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.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.The political and economic systems that underpinned colonial rule not only disrupted people’s lives and livelihoods but also created enduring inequalities that laid the groundwork for more damage.
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.
Thus, in at least some regions, people became a convenient meal for the flies, increasing transmission rates and spreading the epidemic to new areas .
Even as officials trumpeted their benevolent ambitions in colonial Africa, they were forced to grapple with illnesses and debilities they had inadvertently caused or exacerbated, hindering state-building efforts and belying their claims to be helping the populations.
Following Paul Farmer’s lead, we could call these injurious consequences a form of “structural violence” [14, 15].
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 .
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 .
Over the next decade, hundreds of thousands of people in the region died from the disease, causing widespread trauma and fear .
As Manson would have known, the Belgian, German, French, and British officials on the ground were no more equipped to handle the outbreak than anyone else, given their uncertainty about its etiology and the fact that there was as yet no cure.
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.
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.