REVIEW ARTICLE The changing landscape of mission medicine and hospitals in Sub-Saharan Africa Samuel Adu-Gyamfia, Mariama Marciana Kuusaanab, Benjamin Dompreh Darkwac, Lucky Tomdid a PhD, Senior Lecturer, Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Ghana b PhD, Lecturer, Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Ghana c MPhil(c) and Teaching Assistant, Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Ghana d MA(c) and Teaching Assistant, Department of History, University of New Brunswick, Canada Abstract Missions have played numerous developmental roles towards the achievement of economic and social advancement including the provision of healthcare. From their entry into Africa, they have employed numerous methods in order to introduce their Christian faith. The construction of schools and hospitals, engagement in public health campaigns, provision of relevant services for the poor, and spearheading the provision of formal education, among others, have been the most effective mechanisms. The activities of missionaries have taken different dimensions as their scope continues to change over time. Nevertheless, existing literature shows little data on the changing landscape of mission medicine and hospitals in Africa. Using a systematic literature review approach, the current study discusses the changing landscape of mission medicine and hospitals in Sub-Saharan Africa. This contribution dwells partly on the missionary theory of medical practice to define most of the services of these faith- based organization (FBOs) in Africa. Findings from the study have revealed that mission hospitals have established schools and training schemes that allow them to train medical personnel to complement the limited number of health personnel on the continent. In the twenty-first century, they have contributed to achieving the targets of the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs), especially aspects that focus on health. It is evident that while the focus, methods, and partnerships have changed, missions in healthcare have not diverted their attention from sharing the gospel of Jesus Christ. Key words: Changing Landscape, Christian, mission, medicine, Africa, hospitals Dec 2020. Christian Journal for Global Health 7(5) 66 Adu-Gyamfi, Kuusaana, Darkwa & Tomdi Introduction intervention given to the poor and needy.8 The The humanitarian activities of missionaries above, coupled with social changes in African over the years cannot be gainsaid. Throughout societies, have informed various indigenes to 13 history, they have played significant developmental embrace Christianity. Significantly, Christian roles without necessarily shifting from their main missionaries have used Christianity as an alternative goal of evangelizing lost souls. From exploration to system of belief to meet both physical and spiritual 9,10,13 medical care, missionaries like David Livingstone needs for the sick and healthy. Their approach, and Cardinal Charles Lavigerie, among others, have however, has been described to be mostly curative. played significant roles in Africa to open up the In the case of Uganda, Doyle is of the view that, at interior and the people for the spread of the Christian their inception, missionaries used diseases and their gospel.1 positive rush-in to offer counselling and support as 8,14 Missionary groups employed numerous bases to win converts for Christ. mechanisms to make disciples. They constructed Regardless of the above, medical missions are schools and hospitals, engaged in public health mostly regarded as the pioneers—and, in the early campaigns, provided charity for the poor, and days, the only sources—of biomedicine in most 15 contributed cheaper social welfare programmes as areas of Africa, particularly in the rural centers. their most effective tools.2, 3 The establishment of Also, since the colonial era, missionaries have made hospitals and dispensaries stood as the most effective attempts, in collaboration with states, to bridge the 8 soul-winning mechanism for many Christian healthcare gap between the rich and the poor. In missions.4,5,6 Their public health role has been effect, in Africa, missionaries’ strategies have, crucial in incorporating the principles of among other things, aimed at addressing the 15 biomedicine as a viable option in African pluralistic inadequacy of the state provision of healthcare. medical tradition. Since the colonial era, medical A survey of key literature on mission medicine missions have been active in most former colonies.7 has revealed that the major areas of interest for Among the motivations for engaging in the act of medical missions included treating diseases tagged healing are spreading the gospel, making healthcare as unclean among Africans: Hanson’s disease more accessible, and providing holistic care.7,8 (leprosy) and blindness, among others. They also Missionary medicine and its role in Africa does paid attention to maternal and child health as well as not involve the treatment of physical ailments alone.9 public health and hygiene. In colonial Tanganyika, Aside from that, missionaries have promoted and medical missions provided vaccination campaigns, provided hope and encouragement for the sick.7 education for new mothers on hygiene, cleanliness, Also, medical missionaries have provided what and the care for babies in addition to conducting 4 Hardiman termed as an “all-round therapy” intended research on sleeping sickness. to civilize the so-called “primitive people,” getting Some scholars associate missionary medicine them closer to Christian modernity.9,10 Thus, with the colonial state and activities arising within 14 Christian missions resorted to treating both the the same period. Other literature shows the various physical problem of diseases and the spiritual roles and motives of medical missions in Africa and problem of sin.8 other parts of the world. That notwithstanding, The African belief in the social causative literature on the changing landscape of mission theory, which regards diseases as the actions of hospitals remains scant. There exist some data on 16,17,18,19,20 demons or as a result of a misdemeanor, has resulted current mission medicine and hospitals. in the acceptance of missionary medicine and its Nevertheless, the literature has not been directed continuous utilization.11,12 Also, missionaries’ toward the changing landscape of missions and their medicine has thrived in Africa due to their contribution toward the attainment of Sustainable 67 Adu-Gyamfi, Kuusaana, Darkwa & Tomdi Development Goals (SDGs) and Millennium mothers in Christian rhetoric manifested in the Development Goals (MDGs), particularly, in the provision of maternal and child care.4 area of health. It is, therefore, imperative to re- Within the theoretical framework, sin and examine missions’ changing contributions toward suffering are intertwined.25 African physical health delivery in Africa. suffering, thus, reflected the sickness of their soul.5,25 Every sufferer was, therefore, regarded a sinner Theoretical Underpinnings of whose soul needed to be saved while being relieved from physical pains. This alludes to proponents’ Missionary Medicine views on disease as misery and, hence, craving for Theoretically, there is no monolithic approach missionary medicine.4 It can be suggested that to explain and understand the activities of Christian medical missionaries used the above assumptions as missions. Many scholars have propounded varied justification for their commitment to healthcare. theoretical assumptions to define the activities of This, to a larger extent, is used as a premise by some Christian medical missions. Nevertheless, the scholars to argue that missionaries mostly used current discourse finds the missionary theory of medicine to win converts.4,8 Following this view, a praxis a best fit, which holds that missions engage in study on Uganda argues that the quality of care could medical interventions as the examples of Christ in be limited by the decision to attain the maximum 5,21 the Bible. Christian missions have always found number of potential converts.8 As a strategy, some it a necessary responsibility to inform people about medical missions were likely to focus mostly on the gospel before judgement day; Christians hold the “where most converts could be won,” and not belief that Christ would not return until the gospel necessarily where medical provision was in dire 22 reaches all people. In Africa, Christian missions need.4 Since their inception in Africa, the activities resorted to employ strategies that would draw of Christian missions in the area of healthcare have 15, indigenous Africans and prepare them for heaven. undergone significant changes over time. As a 22 One of the major strategies employed was the result, this study contributes to the discourse on provision of medical care. Theoreticians of mission mission medicine by discussing the continuities and medicine believe that missionaries, at inception, changes in medical missionary praxis. defined healthcare provision as part of Christianity The current study attends to Christian medical and a responsibility of Christians arising from the practice as missionaries’ means of attaining a social 23 Bible. References to Jesus’ holistic healing and intercourse with local people over time. Essentially, caring for the sick, as evidenced