Barbra Mann Wall, Into Africa: A Transnational History of Catholic Medical Missions and Social Change Rutgers University Press, New Brunswick, New Jersey, London, 2015.

Barbra Mann Wall, Into Africa: A Transnational History of Catholic Medical Missions and Social Change Rutgers University Press, New Brunswick, New Jersey, London, 2015. £46.50, ISBN 978-0-8165-6633-1 (hardback), pp. xvii +230.


Reviewed by: Joanne R. Davis, Independent Scholar, March 2016.

There can be no question as to the importance of this fantastic study of women religious to contemporary historiography, feminist and gender studies, postcolonial theory, and many other sociological fields besides. This text is an easily digestible investigation into the cross-cultural implications of the work of the Medical Missionaries of Mary (MMM), the Medical Mission Sisters (MMS), Sisters of the Immaculate Heart of Mary Mother of Christ, Nigeria (IHM), and the Maryknoll Mission Sisters (MS), in Ghana, Tanzania, Nigeria and Uganda, between 1945 and 1985. It highlights the participation of women religious in the development and progress of Christianity in third world countries, once the Pope had granted women religious permission to employ their medical education as surgeons and doctors on the missions, where women religious ran medical missions, primarily ‘acute and primary health care delivery systems’ (4). It seeks to relay the ‘mobilization of religious women, their ideas, and their institutions across national borders and continents; the groups with whom they aligned; the outcomes of their work; and how their organization and mission changed during the decolonization and independence periods’ (1). Into Africa is a compelling, varied and pacey read, tracing the participation of women religious in unpredictable wars and political endeavours. It would be useful for laypeople who will find it fascinating and beautifully produced with lavish illustrations, and scholars of all levels who will find Mann Wall’s scholarship at once most timeous, excellent, and useful.

Into Africa takes its place in a moment of a resurgence of interest in alternative purveyors of and perceptions on the reception of Christianity; the text explores some of the stories, which have been buried by the weight of their male counterparts, and undervalued as sites of knowledge. Mann Wall’s archival sources reveal voices of women religious and others traditionally excluded from these histories and depict their vital impact in the lives of people they sought to save as they contributed to the health expectancies of a wide range of communities. They were particularly concerned to care for women and children, and a great deal of their work seems to have focused on developing maternity wards and ante- and post-natal and post-partum care, especially for women with complicated pregnancies and deliveries. Mann Wall includes interviews of ex-patients and users of the hospitals, personnel files and diaries of the nurses and these voices jump in the text. There were literally tens of thousands of Catholic women religious working in this capacity in Africa during the twentieth and twenty-first centuries—in 2007 they numbered 61,886 (2). Deirdre Raftery and Elizabeth M. Smyth (eds), Education, Identity and Women Religious, 1800–1950: Convents, Classrooms and Colleges (2016) to which Mann Wall has contributed a chapter titled ‘Sister-physicians, education, and mission in the mid-twentieth-century’, and Du Mez’s A New Gospel for Women: Katharine Bushnell and the Challenge of Christian Feminism  (2015) also begin to redraft this legacy.

Women religious were distinct from laywomen missionaries and ministers because they had access to the power of the Vatican, which they adopted strategically. They were its emissaries and acted in its auspices with the intention to convert people to the Christian religion and way of life.  Yet their lives were singularly unique and unencumbered by traditional notions of gendered boundaries. It hardly bears mentioning that the lives of many first world contemporaries of these women religious were still bedevilled by sexism and racism in these years––patriarchy still sanctioned marital rape and withheld contraception, even in the first world. These women religious did not challenge assumptions about women’s roles as nurturers. They continued to exist as adjuncts to others’ issues, in service to society. This is never clearer than in Mann Wall’s description of a situation where nuns treated civilians targeted in a civil war during the day only to be approached for medical help at night by the very militants who had targeted them. But their nightly removal of medicines and equipment from hospital buildings in case of a nocturnal take-over shows the artful control they exerted in their application of their work. Indeed, when compared to their contemporaries the French feminists, Irigary, Cixous and Kristeva, who reconfigured the syntactical sexism of French grammar in an attempt to obviate systemic gender bias, American feminists who sought to reconstitute women’s rights to reproductive health systems, and feminists the world over who pared the biological from the ontological in order to create scope for gendered identities autonomous of patriarchal attitudes, these medical women religious shine through as pioneer path-cutters defying patriarchal notions as to their gendered capabilities. Mann Wall highlights the at times quite tense relationships between the women religious and their male counterparts, whether superiors in Rome or in the countries of their residence, through conflict with the bishops and other important men. They took their lives into their hands and lived to the maximum capacity. Moreover these women enabled many African women to access reproductive health, and their positive impact on the dire maternal mortality rates is impossible to calculate. One must respectfully acknowledge a heartfelt gratitude for the safeguarding of these lives.

