Health, Power and Politics in Windhoek, Namibia, 1915-1945

Author: Marion Wallace
Basel Namibia Studies Series, 7
P. Schlettwein Publishing
Basel, 2002
Soft-cover, 17x24 cm, 312 pages, several bw-photos and tabellas, 1 map

Publisher's announcement:

For a century, Windhoek, Namibia's capital, was the site of bitter struggles over racial segregation and colonial rule. This book is the first full-length history of the city's African population and their experience of public health controls and medical care during a crucial part of that period - the first thirty years of South African occupation. In this study, Marion Wallace explores the colonial health care system in Windhoek. She examines the development of hospitals, public health policies and missionary nursing, analysing the dynamics of race, gender and class that shaped them and at the same time building a history of African experience in the capital. The author links public health and the construction of biomedical knowledge to the maintenance of white power in the city, while at the same time arguing for an understanding of the complexity of African agency in choosing options for health care. These options included indigenous healing practices, which remained vibrant in the urban context and helped to shape African identities.

Dr Wallace has seamlessly and meticulously pieced together an impressively large but scattered range of often intractable archival material. Equally impressive, is [her] comparative and theoretical grasp. Her work is grounded in a fine understanding of the history of southern Africa and the recent historiography of colonial medicine more generally. To all these fields she offers some subtle correctives.

Marion Wallace was awarded her PhD from the Institute of Commonwealth Studies at the University of London for this study. She has previously published on 20th century Namibian history and currently works at the Public Record Office (the National Archives of the UK) in London.

P. Schlettwein Publishing (PSP) is an independent publisher, which introduced the Basel Namibia Studies Series to make research from and about Namibia accessible to a wider audience. The Easier Afrika Bibliographien (BAB) houses the only Namibia Resource Centre in Europe, and the only Southern Africa Library in Switzerland. Established in 1971 as a private research institution, it today forms part of a foundation. PSP and BAB share a commitment to encourage research on Africa in general and southern Africa in particular.

Introduction by Shula Marks, University of London:

Until comparatively recently, it was customary to begin doctoral theses on Namibia with a statement about the dearth of its historical literature. Over the past dozen or so years since Namibian independence, that situation has been partially remedied, as the important body of work represented in the volume brought together by 'The Trees Never Meet' Project and published as Namibia under South African Rule: Mobility and Containment, 1915-46 demonstrates. Nevertheless, the scholars involved in that ground-breaking project — including the author of this volume in the Basel Namibia Studies Series — will be the first to admit that enormous gaps still remain. Marion Wallace's doctoral thesis for the University of London, on health and medicine in Windhoek between 1915 and 1945, which was successfully presented in 1997 and is published here, can justifiably claim to be filling at least some number of these historiographical lacunae. The appropriately titled Health, Power and Politics in Windhoek, Namibia, 1915-1945 addresses both the virtually unwritten history of Windhoek and the history of health and healing in Namibia. More broadly, it also constitutes a significant contribution to the small but growing literature on the social and cultural history of medicine in Africa.

In it, Wallace uses health and healing as 'a lens' through which 'to examine the social and political forces which were operating in the capital and the territory more generally' (p. 6). Through studying public health and social healing she is able to unravel the 'complex dynamics' of the gendered racial order in South West Africa in the interwar period; to probe the nature of South Africa's paternalist reformism which especially during the period of martial law was used as a justification for its mandate over the territory; and to reveal the limits of the Union's beneficent rhetoric which always outran its actual practice, which was marked — as it was to a large extent elsewhere in the colonial world — by an indifference to African ill health unless it threatened the well-being of the capital's small white population or undermined the reproduction of its workforce. At the same time, as we shall see, indigenous healing rituals also provide a way of understanding the processes of political reconstruction and social identification for Windhoek's African, especially its Herero, community.

For all her appreciation of the social and political forces at work in the territory, however, Wallace never loses sight of the specificity of medical knowledge and power. While her main interest is in the power relations expressed through and in medicine, not in the production or patterns of disease, she recognises that 'some understanding of the nature of the ill health suffered by Namibians, and its roots in material conditions, is essential to the investigation of issues of discourse and power . . .' (p. 6).

After a powerful introductory chapter on the historiography of colonial medicine and the nature of 'biopower'. Part One of the book thus explores the political economy and municipal politics of Windhoek as the essential context for understanding the dynamics of health and medicine up to 1945, and maps the city's twentieth-century epidemiology.

