The Politics of Disease Control. Mari K. Webel

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СКАЧАТЬ its emplacement. Yet research on colonial public health, and health interventions in history more broadly, largely leaves the siting, location, and development of interventions uninterrogated and the consequential implications for public health unexplored. By approaching the locations of public health interventions effectively as a fait accompli, we reify the logic of past practitioners as the principal way of understanding an intervention. For practitioners who worked in settings such as colonial eastern Africa, racialized ideas of cultural difference were fundamental to their logic, ethics, and strategies. Thinking critically about the places where colonial public health and research occurred allows us to reveal their blind spots and expose their intellectual biases in order to understand the lives and motivations of those people most affected.

      Throughout this book, I argue for a reconsideration of sleeping sickness control efforts that understands historical local contexts to be fundamentally important to how people used the camps and how trajectories of colonial public health changed over time. In the societies that provide my case studies—the Ssese Islands of the Buganda kingdom, the Haya kingdom of Kiziba, and the southern Imbo lowlands of the Rundi kingdom—locally oriented political, social, and therapeutic traditions shaped how and where people lived.²³ There and more broadly in the interlacustrine region, politics, social life, and healing had long been embedded in particular places or kinds of spaces.²⁴ How people lived within or moved through particular places, and how they understood the implications of inhabiting, using, or traveling through them, were matters grounded in historic efforts to carve out a prosperous, healthy life.²⁵ These efforts manifested in the organization of domestic spaces, in agricultural practices, in patterns of trade and migration, and in strategies to heal or avoid illness. Situated, localized knowledge was paramount. Colonial anti–sleeping sickness measures were profoundly affected by the embeddedness of interlacustrine populations’ experiences and intellectual worlds. Processes of negotiation and engagement between African elites, European doctors and administrators, and wider populations, for example, determined where sleeping sickness camps were located and how and when they were built. The past and present uses and meanings of those places shaped how people utilized the camps situated within them and, by extension, had implications for the efficacy of sleeping sickness research, prevention, and control measures.

      This book engages with crucial questions of health and politics by looking to the processes through which African and European actors refined their definitions of illness and its causes, contextualized widespread illness and misfortune, set the political and social parameters for their amelioration, and reconciled colonial public health campaigns with the circumstances of daily life. Case studies from colonial Uganda, Tanzania, and Burundi explore the potential magnitude of the rupture presented by sleeping sickness specifically, as well as the continuities evident in African responses to other forms of illness and misfortune during this era. Epidemic sleeping sickness and broad-ranging interventions may have been novel in the early twentieth century, but they were not without precedent. African political authorities’ historic responsibility to maintain the health of their kingdom and populations influenced their interest in engaging with sleeping sickness interventions, as did the new dynamics of political power that colonial incursion brought. By examining how knowledge, strategies, and tactics regarding widespread illness related over time in this interlacustrine, intercolonial milieu, we see clearly how African engagement, situated within extant political, economic, and therapeutic systems, fundamentally shaped ambitious and wide-ranging colonial public health programs.

      PERSPECTIVES ON THE HISTORY OF SLEEPING SICKNESS

      In both historical and medical literature, sleeping sickness epidemics in the early twentieth century are a singular sort of disaster in eastern and central Africa, vast in scope and unprecedented in the scale of human death. Concomitant with colonial incursion and subsequent economic and political imperatives, widespread illness and death from epidemic sleeping sickness loom large—a crisis that constituted a great rupture in the lives of populations in the Great Lakes region. But if we are to focus our analysis on the people affected by these epidemics, rather than the imperial panic they triggered, we must query the nature of the disaster and the extent of the rupture, asking not only how serious was sleeping sickness to interlacustrine societies, but also how it fit into or departed from known points of reference and comparison.

      Historical epidemiological research has begun this important work, looking back at records from the Uganda epidemic to understand how and why mortality was so explosive in the early twentieth century. These multidisciplinary studies point to the importance of considering climate, food security, disease ecology, and epidemiology in assessing the disease’s impacts in the early twentieth century, and make reference to more recent outbreaks as well.²⁶ Their findings are provocative. One set of research examines case records and mortality rates to conclude that the Lake Victoria epidemics were due to a novel exposure to a different parasite (T. b. rhodesiense rather than T. b. gambiense) triggered by aggressive cattle restocking efforts that caused acute, fast-moving infections and higher mortality rates. The introduction of a non-endemic parasite was, in this research, the epidemic’s spark.²⁷ Other studies likewise use historical climate data and colonial health statistics before and during the Uganda epidemic to assess the impact of climatic variation—specifically several consecutive years of unreliable rainfall and drought—and colonial rule on food security, people’s use of tsetse habitats, and human vulnerability to parasitic infection. Here, sleeping sickness mortality rates actually masked more widespread misery and hunger, exacerbated by both colonial policies and crop failures that made populations more vulnerable to trypanosome parasites.²⁸ Such work has an intellectual affinity to path-breaking work on sleeping sickness in the Belgian Congo that established clear links between the advent of “the colonial disease” and forced labor, rubber collection, and mobility into and out of tsetse habitats generated by the Belgian regime.²⁹ Broadly, this vein of research makes clear the devastating impact of sleeping sickness on vulnerable populations, but is equally insistent that scholars not understand sleeping sickness as a “natural” phenomenon inherent to African environments. Scholars thus refute colonial arguments of the coincidental or epiphenomenal nature of outbreaks of sleeping sickness, while also acknowledging the complexity of identifying what or who precisely touched off these epidemics and how. The extent of the crisis for affected communities was significant, to be sure, but disease dynamics were not natural or inevitable phenomena.

      Studies that have sought to understand how sleeping sickness mortality changed over time at both the small and large scale in Africa situate sleeping sickness in different possible, immediate contexts, such as climatic variation, pathogenic variation or virulence, labor regimes, or food security and human vulnerability. Drawing on their insights interrogating the nature and scale of an epidemic at a population level, this book pursues related concerns: If we can get a sense of what caused disease dynamics to change in the past, what can we yet learn about how people understood these changing experiences of illness and death within their own frames of reference? What did they do in response? How did their actions affect colonial interventions? Studies of sleeping sickness and colonial public health have, by and large, not focused on these issues. Instead, understanding particular historical dynamics of morbidity and mortality, as well as the catalysts of past epidemics, has taken center stage. This book, by contrast, teases out the place of sleeping sickness among wider disruptions around Lake Victoria and Lake Tanganyika and fits this episode of illness into other experiences of illness and misfortune that provided intellectual points of reference and a toolkit of practical strategies for affected communities. It argues that African populations understood sleepy, wasting forms of illness with reference to previous forms of serious or widespread illness and death, particularly recent outbreaks of kaumpuli or rubunga on the northern and western shores of Lake Victoria, as well as pox-causing illness more widely. This book incorporates and expands disease-specific histories of bubonic plague, cholera, and smallpox in eastern and central Africa that have not previously been placed into dialogue with the history of sleeping sickness.³⁰ Seeing important continuities in both intellectual approaches and practical strategies taken by affected people, it also shows that people took measures against sleeping sickness that had historical precedent: they consulted known and proven healing resources, reoriented СКАЧАТЬ