MÉDECINS SANS FRONTIÈRES

Not for nothing was West Africa known as the white man’s graveyard: all over Africa the European colonial project ran the risk of being snuffed out in its infancy. A good illustration of the risks Europeans ran in Africa is the monument on Gorée Island to the twenty-one French doctors who perished in a yellow-fever outbreak in 1878. Tropical diseases took a heavy toll on the French colonial civil service; between 1887 and 1912, a total of 135 out of 984 appointees (16 per cent) died in the colonies. On average, retired colonial officials expired seventeen years earlier than their counterparts in the metropolitan service. As late as 1929, nearly a third of the 16,000 Europeans living in French West Africa were hospitalized for an average of fourteen days a year.52 Things were little better in British Africa. The mortality rate among British soldiers in Sierra Leone was the worst in the entire British Empire, thirty times higher than for soldiers who stayed at home. If death rates like these had persisted, the colonization of Africa by Europeans would surely have been abandoned.

Like all good colonial administrations, the French kept impeccable records. In the National Archives in Dakar you can still find every detail of every reported outbreak of every disease to strike French West Africa: yellow fever in Senegal, malaria in Guinea, leprosy in Ivory Coast. Health bulletins, health laws, health missions – health, it seemed, was an obsession for the French. And why not? A way had to be found to keep these diseases in check. As Sir Rubert William Boyce put it in 1910, whether or not there would be a European presence in the tropics boiled down to this: ‘Mosquito or Man’. ‘The future of imperialism’, in the words of John L. Todd, ‘lay with the microscope.’53 But the key advances would not be made in the squeaky-clean laboratories of Western universities and pharmaceutical companies.

In September 1903 the satirical magazine Punch published an insomniac’s ode to the students of tropical disease:

Men of science, you that dare

Beard the microbe in his lair

Tracking through the jungly thickness

Afric’s germ of Sleeping Sickness

Hear, oh hear, my parting plea

Send a microbe home to me!54

It was no fantasy to imagine the men of science tracking through the jungle. Researchers into tropical diseases set up laboratories in the most far-flung African colonies – the one established in Saint-Louis in 1896 was among the first. Animals kept there were injected with trial vaccines: eighty-two cats injected with dysentery, eleven dogs with tetanus. Other labs worked on cholera, malaria, rabies and smallpox. Such efforts had their roots in the pioneering work on germ theory by Louis Pasteur in the 1850s and 1860s.

Empire inspired a generation of European medical innovators. It was in Alexandria in 1884 that the German bacteriologist Robert Koch – who had already isolated the anthrax and tuberculosis bacilli – discovered Vibrio cholerae, the bacterium that transmits cholera, which only the previous year had killed Koch’s French rival Louis Thuillier. It was after an outbreak in Hong Kong in 1894 that another Frenchman, Alexandre Yersin, identified the bacillus responsible for bubonic plague.55 It was a doctor in the Indian Medical Service, Ronald Ross, who first fully explained the aetiology of malaria and the role of the anopheles mosquito in transmitting it; he himself suffered from the disease. It was three Dutch scientists based in Java, Christiaan Eijkman, Adolphe Vorderman and Gerrit Grijns, who worked out that beriberi was caused by a dietary deficiency in polished rice (the lack of vitamin B1). It was an Italian, Aldo Castellani, whose research in Uganda identified the trypanosome protozoan in the tsetse fly that is responsible for sleeping sickness. And it was Jean Laigret’s team of researchers at the Pasteur Institute in Dakar that first succeeded in isolating the yellow-fever virus and devising a vaccine that could be administered simply, without the need for sterilized needles and syringes, later improved to produce the so-called Dakar scratch vaccine (or Peltier-Durieux vaccine), which also offered protection against smallpox.56 These and other breakthroughs, clustered in the period from the 1880s to the 1920s, proved to be crucial in keeping Europeans, and hence the colonial project, alive in the tropics. Africa and Asia had become giant laboratories for Western medicine.57 And the more successful the research – the more remedies (like quinine, the anti-malarial properties of which were discovered in Peru) could be discovered – the further the Western empires could spread and, with them, the supreme benefit of longer human life.

