Sanctified lives: Christian medical humanitarianism in southern Zambia James Wintrup King’s College July 2017 This dissertation is submitted for the degree of Doctor of Philosophy 2 Abstract Sanctified lives: Christian medical humanitarianism in southern Zambia James Wintrup Throughout Africa today Christian missionaries from the United States and Europe are providing more medical assistance than ever before and yet they remain, in much recent scholarship, more often associated with the colonial past than the humanitarian present. In many rural areas of Africa these missionaries provide much of the day-to-day healthcare that is available, treating commonplace afflictions, such as malaria, broken limbs or complications associated with childbirth. This dissertation considers Christian medical humanitarianism and its historical legacies by examining the lives and relationships of the many people who visited and worked at a small mission hospital in rural southern Zambia. Based on archival research and fieldwork (conducted between August 2014 and November 2015, and a month during August 2016), I consider how rural Zambian patients related to the expatriate missionary doctors and Zambian staff as they sought treatment at the hospital. I look at the motivations of the long- and short-term American missionaries, their relations with patients and staff members, and consider how they imagined the beneficial effects of their work. And I examine the place of the Zambian clinical staff members at the hospital – the nurses, clinical officers, laboratory technicians, and others – as they attempted to balance their multiple obligations to family members, neighbours, and friends with the needs of their patients and the high expectations of their missionary colleagues. Engaging with central themes in recent anthropological work on humanitarianism, Christianity, morality and ethics, I argue that Christian missionaries, staff members and patients at the hospital enduringly perceived different aspects of their relationships as morally significant: from the missionaries’ capacity to see the endurance and suffering of Zambian patients as evidence of God’s action in the world, to patients’ praise of the American missionaries as ‘angels’ (bangelo) who arrived from elsewhere and treated them ‘non- selectively’. At the mission hospital, patients, missionaries and staff members brought to their encounters the capacity to perceive moral meaning in their relations in ways that often exceeded one another’s expectations. In response to this, I outline a way of understanding the capacity, among these diverse actors, to perceive moral meaning in their ambivalent and unequal relations. This approach, I suggest, has implications for how we think about suffering, morality and politics, both in contemporary humanitarianism and in forms of anthropological writing. 3 4 Declaration This dissertation is the result of my own work and includes nothing which is the outcome of work done in collaboration except as declared in the Preface and specified in the text. It is not substantially the same as any that I have submitted, or, is being concurrently submitted for a degree or diploma or other qualification at the University of Cambridge or any other University or similar institution except as declared in the Preface and specified in the text. I further state that no substantial part of my dissertation has already been submitted, or, is being concurrently submitted for any such degree, diploma or other qualification at the University of Cambridge or any other University or similar institution except as declared in the Preface and specified in the text It does not exceed the prescribed word limit for the relevant Degree Committee. 5 6 Contents Acknowledgements 9 Maps 11 Chapter One Introduction: themes and overview 13 Chapter Two Speaking with angels: dependence, detachment and the afterlives of 61 medical humanitarianism Chapter Three Dealing with Jesus himself: moral obligations, material inequalities 97 and the missionary vocation Chapter Four Seeing suffering in Africa: faithful Zambians, parochial cosmopolitans 131 and short-term medical missions Chapter Five Between the village and the hospital: the obligations and anxieties 161 of Zambian staff members Chapter Six Conclusion: anthropology, aspect showing and politics 193 Notes 211 Bibliography 237 Appendices 7 8 Acknowledgements Sadly, I cannot name here the people to whom I owe the most. For making this research possible and for showing me inexhaustible generosity during my time in Zambia, my greatest thanks goes to the family I lived with during 2014-2015. Alongside them, my friends who helped me as research assistants welcomed me into their lives and showed me a level of kindness that I had not