







































Christian Relief, Development, and Advocacy 2(1),  Summer 2020 

Hampton, Book Review   31 
 

Book Review 

 

Conversionary Sites: Transforming Medical Aid and 

Global Christianity from Madagascar to Minnesota...  
By Britt Halvorson 

 
Reviewed by Thomas Hampton  

 

 

 

  
 

Chicago: University of Chicago Press. 2018. $35.00. 

 

As internationally networked Christian aid 

organizations struggle with the implications of colonial 

legacies that shaped them, there is a common trend 

toward partnership with an emphasis on local 

leadership. Less comfortable sending people, some 

organizations in the post-colonial era send only aid and 

equipment. This model leaves the sent objects to 

acquire and transform their meaning in less controlled 

ways that secular anthropological theories can help 

Christian relief and development organizations to 

understand. 

Conversionary Sites is a comparative ethnography 

of Lutherans in Minnesota and Lutheran-run hospitals 

in Madagascar, as together they manage a church-based 

surplus medical equipment supply chain. In its six 

chapters, this book follows donated medical equipment 

through six “conversionary sites” – semiotic systems 

that restructure the value and meaning of the donations.  

The value conversions arise because the 

international NGO is located at the intersection of 

multiple economic systems. The transfer of expired 

medical equipment from the U.S. to Madagascar 

generates the value that stimulates the exchange. 

Volunteers sort the equipment in Minnesota, while 

medical practitioners in Madagascar decide for 

themselves what has value and what should be 

discarded as would have been required in America. 

Halvorson shows that, fundamentally, this decision 

comes down to risk calculations, though Christian 

language of redemption is frequently used throughout 

the process (134). Halvorson notes that volunteers 

often turn to religious language, especially in complex 

moments of cognitive dissonance (216-217).  

Because supply chain management involves 

nurturing relationships, there is also a question about 

which relationships should be given priority. Because 

the equipment imported from Minnesota is not 

intended to fully supply the Lutheran hospital, hospital 

administrators need to maintain relationships with their 

Lutheran partners as well as suppliers in India and 

China. People who are key to maintaining positive 

partnerships are highly regarded by all involved. 

Halvorson describes the role of one white doctor living 

in Madagascar who picks up on the legacies of David 

Livingstone and Albert Schweitzer (175), rising to an 

almost mythical status through the constructed 

narratives. The description of certain doctors as heroes 

derives from the fact that they are rare and seen as 

having taken on a large amount of risk. It also implies 

that their position may be out of reach for many. 

Halvorson helpfully points out that relying on a few 

hero doctors is not ideal. It would be better for well-

trained doctors with international connections to be 

common. 

Halverson argues that accountability structures in 

international NGOs are often one-sided, and they 

betray who really has power in a partnership. If only 

one side can call for an audit and then enforce it, then 

there is still hierarchy and debt – with David Graber’s 

theoretical work on the difficulty of reconciling 

asymmetrical debts featuring heavily in this book. 

American workers located in Minnesota and 

Madagascar say that God is ultimately the judge of them 



Christian Relief, Development, and Advocacy 2(1),  Summer 2020 

Hampton, Book Review   32 
 

all as a way to assume equality, but Halverson argues 

that, organizationally and practically, there is imbalance 

in a one-sided audit culture. Importantly, the necessity 

for aid exists precisely because of inequality in the 

relationship, so ignoring it is unhelpful to understanding 

the relationship’s dynamics. Because of historical 

colonial relationships there are varying financial and 

moral debts expressed between the US aid workers and 

the recipients of aid in Madagascar, but of course aid 

today cannot fully cancel out the effects of earlier 

colonialism.  

While Halvorson draws largely from secular 

anthropological theories to support her observations, 

there are several valuable takeaways in this book 

specifically for the Christian relief, development, and 

advocacy community. One is that while missionary 

agencies often try to embody post-colonial processes 

and may be uncomfortable with the legacies of their 

own history, it is important to acknowledge that partners 

in the Global South will continue to see their historical 

colonizers as strategic partners, because a connection is 

already formed. They can see how the individuals who 

continue the relationships personally benefit. As 

Halvorson states in her concluding sentence: “…It [a 

colonial era relationship] seems somewhat like a muscle 

memory, reigniting a bodily connection” (246). 

The most interesting practical implications are 

presented in the concluding chapter titled “Aid’s End 

Times,” which acts as a sort of postscript to the 

extensive research. Likely due to misunderstanding 

surrounding Madagascar’s decision to increase taxes on 

imported goods (239-240), the American Lutherans 

were unable to understand why their export cost were 

increasing above the rate of the shipping costs. A 

volatile political situation, including a 2009 coup, a 

financial crisis, the hospital’s difficulty in applying for 

non-profit status, and the discontent around audit 

practices led to the dissolution of the partnership. 

Surprisingly, at least to me, people involved in the aid 

partnership were generally OK with this. 

Agency leaders in Minnesota had long said that aid 

partnerships were not supposed to last forever, so there 

was little emphasis on developing a sustainable business 

strategy (242). Imported discount medical equipment 

undercut local manufacturing efforts, and when the aid 

partnership ended, alternative supply chains from 

China and India were prioritized. Doctors in 

Madagascar, especially the ones who did not have direct 

relationships with the Americans, described this 

transition as a part of God’s plan. They saw their self-

reliance as a positive outcome resulting from decreased 

inequalities.  

Like many books with six chapters, Conversionary 
Sites is based on a well-researched doctoral dissertation. 

The fieldwork providing its content stretches from 2003 

to 2014, including two years of direct participant 

observation in Minnesota and Madagascar. This 

volume is a well-edited culmination of conference 

presentations and chapter iterations, with much credit 

given to the University of Chicago editors in the 

footnotes. This book is for graduate level academics 

and practitioners willing to wade through citation-filled, 

36-page chapters with long paragraphs. For those who 

take it on, they will be rewarded with a strong 

understanding of secular anthropological theory 

applied in the field of Christian medical relief and to 

the ways anthropology conceptualizes the changes in 

world Christianity. 
 

 

 

 

Thomas Hampton is a PhD student in Intercultural 

Studies at Asbury Theological Seminary 

researching Christian missionary hospitals.  He is 

also the founder of Parallax Hearing Company 

(ParallaxHearing.com), and is a student at the 

Global Center for Advanced Studies. 

 
Author email:  thomas.hampton@asburyseminary.edu  
 

 

 

mailto:thomas.hampton@asburyseminary.edu

