Pharmacy Shops and Visual Culture in Kabila’s Congo

My personal research archive contains two photographic series of pharmacy shops, one set taken in Kisangani and the other Kinshasa in 2007. Given how risky it is to use a camera in any Congolese city, I was the photographer for neither set. Instead, I commissioned two Congolese photographers—an amateur in Kisangani and a professional in Kinshasa—to take these photographs for me. I always undertake research travel with a camera, however, and use it in Congo when doing so does not risk trouble or arrest. Indeed, without my own photographic forays, I probably would never have developed the idea to constitute a visual inventory of urban pharmacy shops as a way to gather knowledge and sharpen questions for further research.

 

Why study pharmacy shops in postcolonial Africa? And, why might it be productive to use visual evidence on storefronts, clinic drug cabinets, and sales rooms to do so? Pharmacy shops have been important medical marketplaces, social venues, and sites of knowledge and care since the privatization of health began to intensify in Africa from the 1990s. A new generation of anthropologists is busy studying the ethics, markets, practices, and meanings, surrounding global pharmaceuticals. At the same time, anthropologists and historians have been turning to documenting visual cultural practices in African cities. Rarely, it seems, do these medical and visual researchers speak to each other. With these research notes, I suggest it may be time to open a new conversation.

 

My interest in pharmacy shops in the Democratic Republic of Congo began about 2005, when I sought a fresh angle by which to study everyday life in the eastern regions so strongly hit by war since 1996.  Pharmacies seemed to offer an oblique location from which to observe illness, suffering and self-medication within one of Africa’s most important war and humanitarian zones. My idea was to listen to conversations and observe transactions, in part to learn if patterns of resort in this zone of “trauma” already embraced psycho-pharmaceuticals.

 

Instead, with a 2007 Fulbright year in Congo, my location and priorities took me in different directions. I did not yet have time or funding to begin such ethnographic listening, but as I moved through Congolese worlds, I began seeing how my camera could help me pose important questions about pharmacies in this once Belgian colony. Early on, I traveled into southern Equateur in search of a woman healer arrested in 1915. This journey by canoe on small streams led to my spotting—and photographing—a village nurse (a man, of course!) with one functioning technology: a baby scale hung from a tree branch. His clinic spilled out from a small hut and under a tree. To my eyes, chaos reigned; at least, no pharmaceutical debris seemed capable of ever being declared trash. There was no purchasing or restocking system in evidence, and little sense of a desk, examining table, in-patient space, or medicine chest either. The nurse did weigh babies. I saw him struggle to ease the agony of one sick infant, but nothing suggested that anyone expected their resident nurse to impose order on or sell any of his decomposing jumble of medicinal supplies. In contrast, in a clinic in a forest village downriver from Kisangani, my camera spied the relatively tidy pharmaceutical cabinet of a functioning clinic, manned by another nurse. The doors to his medicine chest were wide open (photo 1). Charts and tables covering the clinic walls kept count of numbers served and vaccinated, while signaling competence and efficiency. His medicinal chest was an active pharmacy of sorts. Surely he prescribed and sold medicines contained therein. But little suggests enough capital to buy larger quantities of any item. The charts suggested inspections, fairly regular ones at that. Thus, district-level health surveillance was still going on within this largely Protestant parastatal health zone. Probably inspectors still cycle in, carrying and selling small stocks of most needed pharmaceuticals, as part of a small battery of means to provide essential medicines, collect patient fees, and fuel this mobile, semi-privatized health system.

 

Yainyongo village pharmacy chest. Courtesy of N.R. Hunt.

 

During the same journey down the Congo River as far as Yanonge, I shared a cup of tea with the pastor who so warmly welcomed me to the region almost twenty years before. My photographs tell of an important addition to this calm and orderly neighborhood up above the bustling market town: a new, sedate, church-affiliated pharmacy in a structure resembling a modest, mud-walled, village home. It use of visual icons on its walls announced its identity as a pharmacy (photo 2).

 


Church-run pharmacy in Yanonge. Courtesy of N.R. Hunt

 

From these first photographs grew the idea to collect many more. I had come to know Kisangani well during a year there in 1989. Since 1996, this city had endured a period as a pivotal axis of war at Congo’s “bend in the river.” By 2007, it was doubling as a major entrepôt for diamond sellers with a tidied, upgraded, frontier air to its central business zone. Indeed, the new traffic in artisanal diamonds had produced significant visual change. Fresh paint, clever design, and intense competition among gem purchasers had the city’s center looking new and shiny, while the sheer number of pharmacy shops was striking. Keen to find a way to photograph these storefronts, and knowing neither police nor populace would allow me do it on my own, I asked Rogier Tula, my research assistant from 1989, to spend a day with my camera collecting images for me. 

