Table Of ContentConversionary Sites
Conversionary Sites
Transforming Medical Aid
and Global Christianity from
Madagascar to Minnesota
brit t halvorson
the university of chicago press chicago and london
The University of Chicago Press, Chicago 60637
The University of Chicago Press, Ltd., London
© 2018 by The University of Chicago
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isbn- 13: 978- 0- 226- 55712- 0 (cloth)
isbn- 13: 978- 0- 226- 55726- 7 (paper)
isbn- 13: 978- 0- 226- 55743- 4 (e- book)
doi: https:// doi .org/ 10 .7208/ chicago/ 9780226557434 .001 .0001
Library of Congress Cataloging-in-Publication Data
Names: Halvorson, Britt, author.
Title: Conversionary sites : transforming medical aid and global Christianity from
Madagascar to Minnesota / Britt Halvorson.
Description: Chicago : The University of Chicago Press, 2018. | Includes bibliographical
references and index.
Identifi ers: lccn 2017056177 | isbn 9780226557120 (cloth : alk. paper) |
isbn 9780226557267 (pbk. : alk. paper) | isbn 9780226557434 (e-book)
Subjects: lcsh: Medical assistance, American—Madagascar. | Faith-based hu-
man services—Madagascar. | Faith-based human services—Minnesota. | Missions,
Medical—Madagascar. | Missions, Medical—Social aspects. | Evangelical Lutheran
Church in America—Missions—Madagascar.
Classifi cation: lcc ra390.m6 h35 2018 | ddc 266—dc23
lc record available at https://lccn.loc.gov/2017056177
This paper meets the requirements of ansi/niso z39.48- 1992 (Permanence of Paper).
Contents
Introduction: Conversionary Sites in Global Christianities 1
chapter 1. Remembering and Forgetting through
Medical Aid Work 27
chapter 2. Becoming Humanitarians:
Bodies Multiple in Communities of Aid 64
chapter 3. Redeeming Medical Waste, Making Medical Relief 100
chapter 4. Restructuring Value in Antananarivo 136
chapter 5. Translating Aid, Brokering Identity:
Malagasy Doctors as Precarious Heroes 174
chapter 6. Traversing Shadow Spaces of Accountability 208
Conclusions: Aid’s End Times 239
Acknowledgments 247
Notes 251
Bibliography 265
Index 283
Introduction
Conversionary Sites in
Global Christianities
In Tolagnaro–F t. Dauphin, the main regional center of s outheast Mada-
gascar, a packed dirt path from the main road leads to a three- room
clinic with faded lettering on its side. The clinic is Lutheran, but its wait-
ing room is fi lled with both Catholic and Lutheran patients, as well as
those who mainly follow the ways of the ancestors (fomban- drazana).
The clinic’s staff, a single Lutheran doctor and nurse, greet patients in
a small salle de consultation where a portrait of Jesus hangs over the
threshold, a gurney doubles as an examination bed, and a stethoscope
and blood pressure cuff sit on an adjacent metal cart. These furnishings,
common yet sparse in these particular medical examination rooms, bear
subtle traces of other places, noticeable to observant eyes. Malagasy Lu-
therans in the capital Antananarivo wrote a price in Malagasy ariary on
the stethoscope and, before that, trucked it from the eastern port city
Toamasina. Prior to a long transatlantic journey, it was in the hands of
US aid workers, who prayed over and packaged it and, in the process,
assigned it a new economic value. In an industrial zone of Minneapo-
lis, crosscut by machine shops and infrequently used railroad tracks, two
hundred aid workers collect and sort medical discards from US hospi-
tals, imagining, emailing, and occasionally hosting the Lutheran physi-
cians in Madagascar to whom the discards are sent. Across town, a char-
ismatic Malagasy evangelist– medical doctor instructs US practitioners
how to heal problems holistically with the Holy Spirit, translating tech-
niques from a popular revival in Madagascar.
