1 The paper is based on investigations conducted in the context of a 4-year research project (FWO n° (...) 2 “Situation des Construction C.M.C. au 1-9-1954,” Brussels (Belgium), Ministry of Foreign Affairs, (...) 1When conducting historical research, especially in archives of (state) administrations that hold many documents of a generic nature, one sometimes stumbles onto sources that do not reveal their importance at first sight, but only disclose their relevance over time. In this paper, we will discuss one such a document, unearthed during research on the colonial public healthcare infrastructure in the former Belgian Congo.1 Entitled “Situation des Constructions C.M.C. au 1-9-1954” and produced by the local branch of the Service des travaux publics (or Public Works Department) in the Équateur province (fig. 1), it highlights in a striking way both the centralized and the localized dimensions that were embedded in the implementation of colonial policies through bureaucratic processes.2

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# Healthcare as a spearhead of Belgium’s postwar “welfare colonialism.”

3 Frederick Cooper, Africa since 1900. The Past of the Present, Cambridge: Cambridge University Pres (...) 2In 1949, the Belgian government launched its Ten-Year Plan for the Economic and Social Development of the Belgian Congo, an initiative that was part of a general change in policy in colonial rule. After 1945, the socio-economic development of subject populations came high on the agenda of colonial authorities throughout sub-Saharan Africa, leading to a type of measures for which various terms have been coined: “development colonialism,” “welfare colonialism,...”3 Responding to a changing international climate on colonialism, with a growing critique of colonial rule voiced by, among others, the United Nations, the Ten-Year Plan was also a means of tackling the various challenges resulting from the excessive labor regime implemented during World War II. Forced to provide Allied forces with badly needed resources, the colonial population had suffered from an immense war effort which had profoundly destabilizing effects, especially in rural areas. On the one hand, the Ten-Year Plan continued to serve the agenda of colonial economy in its ambition to enhance the productivity of African labor as well as to make export and import flows of people and goods more efficient. But on the other hand, it also served to introduce a colonial version of the welfare state, in a response to growing local demands for emancipation and self-rule. Central to the Ten-Year Plan was the inclusion of extensive programs for housing, education, infrastructure, and, perhaps most importantly, public healthcare. A vast, fine-grained, and hierarchic network of hospitals and dispensaries, roughly following the administrative boundaries of the Colony, was to take medical care deep into the heart of the Congolese hinterland, and bring even the most remote villages within the reach of public healthcare.

4 Peter Scriver, “Empire-Building and Thinking in the Public Works Department of British India,” in (...) 5 Jiat-Hwee Chang, A Genealogy of Tropical Architecture: Colonial Networks, Nature and Technoscience(...) 6 It should be noted that in their discussions of type-plans, Scriver and Chang mainly focus on a so (...) 3To build a network of large, high-tech medical facilities in urban centers as well as smaller hospitals in rural nodes and dispensaries providing primary care in numerous scattered villages, the colonial government needed an extensive bureaucratic apparatus to buttress this vast construction program. Scholars like Peter Scriver and Jiat-Hwee Chang, who have explored such apparatuses for different geographical contexts within the British Colonial Empire, have described such administrative buttressing of the colonial built production as the “scaffolding of empire” 4 or the “building of building.”5 Both, however, have mainly focused on the central echelon of the Public Works Department (pwd), discussing how it expanded and served as the central node where knowledge was produced in the form of building standards, codifications, and type-plans. The pwd then disseminated this knowledge in a centrifugally organized bureaucratic network that underpinned the empire-wide construction endeavor.6

# Implementing the réseau hospitalier

Although we also subscribe to this line of reasoning, we would nevertheless like to argue that, when investigating the built production of the colonial state, much is to be gained from looking at the colonial administration and its Public Works Departments as multi-layered, complex, and geographically dispersed entities, with a variety of specific processes for decision-making, implementation, and agency. Browsing through the vast series of documents and sources that each of these entities produced provides us with an insight into the multi-layered bureaucratic culture that underpinned the colonial project. By following the actions of these entities, we will investigate, albeit in a rather exploratory manner, how the explicit ambition of the Ten-Year Plan to develop a healthcare infrastructure covering the immense territory of the Belgian Congo was turned into reality.

In establishing this réseau hospitalier, the Service des travaux publics was not the only administrative branch involved, nor was it the most influential. While an overarching Commission du plan décennal supervised planning and construction in general, in practice, the Service médical played the most important role. Already, from the mid-1940s onwards, this branch of the colonial administration had conceived a plan for a hierarchic network of medical infrastructure, thus preparing the ground and in fact already outlining the future contours of the healthcare scheme as it would later be included in the Ten-Year Plan. Both the Service des travaux publics and the Service médical maintained offices in the colonial capital city of Léopoldville (today’s Kinshasa), but each had a sister department in Brussels, the headquarters for the metropolitan administration of the Ministry of Colonies. Furthermore, both Léopoldville-based administrations, Public Works and Medicine, had personnel detached to local departments in each of the six provinces of the Belgian Congo. These local branches had to supervise construction work on the numerous new hospitals and make sure the building campaign was being carried out and progressing according to plan.