Colonization in Africa was limited at first to coastal settlements. But with the advent of another Western breakthrough – the mechanization of mobility – it could spread inland. Railways like the one from Dakar to Bamako in Mali were vital to the Western imperial project. ‘Civilization spreads and takes root along the paths of communication,’ declared Charles de Freycinet, the French Minister for Public Works, in 1880. ‘Africa, lying open before us, most particularly demands our attention.’58 Following the creation in 1895 of the Federation of French West Africa (Afrique Occidentale Française), which stretched beyond Timbuktu into Niger and extended French rule to more than 10 million Africans, this became one of the leitmotifs of French rule. In the words of Ernest Roume, the Federation’s first Governor:

We wish to truly open up to civilization the immense regions that the foresight of our statesmen and the bravery of our soldiers and explorers have bequeathed to us … The necessary condition for achieving this goal is the creation of lines of penetration, a perfected means of transportation to make up for the absence of natural means of communication that has kept this country in poverty and barbarism … True economic activity cannot even be conceived without railroads. It is therefore our duty … as a civilized nation, to take those steps that nature itself imposes and which are the only effective ones … It is now everyone’s conviction that no material or moral progress is possible in our African colonies without railroads.59

Railways helped impose European rule on the African hinterland. But they spread other things too: not only trade in peanuts and gum, but also Western medical knowledge. For without improvements in public health, the railways would end up spreading disease, increasing the danger of epidemics. This was to be Doctors without Borders, nineteenth-century style. The benefits were often overlooked by those, like Gandhi, who maintained that the European empires had no redeeming feature.

The overthrow of native power structures was followed by an attempt to overthrow native superstitions. Today, the village of Jajak is remarkable because it has no fewer than three traditional healers, one of them an elderly woman named Han Diop. People come from miles around to consult her and, as she told me when I visited Jajak in 2010, she can cure everything from asthma to love sickness with herbal remedies and a spot of prophecy. This kind of medicine has been practised by Africans for hundreds if not thousands of years. It is one reason that life expectancy in Africa still remains so much lower than in the West. Herbs and spells are singularly ineffective against most tropical diseases.

In 1897 the French colonial authorities banned witch doctors. Seven years later, they went further by drawing up plans for the first African national health service, the Assistance Médicale Indigène (AMI). Not only did the French extend their own public health system to the whole of French West Africa; in February 1905 Governor General Roume issued an order creating a free healthcare service for the indigenous population, something that did not exist in France. From now on, ‘health posts’ in the localities would make modern medicine available to all Africans under French rule.60Addressing the National Assembly in 1884, the Prime Minister Jules Ferry had summed up a new mood:

Gentlemen, we must speak more loudly and more honestly! We must say openly that indeed the higher races have a right over the lower races … I repeat, that the superior races have a right because they have a duty. They have the duty to civilize the inferior races … In the history of earlier centuries these duties, gentlemen, have often been misunderstood; and certainly when the Spanish soldiers and explorers introduced slavery into Central America, they did not fulfil their duty as men of a higher race … But, in our time, I maintain that European nations acquit themselves with generosity, with grandeur, and with sincerity of this superior civilizing duty.61

This was very different from the indirect style of rule increasingly favoured in British Africa. In the words of Robert Delavignette, an experienced colonial administrator and director of the Ecole Coloniale:*

The representative of the powers of the Republic in Dakar, a member of French Masonry and the Radical Socialist party, will on the spot, in Africa, be an authoritarian governor, and he will use autocratic methods of rule to lead the natives toward progress … Many administrators wanted to treat the feudal lords [that is, native chiefs] in the same way we had treated them during the French Revolution. It was either break them or use them for our purposes. The British administrators had more sympathy for the feudal lords; it was aristocracy respecting aristocracy.62

In the eyes of William Ponty, Governor General of French West Africa between 1908 and 1915, traditional African institutions were the principal obstacle between their people and the civilization he was trying to spread. Tribal chiefs were, Ponty declared, ‘nothing but parasites’. ‘We did not take the feudal lords very seriously,’ recalled a colonial official of the 1920s. ‘We found them rather ridiculous. After the French revolution we could not be expected to return to the Middle Ages.’63 Delavignette took a similar view. In the revolutionary empire of which he dreamt, the heroes were the ‘black peasants’, the title of his award-winning novel of 1931. In the words of the first Socialist Minister of Colonies, Marius Moutet, the aim of French policy was ‘to consider the application to the overseas countries of the great principles of the Declaration of the Rights of Man and of the Citizen’.64

It is easy today to dismiss such aspirations as products of insufferable Gallic arrogance. But there is no question that here, as elsewhere, Western empire brought real, measurable progress. After the introduction of compulsory vaccination in 1904, smallpox was significantly reduced in Senegal. In only four years between 1925 and 1958 did the number of cases exceed 400 a year.65 Malaria was also curbed by the systematic destruction of the mosquitoes’ swampy breeding grounds and by the isolation of victims, as well as by the distribution of free quinine.66 Yellow-fever epidemics, too, became less frequent in Senegal after the introduction of an effective vaccine.

