'FROM STINKIBAR TO ZANZIBAR': DISEASE, MEDICINE AND PUBLIC HEALTH IN COLONIAL URBAN ZANZIBAR, 1870-1963 AMINAAMEIRISSA A Dissertation Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy in History at the University of KwaZulu-Natal May 2009 DECLARATION I declare that this dissertation has not been submitted to any other university and that it is my entirely own work that I have given due acknowledgement of all sources. CMX& AminHLa Ameir Issa rofessor Julie Parle 3 JMri£20pC{ 6s}\MAl lOOf ii DEDICATION I dedicate this dissertation to my children Abdul-Aziz, Nusayba, Atifa and Mahmoud And to my late father Ameir Issa Haji (1939-1995) TABLE OF CONTENTS ABSTRACT viii ACKNOWLEDGEMENT ix ILLUSTRATIONS xi ABBREVIATIONS xii CHRONOLOGY OF THE OMANI RULERS, ZANZIBAR xiii BRITISH ADMINISTRATORS, ZANZIBAR xiv GLOSSARY xv INTRODUCTION Disease, Medicine and Health, 1870-1963 1 Introduction 1 The Literature Review 9 Theoretical Framework 19 Sources and Structure 24 CHAPTER 1 A History of Disease in Urban Zanzibar, c. 1860s - c. 1870s 31 The Entrepot 31 "Stinky Town" 35 Endemic Diseases in Urban Zanzibar: Fever, Yaws and Elephantiasis 43 Epidemic Diseases: Smallpox, Cholera and Dengue fever 54 Disease, Death and Demography 64 Conclusion: Zanzibar Town in the mid-1800s, A Repository of Disease and Death 67 iv CHAPTER 2 The Arrival and Consolidation of Western Medicine in Urban Zanzibar, 1830-1889 68 The Arrival of Western Medicine in Urban Zanzibar 68 Consulate Physicians and Peoples' Illnesses 73 Cure and Christianity: The French Catholics at Ng'ambo 80 UMCA Missionaries and Women in Stone Town 90 German Lutheran and Medical Services in Zanzibar Town 98 Western Medicine: Initiatives of Local Elites 104 Conclusion: The Grounding of Western Medicine in Urban Zanzibar 112 CHAPTER 3 Epidemics and Colonial Government Intervention to 1914 114 Fighting Infectious and Contagious Diseases 114 The Establishment of the Quarantine Station in Urban Zanzibar in 1899 118 Dhows, Port Inspection and the Establishment of the Infectious Diseases Hospital in 1899 131 The Outbreak of Bubonic Plague in Zanzibar Town in 1905 137 Government's Reactions to Bubonic Plague 141 The Responses of the Urban Population to the Bubonic Plague 148 Conclusion: Population, Plague and Public Health 157 v CHAPTER 4 The Colonial Government and the Provision of Biomedicine to 1930 159 The Foundation of the Medical Services in Urban Zanzibar 159 The British Military Hospital (BMH) in Urban Zanzibar, 1896-1900 160 'Government Hospital for Natives and Subordinates' (GHNS), 1900-1930 167 The Confinement of Lepers in Urban Zanzibar, 1896-1930 179 The Confinement of Lunatics at the Kilimani Lunatic Asylum, 1896-1930 194 Conclusion: The Limitations of Western Medicine 208 CHAPTER 5 Malaria Control Programmes in Urban Zanzibar, 1913-1963 210 Public Health and the Urban Population 210 Malaria in Urban Zanzibar 213 Environmental, Sanitary Engineering and Vector Control Programmes, 1913-1963 216 Drugs and the War against Malaria 229 Urban Planning Programmes 233 "Ng'ambo Still Groans"? Anti-Malarial Programmes, 1955-1963 247 Conclusion: Growing Popularity of Health Services 254 vi CHAPTER 6 The Development of Medical Services, 1930-1963 256 Government, Citizens and Biomedicine 256 God, don't let us going to hospital? The Popularization of Medical Services 257 Brokering Medical Services in Urban Zanzibar 272 Reforms in Leprosaria, 1930-1950 289 The Care of Mental Patients, 1930-1960 300 'Zama za Siasa', 1951-1963 306 Conclusion: Medicine and Power 313 CONCLUSION 315 BIBLIOGRAPHY 327 APPENDIX 353 vii ABSTRACT Until recently, scholars of Zanzibar history have not greatly focused on study the history of disease, western medicine and public health in the colonial period. This thesis covers these histories in urban Zanzibar from 1870 to 1963. In addition, it looks at the responses of the urban population to these Western-originated medical and public health facilities during the colonial period. The thesis starts by exploring history of Zanzibar Town during the nineteenth century looking at the expansion of trade and migration of people and how new pathogens were introduced. Local diseases became more serious due to population expansion. I also examine the arrival, introduction and consolidation of Western medical practices. The establishment of hospitals, the training of doctors and nurses and the extension of these facilities to the people are all discussed, as are anti-smallpox, bubonic plague, malaria and sanitation programmes before and after the Second World War. The thesis argues that the colonial government introduced medical institutions in urban Zanzibar with various motives. One of the main reasons was to control disease and ensure the health of the