Mobile Health Teams, Decolonization, and the Eradication Era in Cameroon, 1945-1970 Sarah Cook Runcie Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and Sciences Columbia University 2017 © 2017 Sarah Cook Runcie All rights reserved Abstract Mobile Health Teams, Decolonization, and the Eradication Era in Cameroon, 1945-1970 Sarah Cook Runcie This dissertation examines the intersecting changes of African decolonization and the post-World War II internationalization of public health by showing how Cameroonian and French health officials shaped global health programs on the ground in the 1950s and 60s. I approach this topic through the lens of two tightly interwoven developments in Cameroon: the history of colonial mobile health teams created by French military doctors and the advent of postwar global disease eradication campaigns. While colonial medicine and international health are typically treated as distinct historical subjects, I argue that global disease eradication programs in this period in Cameroon relied entirely on colonial mobile health teams and their reformulation after independence as a basis of infrastructure, personnel and knowledge. I specifically assert that Cameroonian and French health officials positioned mobile health teams as cornerstones of national health policy and regional health coordination in Central Africa and, in turn, as the basis for operations of attempted global disease eradication programs within Cameroon. As Cameroonian, French and international health officials negotiated the work of the mobile health teams through decolonization and the first decade of the independence, they were moreover charting new structures of authority and control over medicine and public health between the global and the local, and forging an international politics of public health rooted in the particular tensions of decolonization in the country. My project thus demonstrates how Africans charted new models for public health through decolonization, models that reflected both the deeply enduring impact of empire and a new post-colonial politics. Table of Contents List of Tables and Illustrations ii Introduction 1 Chapter 1: Medical Mobility and the Politics of Malaria Eradication in 30 Colonial Cameroon Chapter 2: Creating the Health Region: Mobile Health Teams, 93 Decolonization, and the Organization for Coordination in the Fight against Endemic Diseases in Central Africa (OCEAC) Chapter 3: Bilingual Medicine in the Franco-African State 162 Chapter 4: Mobile teams and Smallpox Eradication 206 Chapter 5: From Mobile health teams to Basic Health Services 251 Conclusion 284 Bibliography 291 Appendices 303 i List of Tables and Illustrations SHMP team village visit 31 Statue of Jamot in Yaoundé 47 SHMP at work 51 Photograph of Malaria Campaign included in French report to the United 79 Nations OCEAC Brochure excerpts 101 Table 1: Distribution of State Medical Personnel in Cameroon, Congo, 137 Gabon, Central Africa Republic and Chad in 1961 OCEAC Headquarters in Yaoundé 161 Dr. Jean-Claude Happi at Third Technical Conference of OCEAC 161 Map of Federal Republic of Cameroon 169 Table 2: OCEAC member states, number of reported cases of smallpox, 218 1961-1969 Map of DASP zones 269 OCEAC Headquarters, 2011 287 Table 3: Medical and para-medical personnel in Cameroon, 1964/65 303 Table 4: Medical Establishments in Cameroon, 1964/65 304 ii Acknowledgements The development and completion of this project would not have been possible without the support of many people over the years. First, I would like to thank my dissertation committee: Gregory Mann, Rhiannon Stephens, Kavita Sivaramakrishnan, David Rosner, and Guillaume Lachenal. Rhiannon Stephens and Kavita Sivaramkrishnan have been central to my graduate training, and I’m particularly grateful for their support in this final year of writing. David Rosner showed me early on the possibility in writing and teaching public health history. Guillaume Lachenal’s scholarship was foundational to my conception of this project and I’m grateful for his generous reading of my work. My thanks also go to Abosede George and Mamadou Diouf for their support throughout my graduate studies and helpful comments on this project. I am grateful to the scholars who fostered my early interest in history and African studies, especially Timothy Scarnecchia, Scott Taylor, and Maurice Jackson. Finally, my special thanks go to my advisor, Gregory Mann, whose sharp insights continue to help me see this project in broader terms. His focus on the long arc of this process, and on the need to keep writing, gave me the momentum I needed at many critical junctures. Above all, he is an exemplary historian from whom I’ve learned a great deal. I’m thankful for support that made my graduate studies and research possible including that of the Columbia University Department of History, the Columbia Institute for African Studies, the Alliance Program, the American Historical Association, and the United States Department of Education. Many colleagues and