The Politics of Disease Control. Mari K. Webel
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out space for new, interdisciplinary dialogues, advancing productive conversations between health policymakers and scholars of health programs and informing the conceptualization of future programs. While my case studies examine the period a century ago, they highlight the historical contexts in which particular environmental approaches to vector-borne disease control proceeded or faltered—still pressing matters for modern campaigns around sleeping sickness, as well as onchocerciasis and schistosomiasis, among others.
Current sleeping sickness programs fit with other global health programs aiming at the elimination or eradication of diseases that predominate in rural African communities, consonant with current trends toward the “scaling up” of health programs and the pursuit of ambitious global agendas.48 This study of colonial sleeping sickness camps around Lake Victoria and Lake Tanganyika shows that scaling up has a longer history, one rooted in colonial desires for widely applicable public health schemes and economic efficiency. Likewise, it broadens the history of the paradigm of treatment-as-prevention so relevant for HIV/AIDS that was, as Guillaume Lachenal argues, truly pioneered in French colonial campaigns against sleeping sickness.49 This book’s case studies demonstrate that targeted populations readily confounded public health policymakers’ and practitioners’ designs to operate at the level of entire territories or kinds of environments. This book also periodically considers mobility, in particular, to reveal the disconnects between plans and circumstances on the ground, exploring it as an epidemiological factor, a lens through which public health interventions came into focus, and an element of popular treatment-seeking strategies. This book thus speaks directly to the persistent challenges of surveilling, reaching, and monitoring access to interventions in the target populations of public health.50 Considering how and why people have historically availed themselves of treatments and what factors shape those activities has implications for understanding the dynamics and difficulties of public health practice in the present day.51 I hope, then, that this book will raise questions about the nature of participation in public health interventions, about the importance of historical precedents and experience, and about the factors affecting the sustainability of interventions—questions that project organizers and planners might ask initially in order to achieve their wider goals.
AN ORIENTATION TO THE GREAT LAKES REGION
This book centers on the kingdoms and scattered peoples of Africa’s Great Lakes (interlacustrine) region. This region is distinctive on the African continent for its geography, containing Africa’s highest mountains and largest bodies of water. The book’s three case studies—the Ssese Islands, Kiziba, and the southern Imbo—focus our attention on the northern interlacustrine region, an area bounded by Tanzania’s Malagarasi River in the south and the hinterland of Lake Mwitanzige (Lake Albert) in the north. The distinctive climate and environment of the interlacustrine region differentiate it from nearby plains, semi-arid savannahs, or river basins in eastern-central Africa; the cultural innovations of its populations have given the region an enduring analytical coherence for scholars. Continuities in general cultural forms such as sacred kingship, patrilineal clans, or spirit mediumship stretched across this large territory and helped define the intellectual worlds of its inhabitants. Such continuities, borne of a connected past, meant that people across the region understood political power, causes of illness, and possible steps for its remediation from a similar perspective.
MAP I.1. The Great Lakes Region. Map by Brian Edward Balsley, GISP.
This section introduces several of the root consistencies and broad continuities found across the region’s societies historically. It offers readers—particularly those less specialized in African history or less familiar with the Great Lakes region—an orientation to the central aspects of interlacustrine societies that shaped life and livelihood for people living in the late nineteenth century. It illuminates the important political and social institutions, as well as economic and environmental trends, that shaped daily life. These central elements and key trends in the region’s history provide a foundation for understanding the local variations and specific political and therapeutic frameworks that influenced how people in the Ssese Islands, Kiziba, and the Imbo lowlands managed illness and sought health and prosperity in the early twentieth century. This, in turn, allows us to see with greater precision how and why people affected by sleeping sickness interacted with colonial disease prevention campaigns as they did and to understand the broader consequences of these interactions for colonial public health.
Environmental, Social, and Political Dynamics of Interlacustrine Societies
Over the centuries after 1000 CE, populations in the Great Lakes region innovated political and social frameworks that would continue to influence the intellectual worlds and everyday lives of people living in the nineteenth century. Some of these innovations created structures that defined political power and governed land tenure and use, while others generated identities that bound together wide networks of kin and fictive kin groups. Still others provided ways of understanding connections between people, their environment, and wider cosmological forces and defined actions that could ensure health and prosperity.52 Throughout, geography, climate, and environment historically played a role in shaping agriculture, economic activity, and social organization in the region.53
Agricultural sophistication and diverse food production were central to regional populations’ prosperity.54 On the highlands and near the lakeshores of the region, early populations in the first millennium CE farmed endemic crops such as eleusine (finger millet), squash, and sorghum. The availability of different crops at different times of year within seasonal rainfall regimes provided security for populations, as staggered harvests of annuals combined with perennial crops to safeguard against famine.55 Uptake of non-endemic plants and their cultivation as food staples characterized ongoing, gradual agricultural innovation spanning several centuries before 1500 CE. Such innovation resulted from connectivity with other parts of the continent, as well as the circulation of people and goods around the western Indian Ocean. Alongside endemic sorghum, squash, and eleusine, people cultivated new arrivals from Asia, such as peas, taro, and banana, and then subsequent imports from the Americas, such as sweet potatoes, cassava, and new species of beans.56 In some areas, such as the Burundian shore of Lake Tanganyika, people also cultivated oil palms, a tree species originating in western Africa.57
Generally gendered labor regimes emerged. Clearing work (such as that needed to prepare a field for yams) was typically done by men, while the daily tending of fields and crops fell to women.58 Cattle-keeping further augmented agricultural production and food security in multiple ways, and cattle clientage bolstered political authority and stitched together individuals and households or compounds.59 Fishing also flourished along the lakes and rivers, relying on sophisticated technical and labor inputs, fitting into agricultural production, and augmenting food security.60 Specialized production of valued trade goods such as iron hoes, salt, dried fish, palm oil, and barkcloth occurred alongside the circulation of foodstuffs and livestock produced within households, driving patterns of trade that connected different ecological zones.61 Scattered deposits of iron and salt throughout the region led to hubs of smelting and salt production among interlacustrine societies and catalyzed trade in hoe blades and salt; production of pottery, as well as barkcloth from ficus trees, was also widespread.62 Diverse agricultural production, herding of cattle and small ruminants, and exploitation of heterogeneous natural resources facilitated the growth of populations from roughly 1600 CE onward. Local and regional trade connected these growing polities.
The intellectual resources available to the populations who would ultimately contend with epidemics in the late nineteenth century were rooted in pivotal political, economic, and social changes that occurred in the region between 1500 and 1900. In this era, monarchies rose and expanded, clans and healing cults evolved and spread, caravan routes stitched the lake and coastal littorals together, and people and goods circulated with unprecedented vigor and range.63 Institutions of kingship and chiefship that emerged in the region were generally patrilineal, structuring and consolidating power within royal family lines. Political power and social prestige cohered around the royal or chiefly house and its expansive