The encounter between Africans and the West in early South Africa is as much about Africans as victims as it is about their agency. While the crude power of the West to subjugate Africans for colonial service was real, it is generally over-estimated. The idea that western traditions of education, health and family life just transformed subjugated Africans needs nuancing. Using the experiences of Africans on the south-eastern coast, modern-day KwaZulu-Natal, this work suggests that the evolution of western medicine was conditioned as much by colonial Christian interests as by African agency. Whether as patients of medical missionaries in the countryside or as workers in medical establishments, Africans were no mere victims of the system, but they worked to appropriate and adapt new health regimes as they contended with general sickness and newly introduced diseases. Often, they annoyed the purveyors of western health civilisation by seeking to appropriate rather than merely submit to their 'superior' medical care. This work provides some insights for use in understanding ways of working with the poor Africans in their struggles against poverty and disease today.