7 As a matter of fact, a commission comprised of the most prominent colonial doctors assembled in 19 (...) 6In order to streamline the massive building program and make its implementation on the ground more efficient in terms of organization, time, and financing, generic type-plans were drawn up by a specialized architect recruited by and attached to the Service médical in Léopoldville.7 This would make it possible to serially reproduce future rural hospitals according to a predefined set of guidelines, in terms of both floor plan and building materials. These rural hospitals, or Centres médico-chirurgicaux as they were referred to from the introduction of the Ten-Year Plan onwards, would consist of single-story pavilions, each one purposed for a particular section of the healthcare program: surgery, infectious diseases, maternity care, etc. Type-plans of the overall spatial lay-out of these Centres, as well as detailed type-plans of each pavilion, were bundled in an easily transportable booklet (fig. 2‒3). Distributed, with its set of type-plans, from the central administration of the Service médical in Léopoldville to the provinces, this binder was deemed a crucial instrument in quickly and efficiently establishing medical coverage for the Congolese hinterland. As such, it was an essential component of the modus operandi of the intricate bureaucratic machinery which, constantly piping circulars, tenders, type-plans and general communication through its many, geographically dispersed cogwheels, was to properly manage the successful implementation of the Ten-Year Plan’s vast public healthcare program.

# Planning and building for local conditions

8 Brussels (Belgium), Ministry of Foreign Affairs, Africa Archives, AA/GG(12889), Situation des Cons (...) 7In the course of our research project, we got intrigued by one seemingly mundane archival trace produced by this bureaucratic apparatus, a document entitled Situation des Constructions C.M.C. au 1-9-1954 (fig. 1). It was used by the local branch of the Service des travaux publics of the Équateur province to report to superiors in Léopoldville on progress made in building the planned healthcare infrastructure.8 In our analysis of the document, we seek to demonstrate how centrally defined building policies landed “on the ground” and required negotiation with local realities.

9 Congo Belge, Rapports Annuels, Brussels: Lesigne, editions 1945‒1957. 10 During the academic year 2016‒2017, the four authors of this paper ran a research seminar with mas (...) 11 During this mapping exercise, covering the six provinces of Belgian Congo, including the Équateur (...) 12 Nancy Rose Hunt, A Colonial Lexicon of Birth Ritual, Medicalization, and Mobility in the Congo, Du (...) 8The document Situation des Constructions C.M.C. au 1-9-1954 provides, as its title already suggests, an overview of the ongoing rural hospital building program in the Équateur province anno 1954. It does so in the form of a table. The left-hand column lists all of the various pavilions stipulated by the generic type-plans included in the abovementioned binder: administration, surgery, hospitalization, isolation, maternity care, etc. The top bar of the table lists the different localities in the Équateur province where a Centre médico-chirurgical or other medical infrastructure was planned. For each locality, there are three sub-columns indicating (1) whether the pavilion had been completed, (2) if it was still under construction, or (3) if and when the pavilion was to be built in the (near) future. As such, the document gives us an insight, even if only fragmentary, of the building chronology of the provincial hospital network as defined by the Ten-Year Plan. Other documents, such as yearly reports presented by the colonial administration to the Belgian parliament on work accomplished in the Belgian Congo, enabled us to fine-tune this chronology.9 We then juxtaposed this information with data gathered through a spatial mapping of the hospital network in the Équateur province, making use of historical maps and current aerial photographs, to trace what was actually built in the various localities.10 This exercise proved insightful: first, it demonstrated that the type-plan for rural hospitals defined by the architect of the centralized Service médical was indeed widely put into practice,11 and, second, that most often these pavilion-type hospitals were constructed during different consecutive building campaigns, sometimes at intervals lasting for several years. When the chronology of building campaigns of these hospitals as suggested by the Situation des Constructions C.M.C. au 1-9-1954 was studied further, what became clear was that, in most cases, priority was given to the construction of the Maternity pavilion. Most often, it was part of the first tender launched by local authorities in the Équateur province, suggesting that the provision of maternity care was seen as more pressing than other medical services. While historical studies on colonial healthcare in the Belgian Congo do stress the importance given to maternity care as part of a larger project of social engineering throughout the territory, it was in particularly in the Équateur province that the colonial government saw itself confronted with a major birth rate decline among the Congolese population. In her seminal 1999 book on healthcare policies in the Belgian Congo, entitled A Colonial Lexicon of Birth Ritual, Medicalization, and Mobility in the Congo, historian Nancy Hunt has brilliantly illustrated how the origin of the region’s alarming infertility can be traced back to “the atrocities of the ‘red rubber’ period of violent, coerced labor and woman hostages” that occurred in this part of Central Africa under King Leopold II’s rule.12 Especially after World War II, the colonial administration sought to reverse this trend via a massive program of family health schemes, nutrition programs, and venereal-disease awareness courses, in parallel with the establishment of a fine-grained network of healthcare infrastructure. Our research on the establishment of a network of rural hospitals in the Équateur province corroborates this historical analysis, by revealing that in terms of building program, priority was given to maternity wards.