friends provided invaluable comments, encouragement, and opportunities to present my work, including Mari Webel, Jennifer Johnson, Jennifer Tappan, Jessica Pearson, and Claire Edington. I’m lucky to have shared much of this road with a iii wonderful cohort of Africanists in New York; thanks in particular to Trey Straussberger, Matt Swagler, Sam Daly, and Rachel Kantrowitz for their ideas and friendship over the years. Debra Glasberg Gail, Jessica Lee, Maria John, and Jeffrey Wayno created a much-needed space at Columbia to share writing and commiserate. My special thanks go to Maria whose intellectual rigor and warm support enriched these past years in countless ways. I look forward to continuing to share the path ahead with her. Conducting research in four countries depended on the support of many archivists and scholars. My sincere thanks go especially to archivists at the World Health Organization in Geneva, the Service historique de la Défense in Toulon, and at the National Archives of Cameroon in Yaoundé and Buea for their generous assistance. Caitlin Hawke did an invaluable favor by photographing archives for me in Atlanta when I was just beginning this project. Scholars in Cameroon welcomed me and helped me advance this research, and I would like to especially thank Verkijika Fanso, Joseph Owona Ntsama, and Luc Fongang Kontcheu. I feel very lucky to have met the late Martin Atangana in New York, and it was an honor to later celebrate his life with his family in Yaoundé. I left for my first research trip to Yaoundé with his niece’s phone number scribbled on a piece of paper, and all of my time in Cameroon was shaped by the subsequent phone call. In addition to her invaluable research help, Marie-Chantal Zangna Balla became a dear friend over the course of this project. I can’t imagine my time in Cameroon without her. Both of our families grew along the way, and I’m also thankful for the friendship of Michel Boh and of both of their extended families. My thanks go as well to all of the people in Cameroon who agreed to speak with me, both formally and informally, about this project. I’m particularly grateful to Dr. Thomas Nchinda for his generosity in corresponding and speaking with me about his work in Cameroon. iv Many friends supported me throughout this project, and I would like to give a special thanks to Caitlin McNary, Mike Tough, Felix Guzman, and Sabrina Kansara. Caitlin understands more than most how this path began for me, and I’m grateful for her endless encouragement. Mike and Felix gave my family the gift of community in our biggest period of transition and the final stages of writing. Sabrina’s friendship has been my bedrock for over two decades now and this period of dissertation-writing was no different. I’m grateful as well for the support of my loving family. Nancy and Christo cheered me on and served as reminders that great writing can happen quickly. Izzy inaugurated the newest and best chapter in our family life. My thanks go to the Runcie/Waldron family for embracing me as one of their own and demonstrating that education can benefit a family for generations. My parents, Nancy and Keith, have been an incredible support throughout my life and throughout this process. I’m thankful for their love, for the endless opportunities they provided me, and for all of the essential help they extended over the past two years. They probably didn’t envision this professional path for me, but their support for my youthful travel plans is what made it all possible. Finally, my gratitude for Dale’s support over so many years is immense. He has been an inseparable part of this entire process from his unwavering confidence in my ability to reach the end to his enthusiasm for accompanying me on a research trip full of (mis)adventures. When it mattered most, he made it possible for me to carve out the time to just write. Dale has always dreamt big for us and then found a way to make it happen. I am grateful for his generous spirit, and the satisfaction of completing this project is certainly ours to share. Josephine joined us along the way and has brought joy to each day. I hope she’ll one day see this dissertation and know just how much meaning she added to its completion. v Dedication To my parents and to Dale, for being my home no matter where I went. vi Introduction In 1965, Dr. Jean Claude Happi, the Commissioner General of Public Health for Cameroon, welcomed Central African, French and international health officials to the first meeting of a new regional health organization based in the capital city of Yaoundé. The Organization for Coordination in the Fight against Endemic Diseases in Central Africa (OCEAC) aimed to coordinate mobile health teams, which had originally been created by French military doctors under colonial rule, across its five member states.1 The mobile health team model remained the pride and joy of French military doctors, and its enshrinement in independent African health administrations marked the enduring impact of empire on public health.