The African Transformation of Western Medicine and the Dynamics of Global Cultural Exchange (review)

David Baronov has published a book whose subject matter should appeal to Africanists in a number of different ways. He examines Western medicine in Africa—and also, purportedly, the African transformation thereof—and he does so through the lens of world-systems theory, a perspective with many adherents, including this reviewer. Unfortunately, the promising subject matter is lost in the implementation, and the result is a work likely to be of little use to Africanists.

The book begins with an assertion that signals the problems. Baronov writes that his analysis will rely on many "disparate and overlapping professional fields," including "medical anthropology, medical sociology, medical history, African studies, political economy, and colonial/postcolonial studies," melding them through a "unidisciplinary" approach. He contrasts this approach with "interdisciplinary" research, which he defines as taking place among individuals from different fields working together, but not overcoming the "traditional apartheid structure of academia" (10). This notion of interdisciplinary work is at best a straw man. Baronov seems unaware of the decades of scholarly work in African studies, most often termed "interdisciplinary," in which scholars have drawn productively from a number of different fields. Instead of convincing the reader that he is offering a new analytical approach, he leaves the impression that he is unfamiliar with the fields in which he intends to work.

That impression is confirmed as the book progresses. Rather than demonstrating any sort of mastery of these various fields, he picks and chooses among a number of works without showing any grounding in their theoretical or methodological contexts. Another problem is that he provides essentially no data; no primary sources are indicated and there is no evidence of research in Africa, with the sections on African medical practices based on a small number of dated secondary sources. These accounts (154-78) consist of a section on the Azande based on Evans-Pritchard's 1937 book, Janzen's work on Lower Zaire from the 1960s, information about the Zaramo in Dar es Salaam by Swantz published in 1990, and Good's work from the late 1970s and published in 1987 focusing on the Kamba. References to these works are insufficient to prove the author's thesis about Africans transforming Western medicine. In a questionable methodological turn the author critiques Gerlach's work on the Digo, not based on having read it, but based on a description of it in another work.

It is not just African healing that is given short shrift; Africans are as well. A major problem is the lack of any acknowledgment of African agency in the book. Indeed, there are no Africans at all: social and cultural changes are attributed to the impersonal forces of "Western medicine" and "colonial rule." Most of the book focuses on the background of Western medicine or biomedicine. However, most of this generalized discussion offers nothing novel, and is in fact so general as to be misleading. Again and again the author equates the introduction of biomedicine with the colonial state, and also decries its scientific perspective and lack of spirituality, when the history of missionary medicine in Africa, which is well-developed and contradicts his argument, is ignored. It is not just Christian elements that are ignored: Islam is not mentioned until page 135 and then is not discussed until much later. By the time the topic reappears, however, world-systems theory has disappeared.

Baronov could have succeeded with this topic and this approach, but they would have required detailed data from one or a small number of case studies, and meticulous analyses of the perspectives, thoughts, and actions of African healers and consumers over time. But with no evidence other than what was gathered from dated secondary sources, and with an undeveloped explanation of how the claims relate to world-systems theory, this is a book most Africanists will bypass on their way to more complete works.