Health, Power and Politics in Windhoek, Namibia, 1915-1945 (review)

Many historians of colonial medicine are tempted to bury themselves in voluminous colonial archives that create an alluring illusion of completeness. In Namibia, the colonial archive is rather scanty, encouraging careful and creative use of the documentary sources that do exist and close integration of these sources with oral histories—at least in the best studies, like this one. The dearth of social histories of medicine in Namibia (pp. 28-29) has also helped Marion Wallace to achieve a closer integration of debates in medical history with more general historical questions than is common in many more well-worn areas of medical history. She has focused her attention on Windhoek, the largest urban center, but she carefully interweaves the story of the town, the country, and its colonizing neighbor, South Africa.

Wallace describes her book as exploring the "exercise and contestation of power in Namibia through biomedicine and indigenous medicine" (p. 9). Namibia provides an interesting case study for this kind of question, with a small colonial settlement and two colonial powers, Germany (1884-1915) and South Africa (1915-90); strong indigenous medical systems; and relatively late and limited biomedical interventions. Specific issues of interest to medical historians in the book include the anti-VD campaign of 1939, choosing between indigenous and biomedical therapies, marginalized colonial science, and health and urbanization.

In her analysis, Wallace makes good and critical use of comparative material from South Africa and elsewhere, pointing out where Namibia has its own trajectory (for example, on African migrancy and urbanization, pp. 46-47). Doing groundbreaking historical analysis is always difficult, especially in the absence of broader urbanization studies—compounded in this case by the scantiness and unreliability of certain key sources, such as demographic and morbidity figures in the interwar years (p. 99) and government records after 1920 (p. 31). (Given the fanfare heralding access to government information in South Africa, it is curious that she was unable to use the archives of the Union Defence Force in Pretoria.)

Wallace concludes, unsurprisingly, that "colonial conditions helped to undermine the health status of the black population and biomedical services reflected and reinforced racial inequalities in the wider society" (p. 247), at both a material and an ideological level. She does also, however, emphasize the ambiguities of Western medicine, as a tool of healing as well as repression; and the way in which Western medicine and the colonial state selectively turned their stereotyping and repressive gaze mainly on black men rather than black women, at least until the 1930s (pp. 248-50).

Another conclusion of the book is that indigenous medicine helped to create a supportive community framework in the context of urban-rural mobility, and, at least among the Herero, was a symbolic means by which men reinforced their authority as elders (p. 142). Africans also used indigenous medical practices to build distinct and new identities, and to "carve out spaces for survival and regeneration in the new colonial order" (p. 197). Africans (and colonists) sought the medical treatments perceived as most effective for specific complaints, whether biomedical or indigenous.

It is hard to fault the careful research and clear focus of this book. It does, however, still read as a Ph.D. thesis, and sits in what is (but should not be) the difficult territory between urban history and medical history. A rewriting exercise might achieve a better integration of the material, including analyses of biomedical and indigenous medicine, and the tables; make more of a narrative; and be easier on the casual reader. But on balance, the book is currently excellent reading, sensitive to the interplay between the material world and ideology; to gender, class, and race; and to language, culture, and ethnicity. It will be of interest to many historians, even those who do not work on Namibia or on colonial medicine.