The Politics of Disease Control. Mari K. Webel
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Название: The Politics of Disease Control
Автор: Mari K. Webel
Издательство: Ingram
Жанр: Историческая литература
Серия: New African Histories
isbn: 9780821446911
isbn:
This book argues that reorienting explorations of sleeping sickness around interlacustrine African concerns can generate productive new insights for an admittedly well-studied phenomenon in African history. Such a reorientation requires viewing sleeping sickness prevention and control from a different perspective, subordinating biomedical priorities and scientific detail to focus instead on the social, environmental, and political contexts of public health. To illustrate this shift and its consequences, consider two German colonial maps (figures I.1 and I.2) produced during the sleeping sickness epidemic. Figure I.1 is a 1907 map depicting Lake Victoria and its immediate environs and figure I.2 is a map of the northeastern littoral of Lake Tanganyika and its environs, circa 1913. Each map resulted from the combined efforts of colonial cartographers, medical researchers, and countless auxiliaries and assistants in the early twentieth century.19 The Lake Victoria map emphasizes three spaces, each roughly equidistant on the three sides of the lake in German colonial territory, and highlights known outbreaks of human illness around the northern arc of the lakeshore. Colonial borders are important on the Lake Victoria map, which draws the eye to where British Uganda and German East Africa meet as bright red hotspots, concentrations of human cases in German territory; important, too, are sketches of green along the lakeshore, depicting the range of the tsetse fly vector and suggesting the epidemic’s potential spread. A map-reader anticipates a problem—what would happen if the green and red zones should overlap?—and thus also considers the potential location of some checkpoint or intervention in those areas of impending overlap of fly vectors and human disease, to keep the disease from spreading. The Lake Tanganyika map shows a series of stations, evenly spaced along the lake, where eight sleeping sickness camps (Lager) in colonial Burundi were located. Shaded areas along the lakeshore and adjacent rivers indicate that colonial geographies prioritized particular ecologies, denoting areas where fly habitats had been “saniert”—cleared away.
These two maps encourage an aerial imagining of a colonial public health problem and the campaign that solved it: tactically precise, strategically balanced, rationally comprehensive, and covering all bases. The mapped campaign seems proportional: sensible for the management of both manpower and resources and fitting with contemporary epidemiological practice. These maps and their makers’ perspectives capture colonial public health as it emerged in the early twentieth century to begin considering epidemic diseases among colonized populations: a top-down, hierarchical apparatus of the state, targeting specific problems in geographically focused campaigns, and prioritizing the implications of illness for the imperial economic bottom line.20
FIGURE I.1. Overview Map of the Extent of Sleeping Sickness in East Africa, 1907. Courtesy of the Geheimes Staatsarchiv-Preussisches Kulturbesitz, Berlin-Dahlem. This map of the known extent of sleeping sickness in German East Africa accompanied materials submitted to a meeting of the Imperial Health Council’s Committee for Maritime and Tropical Medicine in November 1907, after Robert Koch’s expedition to eastern Africa. Areas with confirmed cases of sleeping sickness are shaded red; areas with the Glossina palpalis (tsetse) fly vector are shaded green. The colonial border between British and German territories bisects Lake Victoria. Source: Geheimes Staatsarchiv-Preussisches Kulturbesitz, 1 HA. rep. 8, no. 4118, “Aufzeichnung über die Sitzung des Reichsgesundheits-rats (Ausschuss für Schiffs- und Tropenhygiene und Unterausschuss für Cholera),” 18 Nov. 1907.
FIGURE I.2. Detail of “Plan—Tanganyika,” c. 1913. Courtesy of the Bundesarchiv, Berlin-Lichterfelde. This map shows the German sleeping sickness campaign’s field of work on the northwestern littoral of Lake Tanganyika in colonial Burundi. Seven camps dot the shoreline between Kigoma and Usumbura (modern Bujumbura). “Cleared” areas where tsetse fly habitats had been destroyed are shaded in along much of the lake shore and river courses descending toward the lake; areas where clearing is not planned are noted with cross-hatching. The Ubwari peninsula opposite Rumonge is not depicted. Source: Bundesarchiv, Berlin-Lichterfelde, R86/2632, Report, 12 May 1914.
But if one should shift from these distant, bird’s-eye views to instead land on the ground, making an imagined, swinging pivot from a map hanging on a wall to the terrain itself where the everyday activities of a public health intervention occurred, clarity all but disappears. The camps are isolated outposts, set apart from established villages, colonial administrative stations, and lakeshore trading towns alike. They share no particular consistency in elevation, terrain, or vegetation, as contemporary ideas connecting climate and disease might have dictated—even their proximity to the lakeshore is irregular. Some are near to concentrations of sick people, others are not. They might be surrounded by dense forest, intensively farmed land, or wide swampland. Situated within local geographies rather than imperial perspectives, policymakers’ decisions about siting and location are not evidently intuitive, efficient, or rational. Rather, the siting of sleeping sickness camps was contingent, perplexing, and jarringly unique. Interrogating these maps produces a series of questions: Why did colonial attention focus here or there, then, and not elsewhere? Why put a sleeping sickness isolation camp in one place, and not in another nearby? Why did a camp focus on certain communities, and not on their neighbors? What was here, or there, before a camp was built?
These questions lead to still others that animate my broader inquiry into the history of politics and health in the Great Lakes region. How did the colonial choice to site an intervention at one place or another interact with extant meanings and uses of that place by the people living nearby? Did a camp’s location overlap, conflict, or establish some kind of congruence with extant sites of healing, political power, or economic production? Did the pasts of these places impact how the targeted populations—sought after as patients, carriers, or suspicious cases—went to colonial sites and under what circumstances? Did where and how an intervention was located affect how people availed themselves of the treatments offered there? Sleeping sickness camps did not, of course, simply drop from the sky and slot neatly and smoothly into open, empty land. They resulted from strategic decisions by researchers, doctors, and administrators and often from negotiations with nearby political authorities. Where colonial officials located a sleeping sickness camp had meaning for people nearby, particularly in a cultural milieu such as the Great Lakes region, where place-centered healing practices had a deep history and where management of land was a fulcrum of political power.21
More broadly, thinking about where a public health intervention makes its home attunes us to its fundamental social and political contexts. Imagine the specificity of a new, dedicated building with fresh construction, a room inside a church or school with other uses during the week, an established government dispensary in a small town, or an urban hospital’s busy ward.22 An intervention site’s context has ramifications for how (or whether) people use it; these ramifications derive from the experiences and judgements of its target populations regarding its cost, its efficacy, СКАЧАТЬ