Las tecnologías de la información y la comunicación – TIC y su uso

If Innocent had lived near a vascular surgeon, he might have left the hospital with both legs. The process of training, employing and equipping surgeons is no mystery. But it takes money, and money—as this chapter has shown—is something Malawi’s health sector has long been denied. Innocent’s avoidable amputation was the product of a thousand decisions and omissions that left Malawi without the equipped and trained medical practitioners needed to salvage his leg. Many these causes (such as the exclusion

85 _{Shircore, “Report on the Nyasaland Medical Service with Special Reference to a Grant Under} the Colonial Development Fund.” Page 6.

86 _{Gopsill, “A Few Notes on My Life in Zanzibar and Nyasaland from 1926 to 1945.” Page 21.} 87 _{Ibid. Page 20. Gopsill did not explain why he singled out VD patients to bear these costs,} though it was not uncommon for medical officers to consider such patients responsible for their illnesses. See Berry, Before the Wind of Change.

88 _{Gopsill, “A Few Notes on My Life in Zanzibar and Nyasaland from 1926 to 1945.” Page 22.} When in 1937, Gopsill was transferred to Karonga, he arrived to another 100-bed hospital built with funding from the CDF in 1932. Shircore had called for a new hospital at Karonga in 1930. Upon his visit to Nyasaland, he had found a medical officer working out of a mud bricked hospital with a thatched roof. See Ibid. Pages 26, 31.

of education from the 1929 CDA) are quite distal, and only come to light with an analysis that is both geographically broad and historically deep.

The focus on health budgets, political economy, and the moral commitments or greed of individual actors might seem a tad retrograde. Since the postmodern turn, Africanists have written about scarcity in medicine, but they have been especially curious about the innovations, improvisations, appropriations, and hybridizations wrought by health

providers and patients. This vein of inquiry has inspired rich literatures in both the history of medicine and medical anthropology.89

Yet there are pitfalls to this focus, especially when it moves into the realms of policy and practice. Of late, the notions of “reverse and “frugal” innovation (terms imported from business management) have become infatuations in global public health.90 _{The term}

“reverse innovation” assumes that the flow of innovation has historically flowed from

89 _{Projit Bihari Mukharji, Nationalizing the Body: The Medical Market, Print and Daktari} Medicine (London; New York: Anthem Press, 2011); Julie Livingston, Improvising Medicine : An African Oncology Ward in an Emerging Cancer Epidemic (Durham: Duke University Press, 2012); Hunt, A Colonial Lexicon of Birth Ritual, Medicalization, and Mobility in the Congo; Claire L. Wendland, A Heart for the Work : Journeys through an African Medical School

(London: The University of Chicago Press, 2010); Stacey A. Langwick, “Articulate(d) Bodies: Traditional Medicine in a Tanzanian Hospital,” American Ethnologist 35, no. 3 (August 1, 2008): 428–39.

90 _{Shamsuzzoha B. Syed, Viva Dadwal, and Greg Martin, “Reverse Innovation in Global Health} Systems: Towards Global Innovation Flow,” Globalization and Health 9, no. 1 (August 30, 2013): 36. Syed, Dadwal and Martin are quick to point out that the “West” has, and never has had, a monopoly on innovation, they still embrace the term “reverse innovation.” The term itself was coined by Vijay Govindarajan. See Jeffrey R. Immelt, Vijay Govindarajan, and Chris Trimble, “How GE Is Disrupting Itself,” Harvard Business Review, accessed September 17, 2015, https://hbr.org/2009/10/how-ge-is-disrupting-itself. Also see Nigel Crisp, Mutual learning and reverse innovation—where next? Globalization and Health 10 (2014); 14, and Thomas J Bollyky, “New cheap and improved: assessing the promise of reverse and frugal innovation to address noncommunicable diseases,” Discussion Paper, Council on Foreign Relation, June 2015.

“West” to “non-West.” This is, of course, obscurantist, continuing a long-standing and widespread ignorance about the history of innovations stemming from the “non-West.”91

In this way, the politics of reverse innovation” are entirely inapposite to postmodern Africanist literatures, even if both share a concern with “innovation.” The politics of the term “frugal innovation” are subtler, but can have insidious side-effects. Extolling “necessity as the mother of invention” runs the risk of downplaying the fact that, now as in the past, the absence of strong health systems leads most often to suffering and death, not the spark of creativity.

