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In the case of the struggles over the control over the ZMA it therefore suited Colonial Medical Service objectives to portray Indians and Arabs as untrustworthy sponsors — representatives of communities that were particularly susceptible to disease and that lacked personal hygiene. The organisation was conceived as a means of supplying trained midwives to attend Asiatic, Arab and African women in their confinements. As registrations of births on Zanzibar were unreliable, it is difficult to gauge how successful the ZMA was in real terms, although the yearly statistics show that attendances rose steadily throughout its existence, except for a dip in , which was explained away as part of the worldwide Depression.
From the start the ZMA had a rather ambiguous status. The British contributed an annual grant initially 4, rupees 18 towards the running of the ZMA and the rest of the Association was supported by private subscriptions and donations, as well as from the profits made from any fees charged to patients who could afford to pay set at 75 shillings per case. While the Indian and Arab representatives understandably wanted to make provision for their own communities, the British tended to advance the African cause, which they increasingly saw as their responsibility within the terms of the dual mandate.
Aside from the date of its foundation, a few other dates mark important points in the history of the ZMA and highlight the progressively acrimonious relations that developed between the Association and the Colonial Medical Service and peaked during the s.
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In the Mwembeladu Maternity Home was opened as the institutional base for maternal welfare work. A period of particularly intense British criticism led up to this administrative overhaul. In the ZMA announced its hope to start a midwife-training programme, as a means of extending its services to the rural areas.
It planned to recruit rural women for training at Mwembeladu and then let them return to their home communities to practise their skills. The British, however, refused to help the ZMA in their scheme, a move which ensured its failure. They knew that the ZMA could not expand without their support and went so far as to financially punish the ZMA for its apparent lack of foresight. The bitter attitude of the British medical department preferred total absence of rural maternity services to exclusive provision by the ZMA.
The new Reserved Articles of the Association were produced in reaction to this dissatisfaction over representation, financial mismanagement and long-brewing misunderstandings over administrative proprietorship of the Mwembeladu Home. The aim was to make the ZMA more transparent and administratively efficient and was a clear response to vocal British claims of financial incompetence, cumbersome bureaucracy and internal discord. Almost as soon as the Articles were enacted, the British began to actively pursue investigations into the financial dealings of the ZMA and to re-agitate for control over Mwembeladu.
These prolonged investigations coincided with more general moves towards the regulation of colonial midwifery.
The British government seized upon them as further support for its argument that the ZMA could function adequately only if it was run and policed by the Colonial Medical Service. The Central Midwives Board in the UK had been established in , but during the s it began to extend its regulatory framework for the training and conduct of midwives within the British Empire. Partly in response to this, in Medical Officer Violet Sharp introduced her new formal training scheme for midwives on Zanzibar — a clear snub to ZMA midwifery training initiatives which had been underway since the s.
Miss Locket, the ZMA chief midwife, was only too aware that tighter restrictions were to be introduced and saw the potential effects that this would have on the ZMA, which relied on illiterate local midwives trained via an apprenticeship system. The succession of events was relatively rapid. By discussions were already underway for the ZMA presidency to be taken over by a British Medical Officer, and in — the year of Indian independence and a point when nervousness about colonial rule was at a high — the British government formally took over control of the ZMA, installing Dr J.
Earl as president and severely limiting Indian and Arab representation. Against such legislative pressures, the ZMA had little option other than to capitulate. The work of the ZMA and the tensions between it and the British government need to be understood in the broader context of colonial maternal health provision at that time. It is striking that the Colonial Medical Service was so antagonistic towards the ZMA, as no other formal provision for maternal welfare existed in Zanzibar under the government medical services. Over and beyond the local tensions, this perhaps demonstrated a more general nervousness about any organised social provision on the island outside government control.
The late arrival of government maternal and child welfare services in Zanzibar is somewhat of an anomaly in the region. Medical reports of the period all reiterated the ill-effects of the chronic lack of resources and constantly complained about the lack of personnel and the consequent inability to make any real inroads into either hospital-based or community-based healthcare provision. The low priority afforded to maternal healthcare on Zanzibar no mention was made of maternal or child health in any AMR before 46 should be understood in this local context, but it was still enormously behind the rest of Empire; with discussions of colonial healthcare within contemporary textbooks devoting chapters to the centrality of structured maternity care within British possessions.
Indeed, the lack of such healthcare provision on Zanzibar also frustrated the British medical administration. It was conventional throughout Empire for a Woman Medical Officer WMO to be appointed to oversee maternity and child welfare work and, from , the British medical department on Zanzibar regularly lobbied the Colonial Office to have such a colonial servant posted to the island.
When the chief medical advisor to the colonial officer, A. Although the British were unable to offer any alternative organised maternity provision on Zanzibar until the early s, they were nevertheless extremely anxious about the work of the ZMA and what this might indicate in terms of the erosion of their perceived Western medical hegemony. Simply put, the medical department found it very difficult to support any healthcare facility that it could not absolutely control, regardless of the local needs it fulfilled or the popularity it enjoyed.
