Colonial Medical Campaigns - Lowes and Montero (2021)

Question 1

European imperialism in Africa

Answer 1

established few permanent colonies in SSA before the mid-1800s

tropical diseases as a major barrier to military conquest and settlement (AJR 2001)

Question 2

rapid expansion of European exploration, travel and military expeditions in the 1850s-1870s

Answer 2

development of quinine to treat malaria in the 1850s which was a major medical breakthrough and enabled greater European travel beyond coastal areas

different forms of interaction between African and European powers
- time when the slave trade was ending
- Africa as an extension of global rivalries of major European powers

imbalance of military power even more extreme after the invention of the machine gun circa 1870

Question 3

scramble for Africa

Answer 3

major shift in governance occurred between 1870 and 1914

combination of quinine and machine guns as medical and military technology set the stage

competing European territorial claims came to a head in the Berlin conference (1884-1885)
- in 1870, only 10% of African territory was under European control
- by 1914, it rose to 90%

big exception to European control and occupation was South Africa

Question 4

what did Lowes and Montero document?

Answer 4

episodes in French controlled regions of central Africa between 1921-1956 and long-run consequences of abuses for health and development

focus on Cameroon, which was divided into British and French zones after Germany’s defeat in WWI

Question 5

central Africa and tropical diseases

Answer 5

regions where trypanosomiasis (sleeping sickness) was endemic

spread by tsetse fly, sleeping sickness leads to fever, headaches, lethargy and in extreme cases, death

affects livestock

historical work shows that areas prone to tsetse fly have slower economic and political development (Alsan 2015)

Question 6

French medical campaigns in 1920s

Answer 6

medical campaigns against sleeping sickness in 1920s as well as smaller campaigns against leprosy, syphilis and malaria
- 17% of the population infected in central Africa according to medical surveys

concerns about the labour force (working for the French benefit)

potentially positive intervention, bringing current international medical knowledge

Question 7

tremendous brutality of the medical campaigns

Answer 7

diagnosis was highly invasive (spinal taps, blood draws leading to infection)
- for people with and without symptoms
- needles reused multiple times with no sterilisation

individuals forced to take part in testing/treatment at gunpoint

existing drugs were not very effective and had terrible side effects
- high arsenic content of atoxyl (only drug) caused partial/total blindness in 20% of patients

blood draws and injections reused needles
- didn’t follow good sanitary practices, leading to the spread of infectious diseases
- rates of hepC in Cameroon have long been the highest in the world
- campaigns may have contributed to the initial spread of HIV (prior to identification)

Question 8

scale of campaigns

Answer 8

in 1928 alone, over 600k people were examined and 17% identified as positive for sleeping sickness

Question 9

historical memory of the campaigns

Answer 9

well-remembered decades later as a collectively-traumatising episode

Question 10

question that Lowes and Montero investigate

Answer 10

question of how historical medical campaigns affect current trust in the medical system and vaccination

looking at areas that are visited more/less by medical campaigns, and looking at DHS for countries which provides information on willingness to have a blood draw and vaccination rates

Question 11

findings

Answer 11

strong relationship showing that the more you were visited, the fewer vaccinations people get in that region today and the more people refuse a blood test

going from 0 years visited to 0.5 years visited means that the proportion of people who refuse the blood draw doubles from 5% to 11%

going from 0 years visited to 0.5 years visited means that vaccination rates fall from 4 percentage points from 53%

Question 12

IV strategy

Answer 12

using a UN food and agriculture organisation measure of relative soil suitability for cassava vs. traditional crops
- correlation between areas that grew cassava and sleeping sickness

cassava produces more calories and requires less clearing of brush for farm land but this is a tsetse fly breeding ground
- need to soak cassava also leads to pools of standing water

Question 13

first-stage regression

Answer 13

medical campaigns on crop suitability

predictive power
- French campaigns going more often to areas where they know there are more tsetse fly infections and cassava planting

Question 14

reduced form regression

Answer 14

refusing blood test on crop suitability

Question 15

IV estimate

Answer 15

0.201 and greater than the OLS second stage estimate
- statistically significant at over 99% confidence

shouldn’t overinterpret this since there may be OVB

Question 16

leading concern

Answer 16

something about soil types that affect agricultural productivity/wealth, which affect incomes, educations and attitudes towards healthcare

Question 17

how can we assess whether IV assumptions hold, in particular regarding the exclusion restriction?

Answer 17

falsification/placebo test for an IV

looking at a neighbouring setting (former British Cameroon) with similar economic conditions but no medical campaigns
- is there a reduced form relationship between the IV and refusing blood test?

0 effect in former British Cameroon so no relationship between cassava soil suitability and blood test refusal without medical campaigns
- exclusion restriction holds

Question 18

long-run health consequences

Answer 18

lower infant vaccination rates

less interaction with the formal healthcare sector and longer stretches of time without seeking treatment

higher rates of anemia, HIV infection

less successful health projects funded by the World Bank

no effect on other measures of stated ‘trust’

Question 19

bottom line on colonial medical campaigns

Answer 19

european rhetoric was altruistic but reality was often the opposite

little concern for African lives, health, wellbeing or aspirations

adverse long-run consequences of the colonial period for African societies

outside of Africa, few are aware of episodes of brutality during European colonialism