Health Care Provision in the Central African Federation, 1953-1963
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Portland State University PDXScholar Dissertations and Theses Dissertations and Theses Spring 6-8-2017 Settler Visions of Health: Health Care Provision in the Central African Federation, 1953-1963 Catherine Janet Valentine Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/open_access_etds Part of the African History Commons, and the African Studies Commons Let us know how access to this document benefits ou.y Recommended Citation Valentine, Catherine Janet, "Settler Visions of Health: Health Care Provision in the Central African Federation, 1953-1963" (2017). Dissertations and Theses. Paper 4020. https://doi.org/10.15760/etd.5904 This Thesis is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. Settler Visions of Health: Health Care Provision in the Central African Federation, 1953-1963 by Catherine Valentine A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts in History Thesis Committee: Jennifer Tappan, Chair Richard Beyler Laura Robson Melissa Graboyes Portland State University 2017 © 2017 Catherine Valentine Abstract This thesis examines healthcare provision in the Central African Federation, the late colonial union between the British colonies of Southern Rhodesia, Northern Rhodesia, and Nyasaland (the later independent nations of Zimbabwe, Zambia, and Malawi respectively). Unusually in federal formations, healthcare delivery in the Federation of Rhodesia and Nyasaland became a federal function. “Settler Visions of Health” seeks to explain how the white settler elite reconciled the language of development and multiracial partnership with the underlying values of a settler society. Throughout its short existence, the Federal Health Service maintained a celebratory narrative of success designed to legitimize and justify both the decision to federate health and the Federation’s existence. The takeover of health allowed the federal government to project an image of the Federation as a rapidly developing, progressive nation that had brought significant benefits to the standard of living of African people. The reality was more checkered. The Federal Health Service struggled to live up to its promise of benevolent biopower. It largely perpetuated a colonial legacy that neglected to establish solid foundations of health consisting of sufficient infrastructure, adequate training, and equitable healthcare policies. I argue that the decision to federate health is best understood within a context of settler nation building and that paying attention to the rhetoric and realities of healthcare provision in the Federation illustrates how progressive ideas about access to healthcare and medical careers for African people could serve to maintain a settler colonial order. In addition to maintaining earlier colonial inequities of healthcare provision, federal healthcare policies and practices tended to marginalize i health delivery in the northern territories contributing to the fragile health systems that Zambia and Malawi inherited when they attained independence. ii Acknowledgements This thesis is the culmination of an academic journey that began some years ago as an undergraduate at Portland State University. As such I am indebted to the support and encouragement I have received from the many faculty members of the history department that I have been privileged to work with. I entered the Master of History program at Portland State because I wanted the opportunity to carry out a major research project. It has certainly lived up to expectations. Writing this thesis has been challenging but ultimately deeply rewarding. I am not sure that I can ever adequately express my thanks to my advisor, Jennifer Tappan for all that she has done. Her thoughtful and compassionate teaching of the African past has been inspirational and was a major factor in my decision to go onto graduate school. As my mentor for this project, Jennifer has been a constant source of inspiration. She had an uncanny knack for picking me up when self-doubts threatened the entire endeavor while holding me accountable to get the thesis completed! Thank you, Jenn. I would also like to thank the other members on my committee. I was privileged to have a second Africanist as my outside reader. Melissa Graboyes travelled to Portland from Eugene for my defense and my thesis is that much stronger for her insightful criticism. Laura Robson and Richard Beyler similarly helped me hone my thinking about my project. iii An unforeseen benefit of this work has been the opportunity to interact with scholars from around the world. In Africa, Clement Masakure and Walima Kalusa were quick to respond to my questions about various aspects of my research. British scholar Colin Baker deserves a special mention. An ex-colonial administrative officer and historian of Malawi, Colin provided me with a great deal of information and pointed me to pertinent archival sources for my project. Pamela Shurmer-Smith introduced me to a number of ex-colonials who gave me information about working in the Central African Federation. The staff of the various archives and libraries in London, Edinburgh, and Oxford patiently responded to my requests for research material and graciously suggested other sources. I owe a debt of gratitude to many outside academia too. My friends in the Portland tennis world, some of whom, no doubt, heard more about my project than they wished to, supported and encouraged me. Liz Lamade and Bob Calo generously opened their home to me in London. Heartfelt thanks also go to my family in Australia and South Africa. My adult children, Andy and Claire have always been there for me. Finally, I am profoundly grateful for the emotional and financial support that I have received from my husband and best friend, Ian. I have lost count of the number of delicious and sustaining meals he has cooked for me while I have been buried in books and paper. Thank you, Ian, for everything. iv Table of Contents Abstract .................................................................................................................................. i Acknowledgements............................................................................................................... iii List of Tables ........................................................................................................................vi List of Figures .....................................................................................................................vii Introduction..…………………………………………………......…………..…….……..…2 Chapter One Shaky Foundations of Healthcare in Central Africa…………….…………………..….31 Chapter Two Federating Health………………………………………………..…………………..…57 Chapter Three Creating a “Great Health Service,” 1954–1958……….……….………………………86 Chapter Four The Struggle to Maintain a Colonial Medical Order, 1959–1963………….………...117 Epilogue Endings and Beginnings………………………………………...……………………153 Bibliography.……………...……………………………………………….…………168 v List of Tables Table 1 Staffing: European Government Hospitals, Central African Federation, 1959. ..................................................................................................................................147 Table 2 Staffing: African Government Hospitals, Central African Federation, 1959. ..................................................................................................................................147 vi List of Figures Figure 1 British Central Africa 1950’s. ...........................................................................1 vii BRITISH CENTRAL AFRICA 1950’s Source: www.stampworldhistory.com. 1 Introduction “Although the forward vision and bright ideals of the Federal Ministry withered at the end of [Federation], …it can be justly claimed that the Federal Government in its nearly 10 years of life gave a great impetus and drive to the development of health and medical service of the Federation… The Federal Ministry of Health made a major contribution to the improvement in health and happiness of all the people of the Federation.”1 This thesis is the story of how a postwar vision of health manifested in a late colonial developmentalist setting. The Central African Federation, created in 1953, was the political union between the British colonies of Southern and Northern Rhodesia and Nyasaland.2 The colonies were very different in character. Southern Rhodesia was a settler society and had enjoyed virtual political autonomy since 1923.3 Northern Rhodesia and Nyasaland were administered by the British Colonial Office through the institution of Indirect Rule, a system of Native Authority designed to organize labor, collect taxes, and enforce law. Their economies, too, were different. Northern Rhodesia’s was dominated by copper mining, Nyasaland was predominantly agricultural, and Southern Rhodesia’s was mixed. 1 Federation of Rhodesia and Nyasaland, Annual Reports on Public Health, British Online Archives (BOA), 1963, 2-3. 2 These are the present African nations of Zimbabwe, Zambia, and Malawi respectively. The Central African Federation was also widely known as the Federation of Rhodesia and Nyasaland but also as British Central Africa or Central Africa or simply the Federation. I use all terms interchangeably. For general histories of the colonies see Alois S. Mlambo, A History