 

Most of my 2007 year was in Kinshasa, where I spent at least 20 percent of my time blocked in traffic. Traffic jams became my best time to puzzle over household budgets and the advertizing strategies of businesses and persons, using all manner of dress, style, and symbolic power to sell products and themselves. I also witnessed a myriad of pharmacy shops, including the many packed into Kinshasa’s special district of wholesale importers and sellers; fancy retail stores resembling Belgian pharmacies with modernist, bilingual (French and Flemish), neon signs that cater to wealthy and expatriate consumers seeking Belgian- and European-made pharmaceuticals; and all manner of retail shops selling generic, especially Chinese-made medications. By the time I commissioned a photographer to go to work for me in Kinshasa—the marvelous, famous, professional press photographer, Etienne Kokolo—he and I expanded our definition of pharmacy to include all medicinal sellers, including those selling handmade suppositories for hemorrhoids and “sexual force.”

 

All in all, the two city series suggest a more consistent attention to creating a sharp, tidy, and licit look in Kisangani, where most pharmacies display official registration numbers and the recent paint jobs created a strong, clean look. My photographic archive also suggests two perplexities for further exploration. One is about photographic practice as an aspect of Congo’s visual culture; the other is about the visual culture of Congolese pharmacies. The first comes from my inventory of Kisangani pharmacies. Why, I began to wonder, is the same youth present, posing with bicycle in almost all of Tula’s photographs? The cyclist had converted his back fender into a second bicycle seat, decorating it with a colorful, specially knitted cover, announcing that this man with bicycle constituted a team ready as taxi for hire. That Tula expedites his work through hiring a cycling taximan is no surprise. The days were hot, the distance to be covered significant. Yet how did it come about that the amateur photographer and the professional taxi-man negotiated their bargain in terms that placed the cyclist-for-hire within most every frame? For these two entrepreneurs with minimal educations and much street smarts, does every photograph need—deserve—a proud human subject? Did the taxi-man’s inclusion lower the fee for the unusual city tour they made? Regardless, Tula never imagined I might find the repetition unfitting, irksome—or fascinating!

 

Is there a parallel lurking here in relation to selling pharmaceuticals? This question takes me to another, more deliberate repetition and my second perplexity. Most of Congo’s pharmacies—albeit more in proud Kisangani than grubby Kinshasa—signal their legitimacy and identity through an international icon, long used to brand a pharmacy a pharmacy in Belgium, France, and other parts of Europe. The “Bowl of Hygeia,” still widely recognized internationally, allegedly depicts a healing snake wrapped around a bowl or cup containing a medicinal potion of Hygeia, the Greek goddess of health. This symbol, whose use perhaps dates back to 13th century Padua and at least 18th century France, became standard fare for Belgian and French pharmacy shops by the 1940s, and likely in the few pharmacies found in colonial territories about the same time. When and why the icon began to be supplanted in much of western Europe by today’s simpler, green pharmacy cross needs research; the meanings Catholic Belgians among other Europeans made of imagery easily conflated with Eucharistic blessings and a perilous snake is also in order. Still, that the healing cup with snake icon seems to have survived more tenaciously in former Belgian Africa than in Belgium is intriguing.

 

The big question of course is this: If this is the icon that signals a pharmacy, how do Congolese read this visual sign? My findings powerfully suggest that pharmaceutical businesses in Congo think customers are more likely to be drawn to signs promising powerful spiritual effects; thus, the “Apocalypse” label in image no. x. But, what in the world do owners, clerks, and customers make of this complex symbol with container with cavity and a winding, perhaps poisonous, devilish snake? Thus, when I next go to Congo, I will be seeking evidence on such meaning-making. This work also will find me shifting my evidentiary register from visual clues to vernacular speech, to the more storied kinds of evidence that come from talking with people and observing practice. Still, my current Congolese archive suggests that Hygiea’s cup is imagined more as a mortar (a cooking item still used to pound starchy foods and medicinal barks) or as a healing drum. Indeed, the church-affiliated pharmacy at Yanonge (photo 2) included a Christian cross within its visual mix, a dignified gesture signifying grace and trust (in keeping with Congo’s more mainline Baptist churches), and quite unlike the advertizing ploy of more Pentecostal-leaning pharmacy shops  (photo 3) who announce their powers and appeal with labels like “Apocalypse.”

 


“Apocalypse Domaine” pharmacy in Kisangani. Courtesy of N.R. Hunt.