Saving Souls, Healing Bodies: Missionaries and Healthcare Delivery Among Black Communities in the Former Transvaal Province of South Africa during The Twentieth Century

Abstract

The advent of western medicine in imperial/colonial Africa was cast by its mix of advocates as “mission and mandate”. Missionary groups, who comprised a very active stakeholder in colonial social welfare, regarded themselves as being involved in a double mandate of saving souls and healing bodies. Across the length and breadth of colonial Africa, missionaries made their mark as providers of frontline healthcare services in under-served African communities. However, in South Africa the turn towards apartheid stifled missionary activity in the provision of healthcare services. But as this study seeks to show, in the case of the rural Transvaal, when the apartheid state took over the running of medical missions, a variety of missionary groups had - for all their ambiguity - already entrenched themselves as potential pioneers of primary healthcare in some localities. And there were legion.

Keywords: Medical missions, South Africa, Transvaal, native health, primary healthcare

Introduction

Missionary medicine was a pioneer of health services in many parts of rural colonial Africa. As Michael Worboys (1991, 2007) [22] has noted, colonial medicine advanced and presented itself as a “broader enterprise than I[mperial] T[ropical] M[edicine]” as it included “missionary activity, modernization, and protection of the health and welfare of indigenous peoples”. In other words, it was “mission and mandate” (Worboys 1991, 207) [22]. In Africa, mis­sionary explorers such as the Scottish-trained doctor, David Living­stone, and medical pioneers such as Albert Schweitzer and Albert Cook are some of the key names that often feature in discussions about the role of medical missions in Africa. Albert Schweitzer be­lieved that “Medical mission was penitential, a means of ‘righting the injustice and cruelties that in the course of centuries Africans have suffered at the hands of Europeans. Other mission doctors of­ten imagined illness as a manifestation of spiritual corruption, re­garding Africans as inherently diseased and sinful”. On his part, the colonial Ugandan healthcare pioneer, Albert Cook, believed that the medical mission was there to attend to the physical sufferings of the Africans, caused by the diseases, which could be solved through a hybrid spiritual and medical approach (Doyle 2015, Ch.9) [3,4,21].

The dual missionary mandate of “healing bodies” and “saving” souls (Hardiman 2006) [8] was developed in the colonial frontier as a pragmatic approach to the missionary evangelical enterprise. This study outlines the activities of various missionary groups in pioneering ‘native health’ services in the rural Transvaal during the twentieth century. Across the length and breadth of colonial Africa, missionaries made their mark as providers of frontline healthcare services in under-served African communities. However, in South Africa the turn towards apartheid stifled missionary activity in the provision of healthcare services. But as this study seeks to show, in the case of the rural Transvaal, when the apartheid state took over the running of medical missions, a variety of missionary groups (there were legion) had - for all their ambiguity - already started entrenching themselves as providers on community-based health­care services in some localities.

Because of their public image as crusaders of religious moder­nity and anti-indigenous advocates, missionaries have largely re­ceived negative reviews in critical post-colonial literature as they are regarded as part of the broader colonial enterprise. Indeed, quite often missionaries found themselves at loggerheads with in­digenous medical systems, which has been a refuge for many blacks even long before colonisation or the arrival of the missionaries on African soil. However, the negative image of medical missions in the literature is being revamped as scholars underscore their critical importance in challenging and forcing the colonial state to adopt certain policy initiatives that would eventually benefit African com­munities. In Tanganyika, for example, medical missions pioneered “maternal and child healthcare” (Jennings 20006, 227) [2,8,18]. In colonial Uganda, medical missions contributed immensely in the development of a system of primary health care” (Doyle 2015, Ch.9) [4]. In South Africa, missionary medical enterprises do not feature quite prominently in the historiography due to the fact that their work was overshadowed when the segregationist apartheid state took over the provision of medical and educational services in its consolidation of a separate development policy. However, what they had done before deserves attention.

