Pre-colonial health in Malawi
The Maravi Empire and people as the early inhabitants of the region were known, spanned an area encompassing Zambia, Southern Tanzania, Mozambique and modern Malawi, as it exists today. The word, Maravi, translates to ‘land of fire’; therefore famine, drought, fire and conversely rain constitute the four major motifs in Malawian oral literature. The Maravi were a loosely organised society; therefore, the lack of a unified political chieftaincy made the region more vulnerable to slave traders and other tribal intruders. Before the arrival of the missionaries, the Maravi believed in one high god, known as Chauta, practiced ancestral worship, and believed in evil forces of witchcraft were a part of daily life in their religious ‘trichotomy’.
Figure 1 Map of Maravi Migration Routes
Although Malawi is commonly characterised as being ‘discovered’ by the Scottish missionary, Dr David Livingstone, on 1 January 1859, he certainly was not the first European to set foot in the region. The Portuguese had already been present in the area for more than two centuries; however, Livingstone’s arrival effectively marked the beginning of a strong bond between Malawi and Scotland, which continues to this day. Dr Livingstone is said to have shown some respect for the methods of the local African doctors and suggested that the practices of the sing’anga, or traditional herbalist, could provide effective, but rudimentary, remedies such as the use of charcoal and leaves as wraps for wounds. In 1874, following the death of Dr Livingstone, the Church of Scotland arranged for Dr Robert Laws to establish a medical station in the Lake Nyasa region.
According to John Lwanda, in pre-colonial times, the Maravi response to disease encompassed ‘a political element […] bringing together the institutions of spirit worship, medical practice and aspects of taboo enforcing sorcery, witchcraft’, which was organised in the same manner in the village. He maintains that a sophisticated system using effective herbal remedies to respond to disease and epidemics already existed before the inception of Western medicine in the region. It is proposed, therefore, that the Scottish missionaries took an interest in further developing the practice of medicine in this territory out of respect for Livingstone’s professed admiration for the local medical culture. Markku Hokkanen provides a more direct assessment of the missionary objectives in Malawi: ‘[they] had hegemonic aspirations to create a healthy Christian society where missionary medicine would be central’.
David Livingstone’s legacy in the British colonies and protectorates was largely shaped by his success in not only sympathising with the plight of local Africans against the brutal slave trade and colonial systems but by developing an interest and respect for their customs and traditions. His campaign to eradicate the slave trade and his outlook for central Africa (known as the 3 Cs: Christianity, commerce and civilisation) helped to ensure the smooth transition and steady influx of Scottish missionaries into the region. In 1875, the United Free Church of Scotland (hereon referred to as Free Church) had instituted the first schools in Malawi, starting with the Livingstonia Mission at Cape McClear in the Mangochi district. Eventually it established a strong primary education and health system, particularly in the Northern region.
Transition to colonial rule
The Protectorate came into being at the insistence of the Scottish missionaries, who after the initial meetings with Livingstone, became increasingly concerned about the possible division of the territory into an Arab and Swahili slave trade controlled northern portion and the Portuguese settler controlled southern region. In 1889, Alexander Hugh Bruce (Lord Balfour of Burleigh), acting in his capacity as an elder in the Church of Scotland, approached the British Prime Minister Lord Robert Cecil (Lord Salisbury) with a petition signed by 11,000 prominent Scots requesting that the British government declare the ‘land east and south of Lake Malawi a British sphere of influence’.
In July 1889, Cecil Rhodes approached Lord Salisbury with an offer to oversee British interests in the Nyasa region through the British South Africa Company, which already had dominion over colonial expansion in Northern and Southern Rhodesia (present day Zambia and Zimbabwe); however, the Blantyre Mission led by Dr David Clement Scott feared for the outcome of the inhabitants if Rhodes was granted greater influence in the region, citing his ruthless imperial expansion in the Rhodesias as a concern. After great interest and pressure to secure the region, the missionaries of Scotland were successful in their efforts to protect Nyasaland and its inhabitants; the Maravi Empire became the British Central Africa Protectorate (BCA) officially in 1891, with Sir Harry Johnston appointed as Her Majesty’s Commissioner and Consul-General for the Protectorate. The Scottish therefore took advantage of the imperial might of the British Empire to realise Dr Livingstone’s goal to produce a self-sustaining, Christian, African nation.
