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WellcomeHistory
ISSUE 38
SUMMER 2008
 AFRICA FEATURE 2WORK IN PROGRESS 9
Healing in South Arica Vaccine opposition Ayurvedic educationThe Glasgow Spy
CONFERENCE REPORT 15
Medical marketplace andmedical tradition
RESEARCH RESOURCES 17BOOK REVIEWS 20CALENDAR 24
 
2Work in progress
Wellcome
History Issue 38
3
Wellcome
History Issue 38
 Africa feature
BENjAmIN N LAWRANCE
In September 2001 a group o 68 children,aged between 18 months and 18 years,was rescued rom a sinking ship o thecoast o Cameroon and returned to Togo.In April o the same year, a larger group ochildren rom several countries includingTogo was rescued rom a vessel o theNigerian coast and brought to UNICEFheadquarters in Cotonou, Benin.
Scholars and activists can point to numerousincidents almost every year over the past two decades.UNICEF ofcials estimate that at least 200 000 WestAfrican children are bought and sold by professionaldealers each year. Trafcking in children affects allcountries in Africa. Indeed, child trafcking in WestAfrica has become such big business that vendorsoften operate hubs in Europe, North America andSouth Africa, feeding their human cargo into amuch larger international child slave network.The incidents of 2001 provide a window into adeepening humanitarian crisis in West Africa, but theyare also part of a set of deeper historical processes in theregion. Wily businessmen have not suddenly turnedto child trafcking in recent decades, but rather, asBeverly Grier (2006) has argued, the trade itself is builton a series of important post-colonial developmentswith antecedents reaching deep into the colonial andpre-colonial periods that created a dependency onchild labour. My intention in this project, a chapter of alarger book, is to account for the diverging approachesto the mental and physical welfare of children ‘rescued’from various trafcking operations over the pasttwo decades. The larger project provides a historicalexplanation of the structure and currents in the childlabour trafc of West Africa, and to tie this explanationinto the literature on the African slave trade, thedecline and end of slavery, and the rise of 20th-centurylabour patterns. By taking as a case study the childrenbought, sold and brokered in and through Ghana, Togoand Benin – children who originate throughout WestAfrica – my hope is that this book will enable scholarsand activists to see the shifting and evolving terrain of child labour markets over a period of two centuries, andstimulate discussion and further historical analysis,perhaps with implications for policy developmentand implementation leading to the ameliorationof the conditions of Africa’s child labourers.The idea for this project came from a series of marginalia by French colonial ofcials working inTogo in the 1920s and 1930s, which drew me to thekey location and intrinsic role of Togo in larger WestAfrica economic ows. The small territory of FrenchTogoland was, in the minds of many administrators,“nothing more than a conduit” of trade in goodsand people. People moved back and forth throughthe region because there was little obstruction in theform of border administration or local opposition;indeed, as Paul Nugent has shown, colonial politicsand economics incentivised such borderlandsmovements. And while colonial administratorsrarely took note of children, whether as subjects of political power or pawns in an economic transaction,other parallel communities, including Christianmissionaries and African intermediaries, observedthe signicance of child labour and the child labourmarket. What the French administrators of the 1920sand 1930s were observing was the rearticulation of a trade in people in a region with a long history inpeople trading, and a historical transition that bearssome similarity to the distinction that David Kyleand John Dale (2001) identify as “migrant exportingschemes” versus “slave importing operations”.The children ‘rescued’ in 2001 and throughoutthe past two decades are primarily agricultural anddomestic workers, and to a lesser extent childrenbonded to religious shrines; sex workers and childsoldiers feature, but they remain a small percentage.Religious slavery is a pre-colonial institution, demandfor agricultural and domestic labourers expandedrapidly in the colonial period, while sexual slavery andchild soldiering only gain a foothold in West Africain the 1980s. With the arrival of formal colonial rulein West Africa, the economic and political role of urban centres was cemented and additional demandsfor household labour and domestic service expandeddependence on child labour. The burden for theeconomic operation of the colonies was quicklyshifted onto the colonised. Incentives to expand cashcropping, particularly cocoa and coffee, throughmuch of tropical West Africa, created urgency in thelabour market. The position of labour recruiter, a jobwith striking similarities to that of slave purchaser,became very protable. The rst labour recruiterswere Europeans, but Africans quickly took on thisrole. Individuals and groups moved from villageto village luring parents into informal contractualarrangements – promising to bring children to work intowns or on farms and to remunerate them regularly,or promising prosperity and education opportunities.
