Hadfield on Armstrong, 'An Ambulance on Safari: The ANC and the Making of a Health Department in Exile'

Melissa Diane Armstrong
Leslie A. Hadfield

Melissa Diane Armstrong. An Ambulance on Safari: The ANC and the Making of a Health Department in Exile. Associated Medical Services Studies in the History of Medicine, Health, and Society Series. Montreal: McGill-Queen's University Press, 2020. 344 pp. $37.95 (paper), ISBN 978-0-228-00330-4

Reviewed by Leslie A. Hadfield (Brigham Young University) Published on H-Africa (November, 2021) Commissioned by David D. Hurlbut (Independent Scholar)

Printable Version: https://www.h-net.org/reviews/showpdf.php?id=56636

Because health care is such a routine part of life, it may seem mundane or secondary to other history. Melissa Diane Armstrong shows, in An Ambulance on Safari, just how important health care was for South Africans in exile during the fight against apartheid—for survival, for mental health, and for key financial and political support for the African National Congress (ANC). The history of ANC medical services in exile thus adds unique insights to our understanding of the exile experience, particularly in other African countries. Armstrong also argues that the history is important to understanding what came after the ANC came home: the new health system put into place during and after the transition to democracy. Armstrong uses a revealing archive of ANC health department records to detail the workings, successes, and failures of these efforts. However, more cohesive organization would have facilitated deeper analysis and provided clarity. Furthermore, while the book offers an important understanding of the exiled ANC health department, it leaves unanswered the question of its role in creating the new South African health system.

The book includes five chapters in between the brief and useful introduction and conclusion. The first chapter sets up the rest of the book with the history of medical services in the ANC as they evolved into the ANC’s Department of Health in the late 1970s. It starts with the services offered in Tanzania as the ANC set up operations there in the early 1960s. It then charts the shift of the headquarters to Zambia, funding provided by international supporters, and the growth of the ANC in exile in the mid-1970s, after the June 16, 1976, uprisings sent a growing number of people outside of South Africa. As Armstrong summarizes, the ANC’s “delivery of healthcare grew over time from a case-by-case, reactionary, military-focused form of care to a fully fledged Health Department complete with administration, infrastructure, and an international training and support scheme”; the ANC carried a huge responsibility for the health and well-being of “thousands of cadres and refugees, and for a new generation of South Africans born in exile and raised in ANC settlements” (p. 7). However, Armstrong argues that the ANC also prioritized gaining political legitimacy in establishing a health department and sought to act as the rightful government of South Africans. The chapter ends by outlining the structure of ANC health services in various regions across southern Africa where the ANC was stationed.

Chapter 2 dives into more detail regarding the relationships the ANC had with local health services in the different countries, opening a window into the give and take between the ANC and their various hosts: Tanzania, Zambia, Zimbabwe, Angola, and Mozambique. After detailing the structures, relationships, and issues in each place, the author uses malaria and, to a lesser degree, HIV/AIDS as ways to further explore the dynamics of regional health teams and the interconnectedness between the different regions. The third chapter is focused on the role that medical services played in the broader liberation movement. The author shows in this chapter how the ANC sought to discredit apartheid health care and gain political legitimacy, both in attracting support for the ANC and in acting as the authentic South African health agency on the international stage. Armstrong brings the debates about abortion and birth control into this chapter as well to illustrate how the ANC did this, although these issues also raise questions about the ANC and women’s health in exile. Chapter 4 evaluates the effectiveness of the delivery of care and the facilities that the ANC offered through “anecdotal snapshots” from Tanzania—a clinic in Dar es Salaam and a hospital in Morogoro—and interpersonal conflict between staff. Armstrong concludes that the services were plagued by inexperience, lack of coordination, and interpersonal tensions, all of which negatively affected the care patients received; yet, she points to international funding for the projects as a major political success. The fifth chapter focuses on the treatment of mental health. The chapter highlights the mental health challenges exiles faced, developments in understanding mental health internationally, the politization of mental health, mental health and internal ANC security concerns, and further reasons for mental health challenges.

Armstrong consulted thousands of pages in the ANC archives at the University of Fort Hare. This provided her with many details and insights into the ANC’s working. (Sources in other archives and a few original interviews supplemented her research, but she admittedly relied heavily on the ANC records.) The detailed narratives and reliance on primary sources is commendable. However, a focus on play-by-play accounts of correspondence and developments tends to exclude synthesis and deeper analysis of the implications of these details. More cohesion overall could have added clarity and prevented repetition. In places, the commentary vacillates between points, resulting in some confusion. The title is a case in point. “Ambulance on safari” comes from a phrase in a report about the major problems of a psychiatric clinic in Tanzania. One of the failings of the clinic was that the ambulance was commandeered by staff for personal reasons and thus not always available for patients who really needed it: “It is no surprise lately to go to the clinic and find that the ambulance is on safari,” in other words, missing in action (p. 141). This makes the reader wonder if the book title was meant to allude to the failings of the ANC Department of Health rather than signal that the book is about the delivery of health care abroad. And yet at other times the tone is more congratulatory.

Armstrong argues that her book illuminates the importance of health-care delivery to South African liberation movements and the exile experience as well as contributes an important understanding of the predecessor to the system that the ANC put in place in the post-apartheid period. The book certainly shows that the ANC’s health department and medical services were an important part of surviving in exile and gaining crucial international support (especially when discussing funding). However, the book left me wondering just how much the ANC’s health department in exile shaped the post-apartheid system. It stops short of dealing with the transition period and does not engage other relevant literature on the history of health care in South Africa. For example, although the fifth chapter incorporates much of the literature on mental health, chapter 4 on the delivery of primary health care does not analyze the ANC’s definitions of and approaches to primary health care in conjunction with the history of primary health-care initiatives. This makes it difficult to follow ideas and approaches into the transition period to ascertain if they shaped what the ANC established in the post-apartheid period. Considering all the health-care practitioners shaping the system inside South Africa who helped create the new system, plus the failures of the ANC Department of Health and infighting among its health officers, several questions arise: Just how significant was the ANC Department of Health in creating the new system? Was this influence positive or negative? Can we really see this as the nascent post-apartheid government, even if the ANC itself saw it that way? While the book has filled gaps in the history of the ANC in exile, these questions are left for further analysis to answer.

Citation: Leslie A. Hadfield. Review of Armstrong, Melissa Diane, An Ambulance on Safari: The ANC and the Making of a Health Department in Exile. H-Africa, H-Net Reviews. November, 2021. URL: https://www.h-net.org/reviews/showrev.php?id=56636

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.