Reexamining the history of health spending—or lack thereof—in British colonial Africa does not necessarily require rehashing the same questions. At stake in much of the earlier literature on this subject was the nature of an imagined unitary soul of colonialism: was it benevolent or malevolent? The battle lines were clear; on one side stood the

hagiographers, and on the other the radical critics.92 _{Here, though, I treat the British}

91 _{Londa Schiebinger, Plants and Empire: Colonial Bioprospecting in the Atlantic World}

(Cambridge, Mass.: Harvard University Press, 2007). Also see Abena Dove Osseo-Asare, Bitter Roots: The Search for Healing Plants in Africa (Berkeley: University of California Press, 2014). 92 _{For examples of hagiographic accounts by colonial apologists, see such works as Gelfand,} Proud Record; Gelfand, A Service to the Sick: A History of the Health Services for Africans in Southern Rhodesia, 1890-1953. For a canonical and wholesale of colonialism, see Walter Rodney, How Europe Underdeveloped Africa (London: Bogle-L’Ouverture Publications, 1972). Frantz Fanon believed that to admit the good that some colonial medicine did would be to concede too much. It would, he feared, allow colonial apologists (like Gelfand) to claim their entire exploitative regime was essentially good. “When the French authorities show visitors through the Tizi-Ouzou sanitarium or the operating units of the Mustapha hospital in Algiers, this has for the native just one meaning: ‘This is what we have done for the people of this country; this country owes us everything; were it not for us, there would be no country.’ There is a real mental observation on the part of the native; it is difficult for him to be objective, to separate the wheat from the chaff…In certain periods of calm, in certain free confrontations, the colonized individual frankly recognizes what is positive in the dominator’s action. But this good faith is immediately taken advantage of by the occupier and transformed into a justification of the

colonial enterprise as simultaneously exploitative, unfree and invested with moral fervor and even heroic works. I turn, instead, to more practical, even prosaic questions: when and why did colonial medicine actually reach African subjects? In what form? And with what consequences? The new resources for health discussed in these chapters were, in the scheme of things, paltry. But, as later chapters will demonstrate, the medical facilities constructed in Nyasaland in the early 1930s would in time become important—and highly valued—to millions of people.

occupation…The colonizer perverts his meaning and translate, ‘Don’t leave, for what would we do without you?’” Frantz Fanon, A Dying Colonialism (New York: Grove Press, 1965).Page 122.

Chapter 4

“We have to wait for riots and disturbances”: Budget cuts in a uniquely quiet Nyasaland, 1935-1945

Abstract

This chapter explores the role of political unrest in colonial medical spending. During the mid- and late-1930s, Nyasaland’s Medical Department annual expenditures barely budged, even as revenues continued to rise. This was a product, in part, of the perception in Whitehall that Nyasaland was a placid backwater, and therefore did not need the political palliative of health spending. This perception, and the resulting retrenchment in health spending, continued after the mchape anti-witchcraft movement swept across the countryside, and even after the return of the millenarian preacher Elliot Kamwana from forced exile in 1937. Looking elsewhere in the British Empire, though, officials saw far graver threats to economic and political stability. Between 1935 and 1940, waves of riots and strikes roiled the oil fields and ports of the British West Indies, the mines of Northern Rhodesia’s Copperbelt, and the cocoa farms of West Africa. This unrest proved capable of stirring the Colonial Office and even the UK Treasury to call for greater health spending as a demonstration of beneficence. The Colonial Office’s connection between unrest and social services spending was forged deliberately. Malcolm MacDonald, the son of the first Labour Prime Minister, became Colonial Secretary in 1938. He played on British anxieties about the future of the Empire to drum up support for the 1940 Colonial Development and Welfare Act. Most of the Act’s initial funding went to perceived centers of unrest, especially the West Indies. Medical administrators in Nyasaland complained bitterly to their superiors, but to no avail; few development funds went to colonies that did not provoke metropolitan anxieties.

