History Alum pens ground-breaking book on the ANC’s apartheid-era Health Department. By Nick Ward
Recent History PhD graduate Melissa Armstrong’s new work is the only published book-length analysis of the political and medical history of the African National Congress’(ANC) Health Department that cared for anti-apartheid exiles during the struggle for liberation.
Titled An Ambulance on Safari: The ANC and the Making of a Health Department in Exile, Armstrong, a former Vanier Scholarship winner, spent time researching in Alice, South Africa at the ANC’s political archive where she examined over 3000 documents related to the ANC’s Health Department. She also conducted interviews with healthcare workers affiliated with the Department – individuals who treated the thousands of anti-apartheid activists, militants and migrants who were physically or mentally injured as they fled South Africa to neighbouring countries to avoid arrest or worse.
As explained by Armstrong, the Health Department would not only treat people in need of care, but it would also go on to assist with legitimizing the ANC as a political entity and thus cultivate international anti-apartheid sentiment.
Quite amazingly, she wrote much of An Ambulance on Safari, her first book, while training to become a medical doctor at the University of Saskatchewan.
During a rare break in her schedule of working on the wards, Armstrong was able to track down an unused hospital room to have a phone conversation outlining her sure-to-be-influential new book, her Carleton experience, and her remarkable academic career.
Thank you for taking the time to chat, Melissa. Congratulations on the release of An Ambulance on Safari! I’m curious, how did you come to research African National Congress’ (ANC) exiled medical sector during apartheid?
Great question and one I am frequently asked – how does someone from Saskatchewan with no ties to South Africa become interested in this specific topic? Mostly, it started with a few inspirational lectures on the history of African independence movements and a memorable study abroad in South Africa. Then, after I was accepted to pursue a Master’s at Oxford in African Studies, I discovered that my supervisor Professor Colin Bundy was researching the ANC’s exile history. So he pointed me in the right direction.
Truthfully, when I first went to South Africa to do my research, I had no idea what I would find in the archive, and I stumbled upon a gold mine of information about the ANC’s medical sector in exile. I finished a short Master’s thesis and then came to Carleton University to work with Susanne Klausen. Her work in the field of South Africa’s history of medicine was well established and impressive.
Upon starting my PhD, I had hundreds of documents which held a lot of research promise already stored and I was able to collect more than 2000 additional documents related to healthcare in exile on a return venture to South Africa. So, in short, inspiring teachers and good fortune brought me to this research topic.
In An Ambulance on Safari, you look at the ANC’s 1977 creation of its own Health Department to offer alternative medical services for anti-apartheid activists, militants and refugees.
The ANC’s Health Department in exile was a messy and evolving institution that was primarily defined by a few influential characters on the ground and several international supporters abroad. Perhaps this is why it is so interesting. Some of the staff running the ANC’s Department were South Africans who were sent to the USSR where they amazingly managed to learn Russian and train to become doctors. They would then move back to Tanzania or Zambia to treat other South African exiles. The Department was defined by these individuals who were full of tenacity, but also carried a lot of the baggage that comes from such experiences.
What did the Health Department look like exactly?
The Department had regional offices in Tanzania, Zambia, Angola, Mozambique, and Zimbabwe and each of these offices varied in size and effectiveness. The services provided were defined by the region in which the Department was operating. Southern African hosts were involved in supporting and critiquing the ANC’s medical efforts. Therefore, the individuals making up the Health Department had to adapt their structure and practices to what was already available on the ground. For instance, in Tanzania, the Department was able to piggyback on local resources and provide some level of primary care to South African students who had moved into exile. The relatively peaceful climate in Tanzania enabled the ANC to build their own hospital. In Angola, a country still trying to rebuild itself in the post-independence period, the ANC struggled to reactively meet the needs of cadres suffering from war ailments, malaria, or mental illness.
Were those the main maladies that the Health Department was responding to on an everyday basis?
The ANC had a variety of specific illnesses that caused them grief. Malaria was a major issue as South Africans had no previous exposure to the disease. The onslaught of this illness was a constant struggle for the ANC.
There were a number of health related needs that come with having a more settled population in exile. The ANC also had to figure out ways to provide birth control or create health services for infants and children. Given that this Health Department was borne out of military necessity, this was a bit of a departure for them. And just as the ANC was getting itself ready to move home, the Department was faced with the new epidemic of HIV/AIDS amongst their exile population. Mental illness was also a major concern for the Department because it effected exiles across all regions in which the ANC operated.
In the book, you pay particular attention to the Health Department’s approach to mental health. Was mental wellness a priority?
