The Experiment Must Continue. Melissa Graboyes
medical research and public health interventions because they assess risks differently, or have an entirely different understanding of what constitutes the medical research encounter. These differences are significant—they highlight huge chasms that have profound implications for whether modern East Africans can be considered freely consenting volunteers in medical research projects, how risks and benefits are judged, and how therapeutic misconception has become a common part of the research experience.
Many early medical workers presumed that, as people were exposed to biomedicine, traditional systems would be replaced. In 1937, the Kenya Annual Medical Report presumptuously announced that European medicine was “thoroughly established throughout the colony.”125 Yet more recent research has shown that “education and extensive use of biomedical services appears in many cases to have had limited impact, if any at all, on the popularity of traditional medicine.”126 Expecting East Africans to suddenly adopt a biomedical model wholesale—rather than continuing to create a syncretic system based on centuries of contact with foreign healing systems—is naive and contrary to basic historical and anthropological evidence.
RESEARCHERS ARRIVE
Historical Narrative
“INSPEAKABLE ENTOMOLOGISTS”
H. H. Goiny and a Failed Attempt to Eliminate Lymphatic Filariasis, Pate Island, Kenya, 1956
On February 5, 1956, entomological field officer H. H. Goiny of the Kenya Medical Department arrived at Pate Island in the Lamu Archipelago.1 He came with a clear mission: to do his small part to help eliminate the disease of lymphatic filariasis from the island. He also came with three African assistants to help him, and after a thirty-six-hour boat ride from the Lamu harbor, where he had dragged his own equipment through the mud and slime, they disembarked, exhausted. Since no one met them at the port they wrestled their supplies to shore and set up tents. The following day they would start their work: mapping mosquito breeding sites, trapping mosquitoes indoors and out, and preparing for the future phases of the elimination attempt that would include spraying DDT inside homes, testing local residents’ blood to estimate the prevalence of the disease, and administering drugs to all islanders.
Just because no one met Goiny at the port didn’t mean the islanders didn’t know of his arrival. In fact, as Goiny was setting up his tent a meeting was in progress with the mudir (one of the traditional leaders on the island). The meeting was about the villagers’ strong belief that Goiny was there as a government emissary intending to do them harm. When the meeting concluded, a group of local Arab men arrived at Goiny’s tent to pointedly ask who had given him permission to camp on “private property.”2 Goiny protested and the men grudgingly allowed him to stay, but he had been put on notice: the village was not happy to see him.
The following morning, February 6, a delegation of villagers invited Goiny to a meeting to “discuss his plans.” He arrived to find hundreds of people (with “sullen, sulking countenances”) gathered for a “deliberately planned and punctiliously organized defiance meeting.” Residents “packed the verandah of the communal store” and filled “every inch of available ground.” Community leaders emphasized that the whole village was present and they had “unanimously” decided that “every man, child and woman” would oppose all forms of “domestic control.” They would resist his work “by all and any means”—including violence. Goiny left with “the formal assurance” that his work “would be resisted and prevented by the entire population.”3
MAP 3.1. Kenyan coast. Map by Chris Becker.
Goiny had arrived on Sunday and on Monday morning he had attended the protest meeting with hundreds of residents. On Monday afternoon, another delegation of men arrived threatening violence if he tried to enter any homes, alerting him to additional meetings that had been held at mosques where a “resolution” had been endorsed to obstruct Goiny’s work “by all and any means, not excluding . . . violence to the European.” On Tuesday morning, when trying to do outdoor mosquito catches and identify breeding sites, a group of villagers followed Goiny and his assistants, heckling them. An African health officer was almost pushed down a well by a group of angry youth with adult villagers looking on. Goiny was outraged and on Wednesday morning he went directly to complain to the mudir. On his way to the mudir, Goiny stumbled on yet another protest meeting happening at the mosque in a nearby village. This led him to conclude that there was a “concerted movement to defy and defeat the planned anti-filariasis investigations on the island.” As Goiny parodied the meeting in a letter to his boss:
Prayers and sacrificial slaughterings were to be offered up for the deliverance of the island from the wiles and schemes of those inspeakable [sic] entomologists, harbingers of Allah alone knows what pernicious forms of government interference in our domestic affairs in the disguise of benefactors.4
After three days on the island, Goiny was “stripped of the last rags of any illusions” he had about the real attitude of the villagers toward the scheme.
By Thursday, letters in Arabic began arriving at the district commissioner’s office, explaining that the Pate Islanders would not carry out the orders of the “Sanitory Doctor [sic].”5 By the time the letter had been translated and read by the district commissioner on Friday, Goiny and his assistants had already left the island. The arrival had been quickly followed by a premature exit, and the project—long before actually beginning—was on the road to ending.6
. . .
Virtually unmentioned prior to Goiny’s arrival on Pate was the fact that his was not the first medical research project on the island, or even the first lymphatic filariasis elimination attempt. Ten years prior, in 1946, optimistic researchers from the London School of Tropical Medicine arrived at Pate intent on eliminating the disease. Their work ground to a halt as villagers refused to participate, petitioned the liwali (the British-recognized traditional leader of the Kenyan coastal area), and forced the researchers into an early retreat. The government euphemistically declared the investigation “postponed” due to the islanders’ truculence, and that project was also over before it began.7 And while Goiny and others in the medical department had either never known or forgotten about this prior attempt, the islanders had not. As the researchers were surprised to discover upon speaking with residents, there was “violent opposition . . . hostile attitudes and hot tempers still simmering from ten years prior.”8
Residents made clear in the following weeks in a myriad of ways that they loathed government interaction, and it didn’t matter what was being promised. Based on past public health campaigns and the failed 1946 attempt, islanders had decided they were tired of the rough treatment, heavy fines, and destruction of personal property that had often accompanied the government’s goodwill gestures and public health programs. Past public health measures on the Kenyan coast included anti-mosquito campaigns shortly after the turn of the century, which involved house-to-house visits by the liwali’s representatives. In 1913, anti-plague campaigns included the threat of forced quarantine of railway workers, who were believed to be particularly susceptible. In 1933, the Ministry of Health and local board of health in Mombasa discussed a policy of “slum clearance” as a form of malaria and mosquito control. In the 1930s and 1940s, prosecutions for violations of the mosquito bylaws were “numerous and complaints about their harsh application equally so.”9 From the perspective of local residents, it was far better to continue living with a disease they had grown accustomed to than to risk additional contact with an untrustworthy and heavy-handed government. This local logic was alternately perplexing and galling to the British officials.
Less than two months after Goiny’s failure the Medical Department had given up entirely on the elimination attempt. After much cajoling, only one village on the island had consented to indoor residual spraying and treatment with drugs. Within two years, though, the whole project would peter out quietly without