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From: H-Net Staff via H-REVIEW <h-rev...@lists.h-net.org>
Date: Tue, Jun 23, 2020 at 12:18 AM
Subject: H-Net Review [H-Africa]: Hoppe on Webel, 'The Politics of Disease
Control: Sleeping Sickness in Eastern Africa, 1890-1920'
To: <h-rev...@lists.h-net.org>
Cc: H-Net Staff <revh...@mail.h-net.org>

Mari K. Webel.  The Politics of Disease Control: Sleeping Sickness in
Eastern Africa, 1890-1920.  Athens  Ohio University Press, 2019.  272
pp.  $80.00 (cloth), ISBN 978-0-8214-2399-8.

Reviewed by Kirk A. Hoppe (University of Illinois at Chicago)
Published on H-Africa (June, 2020)
Commissioned by David D. Hurlbut

Reading Mari Webel's history of sleeping sickness control in German
colonial East Africa in a time of global pandemic feels disturbingly
relevant. _The Politics of Disease Control_ is part of a larger body
of work that has emerged over the last two decades seeking to center
local people in our analysis of the impact and meanings of disease
and disease control. This author's objective is to locate African
responses to the East African epidemic in the context of local
peoples' histories with previous sicknesses, their broader and
ongoing biomedical experiences, and local and regional African
economic, political and environmental contexts of disease and disease
control. In the early twentieth century, this came to include limited
German colonial biomedical interventions. The meanings, shapes, and
impacts of German sleeping sickness research, treatment, and control
in particular African Great Lakes sites, beginning in 1906, were
delimited by these African historical contexts.

The monograph is divided into three case studies, each of an
interesting, relatively remote, location in East Africa. The first
primary case study is the Ssese Island group in northwestern Lake
Victoria in the political orbit of the Buganda empire. These islands
became part of British Uganda in 1900, but the renowned German
epidemiologist Robert Koch worked there from 1906 to 1907. The second
case study focuses on the Kiziba coast of western Lake Victoria, in
what became German East Africa just south of its border with Uganda.
The third and shorter case study is of what the author calls the
Southern Imbo--the northeastern coast of Lake Tanganyika in what is
now Burundi. This is not a comparative study. Webel uses each
location to explore different historical articulations of her central
theoretical argument.

Robert Koch's Bugalla camp in the Ssese Islands initially witnessed a
rush of (hundreds of) African people from the northern lake region
voluntarily seeking treatment. Webel argues that the short-lived
success of the camp was a result of German medical practices as they
dovetailed with extant local understandings of disease and treatment
in this particular site. The Ssese Islands were a precolonial
spiritual and religious center for healing. People already went to
these precolonial islands for therapeutic reasons. Furthermore, local
people's experiences with and understandings of disease treatments,
most recently probably for nineteenth-century combinations of plague,
cholera, and smallpox, meant they recognized German puncture
practices, oral medicines, and regular temperature taking as
legitimate treatment types. These actions fit within local
therapeutic experiential worldviews. Patients tolerated Koch's more
experimental, and toxic, regimes of atoxyl injections, but not
without reservations. At Bugalla camp, Koch and German medical staff
unknowingly happened upon overlapping fortuitous circumstances. And
as a last added advantage, the medical hospital was located near a
White Father's mission that had been offering sick people food and
shelter for years before Koch's arrival.

Likewise, local people willingly sought treatment at the medical camp
at Kigarama in the Kiziba Kingdom based on a combination of
political, economic, and spiritual opportunities that the location
presented to sick people and their families. Royal authority supplied
the Germans with clearing and building labor, with medical
auxiliaries, and with patients. But Mukama (a term somewhat similar
to "king") Mutahangarwa supported the camp, "on terms he could claim
to set and on grounds he defined" (p. 145). Again, local people
accepted German examinations, treatments, and labor demands within
their own biomedical, political, and cultural parameters. They
rejected German requests for bodies to autopsy during a plague
outbreak in 1897, for example, as this was outside the bounds of
local practices and understandings of death and burial. Once again,
Webel makes the point here that German staff did not understand
issues of political power, land, resource use, and labor swirling
around them that shaped the medical camp's successes and failures.

