Traditional Chinese medicine, pillar of Beijing's "soft power" in Africa

The Mali Hospital, inaugurated in 2010 on the right bank of the Niger River, in the suburbs of Bamako, is sometimes called "the Chinese hospital"

Traditional Chinese medicine, pillar of Beijing's "soft power" in Africa

The Mali Hospital, inaugurated in 2010 on the right bank of the Niger River, in the suburbs of Bamako, is sometimes called "the Chinese hospital". A few steps inside the entrance hall are enough to understand why. The Mandarin signage reminds us that all the construction elements of this 150-bed establishment arrived directly from China, which donated the establishment as well as materials and medicines.

But the Chinese contribution to this flagship of the Malian healthcare system does not stop there. Strolling through the wards, we come across several Asian doctors who offer traditional Chinese medicine (TCM) care – including acupuncture, used mainly in the management of pain.

Elsewhere in town, there are Chinese medicine "clinics", owned by private entrepreneurs this time, which attest to the popularity of these treatments and products among the inhabitants of the capital. Bamako is far from being an exception on the continent, TCM being present in many African metropolises.

Scholarships and training

Health has been one of the pillars of Beijing's foreign policy for decades. “The establishment of TCM is often a reflection of historical ties between China and states. It is found more markedly in countries where Chinese medical missions have been established since the 1960s,” analyzes Xavier Aurégan, lecturer in geopolitics at the Catholic University of Lille. In Mali, the first Chinese medical mission was established during this period in the region of Ségou.

Since then, Chinese involvement in the African health landscape has taken different forms, with recent major investments in major health-related projects, such as the construction, which has just been completed, of the building of the Control and Prevention Center of Diseases (Africa CDC), Addis Ababa.

Present in the health component of the "new silk roads", the dissemination of TCM is materialized by the establishment of scientific and medical cooperation centers, called "Luban workshops". The deployment of about ten of these workshops, supposed to allow thousands of African students to follow professional qualification paths, was one of the eight initiatives presented in September 2018 by the Chinese President, Xi Jinping, during the Forum on Sino-African cooperation, in Beijing.

The Bamako center was inaugurated shortly before the start of the Covid-19 pandemic, at the end of December 2019. "During the months that followed, China was very present on the health side, in particular by offering products and MTC to take care of patients infected with SARS-CoV-2, recalls Xavier Aurégan. It was also a way to combat the anti-Chinese sentiment that the origin of the virus tended to nurture. Fourteen Luban workshops have since been deployed, from Ivory Coast to Madagascar via Ethiopia and Kenya.

In addition to doctors sent by Beijing and expatriates who work as private entrepreneurs, TCM is also increasingly practiced by African doctors or traditional healers. Some Luban workshops, as well as the Confucius Institutes present on many African campuses, offer training in TCM, such as at the University of the Western Cape, in South Africa.

But China also regularly offers scholarships to allow Africans to train on its soil. A way for a certain number of local traditional healers to diversify their care offer and expand their clientele. TCM is a thriving market, and not just on the continent: in 2018, it reportedly brought in $50 billion worldwide, with the biggest consumer country outside of China being… the United States.

Diabetes, hypertension, malaria…

Is TCM competing with traditional African medicines? "It is tempting to oppose traditional Chinese and African medicines, but it seems fairer to see them as two modalities among others, which cohabit in the local care offer and which do not necessarily target the same people", underlines Elisabeth Hsu, professor of anthropology at the University of Oxford and author of the book Chinese Medicine in East Africa (ed. Berghahn, 2022, untranslated).

A rare specialist in the subject, she has nurtured her research with repeated stays in Tanzania, Kenya and Uganda. According to his observations, TCM attracts clients of all ages but rather male, middle class, who live in the urban periphery and who consult for a wide range of diseases, from diabetes to hypertension to malaria, where the effectiveness of the Chinese pharmacopoeia has been proven. The 2015 awarding of the Nobel Prize in Medicine to Tu Youyou, director of research at the Academy of Traditional Chinese Medicine, for the discovery of artemisinin, a powerful antimalarial, has also helped to strengthen the confidence of many in the TCM.

"We talk broadly about TCM, but a lot of people who go to these clinics don't really know what they're actually buying. And you can find a lot of stuff there! Remedies from traditional Chinese pharmacopoeia like drugs from Western medicine, but made in China,” notes Elisabeth Hsu, who points out that Chinese doctors have particularly established themselves in reproductive medicine, “an area in which Western medicine has a low success rate." Many remedies sold in "clinics" thus promise to improve sexual function and fertility.

“During one of my stays in Bamako, I observed the shop of a TCM practitioner installed opposite my hotel. He almost exclusively sold products for men, with very explicit packaging, and his shop was always full! For many men, it is easier to go see the Chinese practitioner, who will never tell anyone, rather than the local traditional therapist, who probably knows friends or family, "illustrates Xavier Aurégan.

Some voices are raised to denounce the threat posed by certain ingredients of traditional Chinese pharmacopoeia to flora and fauna. Pangolins, rhinos and tigers, for example, are still hunted mainly for the use of some of their organs or appendages (hair, feathers, scales, etc.) in TCM remedies.