The Politics of Disease Control. Mari K. Webel

      Introduction

      AROUND 1900, many people living on the northern shores of the great Nyanza (Lake Victoria) began to die after wasting into thinness and falling into a nodding, impenetrable sleep. Their strength had been diminished and their ability to care for themselves was gone. Similarly, around the vast and deep Lake Tanganyika, wasting sickness and a deadly sleepiness began to affect people on the lake’s western shore, driving their flight from villages and migration to areas not yet touched by illness. The first people afflicted were primarily those who traveled to trade and work around the region’s growing commercial hubs on the lakes, those who farmed on the fertile edges of the Lake Victoria basin and the Lake Tanganyika valley, and those whose lives took them to the shores of the lake to fish, to draw water, or to row across the vast inland seas. In these areas, they were bitten by various insects as they went about their daily routines. They were already contending with the irregular rains and droughts that in recent years had brought widespread hunger and insecurity and coping with outbreaks of illnesses that struck people down swiftly and without respite.¹ They had survived the disruption and violence of European colonial incursions that had divided the region into Belgian, British, and German spheres of influence after 1880. But this wasting sleepiness that led to the deaths of increasing numbers of people on the lakes’ shores was something different.

      In the first years of the twentieth century, the process of making sense of this illness had just begun for people living on the Ssese Islands of Lake Victoria, in the kingdoms of the Haya people on the lake’s western shores, and in the coastal lowlands of Lake Tanganyika. Around Lake Victoria, people named this new form of illness and death kaumpuli, botongo, isimagira, mongota, tulo, or ugonjwa wa malale; on the shores of Lake Tanganyika, people called the sickness malali, ugonjwa wa usingizi, or ugonjwa wa malale. European observers in the region identified a disease, naming it maladie du sommeil, Schlafkrankheit, or sleeping sickness. These diverse names reflect differing experiences rather than a unified and uniform understanding. As illness increased, African elites, affected individuals and their communities, colonial officials, missionaries, researchers, and a few scattered ethnographers began to document the arrival of this sleeping sickness, which seemed to be new to the area and unprecedented in its scale and severity.²

      While evidence exists that sleepy, wasting illnesses were known and recognized as serious by some populations around Africa’s Great Lakes (the interlacustrine region), their greater extent in the early twentieth century was novel and alarming. Tens of thousands of people died around Lake Victoria alone in the first few years of the 1900s; other epidemics peppered the continent simultaneously. As historical phenomena, these epidemics of sleeping sickness loom large in studies of African life. Scholars have argued that the expansion of sleeping sickness and its staggering mortality rates related to colonial incursion and subsequent colonial economic imperatives.³ Equally compelling are studies that demonstrate how colonial disease prevention efforts attempted to completely reconfigure African lives and livelihoods.⁴ But such emphasis on the causes of these epidemics and on extensive prevention efforts that followed has effectively concentrated our attention on the actions of European colonial regimes at the expense of understanding African intellectual worlds and existing systems of managing illness and disaster. Scholars have paid scant attention to how people responded to widespread illness at the time—what intellectual resources they drew upon, how they acted in response.⁵ In the interlacustrine region, many populations linked new illnesses directly to past experiences of sickness and death. Their strategic responses drew on the intimate histories, experiences, and memories that loomed large as family members or neighbors began to sicken and die in new ways. Affected people also engaged with European colonial officials and European missionaries, relatively recent arrivals in the region. While German, British, and Belgian empires were expanding in the Great Lakes region, the area’s social, political, economic, and ecological dynamics also shifted. Between 1902 and 1914, the overlap between the habitat of a particular biting fly and the spaces and lands used daily by people in the region would ultimately catalyze some of the most ambitious, extensive, and disruptive colonial public health campaigns of the twentieth century.

      This book is a history of public health and politics in Africa’s Great Lakes region in the early twentieth century. It focuses on epidemic sleeping sickness and colonial and African efforts to prevent it, drawing on case studies from colonial Uganda, Tanzania, and Burundi. It fits sleeping sickness into local people’s pasts and presents in order to highlight the experiences and intellectual worlds of the vast majority of the people who sickened and died at the time. It argues that African systems of managing land, labor, politics, and healing were central in shaping the trajectory, strategies, and tactics of colonial public health campaigns around Lake Victoria and Lake Tanganyika. African engagement with, evasion of, or negotiation within anti–sleeping sickness measures shaped the very nature of the campaigns, as people sought to make colonial interventions work within their own frameworks and colonial officials were forced to respond to (if not accommodate) this engagement in order to maintain their programs. Possibilities for negotiation opened up through the mutability and uncertainty of biomedical knowledge and practice as well as through the evolving nature of new political and economic relationships. In these changing circumstances, multiple players—such as the German scientists, British officials, Ziba royalty, Rundi or Bwari commoners, Belgian doctors, or Ssese islanders in my case studies—interacted to shape anti–sleeping sickness measures.

      Following Frederick Cooper’s conceptualization of colonial power as “arterial … concentrated spatially and socially … and in need of a pump to push it from moment to moment and place to place,” I argue that sleeping sickness provided just such a “pump” for the movement of new energy and resources into rural communities in the Great Lakes region, but that unpredictable points of friction and openness within African life shaped its ultimate direction and impacts.⁶ The individual and communal goals and ethics of diverse stakeholders sometimes aligned to produce the programs that European policymakers envisioned, but sometimes tilted so drastically in another direction as to require a fundamental reconceptualization of colonial public health practice. In this early era of colonial civilian administration, amid processes of engagement, negotiation, contestation, and accommodation, populations living around Lake Victoria and Lake Tanganyika asserted their own moral politics and therapeutic judgements to shape sleeping sickness control. The situated, spatial dynamics of interlacustrine intellectual worlds—their place-centered politics, therapies, mobilities, and social relations—fundamentally defined the field within which colonial interventions took place.⁷

      At the center of this study is sleeping sickness. From a biomedical standpoint, sleeping sickness, known today as human African trypanosomiasis, is an infection caused by two different trypanosome parasites (Trypanosoma brucei rhodesiense and T. b. gambiense). It is transmitted exclusively by several species of a biting fly (Glossina spp.) known widely as tsetse. Human African trypanosomiasis caused by either subspecies of parasite is generally fatal when untreated. It is, importantly, a disease of two stages; a person may not know that they have been infected for weeks, if not months, after being bitten by a fly. The first stage of illness, following transmission of the parasite by an infected fly, involves fever, malaise, local swelling of the eyelids and face, headache, and gland inflammation as the parasite becomes established in the blood, lymph, and other tissues. Inflammation of the cervical lymph glands on the back of the neck, known as Winterbottom’s sign, has been considered a telltale sign of the disease for centuries. As the parasite moves into the central nervous system and causes inflammation, “progressive neurological disturbances” appear, manifesting in changes in behavior and mood, tremors in the fingers and tongue, difficulty walking, wasting and weakness, and deeply disrupted sleep patterns. Disrupted