African Trypanosomiasis part 2: Colonialism and sleeping sickness
This piece contains description of racist violence, and focusses on the British protectorate period of Ugandan history which was only one aspect of colonialism in Africa.
In my last blog I wrote about the molecular basis for African trypanosomiasis, a lethal disease transmitted by a blood-sucking fly that engages in guerrilla warfare with the human immune system. I discussed the molecular basis for the disease, but in the past century hundreds of thousands have died of sleeping sickness because of reasons nothing to do with the disease itself.
We know that sleeping sickness has been in Africa for a long time, thousands of years at the least. One paper even suggests that trypanosomiasis has been an important part of the natural selection in human evolution. This would suggest trypanosomiases has been relevant to humans and our human-like cousins for hundreds of thousands or millions of years, meaning this type of infectious trypanosome is likely to be older than us. There is also a related, animal-specific, sleeping sickness called n’gana or nagana, a word from the Zulu language meaning “powerless/useless”(1). In fact, there is a 4000 year old scroll describing the symptoms of what we would recognise as n’gana. N’gana infections would have been a big problem in trying to domesticate animals, with some speculation that this was the reason horse domestication wasn’t as successful in East Africa as elsewhere in the world. However, cattle breeding was successful in the Egyptian Old Kingdom. Cattle breeders cultivated immunity in their herd by keeping game animals, which can also harbour n’gana, close by and near to rivers where the flies that carry the trypanosomes breed. This meant that they could breed their herd based on the cattle that were tolerant to N’gana infection.
We can tell that we likely co-evolved with various species of trypanosome in that we are actually resistant to many of them with the exception of the handful that cause diseases in us. Our primate cousins, however, often don’t have these resistances – this tells us that humans in Africa and trypanosomes have been fighting for about as long as there have been humans.
So the disease didn’t mutate or suddenly adapt, but what do we know about the history of the disease in humans? There were many African kingdoms and settlements of course, but precious little remains aside from the written hieroglyphic record keeping of Egypt. This is due in large part to the reliance on oral histories, such as those of the sparsely-documented Empire of Kitara around the 14th century encompassing many kingdoms and in Eastern Africa.
About a thousand years ago Arab traders and adventurists began to explore Africa in search of their fortunes, who did sometimes kept written accounts of their journeys. Abu Abdallah Yaqut, an Arabian geographer, described “an underground village whose inhabitants and even their dogs were just skin and bones and asleep”, a settlement seemingly devastated by sleeping sickness. Another Arab, in the 15th century later described the sickness in the Sultan of the Malli Kingdom:
“His end was to be overtaken by the sleeping sickness (illat an-nawm) which is a disease that frequently befalls the inhabitants of these countries especially their chieftains. Sleep overtakes one of them in such a manner that it is hardly possible to awake him”(2). In the 18th century the British surgeon John Atkins described: "The Sleepy Distemper (common among the Negroes)…” that couldn’t be overcome by thrashing or whipping(2).
In 1896, a multi-epidemic of sleeping sickness tore through the British Protectorate of Uganda, it would last for 40 years and killed hundreds of thousands of people. Only two years earlier Uganda became a British protectorate after being delivered to the crown by the Imperial British East Africa Company (IBEAC). The IBEAC was a trading business that had been permitted by the British government to collect and impose taxes, administer justice, form treaties – it was a business with the power of a government. Partly this was done to protect the Nile from other colonial ventures, as it was a key trade route for British commerce.
Agriculture around the shores of Lake Victoria was an important priority for the colonial venture, to produce cash crops such as cotton for British textiles and to fund export railway construction. A sleeping sickness epidemic killed 200,000 people in this area alone in the beginning of the 1900s – equivalent to two thirds of the regional population(3).
What caused these tremendous colonial outbreaks of a disease that humans in Africa have been in a balance with for millennia? The answer is in the question, the changes brought on by colonialism. Mass migration, human trafficking, colonial settlement. The defences that humans in Africa had developed; molecular and behavioural were being reversed. Large and dense settlements were relatively rare prior to colonialism – as these societies are prone to infection and transmission. We can see this in the eruption of the Black Death in Eurasia centuries prior, which found the increasingly dense settlements to be a rich breeding ground for the disease. This is a factor in the sleeping sickness epidemics of this period. Sick people were in close contact proximity to many healthy people. Even in the worst case scenario as described by Abu Abdallah Yaqut, an infected village has little opportunity to spread to the next village and so on(1). The pre-colonial tendency toward smaller settlements contained these catastrophic infections.
Other factors in pre-colonial settlements gave humans natural protection from the disease-carrying tsetse fly. Settlements in East Africa were often at a distance from the banks of a river, where tsetse flies breed and tend to be most common(3). Post-colonial settlements did not do this. Pre-colonial settlements made a habit of clearing perimeter vegetation with controlled fires. This provided an effective barrier between wild animals and pests including the tsetse flies that lurk on the undersides of leaves.
We can see from the Egyptian cattle breeders’ cultivated immunity that pre-colonial understanding of the disease was relatively sophisticated. The import of European cattle carrying rinderpest, translated from German as ‘cattle-plague’, damaged domestic African cattle, forcing farmers to sustain themselves by hunting in areas that caused greater exposure to tsetse flies. As land used for cattle fell into disuse and overgrowth the habitat ranges for tsetse flies expanded. Trade, religious and scientific missions from the eastern colonial strongholds in East Africa eventually spread sleeping sickness to West Africa, spurring a continent-spanning epidemic, infecting up to 1/5 people in the French Congo, many of whom lived near the Sangha and Ubangi rivers or swamplands, extremely vulnerable to the spread of the trypanosome-carrying tsetse fly. An early reprieve from the Ugandan sleeping sickness epidemic came when Hesketh Bell, governor of Uganda ordered the mass movement of people from the great shore of Lake Victoria, recommended by the microbiologist David Bruce. You can imagine how pleased the colonial venture would have been to have “invented” a practice that Africans had been employing for millennia.
