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СКАЧАТЬ who worked in a lab in Mwanza near the government hospital. He stole and dealt in blood, and also gave out dawa. Mr. Elephantiasis sucked (kunyonya) blood—never to drink, but to sell. Bwana Matende was not a vampire but an unrepentant businessman.¹⁰ It was while pursuing his main goal of collecting blood to be sold that he inadvertently killed Africans. His unlucky subjects would be “finished” (kumaliziwa) and the body disposed of. The African blood was sold abroad for white people to make extremely potent dawa used in Europe and the United States. Bwana Matende was most active in the 1950s and 1960s, and was no longer in the Mwanza Region today.

      As his name made clear, Bwana Matende focused on the disease of filariasis. One of the peculiarities of lymphatic filariasis is that, for accurate testing, blood samples must be taken between eleven at night and two in the morning, when the microfilariae are active in the peripheral blood.¹¹ This medical necessity created a set of conditions that brought researchers during both the colonial and immediate postindependence eras into villages in the dead of night, where they would round people up in the center of town or go door to door, and take blood that they then stored in small vials. Those vials were carefully placed inside coolers, put into vehicles, and driven away to some unknown place, for an unknown use.

      During interviews, stories of Bwana Matende frequently broadened into discussions of the connections between blood, medicine, money, and the government. In meandering accounts, people explained how African blood was stolen, that blood was turned into medicine, and that medicine was sold to Europeans or rich locals. The stories also had to explain why the government would allow citizens to be killed and their blood stolen. When asked if the government approved of Bwana Matende’s work, Tanzanians responded with a version of “Eh—the Government? He is the government!”¹² As one man told me, if a person was unlucky enough to be taken by Bwana Matende, the police wouldn’t help. Since Bwana Matende was part of the government, the case would be closed, and the police officer would write that the death was due to “bad luck.”¹³

      This linking of Bwana Matende with the government is important. He was active before, during, and after the Tanzanian independence and consolidation process of the early 1960s, and when I pressed people to be more specific about which government Bwana Matende was working for, they responded by saying “government is government.”¹⁴ Any government could be bloodthirsty or act as a profiteer on the back of its citizens—that was not a characteristic singular to the colonial state. By giving the government a role (even that of tacit bystander) in blood stealing, people implied that blood stealing, murder, and profiteering were open secrets.¹⁵ In fact, the Swahili word siri (secret) was often invoked during discussion of medical research, the government’s complicity in blood stealing, and the larger nature of government and its relationship to its citizens.

      Aspects of the stories told about Bwana Matende resonate with the history of medical research in western Tanzania from the late 1940s through the 1960s. In the late 1940s, the Filariasis Research Unit and East African Medical Survey were established in the port city of Mwanza on Lake Victoria, and they continued to operate in the area through the 1960s; the original building still houses medical researchers today. The Filariasis Research Unit was particularly active, and thousands of East Africans came into contact with its members as they conducted large-scale surveys (to establish prevalence rates), tested new drugs, determined appropriate doses of effective therapies, and then attempted to provide mass treatment.¹⁶

      In the decade between 1950 and 1960, well over 50,000 Tanganyikans had their blood taken by researchers during the darkest hours of the night.¹⁷ On Ukara Island alone, drug trials conducted in 1950 involved more than 35 percent of the population giving blood and taking pills. Thousands of other residents in villages around Mwanza also had blood samples taken at night and received experimental therapies in the form of pills and injections.¹⁸ Bwana Matende stories circulated and gained currency as European and African researchers entered villages under cover of darkness, took blood, and then quickly departed.

      The Bwana Matende stories influenced how East Africans interacted with, and understood, medical researchers as a group. I asked a few different people how they could know whether a researcher was Bwana Matende or just a typical researcher—or how they might know when it was safe to participate, and when agreement could lead to blood theft and death. Mzee Thomas answered by explaining that, when you mix clean and dirty water, the water may still appear clean, but you know it is actually dirty. As he saw it, Bwana Matende was like a drop of dirty water infecting all researchers: as soon as Bwana Matende was present and people knew about him, all medical researchers were infected.¹⁹ Or, as Mama Nzito explained to me about the perils of keeping bad company, “If you sleep in a place for five minutes, you will start to stink like that place.”²⁰ What this meant in practice was that if Bwana Matende existed (which many people believed, or at least couldn’t disprove), then medical researchers as a group were to be suspected. These suspicions were heightened by perceptions of government involvement.

      The obvious overlaps between two different narratives—official accounts taken from government reports and research documents, and the “unofficial” understandings of East Africans participating in medical encounters—force us to recognize very different explanations of the same event. They also raise a set of challenging questions: Why do East Africans choose to talk about medical research in terms of damu and dawa and money and the government? What are the implications of the continued circulation of these stories, even though Bwana Matende supposedly finished his work fifty years ago? How has the residue of past projects, misunderstandings, mistreatment, and deaths stemming from medical research and public health projects shaded the present? How has this history of medical research shaped people’s understanding of, and participation in, current medical research projects?

      . . .

      In this chapter I show that stories about blood theft are firmly associated with biomedicine and biomedical research, and have been shaped by medical and public health encounters. I use the stories as a starting point to illustrate some of the ways modern East Africans choose to talk about medical research: through stories of blood theft, the invocation of researchers’ ability to kill or cure, the firm characterization of researchers as a generic group of experts with questionable ties to the government, and understanding medical research almost entirely through a lens of blood. The continued circulation of stories like that of Bwana Matende, and more general understandings of medical research that do not match up with Western definitions of it (either in terms of who is conducting such research, or what it consists of), profoundly influences the behavior of modern East Africans. Yet it is difficult to sort out precisely how and when East African understandings of blood, dawa, medical research, and its risks and benefits have changed. Modern East African understandings, and my portrayal of these notions, are clearly accumulated reflections based on decades of past experiences.

      While this chapter builds upon a rich literature focused on East Africa, the themes presented speak to the work of social scientists and medical researchers beyond the region. Other large-scale medical campaigns carried out over the past century—often labeled as public health interventions, but where the activities were still experimental—suffered from similar instances of misunderstandings. The best-known and best-documented cases created unexpected, unintended, and devastating consequences that changed the human disease risk environment and set the stage for new epidemics. One obvious example is the Hepatitis C epidemic in Egypt that stemmed from schistosomiasis (bilharzia) control efforts in the 1950s.²¹ Another episode, with medical doctors being given permission to administer a province of French Cameroon in the early 1940s, led to an increase in sleeping sickness cases and generally poor health outcomes.²² Likewise, it has been suggested that French and Belgian policies in West and Central Africa of mass treatment for sleeping sickness not only contributed to Hepatitis C epidemics in the first half of the twentieth century, but created ripe conditions for the amplification of HIV from a local disease to a pandemic.²³ While we continue to focus on East Africa, we must keep in mind that unfortunate outcomes coupled with deep misunderstandings were not unusual far СКАЧАТЬ