At the heart of the increasingly problematic relations between the ZMA and the Colonial Medical Service lay the general assumption of European racial superiority, as demonstrated throughout Empire in the motives of the civilising mission. A short history of the ZMA, written by an anonymous British official, explicitly reminisced on the regrettable predominance of old-fashioned birthing practices that existed in Prior to its inception the populace was dependent on the services of untrained and ignorant women whose unclean habits and ingrained prejudices and customs were responsible for much suffering and mortality among lying-in women and new-born children.
Typically, high mortality and propensity towards disease were explained in terms of indigenous culpability through resistance to change. Similarly, the AMR of the British government declared that:. Natives of a tropical country have many and varied parasites to contend with. Their past traditions are those of apathy and indifference and these can only be gradually overcome. Nothing dramatic can therefore be expected, but rather a gradual improvement spread over the course of years. Ideas specifically connecting maternal health with flawed and unhygienic behaviour were particularly marked.
The need for maternal health provision was presented as one of the most important challenges because indigenous women were generally considered to be especially superstitious influences within the social fabric. Shocking stories were current of methods employed. The self-proclaimed ardency of the ZMA to bring clean and safe modern practices to traditional communities gave it an affinity with the biomedical priorities of the Colonial Medical Service, which was also preoccupied with stamping out superstition and enlightening its colonial subjects to the benefits of modern Western medical techniques.
However, during times of conflict between the two groups, the British preferred to distance themselves from the funders of the ZMA, often making derogatory comments against the health habits and management acumen of the Indian, and, most damningly, the Arab, populations of Zanzibar.
Such negative rhetoric was used to justify attitudes towards, and even sanctions against, these particular groups. At the same time, the British frequently used opportunities to criticise the health habits of the Arab and Indian communities, characterising them as far from redemption in matters of health and hygiene, and hence calling into question the utility and effectiveness of the ZMA.
This was an inversion of the usual British ordering of indigenous civilisations, but it crucially served British purposes in that it tarnished the reputation of the group that was giving the government the most competition with all the implied political threats that this entailed on the islands.
A snippet from the AMR is indicative:. It is to be regretted that the average poor-class Indian is utterly deficient in any sense of hygiene. To shut out all light and air, to crowd together, to spit freely and constantly all over the place, whether indoors or out, seem to be ingrained habits with them. They have a complete disregard of sanitation laws for the public welfare and are quite prepared to hide cases of infectious disease if they think that its notification to the authorities will cause them inconvenience, as was shown in the case of Small-pox concealed by Indians in the bazaars.
The natives, too, are equally fond of stuffiness, overcrowding and expectoration, and, although when they live in their own mud and wattle huts they make some attempt at cleanliness, they soon lose this when they crowd into the already crowded bazaars.
Corrie Decker — People in the Social Science Departments at UC Davis
It might be thought that if the British genuinely felt that the Arab and Indian communities of Zanzibar were most in need of health improvements, these sectors would be thought the most deserving — or at least the most worthy targets of reform — but rather, the British seemed to use these denunciatory images to justify and help reiterate their exclusive orientation towards the African communities.
This points to the crux of the issue, clearly summarised in a letter of The Association [therefore] caters for an unavoidable Racial [ sic capitalisation] prejudice … If the British were going to help indigenous groups via their medical department as was becoming the colonial expectation by the s , they wanted to be seen to be helping Africans.
This emphasis was quite explicit. The Honourable Chief Secretary of the ZMA a British representative, but not of the medical department level-headedly summarised the situation as follows in All of you know how the Association started — to meet a very serious need in the town — and it would be deplorable if the public spirit and efforts made in the earlier days were to be defeated by any failure to come to some workable arrangement for carrying on the work of the Association. Naturally the communities who are chiefly concerned ask for an effective say in the affairs of the Association, but at the same time as a large annual grant of public funds is involved it is essential that the Government should also be in a position to ensure that the money is applied effectively.
The Zanzibar Maternity Association and the British
It is the difficulty of reconciling these two principles which has led to a good deal of trouble. Worries about excessive Indian and Arab representation in the ZMA also found their resonance in downbeat British comments about the midwifery services provided. The British, in theory at least, were much more concerned with providing rural healthcare for Africans than healthcare for the cosmopolitan and politically active communities of Zanzibar town, but obviously this was a selective and inconsistent claim.
When the Colonial Medical Service had an opportunity to cooperate with the ZMA in its ambitions to establish a network of rural maternity health centres in , the British declined to become involved because they were unable to dominate the rural expansion programme. The British denial of their responsibility towards the Indian and Arab communities of Zanzibar in their dealings with the ZMA betrays a curious tension in colonial circles.
The struggles for control of the ZMA therefore highlight some of the internal dynamics of the colonial encounter which are rarely explored: namely the racial hierarchies constructed by the British towards the heterogeneous populations of the island. Of course European health was the tantamount concern, but in terms of the indigenes it was Africans, from the British perspectives, that were most deserving of their help and charity.
At one level this account reveals a very sorry local story of thwarted good intentions. In a broader context, however, this study shows the highly manipulative and selective way the British applied their policies of health.
This in turn reveals the way colonial governance embodied elements of stagecraft — ultimately always serving a broader racial-political agenda. What is more, in justifying their withdrawal of support for the ZMA in the late s and s, the British used various methods to undermine its reputation.