population. The anti-malarial, smallpox and bubonic plague campaigns are an example of how the government tackled these issues. The introduction of preventive measures was also important. The Quarantine Station, the Infectious Diseases Hospital and the Government General Hospitals were established. Other facilities were the Mental Hospitals and Leprosaria. The work of extending medical services was not only done by missionaries and the colonial state but was in great measure through the contribution of Zanzibari medical philanthropists, community, religious and political leaders. Mudiris, Shehas, family members and political parties also played a significant role. In the twentieth century, newspapers owned by individuals and political parties and community associations played a major role too. Zanzibari medical doctors, nurses, orderlies, ayahs, public health staffs were cultural brokers who facilitated the extension of biomedicine and public health measures. By the end of the British colonial rule in Zanzibar in 1963 Western medicine was an important therapeutic option for the people not only in urban Zanzibar but also in both Unguja and Pemba islands. viii ACKNOWLEDEGMENT All thanks and honours are given to God, Almighty for giving me the strength and the ability to achieve my aims and objectives. I wish to thank many people who encouraged, advised and assisted me in one way or another in the writing and production of this dissertation. I would like to thank my supervisor, Professor Julie Parle, for her support, understanding and encouragement when efforts were less. I have learnt a great deal from her over the past three and half years. My deepest gratitude is for all her time and guidance, knowledge and patience that have helped to shape this thesis. When I arrived at the Durban International Airport in August 2005, Stephen Sparks and Prinisha Badassy received and welcomed me at the Department of Historical Studies. The professors at the Department were kind to me and were ready to offer suggestions and comments. My appreciation is to Mandy Goedhals, Keith Breckenridge, Marijke du Toit, Catherine Burns, Thembisa Waetjen, Vukile Khumalo, Vanessa Noble, Kalpana Hiralal, Goolam Vahed and Suryakanthie Chetty. I would like to thank my colleagues, Hannah Keal, Ian Maqueen, Scott Couper, Mthunzi Zungu, Warren Manicom, Andrew MacDonald, Percy Ngonyama, Jo-Anne Tiedt, Vashna Jagarnath and Nafisa Essop Sheik who assisted me in one way or another and to the administrator, Clare Hull. To all I say thanks. I am grateful to my employer and other staff at the State University of Zanzibar (SUZA). The Vice Chancellor, Professor Ali Sefu Ali Mshimba and the Registrar, Dr. Abdalla Ismail Kanduru allowed me a study paid leave and gave me other necessary assistances. Special thanks go to Juma Mabasa Kanuwa, who encouraged me to pursue this field of study and to my friend Amina Ramadhan Hilika who always kept in touch. Professor Abdul Sheriff commented on my research proposal and Professor Nestor Luanda was ready to offer suggestions whenever it was necessary. ix I would like to acknowledge the financial assistance that I got from the Council for the Development of Social Science Research in Africa (CODESRIA). I have also benefited through the 'Methodological Workshop' that was organized by the same institution at Gaborone in September 2008. My husband Rajab Omar Rajab gave me concern and support throughout my study. My children Abdul-Aziz, Nusayba, Atifa and especially Mahmoud, whom I left while he was very young, and missed the warmth of his mother's care and love during the whole three years and half of my study, and writing of my dissertation. My indebted thanks are due to the staffs at the Zanzibar National Archives. In particular I would like to thank Moza Zahran, Khadija Iddi, Omar Sheha, Hamza Haji, Lulu Abdalla, Makame Mtwana and Mwanakombo Ali. Issa Sariboko, Mohamed Zahran and Suad Nassor of the Zanzibar Stone Town Conservation and Development Authority (STCDA) assisted me with the maps. Special thanks go to Abdurrahman Ahmed and his wife Zakia and children Ahmed, Fatma, Raisa and Nadia of Hounslow, Sussex and Rahma Abeid and her daughters Habiba and Fatma of Clapham, who assisted me during my research in London and Oxford. Also, I received assistances from Mohamed Najim and his wife Zuwena and their brother Ali and children Nadra and Najim of Coventry whom I lived with them while I was collecting data at the library of the University of Birmingham. I would like to extend my sincerest gratitude to my mom, Khamisa Abdalla, for her spiritual support. My brother Abdul-hakim, Issa, Said and Abubakar and my sisters Nafisa, Husna, Fatuma, Sabra, Asma, Khadija, Mariyam and Ruhaila for their unending patience and support.