# The generic and the local in “gray architecture”

13 In this context, one can point also to the difference between a “model,” as “an object that should (...) 9What, then, are we to make of this specific case and what, more in particular, does a source like the document Situation des Constructions C.M.C. au 1-9-1954 bring to our understanding of the building policy of the Belgian colonial state in the domain of healthcare in the context of its Ten-Year Plan? Here, we would like to point out that the type-plan defined by the central Service médical should not be understood as a fixed, predefined, “copy-paste” solution to be implemented as such in every rural node of the extensive healthcare network. Instead, it provided local administrators with a flexible tool enabling them to respond to particular local conditions.13 The binder with the set of type-plans that was distributed to local branches of Public Works Departments thus functioned more like a menu. Provincial administrators could browse through it, selecting which pavilions were the most strategic to build, based on both budget considerations and the most pressing healthcare needs encountered locally.

14 For this paper, we have mainly focused on archival collections kept in the Africa Archives in Brus (...) 15 Ann Laura Stoler, “Colonial Archives and the Arts of Governance,” Archival Science, vol. 2, p. 99. (...) 16 Ibid., p. 87. 17 Jiat-Hwee Chang, A Genealogy of Tropical Architecture, op. cit. (note 5), p. 248. 10In this respect, our choice to highlight this particular source from an abundant documentation related to the implementation of the healthcare infrastructure network in post-war Belgian Congo, consulted in the Brussels-based archives of the colonial administration, was also driven by an interest in the mundane paperasserie of the colonial administration.14 Such everyday sources might seem trivial at first sight, but, as historian Ann Laura Stoler has convincingly argued, they can be read “along the archival grain.”15 The table underpins Stoler’s argument that archives are not just historical sources as such, but should be understood as “transparencies on which power relations were inscribed and intricate technologies of rule in themselves.”16 This single tiny but crucial document exemplifies a massive flow of bureaucratic processes needed to implement the large-scale network of a healthcare infrastructure on a territorial scale. As a particular step in the day-to-day operational workflow of the colonial administration, the table unveils the ways in which the colonial government centrally monitored and steered its healthcare building campaign, relying on what Jiat Hwee Chang has termed “technologies of distance.”17 Yet, at the same time, it provides us with a glimpse of the importance of local realities, showing how, in a generic decision making process, various peripheral layers of the colonial administrative apparatus involved in building the hardware of the colonial project were nonetheless given agency to accommodate and respond to local challenges.

Similarly, the set of type-plans was conceived as a means of providing a comprehensive framework to guide an efficient as well as coherent building campaign in the domain of healthcare in postwar Congo. Our mapping clearly demonstrates the widespread use of this type-plan all over the territory. At first sight, these type-plans seem to disregard varying local conditions of climate and topography, as well as of sickness, population density, and even availability of labor and materials. And while the one site-plan of the binder shown here (fig. 2) does provide for a main entrance (entrée principale) and an indication of the most suitable orientation according to the compass rose, it is designed as completely detached from its immediate surroundings. Yet, what our research on the execution of the fine-grained network of healthcare infrastructure in the context of the first Ten-Year Plan for the Economic and Social Development of the Belgian Congo (1949‒1959) suggests is that the generic plan for rural hospitals along a pavilion-type could be adjusted to respond to local conditions that might differ substantially from one node in the network to another. As such, our investigation of the bureaucratic procedures underlying its execution in particular nodes of the healthcare infrastructural network, illustrated by the document Situation des Constructions C.M.C. au 1-9-1954, in fact suggests that we need to think of the generic and the local not as mutually exclusive, but rather as intrinsic to the “gray” architecture that constitutes a large part of the colonial landscape of healthcare in the Belgian Congo.

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Source: Brussels (Belgium), Ministry of Foreign Affairs, Africa Archives, file GG18186 (courtesy Ministry of Foreign Affairs).

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Source: Brussels (Belgium), Ministry of Foreign Affairs, Africa Archives, file GG18186 (courtesy Ministry of Foreign Affairs).