The Advent of Missionaries in South African Society - An Overview

In South African context the role of the missionary societies in the provision of health services could be traced in the late 18th cen­tury when the London Missionary Society became the first to be established after Britain annexed the Cape in 1795. Subsequently, other European missionary societies followed suit. This was part of the broader European self-given mandate civilise the ‘uncivilized’ and redeem the ‘heathens’ from wallowing in sin and darkness. The redemptive narrative was the mainstay of the evangelical activities of European origin, including the British, Dutch, Germans, Ameri­can, Swedish, and Roman Catholic denominations.

As colonialism started to transform African societies, need be­came even greater. In the rural Transvaal, the so-called ‘reserves’ became prime targets of missionary activity. The involvement of these missionary in health service provision filled the health gap left by the state, whose commitment as lethargic. Missionary insti­tutions saw it fit to establish community medical centres for the provision of medical support to the communities. Keegan Kautzky’s (2008) [10] work has highlighted the significance of Elim and Ge­lukspan hospitals in the Transvaal which became ‘seedbed’ of the community-based health and development initiatives that enjoyed the active involvement of rural communities. (Kautzky K.A and Toll­man S.M, 2008) [10] The Care Groups in Elim was one of the most highly effective community health initiatives, which played a major role in the treatment and prevention of eye diseases such trachoma. The different missionary groups and their activities in the Trans­vaal are discussed below.

Dutch Missionaries and Healthcare in the Transvaal

Dutch missionary involvement in the health of the black peo­ple in the Transvaal can be traced back to 1908 when the Neder­duidz Gerformeerde Kerk was established at Bochum. Although their main objective was to convert black people to Christianity, health came to be considered by the Dutch missionaries as crucial arena of missionary enterprise. This interest emerged as a result of the prevailing state of poverty and ill-health among the Baha­nanwa communities under Malebogo, who were marginalised by the Transvaal government when their land was taken and given to the white farmers. As the disease of poverty like tuberculosis was increasing, the ‘NG Kerk’ saw the need to erect a clinic within the church to overcome the problem. The clinic eventually developed into a hospital which is now called Hellen Franz. The success of the Dutch Missionaries at Bochum paved way for additional communi­ty health centres throughout the Transvaal. The opening of George Steggman Hospital at Saulspoort near Rustenburg in 1938 and a clinic at Gelukspan were other developments that extended the ten­tacles of Dutch medical missionary enterprise (Gelfand 1984) [5].

Reverend Abram Rousseau under the auspices of Dutch Reform missionaries, pioneered and contributed to medical missionary work in Sekhukhuneland from 1926 to 1940. His gravely illness, when he was serving in the Anglo-Boer War of 1989-1902, motivat­ed him to accept an offer to serve in the evangelist and healing mis­sion after he prayed and was healed (Jordan 2013, 184) [9]. Rous­seau’s work was a broad social responsibility as he managed to build schools and hospitals in the entire Sekhukhuneland area. One of the Dutch missionary hospitals established as a result of his in­spiration was Maandagshoek, followed by several other missionary hospitals and congregations from 1946 to 1956 (Jordaan 2013,192) [9]. According to G.J. Jordaan’s description of the ‘integral mission’ of the Dutch missionary work, “The different “mainline” churches responded to the needs that they saw, such as sickness and illiter­acy, with the resources they had, such as modern health care and education” (Jordaan 2013, 192) [9].

In 1940 Dr. S. I. Le Roux started a mission station at Groothoek near Zebediela Estate which became one of the most important hospitals in the area (Gelfand 1984,28) [5]. The missionary health services were extended to the southern portion of Sibasa District of Vendaland where a large population of the Venda and Shangaan speaking people were residing. Tshilidzini Mission Hospital was established in 1956. Other mission stations established by the ‘Nederduidze Gerformeerde Kerk’ in the Transvaal included the Ratanang Mission Hospital near the old Bourke’s Luck Gold Mine, Haakdoorndraai about 400 miles from Potgietersrus (Mokopane), a 50-bed tuberculosis treatment centre at Mogalakwena Mission Hospital completed in 1960, Knobel Mission Hospital near Piet­ersburg District in 1961, Mandagshoek near Burgersfort in Sekhu­khuneland and Metse-A-Bophelo near Trichardsdal in the Tzaneen District (Gelfand 1984) [5].