Released children are placedin halway houses where theyreceive treatment or post-traumatic stress disorder, sexualhealth, and wounds and injuries
During the colonial period, the small numbers of children rescued from systems of bondage were placedunder the care of missionaries in privately run missions,or in government institutions and orphanages. Littleemphasis was placed on the mental and physicalwellbeing of these children. Colonial ofcials wereindisposed to disrupting ‘traditional’ bondage systems,such as the
trokoisi
religious slavery prevalent in south-eastern Ghana. The Great Depression had profoundimplications for the economies of West Africa,deepening the dependence on cheap, controllablelabour. Budgetary cutbacks directly affecting childrenincluded the closing of state and parochial schools,orphanages and other welfare programmes. In manylarger cities greater numbers of children were forcedto fend for themselves, particularly older children,frequently the rst to be cast out of homes in economiccrisis. Many cities witnessed an explosion in childhomelessness and prostitution from the 1930s onward.Many of the economic and development modelsof the 1940s and 1950s that paved the way to WestAfrican independence were responses to the socialand political crises emanating from the deprivationof the 1930s. Each developmental model posited aproblem in a scientic and rational way and offeredconcrete solutions for implementation: problems suchas urbanisation, prostitution, epidemic disease anddemobilisation of soldiers, among others, were dealtwith through scientic studies and micromanagedsolutions. What was conspicuously absent from theagenda of modernity in the 1950s and 1960s, however,was how to deal with the growing dependenceon child labour in cities and farms throughoutdecolonising Africa. Child labour and the market inchildren for the purposes of labour outside of thefamily were consequently also absent from grandplans for nation- and state-building implementedby African leaders in the 1960s and 1970s.From the 1970s to the early 1990s, international politicaldevelopments signicantly impeded campaigns toeradicate child labour and child trafcking in WestAfrica and beyond. The realisation that much of independent West Africa was deeply embedded inexploitative economic systems drawing on the labourof children resurfaced as a concern after the ColdWar. Several countries were early foci of such research,particularly Mauritania and Sudan, where US-basedreligious organisations collected funds to purchasethe freedom of children who were subsequently‘adopted’ by individuals, couples, families and churchesin programmes that mirror adopt-a-child planssponsored by Oxfam, World Vision and other NGOs.Recently, more aggressively interventionistprogrammes of rescue and rehabilitation have gainedpopularity in Ghana, as well as neighbouring Togoand Benin. Local NGOs troll the streets and beachesof Accra, the waters of Lake Volta and the forestedregions of central and south-eastern Ghana lookingfor children in exploitative systems of labour.These children might be engaged in street hawking,cocoa harvesting, shing or religious ceremonies.Government agents of the Ministry of Women,Children and Social Welfare, supported by various localand international NGOs and West African regionalbodies, negotiate the release of the children from theirrespective contracts. They are subsequently placedin halfway houses where they receive treatment forpost-traumatic stress disorder, sexual health, andwounds and injuries, as well as rape counselling. Inthe rare case where a child’s family can be trackeddown, the children are reunited with them. In thevast majority of cases, the children are provided withformal technical training and resettled with nancialsupport from national and international organisations.
 This article is based on NGOs reports and interviews withtracked and rescued children, as well as the rescuers.
Proessor Benjamin N Lawrance
is attached to theUniversity o Caliornia, Davis (
E
bnl@ucdavis.edu).
 
 Tradingchildren
Mental health and physical rehabilitationo trafcked West Arican boys and girls
 Above:
 A girl carryingher brother.
Drs John and Penny Hubley 
Cover:
 Two boyscattle armingin Tanzania.
Note:
Wellcome History 
 wishes to make clearthat the childrenpictured have noconnection totracking.
 
45
Wellcome
History Issue 38
 Africa feature Africa feature
Wellcome
History Issue 38
GUILLAUmE LACHENAL
 Ater World War II, a new strategy to ghtsleeping sickness was launched. Mobilemedical teams in French and Belgian coloniesbegan to use prophylactic injections opentamidine (registered as Pentamidineand Lomidine) in mass campaigns.
