The Politics of Disease Control. Mari K. Webel
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efforts; they underscore how profoundly these efforts were shaped by local experiences. This is especially important when, in time, anti–sleeping sickness campaigns have come to be understood as rigid and draconian manifestations of colonial power, and, further, when medical and scientific literature continues to either obliquely or directly credit colonial campaigns as effectively reducing sleeping sickness mortality.36
My work builds on scholarship that established clear connections between the political, social, and ecological disruptions of colonial incursion and the spread of trypanosomiasis (among other maladies), and that has shown how sleeping sickness was intimately linked with new, extractive economic processes such as mining or rubber collection.37 Histories of sleeping sickness that explore these connections generally keep within the confines of the nation-state and its colonial predecessor, emphasizing the singular approaches of the different European imperial powers and colonial administrations to controlling and preventing sleeping sickness.38 Some have focused on the experiences of a specific region; others have addressed entire colonial programs to understand their implications for later national histories.39 While histories of research emphasize the transnational and intercolonial nature of past scientific and medical efforts, and Africanist studies of labor and migration have long traversed colonialnational boundaries, this book is the first study to consider sleeping sickness prevention and control within a transnational and intercolonial frame.40
The particular circumstances of Lake Victoria and Lake Tanganyika, where multiple colonial states divided the lakes’ shores and engaged directly with one another around the problem sleeping sickness posed, encourages this approach. But the lived experiences of littoral populations, where mobility around the lake and connection with other societies were central, make it an intellectual necessity.41 Reflecting shifts in historical scholarship toward transnational and comparative methodologies, and, equally importantly, recognizing that the lives and experiences of Africans and Europeans alike were shaped by the vigorous mobility of people, goods, diseases, and ideas around the lakes, this book frames the problem of sleeping sickness within the ecologies and landscapes around Lake Victoria and Lake Tanganyika. This reframing of sleeping sickness not simply as a Ugandan, Tanzanian, or Burundian concern foregrounds the connections between populations that preceded partition and endured despite the advent of the colonial state. Considering the phenomena of sleeping sickness mortality, prevention, and control within an interlacustrine world—a world defined by historic states and tributary kingdoms, complex economies of land and labor, and the lakeshores’ ecosystems—rather than in colonial-national units allows me to focus on the vitality of African mobility and interchange. This interlacustrine and intercolonial frame also allows me to pay particular attention to polities and societies for which colonial borders were a new imposition and one with varying significance for daily life. By virtue of their location at or near colonial borderlands, these populations had distinctive experiences of mobility and sleeping sickness. They were marginal to the centers of power in the region: distant from commercial and political hubs of the Indian Ocean coast and peripheral to the capitals of interlacustrine kingdoms. But they held an important place in colonial prevention and control campaigns and were central to managing the spread of disease in a new era of public health surveillance. Often, sleeping sickness research, surveillance, and prevention were African populations’ earliest and most consistent engagement with Europeans or the colonial state, and the book’s interlacustrine and intercolonial framing illuminates similarities and divergences in their experiences.
I also approach my three areas of focus—the Ssese Islands, the kingdom of Kiziba, and the Imbo lowlands—with time in mind, concentrating on a particular moment when sleeping sickness had a high impact for colonial and African authorities alike. The early 1900s were a moment of uncertainty: neither African authorities nor healers nor European scientists nor colonial bureaucrats had a firm grip on where the sleeping sickness epidemic came from, how precisely it spread, or what measures should be taken to control it. This productive uncertainty shows how simultaneous intellectual, political, and practical efforts of European and African actors mingled and conflicted in generative ways.42 I show that accretions of new information and processes of scientific change in tropical medicine and public health more broadly did not occur solely based on Europeans’ intellectual orientations and experiences—the “eureka!” moments of white researchers in a remote, humid laboratory or a dusty field site. Rather, new ideas and strategies that manifested in colonial sleeping sickness policies—such as the atoxyl-focused sleeping sickness camp—had their origins in interactions with and adaptations to the political, social, and environmental dynamics of Ssese islanders, Ziba royal authorities and their subjects, or Bwari and Rundi people in Imbo. Researchers, doctors, and colonial public health officials immersed in sleeping sickness work also absorbed elements of the intellectual worlds, morality, and political ideologies of their African interlocutors, even if these Europeans at the time saw those African people primarily as patients to dose, bodies to study, or people to target.
Sleeping sickness proves a particularly apt tool for prying open the discrete eras of modern African history—divided by colonial rule, the world wars, or political independence—to facilitate considerations of historical continuity in public health.43 This stems from the persistence of sleeping sickness as a health concern in rural Africa and relates to the nature of human African trypanosomiasis itself. It is a focal disease, its transmission limited to particular places: environments where its fly vector thrives and where human and animal hosts of the parasite live or transit. People, parasites, and flies have to be in specific places, together, within a particular span of time, in order for the trypanosome parasite to undergo development in both its host and vector and to survive successfully. Break the chain of contact at any point—secure people from fly bites or prevent flies from ingesting parasites as part of their blood meal—and transmission ceases. And so, biomedical approaches to trypanosomal infections, beginning in the period of my study, developed an environmental and ecological orientation that spatialized the disease and the potential for epidemic outbreaks around “fly zones.”44 Work on sleeping sickness and other such ecologically specific, vector-borne diseases has since persistently prioritized the environmental dimensions of health and illness in identifying at-risk populations or ideal targets for vector control campaigns, generally limiting work by the climatic range or ecological niches of their disease vectors.45 This has meant that, across the twentieth century, vulnerable and affected African populations have seen successive interventions by different regimes, states, and nongovernmental organizations, each oriented around that spatialized, environmental logic of sleeping sickness control and each building on precedents in particular ways. The book’s three case studies in the Ssese Islands, Kiziba, and the southern Imbo highlight the kinds of complex relationships that often accompanied and shaped public health interventions historically and continued to inform subsequent interventions after World War I. I prioritize people’s experiences to understand meaningful points of reference and resonance that impacted their engagement with, and therefore also the efficacy of, health interventions.
After decades of centrality in imperial research agendas, eastern and interlacustrine Africa emerged as hubs of global health activity after the 1990s. Global health programs have frequently come to supplant the core health-related functions of the state and often altered citizens’ engagement with national governments.46 Programs in Africa (as elsewhere) frequently focus on the strategic deployment of specific pharmaceutical or medical goods and emphasize community participation, sustainability, and capacity-building. Yet, while these programs are sometimes flummoxed by local complexity or unpredictability with historical roots, consideration of their contexts by global health practitioners tends to be strongly presentoriented. Programs and interventions often proceed without a sense of history, failing to reckon with historical precedents in specific contexts or lacking full perspective on comparable programs that have sought to solve the same or similar problems.
Nuanced appraisals of the successes and failures of historic public health campaigns should provide an expanded framework within which we can evaluate modern programs’ practical tactics as well as their ethical implications. A rich, new vein of scholarship, relying on diverse scientific, medical, and political archives alongside ethnographic and oral history research, has built a narrative of health and politics stitching together the impacts of a long twentieth century.47