A priority? Yes and no.
One has first to understand that there is no account of physical health in exile without an account of the mental illness suffered by South Africans while they were so far away from home. This book is a story that follows a group of people who left home, thought that they would fight a short military battle and return to South Africa, but instead were trapped in exile for years.
These exiles suffered traumatic war experiences with little social support and an inability to talk about their experiences due to the sensitive and secretive nature of guerrilla warfare. Exiles turned to alcohol, drugs, or suicide to escape their present realities. But the pervasiveness of mental illness did not make treatment a central priority for the ANC. This is partly due to a lack of suitable resources, and also because the ANC did not want its people to speak freely with psychiatrists or psychologists about the things that they had been a part of or they had witnessed.
However, while mental illness was not appropriately addressed on the ground, the politicization of mental illness was a priority for the Health Department. Mental illness was a political weapon, and the ANC was able to point to the atrocious treatment of mentally ill, black South Africans at home to get international attention. They were also able to use some of the growing interest in mental healthcare worldwide to garner support and political legitimacy in the international realm. So mental healthcare was both a priority and a sidelined medical problem.
What challenges did the Health Department face?
The Department faced a nearly impossible assignment – it was tasked with providing healthcare to thousands of South African exiles, as well as locals, across more than five countries, primarily Tanzania, Zambia, Mozambique, Angola, and Zimbabwe. They also had minimal staff in the middle of an armed struggle for independence in South Africa.
The Health Department had to attempt to build hospitals, clinics, and provide these facilities with equipment and staff. They received money from a variety of stakeholders, including their Cold War allies like USSR, Cuba as well as humanitarian donors from Scandinavian countries. And, complicating this, the staff was green; many had never led bureaucratic structures before, and there was near-constant in-fighting, many struggled with alcoholism and patients were often neglected.
What impact or impacts did the Department have on its patients who lived in exile?
The impact was definitely not uniform; the Department’s patient demographic varied dramatically between regions, and the type of healthcare delivered changed in the decades between 1964 and 1990. In chapters 4 and 5 of the book, I attempt to characterize the practical impact of the Department using several anecdotal stories of patients and policies. At a basic level, the Health Department was eventually able to provide basic primary care to many of the South Africans in exile – particularly in Tanzania and Zambia. Thousands of cases of malaria were successfully treated with appropriate medications; minor injuries and ailments were addressed at the clinic; and when medical problems surpassed the capabilities of the Department at ANC locations, patients were moved to local Southern African medical centres for more specialized treatment. At times, ANC patients received better quality healthcare than their local counterparts. However, the ANC really never met its full potential, and many patients were let down by internal corruption or interpersonal battles within the Department. As the title suggests, when health professionals needed to transport a patient from one community to another, they would find that “the ambulance is on a safari”.
What role did the Health Department have in legitimizing the ANC as a government in waiting?
The ANC’s Health Department in exile was fascinating in this respect. The ANC inaugurated the Department with the explicit aim of establishing the ANC as the legitimate representative of the needs of South Africans. It was desirable for the Department to attend international medical meetings and fashion their own policies around the current global trends so that major political bodies would recognize their efforts. At the same time, the Department submitted letters, delivered speeches, and networked at conferences to blow the whistle on the racist, two-tiered medical system available in South Africa. The highest international bid for political legitimacy was contained in the message that the Medical Association of South Africa was not delivering equitable healthcare for all people in South Africa while the ANC in exile was putting WHO-approved policies and procedures into place. This had some degree of success. The global anti-apartheid movement coincided with the best of the Health Department’s efforts. It resulted in UN declarations of solidarity with the ANC and the expulsion of the Medical Association of South Africa from a variety of medical conferences and committees.
What international support did the Department have?
International support also changed over time. This has everything to do with the political dynamics of the ANC and the global state of affairs. In the 1960s, the armed wing of the ANC, Umkhonto weSizwe (MK), was formed. This represented a departure from the formerly peaceful anti-apartheid ANC movement. MK received support from new allies in the communist bloc; these allies included the USSR and Cuba. The USSR trained medical doctors, and Cuba sent doctors to support exiles in the military effort. South Africa was receiving support from the US, and therefore this left Southern Africa to be yet another hot pocket of the Cold War. In the 1970s, Scandinavian countries – desiring to be neutral in the war – provided financial support under the banner of humanitarianism to back the ANC medical services in exile; this was largely a way to make an anti-apartheid statement without having direct military involvement. With this support, the Department built hospitals and clinics across Southern Africa and had money to buy medical supplies. Eventually, the Department also gained support from the UN and the WHO. The WHO wanted to help the ANC provide healthcare to the thousands of South African refugees, and the UN-supported the ANC in the anti-apartheid project. Finally, the most significant international help came from Southern African host countries. These countries provided space for the ANC, allowed doctors to train in their hospitals, and treated South African patients in their facilities.
