Religion in Global Health and Development

Front matter

RELIGION IN GLOBAL HEALTH AND DEVELOPMENT

The,Case of Twentieth-Century Ghana

BENJAMIN BRONNERT WALKER

Contents

Figures and Tables | vii Abbreviations | xi Preface | xiii

Acknowledgments | xvii t The Colonial Foundations of Global Health: Britain, Gold Coast, and Ghana, 1919-61 | 29 2 Religion and Africanising Health: Ghana, 1957-68 | 76 3 Reframing Postcolonial International Health: Ghana, the Netherlands, and West Germany, 1957-90 | 109 4 International Health Campaigns and Christian Mission: Ghana, Europe, and North America, 1950-94 | 146 5 Primary Health Care, Global Health, and Medical Mission: Ghana, the wHo, and the World Council of Churches, 1960-2000 | 186

Conclusion: Religion, the Ghanaian State, and the Future of Global Health | 219

Preface

The dominant historical narratives of global health are strikingly narrow when it comes to religion. In many sub-Saharan African countries the amount of religious health assets (clinics, hospitals, and dispensaries affiliated with or run by religious organisations) can be up to 40 or 50 per cent." Yet, frequently, global health histories are overly instrumentalist and, in focusing solely on high-level institutions like the World Health Organization (wHo), exclude religion.* The diverse, long-term, multi-layered, and contingent formations that created global health (and in which the WHO operates) are squeezed out, along with many non-European and non-American practitioners.’ By exploring the historical role of religion in global health and development, using previously unexplored or underexplored archives, this book breaks new conceptual ground. It offers new ways of imagining transnational collaborations, adding to the increasing efforts to decolonise our health histories both nationally and internationally.

Honing our studies of what global health is and where it comes from requires looking closely at the history of how religious groups — small and large — have jostled for power in communities, colonial states, emerging decolonising nations, and regional governments. It also demands better attention to the battles for supremacy over the meaning of medical care at different spatial scales and to the consequences of delivery, which have been some of the most intractable and far-reaching of the twentieth century. This book interrogates these competing actors and, by using a case study of colonial and postcolonial Ghana, it explores the sometimes slow and sometimes rapid processes of religious transformation that have informed what xiv Preface global health has become. It emphasises how some of the greatest triumphs of global health practice — smallpox eradication, Primary Health Care, disease crisis management — make little sense without understanding the role of medical missionaries, faith-based organisations, and religious communities.

A historical approach focused on religion can offer the chance for improved categories as well as a better picture of who made global health and which various long-term processes factored in its creation. As a political category ‘global health’ has been useful to its practitioners partly because, under its umbrella, a variety of interests can join together while masking deeper conflicts.4 Joseph M. Hodge and Gerald Hödl have conceptualised development as ‘a conscious process of ideas, interventions and practices — one filled with contradictions and fueled by crises, but also amorphous enough to encompass a wide spectrum of expressions and experiences’.5 The concept of ‘global health’ has similar qualities. Organisations and individuals that want to empower particular interpretations of health, to eradicate specific diseases, or even to create wholesale social engineering have united within narratives of universal human endeavour. Yet, it is also within specific cultural encounters between diverse groups that the meanings and the interpretative communities that could practise development and global health took shape. Crucially, both terms were formed and contested in local contexts and traditions, in conjunction with international communities and networks.‘

Developing a coherent debate about how religion, development, and global health relate historically is especially important for understanding fragile and fragmented states. This was abundantly clear during the 2014-16 Ebola crisis in Liberia, Sierra Leone, and Guinea. As Sally Smith and Katherine Marshall argue: ‘Despite religions’ deep-rooted health and social roles ... national governments and international actors were late to appreciate the vital roles of religious actors in addressing Ebola and supporting health systems’.” Not only in this specific instance but across the world, the spread of disease and the absence of well-being can be challenged by better attention to religion, its cultures, its relation to power, and its role in the state.* Notably, in contexts where health care is made up of a patchwork of humanitarian interventions, weak or hollowed-out state services, multi-lateral development financing, and local community medical pluralism, the role of religion can be critical — socially,

Preface xv culturally, and in the basis of governance. Continuing to neglect the historical complexities of religion in our definitions of global health and development will mean further harm to those living at the sharp end of national and international agendas.

