The Politics of Disease Control. Mari K. Webel
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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 domestic and social spaces, and made claims on political authorities. For some communities, such as those forced to abandon homes and farms and move into “fly free” areas in Uganda, sleeping sickness arguably caused a significant rupture in everyday life and livelihood; the Ssese Islands archipelago, one of my case studies and part of the Buganda kingdom, was effectively depopulated for most of the first half of the twentieth century.31 In other areas, mortality catalyzed deep and durable change. But focusing only on the singularity of the disaster of epidemic sleeping sickness erases the intellectual, therapeutic, and political work that many people put into living through it. Focusing instead on that work illuminates durable continuities across the nineteenth and twentieth centuries.
The particular interlacustrine cultural context of this book is crucial to understanding the variety of intellectual and practical resources available to affected populations by the late nineteenth century. My research on the responses and efforts of affected communities at the center of this book builds on robust studies of the social and political development of interlacustrine societies ranging over the past millennium.32 Studies of developments in deep historical time provide the basis for my engagement with linguistic and intellectual innovations amid epidemic illness, as well as my approach to long-standing political, social, and therapeutic resources oriented around clans, healing societies, and spirit mediumship.33 These earlier histories of interlacustrine politics and society are also in dialogue with analyses of political legitimacy, health, and prosperity as conditions changed with the advent of colonial incursion in eastern-central Africa in the nineteenth century. Foundational work on the relationship between political legitimacy and health—understood in terms of fertility, prosperity, and/or the absence of serious illness, among others—provides a key register within which I analyze reactions to epidemic illness on the Ssese Islands and in Kiziba.34 Scholarship on eastern-central African societies has encouraged me to be particularly attentive to the politics and meanings of specific places and kinds of spaces, as well as people’s movements within them.
This book brings the insights of studies of health, politics, and healing into dialogue with studies of the technologies and tactics of colonial disease prevention. I focus on the emplacement, development, and ongoing work of colonial sleeping sickness camps and the situated intellectual, therapeutic, and political worlds of the people that the camps targeted. Here, my approach to the early colonial era in the Great Lakes region is also guided by studies of late colonial and post-colonial health and illness. These accounts view efforts to define disease, healing and medical practices, and treatment-seeking as both embedded within and evidence of broader changes. This scholarship has shown that individuals and communities navigated illness or misfortune in creative, generative ways and tried to achieve health and prosperity amid a rapidly changing world through evolving and complex practices.35 The histories I offer here restore a sense of the messy, negotiated, and deeply contingent nature