The Dutch missionary hospital at Tsimanyana, situated about 25km north-east of Groblersdal in Sekhukhuneland had a critical impact in the provision of Primary Health Care in the surrounding rural communities. These were communities afflicted by the twin evils of disease and poverty. In an Pam Mamogobo‘s related her experience of poverty that prevailed in the area during the1960s and 1970s, partly as a result of high unemployment levels and un­equal access to resources (Mamogobo 2016) [15] As a purely rural and mountainous area, most of the members of these communities were forced to work on the white farms in Groblersdal and Roetan, where they were earning ‘below bread level’ salaries. Migrants from neighboring countries also added pressure over scarce resources and opportunities.

The medical missionary activities were felt even beyond the boundaries of the Transvaal. Other Dutch Missionary institutions included Thusong Hospital on the farm Shiela in 1968, Elizabeth Ross Mission Hospital in the north-eastern Free State; Nompumele­lo Hospital near Ciskei Homeland in 1962; and other hospitals in Zululand. The ‘NG Kerk’ was of course in competition with other missionary societies who were also keen to establish similar health institutions in order to fulfill their twin aim of saving souls and healing bodies.

The Swiss Missionaries and Healthcare in the Transvaal

The roots of Swiss missionary activity in Southern Africa can be traced back to the 19th century when its major evangelist work fea­tured in some localities in the region, with the prominent earliest one being the Valdezia settlement on the vicinity of the Soutpans­burg mountain range, near Louis Trichardt. Since its inception in the 19th century, Swiss missionary work pre-occupied itself with a variety of issues including ethnographic work, knowledge produc­tion, and health (Harries 2007) [6]. Henri-Alexandre Junod and his son are some of the key names; while Elim is a key Swiss missionary endeavour in the history of rural South Africa. Like other mission­ary denominations, the Swiss considered healthcare to be a useful component of Christian values.

Elim Mission Hospital is the most popular Swiss Missionary es­tablishment in the Transvaal. It originated in the 1890s as part of the activities of the Mission Romande, which sponsored the found­er of the hospital, Dr Georges Liengme (Mabika; Staehelin 2008) [1,13,19,20]. According to Hines Mabika, “The Swiss took advan­tage of the local authorities’ negligence, and implemented their own model of medicalization of African societies, understood as the way of improving health standards” (Mabika 2015,135) [13,14]. The Elim Mission Hospital was pioneering in running a model of rural eye care service, serving a large community afflicted by tra­choma. Since this eye disease was classified as one of the diseases of poverty, the initiative of the hospital to provide preventative and promotive health activities was to a large extent directed towards community needs, most particularly the ordinary poverty-stricken rural population. Elim became the centre of a community health care initiative called the Elim Care Groups. Valdezia clinic predated Elim Mission Hospital. The Swiss spread their tentacles to a num­ber of localities in the Transvaal especially where the Tsonga people were found. They set-up stations in areas such as Shiluvane (near Tzaneen) and Masana (in Bushbuckridge).

Like other institutions of missionary origin, Masana started as a church aiming at spreading Christianity to the natives in the surrounding district. However, existing health challenges paved way for the establishment of a clinic in 1934, with the help of res­ident missionary Reverend A. A. Jaques, assisted by Miss A. Berry (Gelfand 1984) [5]. The establishment of the Masana Hospital (now known as Mapulaneng Hospital) added impetus to the contribution of Swiss missionary activities on health matters. The hospital was established in 1937 as a result of the increasing demand for health care services by surrounding communities. Swiss missions contin­ued to offer health services until Apartheid and homeland assumed responsibilities from the missions.

The Berlin Missionaries and Healthcare in the Transvaal

The Berlin Missionary Society of the Lutheran Church from Ger­many was one of the European missionary societies that directed their focus on the southern African region from the 19^th century onwards. Just like other missionary establishments, its primary aim was the conversion of Africans to Christianity as Africans were generally perceived as being heathens and uncivilised. In order to facilitate its work properly, a variety of dioceses were established to serve the Africans through Christian education. The health services were considered at a later stage when it was realised that poor health, poverty, diseases were becoming a menacing threat to the African communities.