There is much critical attention paid to the ways in which contemporary societies are involved with one another and enmeshed across borders. The term ‘transnational’ appears frequently alongside terms such as ‘cosmopolitan’, ‘globalised,’ ‘double consciousness theory,’ ‘transculturation’ and ‘multiculturalism’—all used to explain the multitudinous implications of cultural integrations and cross-cultural social growth which Mann Wall argues is at the centre of the exchange between the women religious and their host societies, and which has become more significant in the information age of technology and the internet, email and easy travel. This book refers to historical moments which precede all of these theoretical developments, focusing on the years between 1945 and 1985, between the beginning of decolonisation and the advent of the AIDS/HIV epidemic (6) which took the requirements for primary health provision to new levels. However, the actual significance of the work of the communities in which these women served and practised their medical skills is difficult to glean, and here Mann Wall’s use of evidence and her overall case are less persuasive. Quoting Hunt, Mann Wall explains the term ‘transnational’ as involving “‘micro-historical’ transnational processes at work when ‘histories of diverse places become connected and interdependent’” (3) but this connectedness and interdependence remains unproven within this volume. Whilst Mann Wall explores the impact of western medical practices and religious knowledge on Africa most thoroughly as she depicts the nuns and sisters, both medical and religious, becoming deeply entangled in the African contexts to which they were posted, their reciprocal dependence upon the African communities is not examined, if indeed it did occur. The Catholic Church is described as transnational (4) and, it follows, therefore the Catholic nuns are likewise transnational, but the inherent power dynamics remain unaccounted for, with only one question of the role of the nuns in adopting the ‘white man’s burden’ in Africa; the impact of their African experience on women religious’ development of mission remains unclear: to what extent was their church and activity mutually enriching and built upon equal exchange, and if to a low degree, then to what extent were the women religious perpetuating old models of cultural chauvinism?

Mann Wall depicts the international involvement in the medical work of the nuns most clearly; from the training to the accreditation of nurses, funded and undertaken by European governments and charities, to the donation of medical equipment, medicines, airlifts, from Europe to Africa. It is clear that the nuns were exceptionally resourceful in accessing aid from wherever they could find it with no regard for international propriety. If the Germans were forthcoming, or the Vatican, or the English or Irish, so be it. Also important is the involvement of the women religious in organisations, which foreshadowed Médicins Sans Frontières, and humanitarian aid programmes. But when one considers the lack of representation of the reverse impact of African knowledge systems it seems that ‘transnational’ activities occurring even directly in Africa still only refer to the European experience. Indeed the method of working toward empowerment of the African communities brings to mind the developmental communication model in terms of its dissemination of information. Mother Anna Dengel, founder of the Catholic Medical Missionaries, or the Medical Mission Sisters (MMS) ‘was convinced of the superiority of scientific knowledge, and she wanted to make it available to others’ (3). The participation of African practitioners within the countries’ involvement in the missions is highlighted with particular stress on their role as students in the training programmes which purportedly prioritised their independence and self-sufficiency rather than developing a long-term position of dependencies, but they remain outside of the perimeters of the transnational networks of the countries of these women religious’ origins. What would be useful is a definition of the flow of African people and stakeholders in this transnational movement—it is as if Africa is not and cannot be a viable participant in the transnational sharing of information. There would have been extra information particularly in Chapter 5, Transnational Collaboration in Primary Health Care, where there was space for the impact of traditional African medical knowledge on traditional European medical knowledge and where Mann Wall clearly had access to this information. Perhaps it is the subject of a new book. We wait with baited breath.