1996, 212). In southeast Madagascar, US missions did so primarily through the work of single female missionary nurses, trained at the Lutheran Deaconess Hospital in Minneapolis, who were not subject to the French colonial regulations. From the 1880s well into the 1950s, these nurses dispensed medications from their homes on mission stations, accompanied evangelists to tend to the sick and ailing in outlying villages, and led extensive health and hygiene presentations by "flannelgraph" or during sewing and embroidery lessons. Some carried copies of The New Standard Formulary (1920), a pharmacopoeia guide with which they prepared basic medicines (Vigen 1979, 48). Missionary pastors themselves, using the little medical training they received in seminary, usually brought with them to rural villages during evangelism trips a small medical kit, which included aspirin and later antimalarial medications. I heard stories from retired missionary pastors in Minnesota who continued to do so well into the 1980s.

In the late nineteenth century, foreigners entered a therapeutic environment that already included several kinds of Malagasy medical specialists, such as the ombiasa (Malagasy, healer-diviner) and mpsikidy (Malagasy, herbalist). During the late nineteenth and early twentieth centuries, European and US biomedical practices produced an influential cultural divide between fanafody vazaha, or literally foreign, white, and European medicine, and fanafody-gasy or Malagasy medicine, the latter being an epistemological object brought into existence by the biomedical colonial encounter (Sharp 1993). What came to be referred to as Malagasy medicine or fanafody-gasy is part of a broader complex of ritual practices in Malagasy communities rather than a medical system in the Western sense. These practices center on the ongoing work of achieving a kind of equilibrium in Malagasy relations with the ancestors (Malagasy, razana) and in social relationships with other people, rather than only identifying and treating discrete bodily symptoms. Individuals consult ombiasa, who attribute illness to a range of factors both inside and outside the individual body, including an offense against the ancestors or the breaking of a social taboo (fady) observed by one's kin group or social position. Treatments can include offerings of food for the ancestors, an herbal remedy prepared by a mpsikidy, treatment by a bone setter, or wearing on one's body or placing outside the house a protective talisman, known as an ody, to guard the ailing from external illness-causing agents (Sharp 1993; Harper 2002).


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Table of Contents

Introduction: Conversionary Sites in Global Christianities
Chapter 1. Remembering and Forgetting through Medical Aid Work
Chapter 2. Becoming Humanitarians: Bodies Multiple in Communities of Aid
Chapter 3. Redeeming Medical Waste, Making Medical Relief
Chapter 4. Restructuring Value in Antananarivo
Chapter 5. Translating Aid, Brokering Identity: Malagasy Doctors as Precarious Heroes
Chapter 6. Traversing Shadow Spaces of Accountability
Conclusions: Aid’s End Times

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