The Experiment Must Continue. Melissa Graboyes

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СКАЧАТЬ he had been put on notice: the village was not happy to see him.

      The following morning, February 6, a delegation of villagers invited Goiny to a meeting to “discuss his plans.” He arrived to find hundreds of people (with “sullen, sulking countenances”) gathered for a “deliberately planned and punctiliously organized defiance meeting.” Residents “packed the verandah of the communal store” and filled “every inch of available ground.” Community leaders emphasized that the whole village was present and they had “unanimously” decided that “every man, child and woman” would oppose all forms of “domestic control.” They would resist his work “by all and any means”—including violence. Goiny left with “the formal assurance” that his work “would be resisted and prevented by the entire population.”³

      MAP 3.1. Kenyan coast. Map by Chris Becker.

      Goiny had arrived on Sunday and on Monday morning he had attended the protest meeting with hundreds of residents. On Monday afternoon, another delegation of men arrived threatening violence if he tried to enter any homes, alerting him to additional meetings that had been held at mosques where a “resolution” had been endorsed to obstruct Goiny’s work “by all and any means, not excluding . . . violence to the European.” On Tuesday morning, when trying to do outdoor mosquito catches and identify breeding sites, a group of villagers followed Goiny and his assistants, heckling them. An African health officer was almost pushed down a well by a group of angry youth with adult villagers looking on. Goiny was outraged and on Wednesday morning he went directly to complain to the mudir. On his way to the mudir, Goiny stumbled on yet another protest meeting happening at the mosque in a nearby village. This led him to conclude that there was a “concerted movement to defy and defeat the planned anti-filariasis investigations on the island.” As Goiny parodied the meeting in a letter to his boss:

      Prayers and sacrificial slaughterings were to be offered up for the deliverance of the island from the wiles and schemes of those inspeakable [sic] entomologists, harbingers of Allah alone knows what pernicious forms of government interference in our domestic affairs in the disguise of benefactors.⁴

      After three days on the island, Goiny was “stripped of the last rags of any illusions” he had about the real attitude of the villagers toward the scheme.

      By Thursday, letters in Arabic began arriving at the district commissioner’s office, explaining that the Pate Islanders would not carry out the orders of the “Sanitory Doctor [sic].”⁵ By the time the letter had been translated and read by the district commissioner on Friday, Goiny and his assistants had already left the island. The arrival had been quickly followed by a premature exit, and the project—long before actually beginning—was on the road to ending.⁶

      . . .

      Virtually unmentioned prior to Goiny’s arrival on Pate was the fact that his was not the first medical research project on the island, or even the first lymphatic filariasis elimination attempt. Ten years prior, in 1946, optimistic researchers from the London School of Tropical Medicine arrived at Pate intent on eliminating the disease. Their work ground to a halt as villagers refused to participate, petitioned the liwali (the British-recognized traditional leader of the Kenyan coastal area), and forced the researchers into an early retreat. The government euphemistically declared the investigation “postponed” due to the islanders’ truculence, and that project was also over before it began.⁷ And while Goiny and others in the medical department had either never known or forgotten about this prior attempt, the islanders had not. As the researchers were surprised to discover upon speaking with residents, there was “violent opposition . . . hostile attitudes and hot tempers still simmering from ten years prior.”⁸

      Residents made clear in the following weeks in a myriad of ways that they loathed government interaction, and it didn’t matter what was being promised. Based on past public health campaigns and the failed 1946 attempt, islanders had decided they were tired of the rough treatment, heavy fines, and destruction of personal property that had often accompanied the government’s goodwill gestures and public health programs. Past public health measures on the Kenyan coast included anti-mosquito campaigns shortly after the turn of the century, which involved house-to-house visits by the liwali’s representatives. In 1913, anti-plague campaigns included the threat of forced quarantine of railway workers, who were believed to be particularly susceptible. In 1933, the Ministry of Health and local board of health in Mombasa discussed a policy of “slum clearance” as a form of malaria and mosquito control. In the 1930s and 1940s, prosecutions for violations of the mosquito bylaws were “numerous and complaints about their harsh application equally so.”⁹ From the perspective of local residents, it was far better to continue living with a disease they had grown accustomed to than to risk additional contact with an untrustworthy and heavy-handed government. This local logic was alternately perplexing and galling to the British officials.

      Less than two months after Goiny’s failure the Medical Department had given up entirely on the elimination attempt. After much cajoling, only one village on the island had consented to indoor residual spraying and treatment with drugs. Within two years, though, the whole project would peter out quietly without elimination being accomplished or even neared. As in 1946, residents of Pate Island succeeded at changing the Kenyan colonial government plans, modifying international research agendas devised by tropical disease experts, and bringing another researcher’s grand arrival and hopes for disease elimination to an abrupt end.

       Modern Narrative

      A “REMARKABLE ACHIEVEMENT”?

       A Lymphatic Filariasis Elimination, Zanzibar, 2001

      World Health Organization workers arrived on the island of Unguja (often called Zanzibar) in the Zanzibar Archipelago off the coast of Tanzania in 2000 to begin work on an ambitious yet straightforward plan: to eliminate the disease lymphatic filariasis (LF). The levels of LF on the island were among the highest on the globe: roughly 15 percent of the entire population was infected; in some villages, nearly 30 percent of the population had microfilariae, indicative of the disease in their blood. The disease would be attacked using precise, modern techniques targeting the parasite inside the human body. If everyone on the island—roughly a million people—took a single pill once a year for five years, a disease that had long plagued the island’s residents could be defeated. Getting one million people to all take a pill on the same day would constitute one of the largest “mass drug administrations” ever attempted anywhere on the globe—and present a daunting set of logistical hurdles. Yet according to the WHO, if more than 75 percent of Zanzibaris took the drugs at the same time and then continued to do so for another four years, LF could be defeated. This would be a clear victory for local and international public health organizations, would save many Zanzibaris from disfigurement through grossly enlarged scrotums, legs, arms, or breasts, and would reap untold economic benefits.

      The Zanzibar campaign in 2001 was one part of a larger WHO effort to eradicate LF globally through the newly created Global Programme for the Elimination of Lymphatic Filariasis (GPELF). One early success of the GPELF was to negotiate a donation from the pharmaceutical companies GlaxoSmithKline and Merck & Co., which promised to provide free drugs for as long as was needed.¹ This agreement paved the way for a global strategy that relied on distribution of free yearly treatment in poor countries.

      The WHO worked closely with officials in the Zanzibar Ministry of Health to help coordinate the logistically complex campaign. The WHO made clear that, while they were providing technical support and expertise, it was the Zanzibaris who would be responsible for the actual work—and there was a lot of work to be done. The СКАЧАТЬ