Medicine, Mobility and Power in Global Africa is a welcome addition to a growing body of scholarship examining postcolonial medicine, health, and healing in Africa. More than twenty years have passed since Steve Feierman and Jan Janzen co-edited The Social Basis of Health and Healing in Africa (University of California Press, 1992), which set an agenda for approaching health and healing practices as embedded in a broader set of social, political, economic, and historical relations. In broaching the question of mobility and globalization, editors Hansjörg Dilger, Abdoulaye Kane, and Stacey A. Langwick have taken up this agenda and brought it to the postcolonial present while maintaining historical sensitivity.
The volume contains a set of diverse and empirically rich ethnographic case studies that examine the ways in which the circulation of patients, practitioners, medical materials, public health agendas, pharmaceuticals, and capital shape and transform health and healing in Africa. Ghanaian Pentecostal healing rituals circulate and radically transform gender hierarchies as they move between Accra and Philadelphia (Mohr). Structural adjustment policies in Nigeria decimate the local pharmaceutical industry, creating ‘empty’ space that is filled with the United States President's Emergency Plan for AIDS Relief (PEPFAR)-funded AIDS drugs (Peterson). Newly available assistive reproductive technologies in Senegal reconfigure the hopes and expectations of childless couples in Mali hoping for a biomedical solution for the deeply social and intimate problem of having children and therefore making families, relationships, and meaningful lives (Horbst).
Dilger, Kane, and Langwick bring these threads of mobility and power together by synthesizing three strands of anthropological literature: critiques of neoliberalization, examinations of transnational and multidirectional flows, and studies of health and healing in Africa. This approach enables the authors to trace complex assemblages of actors, policies, therapeutics, and other aspects of health care as they travel and invariably generate contestation over health and healing. As the editors point out, ‘the outcomes of these processes are often unpredictable, unstable, and not necessarily “welcome”’ (p. 15). But these processes are generative and bring the stakes of globalization in Africa into sharp relief. Taken as a whole, the book argues that materials, people, practices, and ideas do not only circulate transnationally, they are transformed by mobility along the uneven terrain of global and personal power relations.
The first section, ‘Scale as an effect of power’, examines how the global comes into being in relation to the national, local, and individual. It focuses on how ideas, concepts, and categories developed elsewhere – be they traditional birth attendants (Langwick), empowered HIV positive individuals (Dilger), or community health insurance schemes (Wolf) – emerge in African contexts. The second section, ‘Alternative flows of globality’, examines the ‘the manifold ways in which alternative forms of medicine and health-related globality are produced and negotiated by health professionals, religious leaders, and the health initiatives of individual men and women “on the ground”’ (p. 19). In this section, we see new iterations of both the quest for therapy and the flows of therapeutics with a particular focus on power (Mohr, Horbst). Kane's work on the movement of people and medicines between France and Senegal destabilizes our thinking about the distance between former African colonies and metropolitan sites of colonial control. Adeline Masquelier considers a different set of power relations in Niger in which international attempts to disseminate oral polio vaccines becomes a point of contestation, rumor, and powerful critique of Western-based models of public health. The final section, ‘Moving through the gaps’, explores the movement of people and therapeutics ‘trying to fill the gaps of the global health system’ (p. 21) which has privileged biomedicine. Long-time Somali diaspora members return home for religious healing (Tiilikainen). Chinese doctors bring herbal medicines to East Africa (Hsu). Local forms of healing and ritual cleansing move between Guinea Bissau, Portugal, Spain, and France (Carvalho). This last section reminds readers that the globalization of health and healing in Africa is multidirectional in a therapeutic sense as well – global subjects track back and forth between a broad swath of treatments and traditions.
Given the diversity of case studies and the ambitious project of bringing concerns of Africanist medical anthropology into conversation with the anthropology of globalization, this volume has remarkable cohesion. One thread linking the chapters is the lingering effect of structural adjustment policies on health and healing practices. Another unifying thread is Janzen's idea of ‘Afri-global medicine’, defined as, ‘on the one hand, situations in which sickness and healing in an African setting are affected, addressed, or handled by wider global forces or agencies, or, on the other hand, persons, practices, or material medica that, having originated in an African setting, are used far from their origins yet in a manner reminiscent of, or in keeping with, their original characteristics.’ (p. 115)
Although the volume is theoretically oriented towards problems in anthropology, historians of Africa, particularly those teaching the history of global health or the twentieth century, will find this collection highly valuable.