The Scramble for Africa has become a byword for the ruthless carve-up of an entire continent by rapacious Europeans. Its bizarre climax was the Fashoda incident, when rival French and British expeditions converged on the Eastern Sudanese town of Fashoda (today Kodok) in the province of Bahr-el-Ghazal. The French, led by Major Jean-Baptiste Marchand, dreamt of a line from Dakar to Djibouti (then French Somaliland), linking the Niger to the Nile and creating an unbroken chain of French control from Senegal to the Red Sea coast. The British, led by Sir Herbert (later Lord) Kitchener, saw control of Sudan as the key to a comparable British line stretching north to south from Cairo to the Cape. The showdown came on 18 September 1898 at the point where these two lines intersected. Though the numbers of men were absurdly small – Marchand was accompanied by twelve French officers and 150 tirailleurs – and the bone of contention an utterly desolate quagmire of reeds, mud and dead fish, Fashoda brought Britain and France to the brink of war.67

Yet the Scramble for Africa was also a scramble for scientific knowledge, which was as collaborative as it was competitive, and which had undoubted benefits for natives as well as for Europeans. The bacteriologist, often risking his life to find cures for lethal afflictions, was another kind of imperial hero, as brave in his way as the soldier-explorer. Now every European power with serious imperial ambitions had to have a tropical medicine institute: the Pasteur Institute in Paris, founded in 1887, was later matched by the London and Liverpool schools of tropical medicine (1899) and by the Hamburg-based Institute for Shipping and Tropical Illnesses (1901).

There were limits to what could be achieved, however. By 1914 there were still fewer than a hundred doctors available to staff the rural health posts in Senegal. Even as late as 1946 there were only 152 health posts in the whole of French West Africa. In the French Congo, the post at Stanley Pool (later Brazzaville) was supposed to serve 80,000 people with a yearly budget of just 200 francs. When the writer André Gide visited there in 1927 he was told that if ‘the medical service is asked for medicines it generally sends, after an immense delay, nothing but iodine, sulphate of soda, and – boric acid!’ This ‘lamentable penury’ allowed ‘diseases that might easily be checked … to hold their own and even to gain ground’.68 This was partly a matter of economic reality. France itself was still a very long way from having universal healthcare. The resources simply were not available to send doctors and vaccines into the isolated villages of inland Senegal or Congo. But it was also a matter of priorities. The Western research institutes were generally more concerned with the diseases that affected Europeans most severely – notably malaria and yellow fever – than with cholera and sleeping sickness, the biggest killers of Africans.

The original French civilizing mission had been based on the revolutionary idea of universal citizenship. But even as the French Empire expanded, that idea retreated. In theory, a West African sujet could still become a citoyen. In practice, few were considered eligible (for example, practising polygamy was considered a disqualification). As late as 1936, out of French West Africa’s total population of 15 million, there were only 2,136 French citizens outside the four coastal communes.69 Residential segregation became the norm (separating the European ‘Plateau’ from the African ‘Medina’ in Dakar, for example), on the ground that Africans were the bearers of infectious disease. Education, too, was restricted to a tiny elite of ‘intermediaries’.70 Once the French had aspired to racial assimilation.71 Now medical science recommended separation. This accorded with the prevailing view that ‘association’ was a more realistic goal than assimilation because, as the colonial theorist Louis Vignon put it, of the ‘opposition between the principles of 1789 and the conservatism of non-European populations’.72

The battle against tropical disease was not just fought in Petri dishes. It was fought in African towns and villages. When bubonic plague struck Senegal, the French authorities were ruthless in their response. The homes of the infected were torched; residents were forcibly removed and quarantined under armed guard; the dead were unceremoniously buried in creosote or lime in violation of Muslim traditions. This was a battle in which Africans felt themselves to be more victims than beneficiaries. In Dakar there were mass protests, riots and the first general strike in Senegalese history.73

The imperatives of medical science required harsh measures to contain the epidemic. Yet the science of the day also provided a spurious rationale for treating Africans brutally. They were not merely ignorant of medical science. According to the theory of eugenics, they were an inferior species. Nowhere did the pseudo-science of eugenics, the mutant half-brother of bacteriology, have a more pernicious influence than in the new and rapidly growing German Empire.

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