Debility and the Moral Imagination in Botswana

3. Male Migration and the Pluralization of Medicine

3 Male Migration and the Pluralization of Medicine Mogopo wa segole ga go ribegwe. —Setswana proverb: The bowl of the cripple is not put upside down. Motse o senang makolwane lo gora lwa one ga loo. —Setswana proverb: A village without young men has no outer walls. This chapter describes two historical processes that transformed the experiences and meanings of debility in southeastern Tswana society from the late 1920s through the beginning of World War II: labor migration and the pluralization of medicine. Both processes had their roots in earlier decades, but in this period they intensi¤ed and came together to reinforce one another. Through labor migration and pluralization of medicine new meanings were assigned to able-bodiedness. Changes in the determination and value of that hazy entity lay at the heart of transformations in disability, debility, and aging. The severe drought and economic depression of the ¤rst half of the 1930s brought great suffering and hardship to southeastern Bechuanaland, forcing thousands of men into the system of labor migration to the South African mines. Migration increased further during the 1940s; the economic upswing brought by World War II deepened the local value of wage labor instead of stemming the tide of migration. Meanwhile, the growth of missionary and government medical services in the region laid the foundations for the binary medical system of later decades. Labor migration drove men into the new western medical institutions for examination and treatment, and biomedicine established the local criteria for migration. Though the impact of these two changes, socioeconomic and medical, were not so radical at ¤rst, they created a series of fault lines running through Tswana society which decades later had tunneled far into daily life. Within these cracks, men and women opened new spaces to renegotiate identities and social institutions. Labor migration and colonial medicine began to alter relations between community members in ways that undermined the moral basis and daily functioning of the southeastern Tswana system of public health. Through wage work, young people gained power and saw increased potential for autonomy from the gerontocracy. This transition threatened the institutional structures of family and generation through which society shaped behaviors designed to placate the badimo. The new regimes of labor and medicine caused a local revaluation of various aspects of personhood,repositioning disabled,chronically ill, and elderly persons within communities and families. Disabled men found themselves marginalized in the emerging socioeconomic order just as the brutality of the mines generated a growing population of debilitated persons. At the core of some of these changes lay a shift in the meanings of key markers in the local imaginative landscape. Wealth, adulthood, and bongaka, like ablebodiedness , all took on new, often-contested meanings through these historical transformations. The changing nature of community was, in part, experienced through the distribution of bodily misfortune and care. In southeastern Bechuanaland in the early 1930s, as in all places during lean and dif¤cult times, the physically frail were the most vulnerable. Megan Vaughan’s work on famine in Malawi suggests ways in which able-bodied men are the least exposed during periods of ecological and economic hardship because of their mobility and social capital . This was the case in Depression-era Bechuanaland. The elderly, the chronically ill, disabled children, and fragile infants succumbed to the vagaries of hunger and disease more quickly than their able-bodied relatives, and men enjoyed much more freedom to seek wage-earning opportunities than their wives or sisters.1 Even for those hardy enough to ride out the drought, hunger and malnutrition had become seasonal and endemic, and access to a wage, which meant access to able-bodied male labor, was now critical for maintenance of basic nutrition.2 Mines were dangerous and unhealthy places where disabling or fatal accidents were frequent events, and life in the mining compounds and work in the deep mine shafts facilitated the spread of infectious diseases. Randall Packard has documented how miners brought home tuberculosis and spread it in their rural communities.3 By the late 1930s, tuberculosis, which was unknown in the nineteenth century, had become endemic in southeastern Bechuanaland. Though pulmonary TB was the most common form among the Tswana, many people suffered from extrapulmonary TB, often in the bones, spine, joints, lymph nodes, or brain, each type with its own particularly disabling effects.4 This debilitating disease left many bedridden and many more weakened and frail, straining the...