The Experiment Must Continue. Melissa Graboyes

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      MEDICAL RESEARCH PAST AND PRESENT

       The East African Medical Survey

      As an introduction it is essential to emphasize the difficulties met with in the carrying out of adequate medical surveys in East Africa. Many of the tribes are primitive and intensely suspicious: there is fear of witchcraft and it is not unusual for a request from us for even a specimen of faeces to be met by a firm refusal on the grounds that this specimen of stool is required for the performing of magic rites aimed at bewitching the donor of the specimen. The taking of a specimen of blood is especially resented: in one survey this resentment was so active as to lead to an abandoning of the survey. Medical officers face on one side the criticism that too many refusals will give a biased and incomplete picture, while on the other side they may be criticized for stirring up trouble in the areas in which they work. Ideally it is essential to carry out repeated exams of the excreta and of the blood . . . from each of the 4,000 natives on whom medical exams have been carried out. Any attempt to enforce this impossible standard would quickly arouse such deep resentment among the people that there would be no alternative but to abandon work. The most that could be expected is one specimen each of stools, urines and bloods from a large proportion of the natives examined and even this calls for much diplomacy and knowledge of the African way of life. Much credit is due to the medical officers for their perseverance even in the face of personal danger, as has twice been the case.¹

      Lieutenant Colonel William Laurie, the first director of the East African Medical Survey (EAMS), paints a fairly bleak—if accurate—picture of medical research in the region in the 1940s and 1950s. He characterizes it through the difficulties, fear, suspicions, refusals, and resentment that surrounded the work; even a simple request for a specimen of feces could be met by a “firm refusal.” Conflict and misunderstandings were commonplace and, from his perspective, there was little to celebrate other than his brave workers. Laurie’s honesty and frustration also indicate that, although this medical research happened in a colonial context and under unequal power conditions, Africans were no mere subjects of medical research. They were active participants in these encounters, forcing projects to change and adapt based on what they deemed acceptable. In doing so, Africans shaped the practical and ethical norms in the literal and figurative space of the “field.”

      The post–World War II project was part of what has been called the “second colonial occupation” of Africa.² The survey was the brainchild of Professor MacSweeny at London University and Professor George Macdonald from the Ross Institute at the London School of Hygiene and Tropical Medicine. The EAMS commenced in 1949, and, as was true of so many of the research institutes and individual projects in the region, the goals of the EAMS were never entirely clear, although they grew narrower during the organization’s six years of work.³ In 1949, the EAMS was described as having two distinct phases: first, that of “mapping of disease,” and, second, an attempt at “selective elimination of disease.”⁴ By 1951, plans to eliminate disease had disappeared, and the organization shifted entirely to describing local conditions: to get “a complete picture of what actually is medically wrong with the African.”⁵

      Six locations across Tanganyika and Kenya were selected for in-depth surveying of thousands of East Africans. In each place, a team of researchers would descend to collect samples of stool, urine, blood, and skin to test for diseases such as anemia, worms, river blindness, malaria, and bilharzia. The medical researcher Hope Trant, who worked for the EAMS, was being both cynical and accurate when she called herself a “collector of specimens.”⁶ The number of Africans involved in each place varied between 2,000 and 6,000, and the science to support the “right” number of samples was not at all clear. In addition to the residents who were medically examined, all women were required to give maternity histories, and thousands of other people participated in community-wide agricultural, veterinary, dietary, or tuberculosis surveys.⁷ In Tanganyika, research was conducted on Ukara Island in Lake Victoria, Bukoba along the shores of Lake Victoria, Kasulu and Kibondo districts in western Tanganyika, and Kwimba in Sukumaland. In Kenya, surveys were completed in the western region in Kisii and along the coast in Msambweni. There were hopes to conduct a survey in Uganda, but because of problems securing help from the Uganda Medical Department, no research was done there.⁸ While those in charge claimed the sites were “representative” of East Africa, it seems many places were selected with an eye toward practical matters such as ease of access, existing infrastructure, and the presence of helpful local leaders. Nothing indicates these locations were representative in any meaningful way, or that conclusions relevant to these places could be convincingly extrapolated to the wider region.

      MAP 1.1. East African towns and main research stations. Map by Chris Becker.

      When the EAMS began, it was lauded as something novel. An annual report boasted “that never before had such investigations been planned on so broad and adequate a base.” After five years of work, the fate of this never before attempted scientific inquiry was plain. The administrators of the project conceded, “experience has since shown that the base was