Part Two looks at the power relations involved in the development of medical policy and institutions, as well as in the delivery of health care by a variety of practitioners in Windhoek — indigenous healers, as well as secular and mission doctors and district nurses. In view of the dearth of such work, Wallace's determination to write the history (as opposed to the anthropology) of changing indigenous healing practices, and to relate them to senses of alternative ethnic identity, and her account of the encounter between biomedicine and the ideas and practices of indigenous healing in South West Africa, are equally striking. It is, moreover, work which can only be done on the basis of painstaking field research, grounded in an understanding of very different popular discourses of the body, and notions of health. Such understandings are not simply of academic interest; they are crucial if we are to find appropriate ways of tackling the HIV/AIDS pandemic, the most daunting health problem to confront the contemporary world in general and Africa in particular.

That indigenous healing practices retained their vitality and remained extremely important in the interwar years (and probably beyond) in Namibia was in no small measure connected to the inadequacies of the under-funded colonial medical services for Africans and their close involvement with the state. For colonial doctors and nurses, as Wallace shows, the colonial hospital may have been intended to convey the superiority of 'western' medicine, and to some extent biomedicine did indeed draw power from its ability to offer effective treatment. Nevertheless as she also shows, because biomedicine was an intrinsic part of the state's system of control, this 'frequently alienated African subjects rather than encouraging [their] acceptance of western values and cultural norms' (p. 162). Thus colonial health care facilities 'were also arenas in which . . . the nature of settler society and colonial domination were challenged, constituted, fixed or altered' (p. 169).

Content:

Basel Namibia Studies Series
Note on this Edition
Introduction by Sbula Marks
Health, Power and Politics in Windhoek, Namibia, 1915-1945 by Marion Wallace
Acknowledgements
Introduction: Understanding Health and Colonial Power
Medicine and Imperialism
Biomedicine as a Component of the Imperial Project
Power and the Practice of Medicine
Systems, Knowledge and Power
The Power of Received Knowledge
Text and Pain
Space, Place and Colonial Domination
The History and Historiography of Windhoek and SWA
Sources of the Book
Conclusion

Part One: Disease, Colonial Medicine and Windhoek
+ Windhoek, 1915-1945:
- Origins, Demography and Politics
- Windhoek's Origins and Development
- Black Urbanisation and Mobility
- White Settlement and Municipal Politics
- Conclusion
+ Windhoek's Locations, 1915-1945:
- The Struggle for the Urban Space
- The Martial Law Period
- The 1920s: Protest and Defeat
- The Depression and Increasing Control
- The Second World War
- Conclusion
+ Health and Medicine in Windhoek during the Period of Martial Law
- The Nature and Effects of Martial Law
- The South African Military, Public Health and Municipal Politics
- The Influenza Epidemic of 1918
- The Measles Epidemic
- The Course of the Influenza Epidemic
- Control and Chaos
- Death and Divisions
- Invisible Nurses?
- The Death Toll and the Aftermath of the Epidemic
- Conclusion
+ The Epidemiology of Windhoek and South West Africa, 1920-1945
- The Sources
- A Chronology of Health and Disease
- Discourses, Silences and Policy
- Infant and Maternal Mortality and Health
- Tuberculosis
- Conclusion

Part Two: Health Care, Politics and Power, 1920-1945
+ Indigenous Medicine
- Indigenous Medical Practices in Central Namibia
- Indigenous Healing in Windhoek
- Conclusion
+ Secular Biomedicine: Structures and Policies
- The German Background
- The Organisation of Biomedical Health Care, 1920-1945
- The Law, the State and Health Provision
- Conclusion
+ Secular Biomedicine: Hospitals and the Contested
- Dynamics of Power
- The Windhoek Native Hospital
- The Location Clinic
- Windhoek's Hospitals: Struggles and Social Control
- Conclusion
+ Missionary Biomedicine
- Medical Mission Work, the RMS and Namibia
- District Nursing in Windhoek, 1926-1945
- Conservatism and Pathologisation
- Hygiene and Evangelism
- Conclusion
+ Conclusions: Choices of Therapy

Part Three: Ideology and Coercion, 1920-1945
+ The Sanitation of Windhoek: Metaphors and Politics
- The Battle-lines
- Struggles over the Main Location
- The Klein Windhoek Location
- Conclusion
+ The Anti-VD Campaign of 1939: Public Health and
- Gendered Repression
- Venereal Disease in Namibia and the League of Nations
- Examination and Coercion
- The Implementation of the Examinations
- From Health to Employment Legislation
- Conclusion

Conclusion
Appendix: Graphs and Tables
Glossary and Note on Orthography
List of Abbreviations
Bibliography
Index (Names, Organisations, Places)