Behind the Dispensary's Prosperous Façade: Imagining the State in Rural Niger
Pour sortir [l’état] de sa faiblesse congénitale, il ne suffit pas de prétendre le ravaler comme on le ferait pour une façade.
Etienne LeRoy, L’odyssée de l’état
Why is a building called a “national bank,” “university,” “state department,” “hospital,” or “school” when the activities which take place in it cannot be given standard meaning and realities usually covered by those words?
Filip De Boeck, Postcolonialism, Power, and Identity
For the regular visitors to the Dogondoutchi dispensary in the late 1980s whose persistent search for health was repeatedly frustrated by the inadequacy of the medical supplies, the empty shelves of the state-sponsored facility—a stark contrast to the usually well-stocked shelves of the local pharmacy—displayed one of the most flagrant symptoms of the decline of the Nigerien postcolony and the attendant dissolution of authority. Just as the mismanagement of food relief in famine-stricken Niger some twenty-five years ago gave rise to a host of rumors centering on President Hamani Diori’s kin and close associates—whose predatory practices earned them the title of le clan des bouffeurs (the clan of the gluttons)— so the resident doctor and nurses of the rural dispensary became in the late 1980s the target of disturbing rumors about the apparent mutilation of the bodies of deceased patients. While the medical personnel were later exonerated after rats were discovered near headless corpses on hospital grounds, the incident nonetheless contributed to increase people’s fear of the local facility.
“A place of death (wurin mutuwa), that’s what it is!” Dije, the old woman who often visited my neighbors, had once exclaimed. She was referring to the wellknown fact that many of those—especially among the elderly—who were hospitalized ended up dying at the dispensary. Whether or not their deaths could have been prevented with “adequate” medical assistance is not clear. During fieldwork conducted in 1988–89, I was told on several occasions that the local doctor rarely made use of the ambulance to transport patients who were in serious condition to the better-equipped hospital of Dosso, some three hundred kilometers away. With little or no fund allocations for gas, the decision to transfer patients was only made for desperate cases. That the patients invariably died on their way to, or in, the Dosso hospital only confirmed some people’s suspicions that the dispensary was, in Dije’s words, “a place of death.” “Those who leave in the ambulance, they never come back,” my assistant Yahaya had remarked. Conversations with other residents later confirmed that indeed “the doctor always waited [to send patients away] until it was too late.” This sad reality had prompted some residents to nickname the ambulance “the hearse.”1
The Dispensary: “A Place of Death”
Much has been said and written about the modern state’s seemingly boundless capacity to prey upon its citizens in postcolonial Africa (Bayart 1989;Mbembe 1992). Accounts from Nigeria, Sierra Leone, Tanzania, Cameroon, and elsewhere that offer culturally specific commentaries on the “politics of the belly” through which the state and its cronies appropriate the vitality of those subordinated to them periodically remind us of the omnivorous potentialities of the postcolony (Bastian 2000;Geschiere 1995;Masquelier 2000; Shaw 1996;Weiss 1996). Yet, while these visual and visceral displays of predation point to the specific ways in which people are consumed, depleted, or violated by a perverse—but often historically legitimized—power structure, they rarely offer concrete instantiations of what stands behind the gluttonous practices and immoral politics that inscribe themselves so tangibly onto the bodies of the state’s victims. Simply put, the state appears to have no palpable existence outside the discursive formations that emphasize its alleged rapacity. Even the images of perverted and predatory consumption that lend it some materiality do not disguise the increasing withdrawal of the state from public life. Despite the growing fragmentation of government, however, the state is hardly powerless, as Jean-François Bayart, Achille Mbembe, and Comi Toulabor (1992) remind us, because administrative procedures and institutional rules are “only one channel among many which the public authorities use to manage the country’s affairs” (Bayart, Ellis, and Hibou 1999: 91). The state’s withdrawal has led to the rise of a multitude of parallel and independent circuits of power, alternative networks, and personal relations that “frequently offer far more effective instruments of public management” (Bayart, Ellis, and Hibou 1999: 91). It is the presence and implications of these multiple administrative fiefdoms that concern me here as I analyze the management of power, the production of contradictions, and the application of disciplinary techniques in the context of state-sponsored health care in Niger.
