The Experiment Must Continue. Melissa Graboyes
public health projects have found that most Tanzanians know that mosquitoes spread malaria.86 But the knowledge is not exclusive. Medical anthropologists have shown that, while people agree that mosquitoes cause malaria, there are also other well-known and widely accepted causes. As Susan Beckerleg reports, “the view that mosquitoes cause malaria by introducing wadudu [bugs/parasites] into the blood stream is not well accepted. . . . And even where accepted, the theory has to coexist with apparently contradictory causes such as changes in the wind.”87 In central Tanzania, people recognized mosquitoes as causing malaria, but also felt that exposure to “hot sun” and “hard work” could lead to malaria.88 In Ifakara, Tanzania (in the southeast), anthropologists found that people’s explanations for malaria often wove together notions of witchcraft with “knowledge of the biomedical cause of malaria.” They found that in addition to noting mosquito bites as a cause of malaria, other modes of transmission included drinking or wading through dirty water and/or being exposed to hot sun.89
One disagreement between biomedicine and indigenous health concepts centers on blood regeneration. From a biomedical perspective, blood regeneration occurs naturally: the body produces new blood in the same way that the heart beats or the lungs take in oxygen—without conscious thought on the part of the person. Thus, in this framework, the loss of small amounts of blood for donations or medical tests is not considered dangerous, and in most medical research projects blood taking is labeled as “no” or “low” risk. However, for many East African groups, blood regeneration is considered difficult if not impossible, and occurs only through conscious changes in diet or avoidance of certain behaviors. As it has been described among the Haya of western Tanzania, certain foods increase the blood (meat, green leafy vegetables, and fish) while others decrease it (coffee and citrus). Additionally, “hot” activities such as working in the sun or excessive sex can cause “illness such as feverish chills, which are characterized by a lack of blood.”90 In general, women and children are thought to have weaker blood and to be more at risk during procedures like blood donation or surgery because of the difficulty of blood regeneration.91
Disagreement about the ability or inability to regenerate blood means that East Africans and biomedical researchers are likely to come to radically different assessments of the risk of giving blood. This is partly linked to physical health: whether one will have enough blood in the body to be healthy and strong. A second concern regards the risk of having blood move through unknown hands in unknown places, opening oneself to the risk of witchcraft.92 The general feeling is that there are only a few acceptable occasions when blood can circulate outside the body, such as during marriage ceremonies or rituals to mark blood brotherhood or blood friendship. Moreover, even while blood is shared at such times, these are fraught exchanges. It is the very risk involved in sharing blood that emphasizes the depth of relationship with the person the blood is being shared with. By contrast, when the prospect of giving blood to an unknown foreign medical researcher is raised, an East African is likely to come to a very different assessment of the risk involved in such an encounter.
Stories about blood theft and medicines made from human blood have a long history. For at least the last 130 years, one frequently mentioned nefarious use for blood is as an ingredient for mumiani.93 The word mumiani is often translated today as a person, someone who is a “bloodsucker.”94 But, when the term was first recorded in the 1880s, it referred to a potent medicine made from human blood. Krapf’s 1882 Swahili dictionary defines mumiani as “a fabulous medicine which the Europeans prepare, in the opinion of the natives, from the blood of man.”95 In 1923, someone writing to the Swahili paper Mambo Leo noted that the word mumiani was a foreign one, but that people knew of it:
as we have heard, Mumiani is a medicine. Should a person fall and break a bone, any bone, if he is administered with this medicine the bone will heal. Whether this is true of false, those who say will know. Certainly there are those who say the medicine truly exists, especially around Lamu. I have no real need to contest this medicine, except for the way it is [said to be] obtained.
The meaning was largely unaltered in 1939, when Johnson’s dictionary described mumiani as:
a dark-coloured gum-like substance used by some Arabs, Indians and Swahili as a medicine for cramp, ague, broken bones. . . . It is used as an outward application, also when melted in ghee for drinking as a medicine. It is said to be brought from Persia, but many natives firmly believe that it is dried or coagulated human blood taken from victims murdered for the purpose, and when a rumor is started that mumiani is being sought for, the natives in a town are filled with terror and seldom go out of their houses after sunset.96
It is widely accepted that the term mumiani is an import, although from where is unclear.97 The fact that the medicine was made from human blood was repugnant but not surprising. As Simeon Mesaki notes, “Since human life is the most precious commodity . . . the most powerful dawa (medicine) may be sought from human flesh and blood.”98 Modern accounts from the Swahili Coast note similar beliefs about sorcerers using “human beings preserved half-alive as medicines.”99 In western Kenya, when discussing “research” and “blood,” one child “suggested that research and blood collection serve to produce new medicines,” while another girl wrote of how “Whites used to make medicines from blood and bodies.”100
These concerns about the loss of blood have been captured most clearly in relation to East Africans’ reluctance to participate in blood donation or blood bank programs since the technology was available in the mid-1940s. In colonial Nairobi, when Kenyan soldiers were encouraged to give blood, many refused, with half mentioning “fear of losing blood that could not be replaced.”101 The same fears were expressed around blood donation in western Tanzania, where 35 percent of the people polled at a variety of public and private hospitals in Mwanza Region viewed donation as harmful and believed that it could damage health.102 Clearly, damu is a concept that is broader than just “blood,” and one that carries with it a different set of perceived risks that would affect a person’s willingness to give blood. But, as the discussion of mumiani alluded to, there are also connections between blood and medicine: blood as an ingredient for medicine, and medicine given in return for blood in the medical research exchange. Furthermore, the possession and distribution of dawa (a powerful substance) makes researchers powerful and also dangerous people.
Research Is Medicine
As with damu, the Swahili word dawa benefits from a translation more nuanced than just “medicine.” Dawa is best thought of as something powerful, something that can have a good or bad effect, as an agent that causes a change. Among the Pogoro of Tanzania, medicine/dawa is “a generic category which refers to substances with transformative potential.”103 The concept of a “medicine” or the use of the specific term dawa is broad enough to refer to insecticides to kill mosquitoes, pills to treat a case of malaria, or an amulet meant to protect against witchcraft.104 An important characteristic of dawa is that it can be either curative or harmful—its most important quality was not the type of change it affected, but merely that it had the power to change a person, thing, or situation.105 “Medicines change the state of the person, either by curing, protecting and empowering or, for victims of witchcraft, by weakening, draining and poisoning.”106 The decision about whether dawa would harm or heal depended on the person using it—a healer who wanted to cure, or a witch who wanted to harm—and their knowledge and ability to use the medicine. “The special transformative powers of particular medicines are not intrinsic to the plants comprising them, but depend on the powers of the person who made them. Any plant, it is said, can become medicine in the right hands.”107 That belief was further reaffirmed through direct observation and experience. There is record of at least two herbal remedies used in East Africa prior to European colonization (Abrus precatorius to cure eye ailments, and Myrsinaceae root to treat worms) that are highly effective at appropriate dosage, but poisonous in higher quantities. It was only with specialized knowledge that a dawa could be guaranteed to be curative rather than dangerous.108
Is It Dawa or Not?
“Is it dawa or not?”