While the British appeared to have minimal interest in the new protectorate, the Scottish medical missionaries were determined to oversee its success, having already invested in some resources in the area by providing educational, health care and missionary services. Sir Henry ‘Harry’ Hamilton Johnston (12 June 1858 – 31 July 1927), a native Londoner, was an explorer and colonial administrator in British Central Africa from 1882 until 1896.
Figure 2: Sir Henry ‘Harry’ Hamilton Johnston
One of Johnston’s key appointments was Allan Blair Watson, a doctor of medicine, who arrived in British Central Africa in 1891 and was tasked with building the nation’s government sponsored medical service. Though the Scottish consistently challenged each of his ventures vehemently, Johnston pushed his initiatives in Malawi as he was also determined to establish British dominance in the region.
One of Johnston’s main initiatives was on the construction of hospitals across Malawi that were managed by white doctors and mainly served white settler populations, military personnel and administrative staff. In terms of staffing, the colonial government did not train or employ any African doctors or senior medical assistants until 1953. The Scottish missions, however, differed as they sought to educate Nyasa citizens in the methods of European medical treatment. This was case with the Blantyre Mission hospital, which was led by Dr Neil MacVicar. He believed that the facility would be an important teaching hospital for the country, and trained the first medical dressers in 1896. The provision of medical training to the indigenous Africans was considered to be a central, and highly respected feature of the work of Scottish missionaries. So much so that in 1915, the Livingstonia Mission hospital held a ceremony for Maria Chilimbirano, the first black nurse in Nyasaland, when she died at the hospital that year.
The missionaries enunciated their grievances in a journal called The Life and Work of British Central Africa (which was founded and co-edited by Dr David Clement Scott of the Blantyre Mission and Dr MacVicar). The journal effectively became ‘a vehicle for their criticism of British policy both in the protectorate and elsewhere in southern Africa’; it was of critical importance because it was also widely read by a small core of mission-educated Africans’. It also provided the first printed materials into the formation of public health services in Malawi.
John Lwanda, a Malawian physician and historian, provides a thorough and authoritative scholarship on the history of medicine in Malawi. In his book, Colour Class and Culture: A Preliminary Communication into the Creation of Doctors in Malawi (2008), he argues that, ‘colonial issues of class, race, and the resultant multiple identities created by the interaction between colonisation and indigenous cultures remained largely unresolved and contributed to the formation of perceptions, attitudes, expectations, images and identities of doctors’. He maintains that the division between western medicine (mankhwala azungu) and African medicine (mankhwala achikuda) was later used as a narrative by early nationalists to project the narrative of Dr Banda’s quintessential hybridity between Westernism and Africanism in Malawi, as opposed to it being a construct devised by the colonial British overseers of the land.
So in the time before the arrival of Kamuzu Banda, Malawi was considered an anomaly in comparison to its neighbours in the Rhodesias, and German and Portuguese East Africa. While the neighbouring European powers were plundering the natural resources of the land and exploiting the free labour of black Africans, the presence of the Scottish missionaries meant that indigenous people in Nyasaland were provided with primary education and were trained in vocational skills normally designated for white Europeans. As a result, the Scottish missionaries had helped to enact one of the most sophisticated educational and medical systems in southern Africa, out of which emerged Malawi’s first elected president, Dr Kamuzu Hastings Banda (1896-1997).