N. Mehlape, a long serving member of the Lutheran Church and a historian, revealed that there were seven dioceses which emerged from the Berlin Missionary Society. These dioceses includ­ed the Scandinavian Lutheran missionaries who worked among the Zulu communities in the South-Eastern diocese in Zululand; the Moravian Lutheran Missionaries who worked among the Tswana speaking people under Western diocese; the Northern Diocese for the Bapedi and the Venda in the Northern Transvaal; the Cape-Or­ange Diocese for the Coloureds in the Cape; the Botswana diocese for the Tswana people in the West; the Eastern diocese for the Swa­zi’s and the Central diocese for Johannesburg and surrounding ar­eas (Mehlape 2007) [16-18].

One of the most important Berlin Mission Stations was Ma­sealama, situated about 50kms from Polokwane. This missionary centre was established during the early 1920s. The missionaries in this area saw the need to extend their services from religion and education to community health development (Letsoalo 2016) [12]; hence a health centre was established (Figure 1).

Figure 1: Lutheran Missionary Health centre buildings at Masealama, Mankweng Area.

Note*: Photo credits: Photo taken by author.

Other health health centres were established throughout the entire rural areas of the Northern Transvaal. These health centres were subsequently closed during the 1990s due to financial con­straints as most of the overseas donors withdrew their funding. Masealama Health Centre was also forced to close down during the early 2000s when the German donors and other funders withdrew their donations (Mehlape 2017) [17,18].

The Methodist Missionaries and Healthcare

The Methodist Christian Church, as one of the protestant churches had its origin from Scotland, founded by Reverend John Wesley during the 18th century. John Wesley was supported by his brother, Charles Wesley and the lay people in the preaching min­istry in churches, homes and open spaces (Leleki 2003) [11,12]. Methodism was introduced in South Africa in the early 19^th century and eventually planted in Warmbath before spreading to other ar­eas in the Transvaal, such as Soutpansberg, Waterberg, and Sekhu­khuneland (htts:://Methodist.org.za) [2]. The Methodist missionary interest in healing matters in Southern Africa was motivated by the poverty and racial inequalities and resultant diseases among the blacks. This was an opportunity for them to evangelize through making meaningful change in people’s lives. Dr. Robert Douglas Ait­ken spearheaded the health activities of the Methodist Church in South Africa and the Northern Transvaal communities. His arriv­al at Gooldville, in Sibasa area, in the Vendaland in January 1933 marked the beginning of his missionary work, which was also based on spreading Christianity with education and health care as part of the church’s mission. His studies as a scientist, botanist, and medical doctor, paved way for his work serving the needs of various black communities in and around Sibasa.

In order to achieve his goals of providing healthcare services to the blacks, he converted some of the buildings left by a doctor who had stayed there for many years, to create a consulting room and dispensary. Further developments were made, including the ren­ovation of dilapidated mission house and its extension into what became known as the Donald Frazer Hospital (Gelfand 1984, 225) [5]. The role of Methodist Church in the Northern Transvaal since 1930s had far-reaching implications in the development of commu­nity health care services of the rural blacks, at least in their area of focus. The number of clinics, hospital beds, nurses and nurses’ homes, doctors funding and infrastructure expanded between the 1950s and 1960s.

Catholic Missionaries and Rural Health

The Roman Catholic Missionary work, like other European churches had its objective of civilising and converting the so-called ‘uncivilised world’ into Christianity. However, education and healthcare also fast became major priorities as reflected in many many colonies in Africa. In South Africa, the Roman Catholic Church managed to accumulate many followers in all four provinces since the Union Government came into being in 1910. In the Transvaal, the church’s mission expanded rapidly in rural communities. This expansion was evident among the Venda, Tsonga, Pedi, Ndebele, Tswana and the Swazi speaking populations, most of who were re­siding in segregated areas where poverty was rife and state neglect quite prominent. The establishment of Catholic clinics and schools within the church’s lands allocated by the government was signif­icant.