Prelude: When the ‘warm heart of Africa’ turns hot: protests against land alienation in a zone of media indifference

Nicotine was dead. The news spread quickly among the crowd gathered on the dirt road outside the Monkey Bay District Hospital. The normally bustling shop stalls hawking sodas and mandazis (fried dough) had been shuttered. Policemen and soldiers stood guard inside the hospital gate. Huddled together in small groups, the adults spoke in hushed tones, their eyes downcast. No one wailed with grief, not yet. Those loud lamentations would come a few days later, at Nicotine’s funeral. Incongruously, a girl skipped around blithely in front of the hospital, her face alight with an unknowing smile. A young man

chided her. “Simuli ndi chisoni?” (“Have you no sympathy?”). The girl stopped, looked about, and quickly adopted the somber expression shared by all the other faces.

Nicotine was a nickname, given to the good-natured youth in his early 20s because he always seemed to have a cigarette in his hand. This is unusual in Malawi where, although tobacco is the country’s leading export, few can afford a cigarette habit. Nicotine lived with his grandmother, and had recently received a good score on his terminal secondary school exams. One person in the crowd reported having seen Nicotine being beaten by a policeman, while another said he saw blood coming out of his nose.

Earlier that day, people from the fishing village of Masasa had gathered outside a local government building where they had heard that their local hereditary chiefs and elected

Malawian soldiers in combat gear inside Monkey Bay District Hospital after protests. February 3, 2015.

officials were holding a secret meeting with a representative from Mota Engil, a Portuguese multinational construction corporation. The Malawi Government and Mota Engil, a publicly traded company with over $2 billion in revenue in 2014, had been in talks for months about plans to build a 5-star resort hotel.1 _{It was to be, in the words of}

one Mota Engil promotional article, a “ranch-style resort, with a beautiful pool, a golf course and an inlet connecting the pool to the lake,” to be operated by “a world-famous brand name hotelier.”2 _{To the surprise of government officials, Masasa residents had}

1 _{“Mota Engil Earnings Release 2014” (Portugal: Mota Engil Group, n.d.).}

2 _{European Times, http://emagazine.european-times.com/EPT-Malawi/transport-and-public-} works-mota-engil-global-leader-transforming-malawis-infrastructure

obtained a copy of closely-held plans showing the resort would displace their entire lakeshore village.

After months with barely any official response to their vocal complaints and well- reasoned petitions, Masasa residents were angry. Most of them had already been

displaced seven years earlier from a verdant plot blessed with fertile farmland in order to make room for company housing. Now, they had built modest thatch-roofed huts on the beach, where most eked out a living as fishermen. They knew from experience not to believe those politicians who painted visions of El Dorado, in which the resort would bring jobs for the many. A $400-per-night lodge, offering snorkeling and water sports, had for years operated near their village. But this reclusive retreat warned residents not to approach if they did not want to risk being shot, and employed only a handful of locals.

The soon-to-be-displaced had been promised monetary compensation, but the plot where they suspected they would be moved was suitable for neither fishing nor farming. And Mota-Engil already had a reputation among rural Malawians for being untrustworthy. In the months leading up to the Masasa protest, another Mota Engil project had run into similar opposition in the nation’s southwest, in Neno District. After the Brazilian mining giant Vale subcontracted to Mota Engil to build a railroad from the Moatize coal mine in Mozambique to the coast, Neno residents accused both companies of reneging on pledges to compensate the displaced with money, schools and health facilities. Hundreds of protestors in Neno had even gone so far as to block the main road leading to the railway

line.3 _{Masasa residents protesting Mota Engil’s machinations with local officials would}

soon prove just as determined.

When officials left their meeting with a Mota Engil representative on the afternoon of February 3, they were met by an angry crowd. The assembly had been stoked to a furor by a rumor that their own officials had just signed away their land. What happened next was the subject of much debate among local Malawians and cursory press reports (none of which were written on the basis of first-hand knowledge or detailed research). The account that follows is the consensus view of most of the dozen people I interviewed in Monkey Bay. The Masasa protesters destroyed the car of Traditional Authority

Nankumba, a car they had heard had been paid for by Mota Engil. Both Nankumba and the Mota Engil representative were bloodied, but not gravely injured, by protestors. The Monkey Bay police deployed quickly from a nearby station, and after being pelted by rocks opened fire on the crowd using live rounds.

