The second half of the twentieth century saw momentous changes in Africa, including the end of European colonialism, the transition to national governments, and the rapid growth of African Christianity. African Catholicism flourished with women the majority of active members. Against this backdrop, historian of nursing Barbara Mann Wall has produced a well-researched and multivalent study of Catholic women religious and health care in Africa. Her findings reveal a rich legacy of church-based healing that continues to prosper through transitions from acute to preventative public health care, from western control to African control, and from colonial evangelization to holistic liberation. The combination of in-depth studies of sisters' work in Ghana, Tanzania, and Nigeria with a thematic overview produces valuable insights for historians of African Christianity, global Catholicism, women and gender, medicine and healing, and religion and politics. Wall's major contribution consists of considering multiple generations of health care rather than overfocusing on the colonial moment to the detriment of the Africanization process.

The book begins by situating the medical mission work of Catholic sisters within several scholarly frameworks. Overall, these frameworks emphasize cultural negotiation and indigenous agency over the stereotypical narrative of western religious as solely colonizers. First, Wall addresses the growing literature on transnationalism. She argues that the sisters' work contributed to transnationalism in multiple ways: as part of a global church, they helped to connect different parts of Africa to each other; as multinational religious communities, they transcended national and ethnic boundaries; as healers, they fostered ongoing dialogue among European, American, and indigenous healing practices. A second scholarly framework that Wall engages is gender analysis, which she applies to secularization theory. Wall demonstrates that despite modernization in Africa, women continued to exert religious leadership and connect it to healing. In other words, the work of Catholic women religious countered the secularization narrative of the late twentieth century. The role of white sisters in imperialist contexts is another gendered theme to which the book contributes. Wall points out that religious sisters affirmed African capacities more readily than did other westerners.

The case studies in the book focus predominantly on Anglophone Africa. In Ghana, the first independent sub-Saharan African country, the Medical Mission Sisters (MMS) started hospitals and trained Africans to be nurses. The history of the MMS in Ghana is one of continually negotiated boundaries—between women sister-doctors and male ecclesiastical superiors, between local customs and hospital policies, and between the religious nursing program and a secularizing state. Local nurses and helpers increasingly became the norm. After 1958, the newly independent nation continued to rely on missions to increase medical capacity. In Tanzania, the Maryknoll Sisters undertook programs of rural health care, including the founding of dispensaries and children's clinics. In the Kowak Mission there, Western sisters and local women had a symbiotic relationship, and the foundations were laid for the indigenous community of the Immaculate Heart Sisters of Africa. Wall's research shows that the sisters “provided a wide range of biomedical care as well as preventive services, especially for women and children” (65). The reason why they had a reputation only for curative care was because it was in the interests of the colonial government to paint mission work as inadequate and therefore unworthy of government grants. But after Tanzania became independent in 1961, the government of Julius Nyerere embraced maternal and child health, and the sisters began receiving government support. One of the most fascinating aspects of the history of the Kowak Mission was the complex cultural negotiations that took place between the sisters' use of modern medicine and locals' understanding of disease and between the sisters' and locals' cultural assumptions about payment for services. During the 1970s, the Maryknoll Sisters also got involved with liberation theology and registered strong support for Nyerere's Ujamaa policies.

The Nigerian case study follows the work of the Medical Missionary of Mary, the Holy Rosary Sisters, and the Immaculate Heart of Mary, Mother of Christ Sisters. Igboland, in southeast Nigeria, was the worldwide center for Irish Catholic missions. But the huge investment in medical facilities was threatened once the Nigerian Civil War broke out in 1967. Hundreds of Catholic missionaries found themselves caught in the middle of the war, with the attendant continual theft of medical supplies, hostility to white foreigners from combatants, and ultimate expulsion by the victorious Nigerian government. Fortunately, Nigerian sisters were able to keep Catholic medical facilities from being confiscated by the government by claiming them on behalf of the church and continuing the work begun by the Irish medical personnel. Today, the Catholic health care system in Nigeria is run by Nigerian Catholics.

A theme that cuts through the book is the evolving relationship between Western Catholic and indigenous perceptions of health and healing. Catholic sisters and local healers both assumed a holistic relationship between physical healing and religious worldviews. Over time, sisters' attitudes toward indigenous forms of knowledge moved from condemnation to openness. As they increasingly focused on basic needs and primary health care, they collaborated with indigenous practitioners. Another general trend in health care has been the gradual replacement of missionary sisters by local Catholic leadership, including increased respect for local practitioners and “community participation in decision making” (159). Probably the ultimate symbol of the transnationalism in Catholic medical care is “reverse mission,” whereby African sisters are now working as missionaries around the world.

Barbra Mann Wall has written an excellent book. My only criticism arises from when she attempts to compare Catholics and Protestants. She assumes, for example, that the moratorium debate resulted in a diminution of Protestant missionaries when actually the loss of mainline missionaries was more than offset by increases in evangelical missionaries (22). She ignores the contribution of Mennonites and others when she implies that the Biafran War compromised Protestant medical work (100). But these criticisms are minor and do not diminish her fine research and thoughtful analysis.