Webel's local contextual approach offers an important contribution to
the literature on colonial sleeping sickness interventions in Africa,
and on colonial (and international) disease control in general. The
bulk of histories of colonial sleeping sickness control have focused
on coercion, colonial ideology, and social and environmental
engineering. This literature portrays Africans as resisting and
avoiding colonial biomedical coercion. Sleeping sickness epidemics in
East, West, and Central Africa served as moments for the institutions
and ideas of colonial science and biomedicine to articulate
themselves as ideological lynchpins in legitimizing technologies and
policies of surveillance and control. Colonial disease control
interventions were based on the solipsistic ideologies of modern
science as the apolitical "anti-conquest" driving the "white man's
burden." [1]

By contrast, colonial and African state violence and coercion are not
central to Webel's histories of German medical camps. She tells us
that Africans initially chose to travel to and from these colonial
medical sites primarily voluntarily and sought treatment for a
combination of their own reasons: the camps paid them, they received
land and food, the sick thought treatment might heal them. As African
patients and their families in these camps noticed that treatment was
not working, or possibly that atoxyl injections were increasing their
suffering, people left the camps and over time new patients ceased to
arrive. Operations at Bugalla camp lasted through early 1908, and
Kagarama camp until late 1910. East Africans, both elites and
non-elites, participated in, allowed, and curtailed German disease
control treatment and research in a fluid balance with their own
political, economic, and health interests, and within the contexts of
their own biomedical world views.

Webel's work is based on a careful exploration of a rich trove of
German colonial sources. There are, understandably, few African
voices in this work. A reliance on early ethnohistories to set the
stage of precolonial Sesse, Zimba, and Imbo histories of disease and
biomedicine paints these precolonial settings with a rather broad
brush. The author emphasizes exceptional littoral mobility,
economies, and interactions for the two Lake Victoria settings, but
other than the added option and ease of water travel, it is unclear
how these exceptions mattered.

Lake mobility is central to the third case study, of the tsetse
habitat-clearing labor in the Imbo area of northeastern Lake
Tanganyika. Here Bwari migrants from the Belgian Congo to the west of
the lake often traveled and settled on the east coast. German
officials struggled to control and limit movements and activities on
the lake and lakeshore, and to clear and empty certain shoreline
ecosystems. The important work done in this final case study is to
trace contours of local resistance, avoidance, and negotiations over
forced labor. Bwari individuals and groups, for example, argued that
paying German taxes freed them from labor requirements, and that if
forced to do manual clearing labor (which was indeed brutal), they
would chose outmigration, depriving the Germans of Bwari economic
activity and future taxes.

The author effectively centers local people's experiences and
processes throughout the text. One powerful and lasting impression
from Webel's work is that East Africans had nuanced and thoughtful
biomedical responses to disease that were not necessarily any less
effective or "scientific" than German colonial programs--local
treatments were certainly less toxic. Issues of gender and generation
deserve more attention. They do emerge briefly in the wonderful
history of young male Ziba "gland-feelers" working for the Germans at
Kigarama camp. Webel is at her best when telling the nuanced social
histories of the Bugalla and Kigarama camps. The power relations,
negotiations, resistance, and decision-making between local African
elites and non-elites, and between Africans and Germans, are most
powerfully and clearly revealed in these sections of her book.

In the face of current--and undoubtedly future--epidemic threats, and
of resistance to modern disease control protocols displayed by some
of the world's poorest and richest, many of the arguments in this
history of early twentieth-century East African sleeping sickness
control have a familiar ring to them. People locate disease and
treatment in contexts of past disease and biomedical experiences;
they balance economic, social, and political considerations along
with health in their responses. Political, economic, and
environmental contexts inform who suffers, who receives treatment,
and when and where treatment and disease control occur. However
obvious such truisms on the surface may now appear, Mari Webel's
documentation of the granular mechanics of such biomedical cultural
negotiations provides a welcome and insightful historical perspective
on our own current predicaments.


[1]. The term "anti-conquest" belongs to Mary Louise Pratt in
_Imperial Eyes: Studies in Travel Writing and Transculturation_ (New
York: Routledge, 1992).

Citation: Kirk A. Hoppe. Review of Webel, Mari K., _The Politics of
Disease Control: Sleeping Sickness in Eastern Africa, 1890-1920_.
H-Africa, H-Net Reviews. June, 2020.
URL: https://www.h-net.org/reviews/showrev.php?id=54521

This work is licensed under a Creative Commons
Attribution-Noncommercial-No Derivative Works 3.0 United States

Best regards,

Andrew Stewart
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