Bethesda Hospital is a former Methodist mission hospital in the Umkhanyakude district of northern KwaZulu-Natal. Began by Dr Robert Turner in 1937, the hospital was run by the missionary society of the Methodist Church of South Africa until its take-over by the government forty-five years later. Lena Turner, the first matron of Bethesda, wrote of her time at Bethesda, an account charged with a familiar tone of missionary zeal. She tells her reader of a treacherous journey to this most remote of places, a people whose heathen practices passed down ‘from generation to generation’, and describes stories in which witchdoctors received bodily and spiritual healing through their conversion to Christianity. These accounts evoked a distant place, frozen in time and space, in which witchcraft and heathenism were the overwhelming causes of ill-health.
Yet such representations stand in stark contrast to the huge upheaval and social change that marked this period. Growth in the mining and industrial centres had brought about rapid industrialisation, whilst the labour migration system became increasingly entrenched and the government’s segregationist agendas consolidated. Ill-health in the reserves was closely linked to a deteriorating rural economy as malnutrition, TB and other infectious diseases – virtually unknown prior to colonial expansion – became increasingly widespread as well as, in Zululand, the additional burden of malaria. Meanwhile, increasing political pressure and the need for a sustained workforce compelled the government to turn its attention to the scale of African ill-health. In rural areas, the government focused on a network of mission hospitals to address health needs. Thus when Bethesda was established, it was immediately incorporated into a wider political economy of state health care provision.
The paper describes how this small mission hospital, founded upon a very specific set of ideas, was quickly drawn into a wider apartheid system of health care and labour control that was increasingly incompatible with the missionary vision of health care. Yet, in the hospital’s final years under Methodist control, missionaries drew on a broader, international shift of rhetoric towards that of primary health care, enabling a reinvigoration of the original aims and ideologies of the mission even as imminent take-over loomed large. This account, therefore, describes a complex and changing micro-struggle for power over a single hospital in the context of a wider political economy of health care, and the effects of this struggle on service delivery in the region.