When the structures of its autocratic control are crumbling, when the processes of its dysfunctional economy continually blur the distinction between legal and illegal, the postcolonial state gradually becomes part of a world in which the real and the imaginary are interchangeable (see Apter 1999;De Boeck 1996;Piot 1999). Medical facilities, too, are implicated in the emergence of these regimes of pretense (Hours 1985;Hunt 1999;Scheper-Hughes 1992). In the face of such contradictory realities, people everywhere are developing strategies of exchange, solidarity, and complicity as they search for ways to overcome the fragmentation of their society. These conflations between the real and the imaginary need not be the result of dysfunction, however. As Bayart (1989) and Mbembe (1992) have demonstrated, and as the Nigerien case suggests, they can be the product of historically constituted modalities of power. The resulting political hybridity that emerges out of the apparent decay forces us to acknowledge the limitations of conventional state/society dichotomies in analyses of how ordinary people everywhere come in contact with the state and imagine it (Comaroff and Comaroff 1999;De Boeck 1996). Akhil Gupta (1995: 377) similarly argues that we must “pay attention to the ‘multiply mediated’ contexts through which the state comes to be constructed” to grasp the workings of a translocal institution that is largely made visible in localized discursive practices.
Drawing on these contributions to the study of the political imagination, this essay explores how the Nigerien state is discursively constructed and deconstructed by rural dwellers who, since the 1980s, have been experiencing its withdrawal from public welfare institutions. More specifically, I evoke the vacuum left by the Nigerien state in the wake of economic collapse and political turmoil by focusing on the ways the residents of Dogondoutchi, a Hausaphone town in southern Niger, come to think of the local dispensary as a “place of emptiness” devoid of the medicines that should ideally “fill up” the space.2 Despite the palpable decay, however, the dispensary effectively rules over patients through the management of inequalities and the routine imposition of discursive techniques that produce control, if not health. In an effort to describe how rural Hausa speakers deal with the increasingly abstract entity they refer to as gwamnati (government), I focus on the political imagination at work in the context of rumors and grievances that underscored the inefficiency and, at times, the coerciveness of the local dispensary, a state-run institution that, many agreed, was once accountable to them. My discussion of the dispensary highlights the circulation of images that provide compelling parallels between the facility’s empty medicine chests and the state’s virtually empty coffers for Nigeriens whose most frequent and concrete experience of the benefits they, as citizens, are entitled to receive came, until the economic decline of the mid-1980s, in the form of free health care.
“Why should I bother going to the dispensary, when they have no medicine for what ails me?” I often heard people protest in the largely Islamic farming community of Dogondoutchi, home to some 30,000 Mawri.3 Such complaints may not offer an accurate measure of the frustration residents experience whenever they are faced with the decision of whether or not to seek the services of the local physician. Yet, when examined together with other accounts of people’s contacts with the medical facility, they are nonetheless suggestive of what the dispensary has come to signify for Nigeriens as they struggle to understand the place and role of the state in their local world. For those who have witnessed the progressive collapse of their country’s economy after the mid-1980s slump in uranium prices, the shadowy structures of the state find their most visible expression in the dispensary built some sixty years ago to provide health services to the population of the entire district. The postindependence era of optimism, growth, and prosperity has given way to a period of austerity and want as major sectors of economic and civic enterprise were brought to a virtual standstill. Unable to provide basic care and devoid of medicine, the Dogondoutchi dispensary exemplifies the state of affairs described by Filip De Boeck (1996: 91) for former Zaire when concepts like “law,” “justice,” or “health care” no longer “seem to apply to the realities usually covered by those terms.”