Acknowledgments

Writing and researching a global history has incurred debts of gratitude that cross continents. I was helped by many Ghanaians to whom I am very thankful: Fred Sai, Mary Grant, Anna Mary Grant, Francis Grant, the Bediako Family, Felix Konotey-Ahulu, George Ossom-Batsa, Peter Yeboah, Michael Baddoo, the staff at Korle Bu Library, the staff at the National Catholic Secretariat, the staff at the George Padmore Research Library, and the staff at the libraries and bookshops of the University of Ghana. For his friendship, guidance, and inspiration, Jake Obeng Bediako deserves a special mention. I was also supported and directed by many other medical missionaries, health workers, hospital administrators, anthropologists, historians, and global health leaders, especially: the Medical Mission Sisters (Philadelphia), Anne Louise van Hoening, Suzanne Maschek, Mary Ann Tregoning, David Newberry, Naomi Forbes, Doris Hodds, Louise Duncan, Mwai Makoka, Shiva Murugasampillay, Marissa Mika, Hannah-Louise Clark, Stephanie Newell, Sjaak van der Geest, Ted Karpf, Bill Foege, Aliko Ahmed, Ralph H. Henderson, Natasha Gray, Paul Jenkins, Walter Bruchhausen, Donald Henderson, Arthur Hibbles, Nathan Grills, Fawzia Rasheed, and Mimi Kiser. Archivists and librarians in Italy, Germany, the Netherlands, the United Kingdom, and the United States have also been vital to this research, and although there are too many to name, their assistance has been invaluable.

Iam sincerely grateful to the Wellcome Trust for their generosity in funding the Medical Humanities PhD Studentship (108 5 93/Z/15/Z), and with it the extensive travel — to archives, interviews, and conferences — that made this book possible. The main research was xviii Acknowledgments based at the Centre for Global Health Histories (CGHH) — a World Health Organization Collaborating Centre at the University of York. Thank you to the director of the CGHH and my PhD supervisor, Sanjoy Bhattacharya, for his insight, expertise, diligence, and encouragement. Thank you to the CGHH members and university colleagues for reading drafts and discussing ideas: Margaret Jones, Alex Medcalf, Arnab Chakraborty, Suranga Dolamulla, Monica Saavedra, Sarah Hartley, Tara Alberts, Gerard McCann, Sabine Clarke, Shaul Mitelpunkt, Joshua Cockayne, and David Efird. As well as at the University of York, opportunities to present the arguments in this book were provided by international conferences, seminars, and lectures, where I met many fascinating and able scholars: Peking University, Johns Hopkins University, Hughes Hall, Cambridge, African Studies Association UK, UK Libraries and Archives Group on Africa (SCOLMA), Wellcome Witness Seminar on the Worldwide Antimalarial Resistance Network (WWARN) at the University of Oxford, European Social Science History Conference at Queen’s University Belfast, Socialist International Health workshop at the University of Exeter, the ‘Inspiring Communities in Global Health’ event at the Wellcome Collection, the BBC History Magazine Weekend, the ‘Christian Missions in Global History’ event at the Institute of Historical Research, University of London, Global Health Histories Seminar 112 at the World Council of Churches (wcc) in Geneva (with WHO Euro, the University of York, and the Wellcome Trust), and, lastly, the roundtable on the spiritual dimension of health at the wcc organised by the University of Zurich.

The initial ideas and research that gave a foundation for this book were drawn from conversations, lectures, and seminars during my BA and MPhil at the University of Cambridge. The Newton Trust and Peterhouse funding I received, with further grants for travel to Ghana, facilitated the privilege of postgraduate study. I was supervised by David Maxwell and taught by Emma Hunter, who launched my work on Africa, mission, and development. I am also grateful for the fellows of Gonville and Caius College who taught me the practice of history and have given me support along the way, particularly Melissa Calaresu, Annabel S. Brett, Peter Mandler, Robert Priest, Ruth Scurr, and Sujit Sivasundaram.

In writing the book I have benefitted from many helpful reviews, comments, and feedback. Thank you especially to Richard Baggaley, Stephen Taylor, Emma Wild-Wood, Shane Doyle, Joel Isaac, Jesse

Acknowledgments xix

Boardman Bump, Henning Grunwald, Scott Howard, and the editors and reviewers of McGill-Queen’s University Press.

Thank you to the communities, teams, and staff at St Aidan’s and St John Fisher Associated Sixth Form (Harrogate), Holy Trinity Church (Cambridge), G2 (York), and the Diocese of York. For their love and support, thank you to my parents, Ruth and Andy Walker, my brother Jamie, my grandparents Gwen and Geoff Walker, and John and Freda Bronnert. Thank you to all my family, to Debbie Whitehead and Phil Whitehead, Ann and Andrew Bronnert, Derek and Jo Ward, and Alexandra Ward. Thanks also to Josiah Judson and Richard Braham.

Lastly, thank you to a talented and dedicated health service leader, my wife Holly, for her kindness, patience, laughter, and continuous support over the many years of researching and writing this book.

RELIGION IN

GLOBAL HEALTH

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Figure I.1 |‘CHAG Member Institutions (1976): The Growth of Medical Mission in Ghana