Conversionary Sites: Transforming Medical Aid and Global Christianity from Madagascar to Minnesota by Britt Halvorson (review)

Conversionary Sites tells the story of what happens in the wake of medical missions once the missionaries have returned home, have renounced their colonial presumptions, but do not want to let go of the stories or relationships that gave their lives both professional meaning and spiritual portent. Focused on a Minnesota-based Lutheran NGO that sends surplus US medical supplies to a sister organization in Madagascar, the book follows medical discards—such as sutures and blood test finger sticks—as they travel by container ship or in the ethnographer's suitcase from US hospitals to Malagasy clinics. As part of a broader post-1960s shift among mainstream Protestants away from overt colonial missionary work, US Lutheran missionaries scaled back their travel between Minnesota and Madagascar, re-envisioning mission as "partnership" or "accompaniment" instead of conversion. Excess medical supplies took the place of people, serving as a charitable binding agent between Malagasy Christians and their Minnesota counterparts.

In following the medical discards from warehouses staffed by volunteers in Minnesota to their destinations in Madagascar, author Britt Halvorson demonstrates that the meaning of these forms of medical aid are "instrumental" in many senses. For the Minnesotan Lutherans, the donations are a tangible sign of God's love and their commitment to accompany Malagasy Christians. In a similar yet distinct vein, for the Malagasy Christians, including doctors, the medical supplies were most valuable not for their therapeutic uses, but for the foreign connections and future social capital they promised. From the perspective of US medical organizations, the discards, shuffled from US hospital storage closets to Malagasy clinics, represented a tax break. And from the view of Malagasy port authorities, the container ships full of supplies became an increasingly lucrative source of income from duties.

Not simply a follow the money or follow the suture narrative, Halvorson's book inquires into the motivations and testimonies of Minnesotan and Malagasy participants in this transnational humanitarian trade, situating them in personal relationships and broader systems of biomedical capitalism. In this latter sense, Halvorson offers an unusually cogent definition of neoliberalism (instead of letting the word roam over the ethnography as a foggy specter, as is often the case). Gesturing to Loïc Wacquant, she writes: "neoliberalism is not characterized by the total evisceration of the state but the reconstitution of it through a variety of market reforms that support the interest of a political elite" (30). In this case, the elites include doctors, church workers, and NGO volunteers both in Minnesota and Madagascar. But it is clear from her conversations with people in both countries that to be designated "elite" from this theoretical vantage point did not exempt any one from worrying about money, jobs, health, or faith.

The book is structured by six chapters that traverse Minnesota and Madagascar. The first chapter reflects on how Minnesota Lutherans remember and forget—or sometimes rebuke—their history of medical missions in Madagascar. Distinguishing between a previous model of colonial missionary imposition and a contemporary model of accompaniment and partnership, the Minnesotans, in Halvorson's view, "create a split between the (less moral) early colonial past and the (more moral) humanitarian present" (52). The second chapter details the establishment and workings of two US NGOs focused on providing medical supplies to Madagascar, and argues that these groups are shaped by a "biospiritual imaginary" that brings together conservative and liberal Lutherans in Minnesota.

The third chapter hones in on the people and infrastructures that enable the movement of medical discards, through a lens of "economies of blessings and sins" that label some supplies as junk and other supplies as useful, and even redemptive. In the next chapter, focused on questions and concepts of value, Halvorson shows how the US and Malagasy medical and Christian organizations generate different kinds of value through this exchange and its attending relationships. For example, by casting off their discards, US hospitals seek a redemption at...