Post-apartheid, does there remain a disparity in health services for various groups in South Africa?
There is a significant disparity in health services in South Africa today. The book opens by illuminating this problem. A 2010 WHO report stated that 80% of South Africans have no medical insurance, and the public service available to uninsured people is grossly inadequate to meet their needs. This research initially sought to better explain why such a disparity existed. The role of apartheid in entrenching a two-tiered system is well established in the historical literature, but the exiled ANC health department had its part to play. When the ANC returned to South Africa and established itself in government, those with power in the Department in exile took up major roles in the new South Africa. While not the focus of the book, I would hazard a guess that the alliances forged in exile, as well as the patterns of in-fighting, corruption and secrecy, play a role in perpetuating some of the ongoing problems in the South African medical system today.
What impact do you hope An Ambulance on Safari has on your readers?
I was told that writing history could be an act of social justice; historians can tell stories that need to be told. And I do believe that the historical account recorded in An Ambulance on Safari contains many stories that need to be told. I want people to read about the boy who was bounced around in exile and used as a political pawn to further advance the position of two ANC Health Department officials or the story of two women who reported that the Department forced them to have abortions so that they would be able to have uninterrupted time in the military. I want people to know that the Health Department was made up of many people who gave up their lives for the health and well-being of South African exiles and as a result, struggled with alcoholism or other mental illnesses. I hope my readers can see the impact that an individual, a humanitarian group, or a global movement can have on the lives of everyday people. And I want to be a part of destigmatizing mental illness and telling the stories of people who suffered from being exiled from their support networks back home. I hope that my readers come away with an appreciation for how both personal and political health and healthcare can be and draw parallels to the current realities of healthcare today.
What role did your experience in the History Department at Carleton University play in you becoming a published author?
Carleton University was the right choice for me. The Department of History and the Institute of African Studies offered me opportunities to give lectures and speak at conferences so I could flesh out some of my initial ideas. Additionally, the Department provided me with financial support to do the fieldwork required for this research. I made four research trips to South Africa, two of which lasted three months. The archive that I used was in a rural area of South Africa, and I commuted a total of three hours each day to access the files necessary for this project. I was fortunate that Carleton’s PhD program was structured to enable this type of research.
While there were many people – including faculty, administrative staff and members of my student cohort – that were incredibly helpful to me, my supervisor, Susanne Klausen, had the most significant impact on this work. In my first year, I handed in a short paper, and it was returned, covered in red ink. She commented that my writing would have to improve dramatically before I would be able to write something publishable. After submitting the first draft of my thesis, I had a similar experience; the first few pages were covered in red ink before she commented that three of my chapters needed to be cut nearly entirely. I sulked for 24 hours before conceding that she was 100% correct. I was grateful for her honesty and willingness to make me a better writer. Even after graduation, Susanne continued to read chapters, revisions and new sections of the book. She provided insightful comments, criticisms, and encouragement. I am positive that the book would not be what it is today without her.
What are you up to these days?
Currently, I am in the 4th and final year of medical school at the University of Saskatchewan. This means that I am in the middle of applying for residencies – the training in a speciality following graduation – as well as getting to work under the supervision of a variety of physicians. Also, I am so fortunate to be spending time (even if at a distance) with my parents, three sisters, their partners and my ten nieces and nephews.
How did you manage writing a book while in medical school?!
I am not actually sure; maybe if I had known the work involved, I would not have started this process. Sometimes, I just scraped through med school exams, and I relied heavily on the support of some of my colleagues in school. Other times, I asked for extended deadlines from the publisher and utilized some of my school holidays to catch up on edits or revisions. The staff at McGill-Queen’s University Press were amazing and helped me through this whole process step-by-step. All in all, it was a huge undertaking. However, I was incredibly well supported throughout the process.
What’s next, Melissa?
Well, for now, my focus is on trying to finish medical school and get a residency placement. But in terms of research, I have a few exciting projects in mind. Believe it or not, this book only used a fraction of the documents that I still have on the social history of the ANC in exile. I have a few pet projects on this topic on the go. Additionally, I am growing increasingly interested in some of the history of mental health and institutions in Saskatchewan, and Canada more broadly. We shall see…