On the topic of rinderpest, early administrator of Uganda and later Nigeria and Hong Kong, Lord Frederick Lugard is quoted as saying “‘in some respects [rinderpest] has favoured our enterprise. Powerful and warlike as the pastoral tribes are, their pride has been humbled and our progress facilitated by this awful visitation. The advent of the white man had not else been so peaceful’’(3)
There was a humanitarian movement in Europe that argued for the protection and medical intervention of colonised Africans, though it was often used as a justification for further occupation, and religious missions. This might be considered counterproductive – considering it was these actions that caused the epidemics, which had never been seen on that scale on the continent before. Other than conquest, forms of humanitarian condescension, or sheer scientific curiosity, there was another motive for colonial interest in tropical diseases including sleeping sickness, malaria, and jiggers. There was an existential fear of it spreading back to the heart of the European empires and in particular the American military complex.
Stitt’s Diagnosis, Prevention and Treatment of Tropical Diseases, a significant compilation of medical advice and knowledge by Rear-Admiral Stitt, Surgeon-General of the United States Navy and edited numerous times opens with by stating “…under the greatly changed conditions of this world and the increased opportunities for the aerial transportation of disease the medical profession has come to recognize the growing importance of tropical medicine and its worldwide significance”(2). Which is certainly true and selfless on the surface, though is somewhat undermined by the immediately following printed warnings from sundry military big wigs to doctors in general that tropical diseases cause six or seven times more injuries and absences in the military than battle injury. It’s no surprise then that a great deal of research on treating Neglected Tropical Diseases, including sleeping sickness, comes from the countries that engaged in activities that brought them into sudden and unexpected exposure such as the UK, France, Germany, Portugal, the USA and so on.
The relationship between Western or European culture medical tradition and neglected or emergent tropical diseases is by no means simple as we can see. The invention of what drugs exist for these infectious diseases has no doubt saved millions of lives but in the case of trypanosomiasis we can see that these countries can play a role in culturing and propagating the diseases in question. The often cited small-pox infected blankets given from colonists to Native Americans is another well-known example. If we allow economics to dominate governmental and foreign policy we may well find ourselves agreeing with Lord Lugard, who was quite pleased with the effects of famine caused by rinderpest.
The presumption that the solution to serious problems in the global south can only or must come from the continuing or formerly colonial countries rather than the countries they affect can likewise be fraught.
The recent controversy between Stacey Dooley and David Lammy over an image of Dooley holding an unknown Ugandan child. Lammy wrote "My problem with British celebrities being flown out by Comic Relief to make these films is that it sends a distorted image of Africa which perpetuates an old idea from the colonial era." Dooley defended her humanitarian and informative work: “Comic Relief have raised over £1bn since they started. I saw projects that were saving lives with the money. Kids' lives.” Ultimately this dispute perfectly captures the strain in post-industrial colonial powers interacting with countries that suffered under colonial rule. I would hazard that as humans we have a moral duty to help and protect each other in a way that doesn’t exclude certain national borders, ethnicity, or beliefs. Everybody would agree that ending aid for fear of being offensive is not justifiable I would hope, but it is feasible to provide aid in a way that is empowering to the recipients rather than condescending.
What might empowering aid look like? It should complement decolonisation rather than undermine it. There is tension between the sudden abandonment of colonial governments, such as happened in some cases in the middle of the 20th century and a ‘managed transition’, which may be unpopular for other reasons. This tension has been explored by writers and academics such as Mahmood Mamdani and Stephanie Terreni Brown. Rapid decolonisation lead to a mid-century increase in trypanosomiasis which is only recovering recently, but the existential fear of tropical diseases spreading northward still exists. General panic over the emergence of ebola and zika in recent years, and even HIV, mostly focussed on transmission to people north of the equator and was accompanied by a great deal of moralising and condescension (the myth that HIV entered humans by sexual contact with monkeys has clear roots in racism), It is not an accident that a great deal of tropical disease research happens in Europe, North America, and wealthy Asian countries such as Japan. A possibility for improving aid is including aid that develops biomedical programs and research in the countries affected themselves. I studied trypanosomes in the high-containment laboratories in Dundee, Scotland. There aren’t any tsetse flies or sleeping sickness in Scotland.
A final thought is that with global warming the habitable regions for disease-carrying parasites like the tsetse fly will move away from the equator south and north(4). It is becoming clear that holistic solutions are necessary to halt the impending dangers we are facing as a global species.
1. Steverding D. The history of African trypanosomiasis. Parasit Vectors [Internet]. 2008 Feb 12;1(1):3.
2. Strong P. Stitt’s Diagnosis, Diagnosis, Prevention and Treatment of Tropical of Tropical Diseases. 7th ed. Maple Press Company; 1944.
3. Headrick DR. Sleeping Sickness Epidemics and Colonial Responses in East and Central Africa, 1900–1940. Büscher P, editor. PLoS Negl Trop Dis 2014 Apr 24;8(4):e2772.
4. Kurane, I. The Effect of Global Warming on Infectious Diseases. Public Health Res Perspect 2010 1(1), 4e9 doi:10.1016/j.phrp.2010.12.004
1. Mamdani, Mahmood (1996). Citizen and subject: contemporary Africa and the legacy of late colonialism. Kampala: Fountain Publishers
2. Brown, Stephanie Terreni (2014-01-02). Planning Kampala: histories of sanitary intervention and in/formal spaces. Critical African Studies. 6 (1): 71–90. doi:10.1080/21681392.2014.871841. ISSN 2168-1392