By the 1930s in the Transvaal, many Catholic missions with schools and health centres were already in existence (Gelfand 1984) [5]. Although the main catholic centres were located in the urban areas, their missionary work had spread to the surrounding rural villages where their social services were desperately needed due to high levels of poverty and disease. The St. Vincent Hospital in Warmbath was one of the main Catholic hospitals that conveyed medical needs to surrounding Tswana, Pedi and other ethnic and racial groups who migrated to this area in search for jobs. The name St. Vincent was considered because of sisters of charity, who per­formed auxiliary duties as nurses and midwives. The institution had a long history of serving medical assistance to South African Defense Force who were injured during the Second World War. The provision of nurses as well as the training of additional nurses to run the hospital stimulated the development of community health in the area and elsewhere in the Northern Transvaal (Gelfand 1984, 231) [5].

Apart from St. Vincent Hospital in Warmbaths (presently Be­la-Bela), other mission stations adopted similar models, but most popular in the form of clinics and schools. At Subiaco, located about 45km east of Pietersburg, was a primary school and a clinic which were crucial in the provision of services to the surrounding villages of Ga-Molepo and Ga-Mothapo. The takeover of missionary social services in 1973 however, led to the closure of the clinic during the 1980s, while the school remained (Mahlatji 2015) [14]. Other plac­es included Motse Maria near Pietersburg, Glen Cowie in Sekhukhu­neland, and many other Catholic health centres in the Transvaal.

The Contribution of Anglican Missionaries

The Anglican Missionaries also had remarkable influence in the development of community health services in the Transvaal. Al­though their contributions were minimal as compared to other mis­sionary organisations, Jane Furse Memorial Hospital, located east of Groblersdal in Sekhukhuneland emerged as the most important health institution that performed pivotal role in the provision of health services throughout Sekhukhuneland over many years since its establishment. The growth of this hospital was associated with the growing population in the rest of Sekhukhuneland, during the 20^th century, which subsequently influenced the need for addition­al clinics in the area (Booth 1982) [3]. Pam Mamogobo has argued that although racial discrimination was still a stumbling block in the improvement of health services in the area, the efforts of these missionary doctors and other staff members played an immense contribution in the development and growth of black communities in Sekhukhuneland (Figure 2).

Figure 2: The older buildings of Jane Furse Memorial Hospital.

Note*: Source: www.outdoorphoto.community.com, Jane Furse Hospital Boiler // Outdoor Photo Gallery, Accessed on 22 August 2016.

The State Takeover of Missionary Health Institutions

Although the above discussed missionary enterprises had done a great deal of groundwork in the area of health service provision, these efforts were frustrated by the state’s intervention in health matters from the 1970s onwards. From that period, the apartheid state started the process of taking over missionary health institu­tions like clinics and hospitals. The takeover of missionary hospi­tals and other health centres occurred in 1973 when missionary institutions were transferred to the homelands and placed under the jurisdiction of the Department of Bantu Administration and De­velopment. Since the homelands were financially dependent on the Central Government, it became a clear the apartheid state would be in total charge. Although requests for building more hospitals in the homelands were made, the shortage of funds, doctors and nurses remained crucial challenges. Some of the hospitals formerly run by missionaries closed down due to lack of enough resources.

Conclusion

This study has shown that the Transvaal province was a very popular destination of missionary establishments that competed with each other in proving health services to the needy blacks. These faith-based organizations of European origin were instrumental in the building of clinics and hospitals. With financial support from Western countries, and streamlined services, missionaries were able to sustain their programmes effectively. Their successes were also made possible by their ability to train nurses and other mem­bers of the communities as health workers responsible for the prevention of diseases. These missionary efforts were ultimately hampered when their institutions were taken over by the apartheid government in 1973 and placed under homelands. By the time this happened however, missionaries had set themselves a reputation as being providers of frontline community healthcare.

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