Independence, Dr Kamuzu Hastings Banda and Multi-party elections
Kamuzu Banda was most likely born in 1896 to Akupinganyama Phiri and Mphonongo Banda in Chiwengo, a village near Kasungu, a predominantly Chewa district in the Central region of Malawi. At birth, he was named Kamunkwhala (a small dose of medicine) however, he renamed himself Kamuzu, meaning ‘little root’, to reflect the story of his mother’s inability to conceive him thus prompting her to seek the assistance of a sing’anga to provide an herbal remedy. He was raised in the ‘area of activity’ of the Livingstonia Mission and in fact his maternal uncle, Hancock Phiri was converted and baptised by Dr Robert Laws.
Figure 3 Kanyama Chiume (left) Dr Banda (centre) holding his signature flywhisk and Henry Chipembere (right) in 1963
Dr Banda received his doctorate of medicine from the Meharry Medical College in Tennessee in 1937 and moved to Edinburgh, Scotland where he registered with the Royal College of Physicians of Edinburgh having received scholarships from the Church of Scotland to further his professional development; it was during this period in Edinburgh when he was made an elder of the Church of Scotland. On the bestowment of this title, an obituary in The Economist succinctly expressed the significance of Banda’s indoctrination: ‘to the elders of the Church of Scotland he was a living tribute to Christian missionary endeavour in Africa’. However, despite his illustrious career in the United Kingdom, it was always his intention to return to Malawi to practice medicine. In 1940, this wish was nearly granted when the Church of Scotland in Edinburgh arranged for Banda to fill a medical position at the Livingstonia Mission, however, an expatriate British nursing staff there rejected the proposal because they were unwilling to serve under a black doctor. This suggests that although the Scottish held a relatively liberal outlook on native Malawians when compared to other Europeans on the continent, there were still factions within the Scottish community that were not immune to the colonial racist narratives that defined the experience of being a subject in an imperialist land. Banda took this rejection in stride and instead set up a medical practice in London under the newly formed National Health Service of England (NHS) in 1948.
In response to the creation of the Federation, the nationalists in Nyasaland had mobilised resistance against British rule. However, most of the key mission-educated coordinators believed that they were either too young or too unconvincing (in the case of Chirwa) to persuade the citizens to follow their lead into independence. They decided that putting their hopes in an elderly, mission-educated and successful medical doctor who had led a flourishing independent practice amongst white Europeans was the best hope for rallying the various tribes in Nyasaland who were likely to be apprehensive of black majority rule. Dr Banda was the perfect prototype of postcolonial success; they calculated that his hybridity of Nyasa heritage blended with British refinement would pacify those who were hesitant to entrust power to a black government. He returned to Malawi in 1958 from Ghana and within a year was imprisoned.
Dr Banda’s yearlong imprisonment by the British government from March 1959 to April 1960 in a Rhodesian prison only served to inflame and push Nyasaland towards independence. Much to the dismay of the British, his cult status in Nyasaland became impenetrable and his projection to leadership was almost certainly secured. Dr Banda would first serve as Minister and then Prime Minister under Nyasaland’s last English Governor-General, Sir Glyn Jones, between 1961 and 1966, and effectively become the first elected president of the Commonwealth of Malawi on 6 July 1966. However, two weeks prior, within weeks of his tenure as Prime Minister, Dr Banda had to quell a rebellion from his ministers who began to object to his desire to expand his presidential powers. The aftermath of what is known as the 1964 Cabinet Crisis was to send a resounding message to the public about the consequences of dissent against Banda.
In 1971, the Malawi Congress Party (MCP) proclaimed Dr Banda as the ‘President for Life’. The citizens of Malawi lived under a twenty-three year autocratic rule before his presidency was openly challenged by 8 Catholic bishops on 8 April 1992. The Lenten Pastoral Letter of 1992 forced Dr Banda to concede to internal and international pressure, allowing for a referendum on the possibility of multi-party elections in Malawi in 1993. In June 1994, Bakili Muluzi defeated Dr Banda in the first multiparty elections.