Yet within this regime of unreality, the “hollow” building does not simply emblematize the failure of national progress and of the modernist ethos that shaped it. By condensing into monumental form the paradoxical dimensions of the state—ubiquitous, yet elusive; everywhere, yet nowhere—the dispensary provides a particular historical and social context in which to understand how some Nigeriens on the rural periphery imagine the state. By its very “absent” presence, the Nigerien state forces us to rethink the efficacy of state power in noninstitutional terms that can account for the daily contradictions generated by the system. In this essay, I argue that we must go beyond a conventional reading of the failings of state-sponsored medicine and consider the paradoxical logics of the Nigerien state. This can be done by attending to the specific ways in which fiscal crises and economic collapse have produced alternative and invisible techniques of power, production, and discipline—not to mention dysfunction and decay. The absent state, I show, is still perceived as exercising sovereign power because of the productive logics through which it is articulated locally. How such power is variously performed for the “benefit” of local patients partly explains why some Mawri decry the dispensary as an inadequate and, to some extent, even dangerous institution, while others describe it as a functional facility.4
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Notes
This essay is based on fieldwork conducted in 1988–89 and 1994. Funding for my 1988–89 research was provided by a research fellowship from the National Institute of Mental Health, a dissertation grant from the National Science Foundation, and a grant for anthropological research from the Wenner-Gren Foundation. Further research during the summer of 1994 was made possible by a Summer Fellowship from Tulane University’s Committee on Research. This essay was originally presented at the American Ethnological Society meeting in Toronto in May 1998 and at a conference on “Fantasy Spaces: The Power of Images in a Globalizing World” at the University of Amsterdam in August 1998. The participants at these gatherings have been generous with suggestions and ideas, although they cannot be held responsible for the essay’s remaining flaws. I am especially grateful to Misty Bastian and Brad Weiss for their critical discussions of the material. I thank Elizabeth Povinelli for her constructive comments and her support. The anonymous reviewers for Public Culture offered perceptive comments on which I have drawn heavily. Special thanks to Caitrin Lynch for her careful editing of the essay.
- 1. In his analysis of collective representations of health care in Niger, Maiga Sabbou (1974: 35) also notes the widespread perception that the departmental hospital is a place where people die.
- With the collapse of the price of uranium on the world market in 1985, the prosperity that followed the terrible drought of 1968–74 ended. Major domains of civic and economic enterprise stopped functioning as tax revenues shrank to 9 percent of the gross national product. Following the slump in uranium prices, persistent drought, soil degradation, high import prices, and burdensome debts further weakened the already troubled economy. The fledgling civilian government that succeeded Colonel Seyni Kountché’s rule in 1987 inherited social crises (student discontent, restless elites) and burning fiscal problems. Further popular discontent spawned angry protests, general strikes, and a constitutional crisis that ended when Colonel Ibrahim Bare Mainassara led a military coup in January 1996. Local perceptions of the Dogondoutchi dispensary as an empty and inefficient institution must hence be read in the context of Nigeriens’ widespread discontent and distrust of state services despite the efforts of succeeding governments to escape cycles of endless deficit.
- Traditionally recognizable by their facial scars, Hausa-speaking Mawri identify themselves with the Hausa, a large sedentary population of millet, bean, and groundnut farmers that constitutes about 50 percent of the total population of Niger. An estimated 95 percent of Mawris are Muslim. The rest are primarily devotees of the bori, a spirit possession religion that focuses on the management of spirit-induced afflictions and disruptions.
- The case of Binta illustrates how some see the dispensary as an efficient institution. When she learned that a car had struck her eight-year-old son Harouna, she rushed him to the dispensary, where two nurses promptly took him to the operating room. There, after an inspection of his wounds revealed no life-threatening injuries, young Harouna was given a tetanus shot. His wounds were cleaned, stitched, and bandaged. Within a few days, the little boy was back on the streets while Binta was busy telling everyone how the likita’s (biomedical doctor’s) quick intervention had saved her son from an uncertain fate.