Signifi cant, far-r eaching questions come into focus when one exam-
ines the religious quality of medical humanitarian initiatives that span
2 Introduction
world regions. What cultural understandings and practices of medi-
cine and healing underpin such aid programs, and how do those broader
fi elds of therapeutic activity shape the distinctive meanings of humani-
tarian work? How do medical relief activities transform what counts as
participation in a global religious community? This book argues that
transnational circulations of medical relief are not simply unidirec-
tional commodity chains, countering popular accounts of the cultur-
ally thin, policy- oriented landscape of relief aid. Rather, they take part
in more complex, transformative and historically shaped cultural prac-
tices of medicine and healing within communities. This is especially the
case among global religious communities, for whom medical relief par-
takes in long- established therapeutic practices of caregiving and healing,
as well powerful moral imaginaries surrounding biomedicine’s ability to
save lives. Religiously- based medical aid shares many qualities with sec-
ular medical humanitarianism, as I will explore, but it is also a signif-
icantly different enterprise, grounded in and transformed by religious
movements.
I suggest in this book that geographically dispersed aid activities,
o ften marginalized as “para-c hurch” work, are actually central cultural
spaces in which North American and African Christians defi ne and ex-
perience the politics and meanings of contemporary global Christian-
ity. Christian aid programs like the Minnesota–M adagascar aid relation-
ship that I examine are vital to understanding global networks that now
link former Christian missionaries and their communities in the United
States with members of Christian churches in parts of sub-S aharan Af-
rica. American and Malagasy Lutherans participate today in a series of
far- fl ung aid exchanges and healing services. Yet their ties with one an-
other build on a long-s tanding US missionary involvement in Madagas-
car. Though colonial missions are often characterized as an artifact of a
distant past, many communities in the United States and sub- Saharan
Africa are actively shaping and renegotiating the meanings of these cul-
tural and institutional ties today through a variety of exchanges, includ-
ing the circulation of medical aid. Conversionary Sites explores how
Christian aid relationships share complex ties with what came before
them, namely colonial-e ra foreign mission work, and studies how Chris-
tians attempt to distinguish humanitarianism as a qualitatively different
activity. It contributes a deeper understanding of the role of religion in
globalizing medicine and forging durable networks for medical humani-
tarian action.
Conversionary Sites in Global Christianities 3
Although medical relief arrangements revive ties today between
distinct places, such as the Midwest US and southern Madagascar, re-
ligion’s role in globalizing medicine is not at all new (Feierman 1985;
Hunt 1999). Christian missions often introduced colonial medicine in
sub- Saharan Africa, as was the case in Madagascar, forging close ties
between biomedicine (fanafody vazaha in Malagasy) and whiteness or
foreignness (Vaughan 1991; Comaroff 1993). Medicine’s associations
with modernity and viable career pathways for African specialists even-
tually grew, however, and solidifi ed its role in the evangelistic mission of
church institutions. Economic crisis in African states like Madagascar in
the late 1970s and early 1980s renewed humanitarian interest in global
medicine’s resource inequalities. Aware of the sharp discrepancies be-
tween what medical anthropologist Julie Livingston (2012, 66) calls the
“highly capitalized” spaces of US biomedicine and the realities of “im-
provising medicine” in many African clinics, some clinicians established
programs to send African clinics the “waste” of US biomedicine, or un-
used medical discards created by planned obsolescence, biomedical in-
novation, and insurance regulations. The Minnesota– Madagascar aid
program is an example of this kind of medical relief. I closely examine
this humanitarian model by situating relief arrangements in the cultural
and historical conditions through which they have emerged.
These initiatives now form part of secular aid agencies and univer-
sity global health partnerships, such as those at Duke and Yale (Rosen-
blatt and Silverman 1992; Mangan 2007; Allen 2017). They diverge in
substantial ways, however, from the kind of medical humanitarianism
commonly described in the existing literature, especially responses to
short- term medical crises and “clinical tourism” or brief medical rota-
tions in foreign clinics (Redfi eld 2005, 2006, 2013; Fassin 2007, 2008;
Wendland 2012b). Medical relief arrangements often involve long-
distance circulations of medical commodities with no easily discern-
ible end point, because of the established and enduring inequalities of
global medical commerce. They thus differ signifi cantly from in situ in-
terventions that treat the bare requirements of biological life in refugee
camps (Agamben 1998) or that proffer emergent care in medical crises
(Redfi eld 2013), as well as from longer- term programs to improve health-
care access by building public health infrastructure (Farmer 2004), or
that elicit narratives of serious medical diagnoses from asylum seekers
as a “humanitarian exception” for citizenship in France (Ticktin 2011).
Relief circulations based on medical resource inequalities, which tran-
