While East Africans often sought to understand medical research by better understanding who medical researchers were—and often came to the conclusion that the researchers were government, if not government-affiliated—that was not the most common link people made. More than associations with government, with force, and with secrets, there was one substance most people thought of when they talked about research: blood.
What Is Research?
Most East Africans describe “research” in terms of blood. Mzee Mwendadi, who was a driver for Mwanza-based medical researchers in the 1970s and 1980s, explained research as “the taking and checking of blood.”66 People frequently spoke of how blood was “looked at,” “examined,” or “checked.” “Disease” or “bugs” were searched for or “discovered” in the blood, by unclear methods. This strong linking of medical research with blood is in keeping with findings from other parts of Africa. The West African nation of The Gambia has been a site for British medical research dating to the 1940s.67 There, when villagers were asked if they would prefer medical research without the blood taking, they responded, “But blood is necessary in all medical research!”68
Most respondents agreed that research comprised multiple steps: first, take blood; then, discover disease; finally, distribute medicine.69 One woman explained, “When they finish taking blood, they search for disease and they cure you, and you go home.”70 These stages are in keeping with what has been reported in western Kenya. When secondary school students were asked to write a composition about “research,” they described how “first ‘blood is taken’; second ‘it is studied with the microscope’; finally ‘we are told who is ill and given medicine.’ (Some well-informed children added a fourth one: ‘you get a Ph.D.’)”71 Yet, are we sure that the damu that is mentioned by so many East Africans is really equivalent to the blood of biomedical accounts? Since damu is the substance most East Africans associate with medical research, it’s worth asking whether we really understand what it is, and how a definition of blood that’s broader than Western biomedicine might affect people’s views of medical research.
Research Is Blood
Modern Swahili/English, Swahili/French, and Swahili/Italian dictionaries define damu first and foremost as “blood,” but go on to mention menstruation, blood relationships (children), blood relatives, and the proverb “Blood is thicker than water.”72 In each of these areas, the definitions and connotations of blood do not stray too far from a biomedical understanding; meanwhile, in most American and European language communities, blood can be used as a reference point to family, in addition to being used idiomatically. Swahili dictionaries going back to the 1880s reflect roughly the same usages. It is clear that, as in most parts of the world, a reference to “blood” can refer to both the physical substance and to kin and regeneration. That blood is also linked with menstruation makes implicit reference to the fluid’s role in female fertility and an individual family’s regeneration.73 In some parts of East Africa, moreover, menstrual blood and its regular flow also signify the overall health of the society.74 However, Swahili dictionary definitions do not mention probably the most salient components of East African understandings of blood: that blood is often used as a proxy for general physical health, and that the distribution of blood outside the body is dangerous and should be avoided because it can jeopardize an individual’s physical, spiritual, or mental health.
Many East Africans make assessments of their physical health based on the general quality of their blood. Blood can be weak, strong, run quickly or slowly, and be sick or healthy.75 People are born with either weak or strong blood, and those with weak blood are more likely to become sick and less likely to make a full recovery after being ill. For example, on the Tanzanian coast, many mothers explained their children’s frequent illnesses by saying that the children “did not have enough blood in their body [damu hana or damu imepungua].” The mothers explained this lack of blood by citing numbers they were told at the local clinic, that a child had “only 40 percent” or “.5.” These figures referred to the hemoglobin levels that nurses and doctors had mentioned during consultation with the mothers.76 In explaining their children’s poor health, the mothers drew upon existing ideas of the relationship between the quality of blood and health, but also integrated biomedical information into their explanation, since the 40 percent and 0.5 indicated, to them, an actual lack of blood in the body.
As the above example implies, current conceptions of blood are neither static nor uninfluenced by biomedical ideas. Prior to the introduction of biomedicine in the late 1800s, it was common practice for East Africans to utilize a variety of healers including diviners, herbalists, and those specializing in Islamic medicine. As Europeans arrived, the search for effective treatment and persuasive explanations for diseases broadened again to include missionaries, who were considered just another set of “immigrants and traders.”77 Even outside the cosmopolitan Swahili Coast, there was a strong tradition of accepting foreign specialists, treatments, and explanatory systems. Among the Iraqw of Northern Tanzania, “the incorporation of an alien way of looking at and acting on illness” was not at all new.78 In Uganda, as Susan Reynolds Whyte argues, there is “reason to believe that the exotic has always played a part in Nyole and other East African medical systems.”79 In interviews with modern residents of Dar es Salaam, elders said that the “traditional,” or widely accepted, therapies for some diseases had significantly changed over the years—a change they attributed to “the greater presence of biomedicine in their lives.”80
Although we might be tempted to perceive here a replacement of one (traditional) system of thought with a biomedical (modern) one, that would not be accurate. It would be more precise to see ideas around health, disease, and healing that now exist in East Africa as syncretic.81 To discuss anything as “syncretic” is to imagine two or more distinct systems coming together to form something new—a third system—that borrows bit and pieces from each. This new, syncretic set of ideas concerning health is a patched-together mosaic of medical technologies, systems, and concepts. It is a product of a long history of medical pluralism that has involved centuries of contact with Ayurvedic and Islamic medicine in addition to biomedicine. It incorporates local ideas of witchcraft and sorcery, political and societal health being manifest though individual bodies, and a broad conception of “normal” health and appearance linked to day-to-day functionality.
There are clear examples of East African understandings of blood assuming syncretic forms. “Anemia” is translated in Swahili as upungufu wa damu, which is, literally, “deficiency of blood.”82 Traditional remedies dating back to the 1890s focus on “building” or “strengthening” the blood by eating “hot” foods such as beans, leafy greens, and raisins, which biomedicine identifies as being iron-rich.83 Thus, well before the first vitamin was identified in 1910, and before chemical analysis showed that these particular foods were iron-rich, it was enough to have a category of hot foods that would “strengthen the blood” through the production of the blood humor.84 Yet, biomedical understandings of blood are still constantly rubbing up against preexisting ideas, and that friction creates new explanatory models. When a boy died on the Kenyan Coast in the 1980s, people explained that he had “no blood in his body” and opined that the boy should have eaten “hot” foods. Still, in discussing his death with a foreign anthropologist, they were adamant that either hot foods or vitamins would have cured the boy, since both strengthened the blood.85
This system of medical syncretism forces biomedicine to exist with other, potentially contradictory beliefs. A clear example is many people’s understanding of malaria. From a biomedical perspective, malaria is spread by female anopheles mosquitoes, which carry a parasite from infected person to uninfected person. Every malaria infection can be classified into one of four types, produces a particular (and predictable) set of symptoms, and can be successfully treated with a number of different drugs. Yet, although there is widespread awareness of these biomedical