The bullets struck eight people. Two would succumb to their bullet wounds, and an additional six would survive after being treated in nearby hospitals. Some of the victims were not even involved in the protest. Just as the officials emerged from their meeting, a nearby secondary school let out. Among those shot (but not killed) were a 14-year-old male student and a 22-year-old man accompanying his sister on her walk home. The two men killed by the police were not even from Masasa. Nicotine lived in another village in

3 _{http://www.nyasatimes.com/2014/09/15/brazilian-vales-railway-project-faces-resistance-in-} malawi/

Monkey Bay. The other victim, who died shortly after being transferred to Mangochi District Hospital, was a fisherman from Cape Maclear.

After the shooting the crowd ran, but they were far from finished expressing their displeasure. A few men ran into town and ransacked a local bar owned by Ward Councillor Bulireni. Bulireni had been a local favorite, having run for office

unsuccessfully a few times before winning the people over with displays of generosity such as letting people use his truck to drive to funerals. But he was rumored to have signed away the Masasa residents’ land to Mota Engil.

Others ran to the home of Chief Njogo, also rumored to have agreed to the land

alienation. While Njogo’s wife hid in a neighbor’s hut, enraged Masasa residents set fire to his kitchen and his outhouse, ripped the doors off their hinges, tore the screens off of the windows, and smashed his dishes. One man outside the hospital said he heard Masasa residents say they would rather die than move.

Such violence was highly unusual for this sleepy town. Most residents could recall hearing gunshots in town only once before, in 1993. That event had occurred after President Bakili Muluzi had ordered the Malawi Young Pioneers, a paramilitary organization maintained by his predecessor, Hastings Kamuzu Banda, to disband. In response some Young Pioneers had driven through town on pickup trucks, shooting off guns and looking menacing, but people didn’t remember anyone being hurt.

This episode included all the outrages and David-and-Goliath drama one would expect to find in a muckraking magazine article. But even in the Malawian press the coverage was sparse and one-sided. A Chichewa-language broadcast on the independent radio station ZodiakFM that evening featured an interview with Mangochi’s Police Inspector. None of the protestors were interviewed, nor were other witnesses. Local newspapers quoted statements from local politicians following the “fracas,” but no reporters interviewed the villagers threatened with displacement or even the victims of the police shootings. For its part, the foreign press did not cover the event.

Not that it would have been easy for reporters to discern what had happened even if they had shown up. There was an imperative to obfuscate on all sides. No one I talked to around Monkey Bay admitted involvement in the protests. And why would they? It would profit them nothing, and risked punishment. Fearing there would be police

reprisals during the night after the protests, the men of Masasa found shelter outside their village. Mota Engil disclaimed any interest in building the lakeside resort, explaining to the press that it was more of a favor to the government. They denied that they had even sent a representative to the meeting on the day of the protest. For its part, the Malawi government claimed that a much-criticized letter agreeing to the alienation of the Masasa villagers’ land was a forgery created by an opposition politician attempting to smear the ruling party. It seemed as though a great conflagration had erupted, and then disappeared from view. The episode barely registered in the media; as in the 1930s (see Chapter 4), Malawians could be seen by outsiders as an entirely placid people.

Still, the protests had lasting effects. Two months later, The Nation, a leading daily, published an op-ed decrying the protestors for throwing up “disincentives to investment” and denying themselves the opportunity for “thousands of jobs.”4 _{There would be no}

compensation, neither from Mota Engil nor the government, for the families of the two boys who had died, or the six who had been injured. Yet despite the paltry and biased media coverage, and the absence of any official remuneration for the injured, Mota Engil cancelled its planned $50 million project. Malawian President Peter Mutharika continued to plead with the company to reconsider.5 _{The protestors had proved surprisingly}

powerful, despite their near-invisibility in the local and international media. I. Introduction

During the mid- and late-1930s, Nyasaland’s Medical Department budget barely budged, even as revenues continued to rise. This was a product, in part, of the perception in Whitehall that Nyasaland was a placid backwater, and therefore did not need the political palliative of health spending. This perception, and the resulting retrenchment in health