Recalling a neglected disease: an historical-anthropological view of Human African Trypanosomiasis (sleeping sickness) in Angola, ca. 1900s-present

Leading researcher: Jorge Varanda
Research group: Governance, Policies and Livelihoods
Type of project: National project
Status: Concluded
Keywords: Sleeping sickness | Health programs | Colonial | Post-independence | Ruptures and continuities in Angolans responses


Main institution: CRIA
Participant institutions: Instituto de Combate e Controlo das Tripanossomíases (ICCT); Instituto de Higiene e Medicina Tropical (IHMT/UNL)
Funding: FCT
Reference: PTDC/AFR/100646/2008
Starting date: 15-01-10

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Abstract

This research focuses on the health programs against Human African Trypanosomiasis (HAT), in Angola from 1900s to the present day. The incidence of this neglected disease, commonly know as sleeping sickness, in Angola has not been object of study by social sciences, something this research intends overcome. This study follows previous work carried out on the anti-sleeping sickness campaigns of the Diamond Company of Angola (Diamang) 1917-1975, and the call by the Africanist Frederick Cooper and the anthropologist Ann Stoler to unveil the colonial legacy in idioms of health and disease and access to health care in contemporary populations. (Varanda, 2001,2004, 2007; Cooper and Stoler, 1997) To achieve such goals this study is intended to be interdisciplinary, drawing on illustrations feeding on history of medicine, epidemiological characterisations and anthropological problematisations. The diachronic trait underpinning this study, together with the analytical attention devoted to the several levels at play – from metropolis/global to local, from legislation and programs to medical practices, from the colonial imposition of biomedicine and post-independence public health measures to tensions, negotiations and responses, and the locals’ representations on disease vector (tsetse fly) and HAT neurological effects on the patients behavior – provides a fertile ground for elaborating on the continuities and ruptures between the two contexts, colonial and post-independence. Of the two sub-species of trypanosomes infecting humans this project centers its attention on the incidence of Trypanosoma brucei gambiense, which causes the more chronic form of the disease and if untreated it kills within 2 or 3 years. The first case of HAT reported in Angola dates back to 1870, while the first mission to study to 1901. The disease spread to affect over ten thousands of people by the 1940s . A specialized state service was created to tackle HAT and slowly reversed this dantesque picture. In the eve of independence HAT was almost wiped out, with only three cases registered. However, the 30 years strife of civil war, with its dreadful consequences and the lack of regular campaigns pushed for the outbreak of the disease that by 1999 surpassed 8,000 cases. Despite a steady decrease between 2002 and 2006 11,848 new cases were still found. (Josenando,2007) With the vector present in 14 of its 18 provinces, and 7 provinces labeled as endemic for sleeping sickness, make Angola one of the top three countries most affected by HAT. (Simarro; Jeannin; Catt, 2008) HAT affects mainly poor, rural areas in developing African countries something that hindered advances in diagnosis and treatment. (Atouguia,1999) The persistence of combat actions and therapies, similar to the ones brought forward almost 100 years ago, awards more relevance to the current project as not much has changed greatly. This research will characterise the health care programs (with its active and passive actions) employed during colonial and post-independence periods to combat HAT. It will unravel the evolution of diagnosis and treatments occurring since the dawn of the twentieth-century and the networks set in place that brought these techniques to Angola; how the interplay between passive actions (when patients search for help at treatment centres) and active prospection (mobile campaigns of health staff that periodically travelled through an ascribed area) evolved; and how the anti-vector combat developed. Moreover, it aims to capture the representations of the disease and vector found amidst the local population, understand the people’s reaction to an invasive diagnosis, and follow-up measures and the toxicity of treatments. In doing so, it expects to contribute to a more robust analysis on the failures and successes of health programs and medical practices. This study calls for a more complex understanding on the provision of healthcare over the decades and the persistence of history found in present day Africa, namely Angola. It attempts to understand the similarities and differences between the two historical contexts, be it in the approaches to the patients or suspects of being infected, the nature of the health staff, or the networks of knowledge, technology and goods. This research contributes to a more incisive perception of the sleeping sickness problem and the strategies devised to tackle it in Angola, and also to the role(s) that the colonial and globalisation processes had in shaping the approaches to combat HAT. As such, the project also provides an enhanced understanding of the Portuguese Empire and its colonial medical service. Moreover, in understanding how Africans´ responses to biomedical programs are shaped by the harshness of diagnosis and follow-up procedures, such as the lumber puncture , and the toxicity of drugs, it hopes to highlight how old problems might be avoided and, concomitantly, how new and/or old solutions can be pursued.

Researchers from CRIA

IDNamePositionProjTitleProject typeStatus
pub83*Jorge VarandaPrincipal Investigatorproj6*Recalling a neglected disease: an historical-anthropological view of Human African Trypanosomiasis (sleeping sickness) in Angola, ca. 1900s-presentNational projectConcluded
pub141*Mónica SaavedraResearcherproj6*Recalling a neglected disease: an historical-anthropological view of Human African Trypanosomiasis (sleeping sickness) in Angola, ca. 1900s-presentNational projectConcluded
Other researchers

ResearcherPositionInstitutionProjOutrosTitulo_EN
Jorge SeixasResearcherproj6*Recalling a neglected disease: an historical-anthropological view of Human African Trypanosomiasis (sleeping sickness) in Angola, ca. 1900s-present
Todd ClevelandResearcherproj6*Recalling a neglected disease: an historical-anthropological view of Human African Trypanosomiasis (sleeping sickness) in Angola, ca. 1900s-present