imagined possible. Members of staff at the hospital accepted my presence with tolerance and humour and I am very grateful to them. The American missionaries – particularly the long-term missionaries I call ‘Tom’ and ‘Hannah’ in the chapters that follow – allowed me to spend time with them and I could not have completed this work without their cooperation and enthusiasm. To the patients and former patients, both at the hospital and further afield, who shared their experiences with me and answered my questions, I am incredibly grateful. In recounting some of their stories here I hope that I am doing justice to their experiences and, in some small measure, beginning to repay my enormous debt to them all. In Zambia, I would like to thank John Siakavuba, Charles Mafa, Austin Cheyeka, Marja Hinfelaar, and Walima Kalusa for their help. In 2014, I was fortunate enough to spend several days with Elizabeth Colson. It was a privilege to meet her and accompany her on a memorable trip to find the living relatives of Chief Monze, whom she had known in the 1940s. When I returned to Zambia in August 2016, I arrived the day before Colson died (aged 99) and was able to witness, at her funeral a few days later, the celebration of a distinctive and incomparable anthropological life. My Chitonga teacher, the late Bruno Mwiinga, taught me a great deal during my time in Zambia. Mr Mwiinga was troubled by the direction in which his country appeared to be heading (from the 2015 elections onwards) and it is a great loss for Zambia that he is no longer around to contribute to shaping the country’s future. I gratefully acknowledge the help of the department of Religious Studies at the University of Zambia, where I was affiliated during 2014-2015. I owe thanks to the staff at the National Archives of Zambia, in Lusaka, and the Archives of the Livingstone Museum, in Livingstone. 9 In the UK, my thanks to the participants of seminars at the University of Kent (in November 2016) and at University College London (in May 2017). On those occasions, Giacomo Macola, Finbar Curtis and Tom Boylston, in particular, made very helpful comments. For his encouragement and help in locating sources my thanks to Mac Dixon-Fyle. I am grateful to Peter Redfield for a stimulating and helpful conversation during a visit of his to Cambridge. In the Division of Social Anthropology, I thank the convenors and participants of the ‘writing up’ seminars for many helpful comments. For financial support, I thank King’s College who helped to fund a preliminary trip to Zambia in 2014. The main funding for this research came from the Economic and Social Research Council (Award No ES/J500033/1). I was fortunate to arrive in Cambridge in 2009 at the same time as Alastair Fraser and Luke Billingham. Alastair has been an inspirational and challenging teacher, without whom I would not have developed an interest in Zambia. Luke has been an intellectually stimulating and generous friend and I’m fortunate to know him. Friends who have helped along the way and offered advice and helpful conversations include Zaf Ansari, Theo Chester, Joe Ellis, Pete Lockwood, Alice Pearson, Ed Pulford, Will Richardson, Farhan Samanani, Bruce Sigrist, Michael Vine, Hugh Williamson, Christina Woolner. Harri Englund has supervised this project and offered his inimitable style of penetrating feedback and wise advice from the beginning. It was through reading Harri’s work that I was initially drawn to anthropology and his approach to the subject has been, and continues to be, a constant source of inspiration. I’m profoundly grateful for all of his help. Finally, I’d like to thank my family. In Lisbon, my thanks to Manuela Ferreira and João Nascimento. My parents, Julie and Stuart, my brother Josh and sister Lilly, have all been a constant source of support and humour. And my love and gratitude to Joana Nascimento, who spent several months with me in Zambia and has made the writing of this PhD possible. 10 Maps Map 1. Zambia (with the Southern Province highlighted).1 Map 2. The Southern Province of Zambia.2 11 12 Chapter One Introduction: themes and overview In 2014, an American missionary doctor, Kent Brantly, appeared on the cover of Time magazine as one of the ‘people of the year’ who had worked to prevent the spread of Ebola in West Africa. After being infected with Ebola himself while working in Liberia, Brantly was given an experimental drug and evacuated to the United States where he received specialist treatment and managed to survive. As the anthropologist Peter Redfield has written, at a ‘critical moment of crisis and evacuation some climb on a plane and others do not, their very existence weighed by a passport’ (2016: 223). This point was made visible in February 2017 when Salome Karwah, a Liberian