Academic journal article The International Journal of African Historical Studies

Introduction: Incorporating Medical Research into the History of Medicine in East Africa *

Academic journal article The International Journal of African Historical Studies

Introduction: Incorporating Medical Research into the History of Medicine in East Africa *

Article excerpt

There is a deep history of medical research in East Africa, which is intertwined with the larger and longer history of medical interventions in the region. Since Europeans arrived in East Africa in the mid-1800s, Africans have been exposed to Western medicine and biomedical research practices. The continent has long served as a source of scientific knowledge-what Helen Tilley has referred to as a 'living laboratory" and "natural laboratory" echoing the sentiments of colonial-era researchers in fields as diverse as ecology, forestry, and tropical medicine.1 The impression of Africa as source of data, fertile testing ground, and birthplace of discoveries is rooted in the historical record. Over the years, discoveries have been made in the East African region with global repercussions, such as those pertaining to Kaposi's sarcoma and the nature of drug resistance with antiretroviral drugs.2 Many of these findings were dependent on human experimentation and this history of medical research has been an unexamined-yet important-part of the history of medicine in the region.

East Africans were the human material necessary for research projects focused on malaria, trypanosomiasis (sleeping sickness), leprosy, onchoceriasis (river blindness), schistosomiasis (bilharzia), and lymphatic filariasis (elephantiasis)-just to name a few of the tropical diseases that captured colonial imaginations. Human experimentation covered a wide range of activities, but most frequently it meant providing blood, urine, stool or skin samples, or being examined, measured, poked, and probed. Sometimes research practices on Africans were as invasive as lumbar punctures, and other times as seemingly innocuous as having one's home sprayed with insecticide. While in some cases Africans were clearly subjected to medical research, there were also many cases when Africans were active agents-choosing to abscond from projects that didn't fulfill their needs, shutting down projects that didn't align with their interests, or modifying them in ways that better accommodated their own expectations of fair benefit, acceptable risk, norms of the body, disease, or healer-patient relationships. For more than a century, Africans have been functioning in systems of both medical and ethical pluralism-a world where biomedical interventions and indigenous practices rub against each other, often creating friction and sparks, disagreement and conflict.

There are clear connections between the history of medicine and the history of medical research. Some of the Germans' earliest medical interventions in Tanganyika were in response to sleeping sickness epidemics. Those interventions were a combination of widespread screening for the disease (which involved physical palpation of the glands and lumbar punctures), treating the infected with the best available drugs, and outright drug experimentation in the hopes of discovering a more effective therapy. The British and Belgian response was not substantially different in that they all blended medical interventions with medical research and public health with human experimentation. When considering the international responses, there is no separating medical intervention from medical research, no clear or well-defined distinction between public health intervention and human experimentation. These things were so entwined that the history of medical research is the history of medicine, and to talk about the history of medicine without accounting for human experimentation is to give a partial and biased accounting.

The formal arguments in this introduction are simple. First, large numbers of East Africans participated in many different types of medical research over the past century, and this alone deserves our attention. Second, the history of medical research is a missing-and vital-element of the larger history of medicine in the region. Because medical research frequently blurred treatment and research, these encounters often created misunderstanding and skepticism. …

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