‘Lomidinisation’ was the name given to the newpreventative method, which – it was hoped – wouldreplace the previous strategy, based on the screeningand treatment of infected people. During the 1950s,more than 10 million injections of Lomidine weregiven to the populations of endemic foci in West andCentral Africa. A quick eradication of trypanosomiasiswas proudly announced by colonial authorities.No more than 30 years later, public health specialistsheld a radically different view. Sleeping sickness,though contained in most African countries, wasclearly not eradicated. Moreover, it became clearthat the extensive use of preventative injectionsof Lomidine had been based on false premises.From the mid-1970s, laboratory experimentsdemonstrated that Lomidine hardly gave protectionto individuals for more than a few days. The Frenchmilitary doctor René Labusquière, a specialist intropical medicine, expressed a consensus whenstating in 1974 that Lomidine injections to healthyindividuals were “useless, dangerous, and thereforeuselessly dangerous”. From then on, ofcial historiesof colonial medicine chose to forget this episodeof public health. Once celebrated as a biomedicalrevolution, sleeping sickness chemoprophylaxiswas actively erased from medical memories. Sucha reversal is an intriguing case; it offers an occasionto investigate the role of indecisiveness and faith inthe history of a modern public health technology.Lomidine, like the other members of the diamidinefamily, is an international drug. Synthesised in 1938, itwas tested before the War by British chemotherapistsas a cure for various parasitic diseases. Its testing inAfrica began during the War, in the outpost of theLiverpool School of Tropical Medicine in Freetown,Sierra Leone. Thanks to informal contacts betweeneld medical services, it was transmitted to French andBelgian colonial doctors, who included Lomidine intheir standard protocol to treat trypanosomiasis. In1942, Belgian doctors at the Princess Astrid Institute inLeopoldville (now Kinshasa, Democratic Republic of the Congo) tested its preventative effects. The injectionof a single dose of Lomidine to the entire populationof a village drastically reduced the prevalence andincidence of sleeping sickness in the following months,compared with untreated villages. Lomidine, theyconcluded, was a very effective chemoprophylaxis.From 1945, large-scale trials of Lomidinechemoprophylaxis were run in French EquatorialAfrica, French West Africa, Cameroon, Nigeria, SierraLeone, Angola and Portuguese Guinea. In 1948, theAfrican Conference on Tsetse Flies and Trypanosomiasisproposed a standard protocol and recommendedits implementation in all areas contaminated with
Trypanosoma gambiense
. Lomidine, produced by theFrench rm Specia and by its British subsidiary May &Baker, added its voice to the optimism of the times.Lomidinisation appeared as an antidote to many of the problems faced by colonial medical services in thepostwar years. The liberalisation of colonial regimes,forced by the political mobilisation of colonised peoplesand by international pressures, had an immediate side-effect: populations increasingly avoided mass medicalcampaigns. Unable to respond to that ‘epidemic of indiscipline’ with compulsion and coercion, colonialdoctors had difculties implementing medical surveys.In that context, chemoprophylaxis offered newperspectives. Though it was particularly demanding forpatients and medical teams – the whole of a concernedpopulation had to be given intra-muscular injections– it was also promising: Lomidinisation could bethe last assault against sleeping sickness. Instead of lifelong treatment of trypanosome carriers and costlyscreening campaigns, Lomidinisation was an intenseand ambitious effort. Put simply, eradication wasworth a renewed burst of policing. In Cameroon, forexample, the beginning of Lomidinisation coincidedwith new public health legislation (1948), makingcompulsory the presentation to medical surveys andthe treatment and segregation of contagious subjects.Between 1948 and 1955, Lomidinisation was massivelyapplied in French colonies and Belgian Congo.Mobile teams, composed of local male nurses headedby colonial doctors and assisted by secretaries andpolicemen, were organised on the classic modelof screening–treatment teams. The injection of Lomidine to every healthy subject was added to theother tasks, which included the examination of theblood of the entire population and the treatmentof parasite carriers. The operations had to befurther rationalised and Taylorised, since the intra-muscular Lomidine injection was the ‘bottleneck’in the ‘production line’. A particular emphasis wasput on the injection rate: one every minute was anachievable goal. Campaigns reached remote areas,beneting from the progress of transportation androad infrastructure at that time. Intensity peakedin 1954, with more than 1 million people injectedin French Africa. Results were “prodigious”. Casesbecame rarer and rarer. Infection indexes dropped“vertically”, and ofcial reports celebrated “one of the greatest sanitary victories of our civilisation”.Nevertheless, the success of Lomidinisation appearedfragile from the outset. Lomidinisation proved veryeffective at combating severe epidemics; at the sametime, its efcacy and safety appeared very uncertainwhen considered at the individual scale. Some subjectswho had received Lomidine were found infected thefollowing year. Experts had radical explanations: almostcertainly, they proposed, these subjects had managedto escape from the medical team between theirregistration and their effective injection. Individualindiscipline explained individual failures. On top of this, Lomidine caused worrying side-effects: it inducedhypoglycaemia and hypotension, which caused nauseaand collapse; the injection itself was irritating andcaused pain and oedema; the fact that injections weregiven serially to several hundred people increased therisk of error and contamination, and complicated thesurveillance. But all of these practical problems hardlychallenged the trust in the method: according tocolonial doctors, the cause of most accidents was theindiscipline of Africans, in the form of “lazy nurses”or “malevolent villagers”. Strikingly, British colonialdoctors refused to use Lomidinisation on a large scale.They limited their trials to small communities withintense epidemics, such as mine employees in NorthernNigeria. Classically preferring the ght against tsetseies, British colonial doctors considered Lomidinisationtoo costly and too unpopular, and also dangerous.Moreover, Lomidine prevention had no effect on theepidemics caused by
Trypanosoma rhodesiense
, theparasite causing sleeping sickness in British East Africa.Lomidine’s success as a chemoprophylaxis hadbeen tested at the individual scale only once. Theexperiment, conducted by Belgian doctors inLeopoldville during the War, submitted two Congolesenatives injected with Lomidine to daily bites of tsetse ies. Trypanosomes were found in their bloodonly nine months later, which was taken as a proof of the preventative power of Lomidine. Withoutany control subjects, the trial design was very weak,as British researchers claimed at the time. But thesubsequent success of the community-scale trialsclosed the controversy: the effectiveness of preventativeLomidine was considered to be demonstrated. Fromthis crucial experimentation to the assessment of the efcacy of mass campaigns, the communityremained the only scale on which to evaluate therationale of Lomidinisation. There was one exception:Europeans were systematically excluded fromLomidinisation. It was deemed inefcient and toorisky in their case, notably because it could mask theearly development of the disease and complicate itstreatment. Meanwhile, Africans were compulsorilysubmitted to Lomidinisation, even in the absence of any epidemic menace, for “the health of their race”and for the sake of eradication. The application of Lomidinisation thus relied on – and reactivated –the racialisation of colonial medical thinking.
 According to colonial doctors,the cause o most accidentswas the indiscipline o Aricans,in the orm o “lazy nurses”or “malevolent villagers”
Several factors contributed to the abandonment of Lomidinisation during the 1960s: the dismantling of colonial medical services, the disappearance of sleepingsickness in most African countries, and a dramatic seriesof accidents. Contaminated Lomidine injections causedepidemics of gaseous gangrene on several occasionsin Gabon, Cameroon and Chad, affecting morethan 500 people and causing more than 50 deaths. Justied by the absence of recent sleeping sicknesscases and signicance of the quest for eradication, itwas a high price to pay for the affected communities.
Dr Guillaume Lachenal
is a postdoctoral researcherin Arican history at the Centre d’Etudes des Mondes Aricains, CNRS, Paris. His doctoral thesis at theUniversity o Paris 7 dealt with the history o biomedicineand decolonisation in Cameroon. He now works onthe history o colonial and post-colonial medicine in theFrench-Arican world (
E
guillaume.lachenal@ivry.cnrs.r).
Chemoprophylaxis against sleepingsickness in late colonial Arica
Right:
Blood sampling ortrypanosomiasis inCameroon, 1951.
© Inocam
 Above:
Microscopistsexamining bloodsamples inCameroon, 1951.
© Inocam
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