Behind the Dispensary's Prosperous Facade: Imagining the State in Rural Niger

Pour sortir [l'état] de sa faiblesse congénitale, il ne suffit pas de prétendre le ravaler comme on le ferait pour une façade.

Etienne LeRoy, L'odyssée de l'état

Why is a building called a "national bank," "university," "state department," "hospital," or "school" when the activities which take place in it cannot be given standard meaning and realities usually covered by those words?

Filip De Boeck, Postcolonialism, Power, and Identity

For the regular visitors to the Dogondoutchi dispensary in the late 1980s whose persistent search for health was repeatedly frustrated by the inadequacy of the medical supplies, the empty shelves of the state-sponsored facility--a stark contrast to the usually well-stocked shelves of the local pharmacy--displayed one of the most flagrant symptoms of the decline of the Nigerien postcolony and the attendant dissolution of authority. Just as the mismanagement of food relief in famine-stricken Niger some twenty-five years ago gave rise to a host of rumors centering on President Hamani Diori's kin and close associates--whose predatory practices earned them the title of le clan des bouffeurs (the clan of the gluttons)--so the resident doctor and nurses of the rural dispensary became in the late 1980s the target of disturbing rumors about the apparent mutilation of the bodies of deceased patients. While the medical personnel were later exonerated after rats were discovered near headless corpses on hospital grounds, the incident nonetheless contributed to increase people's fear of the local facility.

"A place of death (wurin mutuwa), that's what it is!" Dije, the old woman who often visited my neighbors, had once exclaimed. She was referring to the well-known fact that many of those--especially among the elderly--who were hospitalized ended up dying at the dispensary. Whether or not their deaths could have been prevented with "adequate" medical assistance is not clear. During fieldwork conducted in 1988-89, I was told on several occasions that the local doctor rarely made use of the ambulance to transport patients who were in serious condition to the better-equipped hospital of Dosso, some three hundred kilometers away. With little or no fund allocations for gas, the decision to transfer patients was only made for desperate cases. That the patients invariably died on their way to, or in, the Dosso hospital only confirmed some people's suspicions that the dispensary was, in Dije's words, "a place of death." "Those who leave in the ambulance, they never come back," my assistant Yahaya had remarked. Conversations with other residents later confirmed that indeed "the doctor always waited [to send patients away] until it was too late." This sad reality had prompted some residents to nickname the ambulance "the hearse." ¹

The Dispensary: "A Place of Death"

Much has been said and written about the modern state's seemingly boundless capacity to prey upon its citizens in postcolonial Africa (Bayart 1989; Mbembe 1992). Accounts from Nigeria, Sierra Leone, Tanzania, Cameroon, and elsewhere that offer culturally specific commentaries on the "politics of the belly" through which the state and its cronies appropriate the vitality of those subordinated to them periodically remind us of the omnivorous potentialities of the postcolony (Bastian 2000; Geschiere 1995; Masquelier 2000; Shaw 1996; Weiss 1996). Yet, while these visual and visceral displays of predation point to the specific ways in which people are consumed, depleted, or violated by a perverse--but often historically legitimized--power structure, they rarely offer concrete instantiations of what stands behind the gluttonous practices and immoral politics that inscribe themselves so tangibly onto the bodies of the state's victims. Simply put, the state appears to have no palpable existence outside the discursive formations that emphasize its alleged rapacity. Even the images of perverted and predatory consumption that lend it some materiality do not disguise the increasing withdrawal of the state from public...