The Politics of Disease Control. Mari K. Webel

FIGURE I.2. Detail of “Plan—Tanganyika,” c. 1913. Courtesy of the Bundesarchiv, Berlin-Lichterfelde. This map shows the German sleeping sickness campaign’s field of work on the northwestern littoral of Lake Tanganyika in colonial Burundi. Seven camps dot the shoreline between Kigoma and Usumbura (modern Bujumbura). “Cleared” areas where tsetse fly habitats had been destroyed are shaded in along much of the lake shore and river courses descending toward the lake; areas where clearing is not planned are noted with cross-hatching. The Ubwari peninsula opposite Rumonge is not depicted. Source: Bundesarchiv, Berlin-Lichterfelde, R86/2632, Report, 12 May 1914.

      But if one should shift from these distant, bird’s-eye views to instead land on the ground, making an imagined, swinging pivot from a map hanging on a wall to the terrain itself where the everyday activities of a public health intervention occurred, clarity all but disappears. The camps are isolated outposts, set apart from established villages, colonial administrative stations, and lakeshore trading towns alike. They share no particular consistency in elevation, terrain, or vegetation, as contemporary ideas connecting climate and disease might have dictated—even their proximity to the lakeshore is irregular. Some are near to concentrations of sick people, others are not. They might be surrounded by dense forest, intensively farmed land, or wide swampland. Situated within local geographies rather than imperial perspectives, policymakers’ decisions about siting and location are not evidently intuitive, efficient, or rational. Rather, the siting of sleeping sickness camps was contingent, perplexing, and jarringly unique. Interrogating these maps produces a series of questions: Why did colonial attention focus here or there, then, and not elsewhere? Why put a sleeping sickness isolation camp in one place, and not in another nearby? Why did a camp focus on certain communities, and not on their neighbors? What was here, or there, before a camp was built?

      These questions lead to still others that animate my broader inquiry into the history of politics and health in the Great Lakes region. How did the colonial choice to site an intervention at one place or another interact with extant meanings and uses of that place by the people living nearby? Did a camp’s location overlap, conflict, or establish some kind of congruence with extant sites of healing, political power, or economic production? Did the pasts of these places impact how the targeted populations—sought after as patients, carriers, or suspicious cases—went to colonial sites and under what circumstances? Did where and how an intervention was located affect how people availed themselves of the treatments offered there? Sleeping sickness camps did not, of course, simply drop from the sky and slot neatly and smoothly into open, empty land. They resulted from strategic decisions by researchers, doctors, and administrators and often from negotiations with nearby political authorities. Where colonial officials located a sleeping sickness camp had meaning for people nearby, particularly in a cultural milieu such as the Great Lakes region, where place-centered healing practices had a deep history and where management of land was a fulcrum of political power.²¹

      More broadly, thinking about where a public health intervention makes its home attunes us to its fundamental social and political contexts. Imagine the specificity of a new, dedicated building with fresh construction, a room inside a church or school with other uses during the week, an established government dispensary in a small town, or an urban hospital’s busy ward.²² An intervention site’s context has ramifications for how (or whether) people use it; these ramifications derive from the experiences and judgements of its target populations regarding its cost, its efficacy, or its legitimacy, but also its emplacement. Yet research on colonial public health, and health interventions in history more broadly, largely leaves the siting, location, and development of interventions uninterrogated and the consequential implications for public health unexplored. By approaching the locations of public health interventions effectively as a fait accompli, we reify the logic of past practitioners as the principal way of understanding an intervention. For practitioners who worked in settings such as colonial eastern Africa, racialized ideas of cultural difference were fundamental to their logic, ethics, and strategies. Thinking critically about the places where colonial public health and research occurred allows us to reveal their blind spots and expose their intellectual biases in order to understand the lives and motivations of those people most affected.

      Throughout this book, I argue for a reconsideration of sleeping sickness control efforts that understands historical local contexts to be fundamentally important to how people used the camps and how trajectories of colonial public health changed over time. In the societies that provide my case studies—the Ssese Islands of the Buganda kingdom, the Haya kingdom of Kiziba, and the southern Imbo lowlands of the Rundi kingdom—locally oriented political, social, and therapeutic traditions shaped how and where people lived.²³ There and more broadly in the interlacustrine region, politics, social life, and healing had long been embedded in particular places or kinds of spaces.²⁴ How people lived within or moved through particular places, and how they understood the implications of inhabiting, using, or traveling through them, were matters grounded in historic efforts to carve out a prosperous, healthy life.²⁵ These efforts manifested in the organization of domestic spaces, in agricultural practices, in patterns of trade and migration, and in strategies to heal or avoid illness. Situated, localized knowledge was paramount. Colonial anti–sleeping sickness measures were profoundly affected by the embeddedness of interlacustrine populations’ experiences and intellectual worlds. Processes of negotiation and engagement between African elites, European doctors and administrators, and wider populations, for example, determined where sleeping sickness camps were located and how and when they were built. The past and present uses and meanings of those places shaped how people utilized the camps situated within them and, by extension, had implications for the efficacy of sleeping sickness research, prevention, and control measures.

      This book engages with crucial questions of health and politics by looking to the processes through which African and European actors refined their definitions of illness and its causes, contextualized widespread illness and misfortune, set the political and social parameters for their amelioration, and reconciled colonial public health campaigns with the circumstances of daily life. Case studies from colonial Uganda, Tanzania, and Burundi explore the potential magnitude of the rupture presented by sleeping sickness specifically, as well