The flies’ habitats had been transformed in the previous decades, bringing tsetses into closer proximity to humans and distancing them from some of the animals, especially cattle, on which they normally fed. He was also concerned about an ongoing pandemic of sleeping sickness ( African trypanosomiasis)-a disease transmitted by tsetse flies and fatal to humans unless treated-that had recently broken out in the territories surrounding Lake Victoria, including the Congo, Uganda, the Sudan, and Tanzania. Manson had in mind certain epizootics, such as rinderpest, which had swept through Eastern and Southern Africa in the 1890s, decimating cattle populations and leading to massive social and economic upheavals. Conquest was violent and disruptive, radically altering landscapes and lives, and producing what medical specialist Patrick Manson aptly referred to in 1902 as a “pathological revolution” in tropical Africa. Yet Europeans’ efforts to ameliorate the health of imperial subjects were typically beset with contradictions both because disease burdens increased and because health conditions were more difficult to control than officials expected. Unsurprisingly, medical projects often received a significant portion of development funds earmarked for social welfare, and medical personnel made up the majority of employees in the technical services of each colonial state. Health activities took on an exalted role given this ethos of improvement since they were a visible and seemingly uncontroversial way to address the needs of the continent’s people. They also embraced a vague mandate to “civilize,” “improve,” and “develop” the populations they ruled, setting up governance structures that invested officials, usually unfamiliar with the regions, with far more political and cultural power than most Africans possessed. While their motives varied, they tended to be optimistic about the potential wealth of the new territories in terms of both natural resources and labor pools. Politicians from several European countries oversaw the conquest of sub-Saharan Africa at the end of the nineteenth century, dividing the bulk of the continent between the governments of Britain, France, Germany, Belgium, Portugal, and Spain. The Relations among Conquest, Development, and Health Indeed, historical analysis of the unintended-and the willful-harms produced during the colonial period bring to light various lessons for the present since these patterns linger and continue to affect people’s perceptions and practices. By exploring the ethical dimensions of medicine in colonial Africa, we can begin to appreciate the moral complexity not only of past interventions but also of international health systems today, given their roots in imperial dynamics. These new ideas and techniques increased people’s faith that diseases could be mastered and human lives extended, if only the new knowledge were applied. It was also a time when hygienic regimes in cities became more uniform. This was a period when germ theories of disease began to predominate in many parts of the world and pharmaceutical treatments and vaccination campaigns were on the rise. The timing and scale of European colonization matter. At over 11 million square miles, Africa is the second-largest continent (after Asia) and was the last massive region of the world that Europeans colonized (between 18). What do we learn about ethics and international health systems when we look to the past? This essay considers this question by examining the history of colonialism in sub-Saharan Africa, focusing on the harms of conquest and on the treatment and research campaigns sponsored by nascent medical services.
This kind of historical analysis helps us home in on different kinds of ethical problems that have grown out of past asymmetries of power-between people, professions, states, and institutions-that shape the nature of international health systems to this day.
This essay examines the history of European empire building and health work in sub-Saharan Africa, focusing on four patterns that shed light on the ethics of outside interventions: (1) the epidemiological and bodily harms caused by conquest and economic development (2) the uneven and inadequate health infrastructures established during the colonial era, including certain iatrogenic consequences (3) the ethical ambiguities and transgressions of colonial research and treatment campaigns and (4) the concerted and inadvertent efforts to undermine African healing practices, which were not always commensurable with introduced medical techniques.
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