Given the number of works written in the field of health, healing, and medicine in African history, it can be easy to lose some threads in this growing tapestry. From political economists, to medical anthropologists, to social cultural historians, historical epidemiologists, and critics of global health, the field is vast and complex. Rebekah Lee's new book, however, not only tells the history of health and medicine on the continent, but adeptly and succinctly helps the reader to follow these various historiographical threads, sometimes untangling them and rethreading for greater clarity. Lee's book is multifarious: it can serve as a textbook on the subject, a summary on the latest work, a guide to some of the ways in which this field is moving, or all of the above. Even as a person who has written on and taught these topics for over twenty years, I found new information to glean. The book is organized into two parts. The first is part historiography, part historical overview. It reviews general approaches to the topic within a largely chronological framework from precolonial times to the present and introduces key medical figures and concepts in tropical and colonial medicine, as well as seminal authors who have studied African health and healing. After establishing a basis for understanding general trends, the second part examines how specific illnesses played out within these wider historical settings. The illnesses Lee considers in the book's second part include HIV/AIDS, malaria and sleeping sickness, mental health conditions, and occupational lung diseases associated with various types of mining in South Africa.
An expert teacher on the subject, Lee's pedagogy informs the book's orientation, which is a framework that can also benefit general readers. Each chapter begins by tackling the various types of sources available on the period or topic; key concepts are bolded; some shaded blocks, separate from the main text, give timelines or basic epidemiological information on specific ailments, while others include primary source selections and analysis. Her inclusion of two or more primary source selections in each chapter is particularly useful. This practice highlights the different types of sources available from travelers’ accounts, historical pictures, biomedical texts, colonial scientific and medical reports and maps, anthropological texts, contemporary photos and body maps of HIV/AIDS patients, public health materials, and local songs. By delineating the challenges of each type of source she illustrates how historians can read along and/or against the grain for medical information. In addition, for a book whose perspective is often aerial and sweeping, these primary sources enable the reader to momentarily ground themselves in the specifics of a text or a person's experience. Finally, each chapter concludes with comprehensive suggestions for further reading on the topic.
Lee's synthesis prioritizes certain narratives and themes. For instance, she pays particular attention to the dynamism of African therapeutics. Where she can, she describes how indigenous approaches to disease and epizootics changed over time, and emphasizes how African healers, patients, biomedical assistants, doctors, and researchers helped shape African understandings of bodies and illness. She extends this analysis to the Atlantic world, considering scholarship about how enslaved persons continued traditions from the continent. Lee's account is focused on how encounters between different population groups led to exchanges of disease, knowledge, and stimulated new knowledge production about health. This work does not neglect the harm colonialism caused to African health and wellness, particularly before the Second World War. Not only did colonialism displace populations and upset local ecological controls, but biomedicine both created and worked from false and dangerous assumptions — such as a belief in native immunity to certain diseases, the designating of Africans as disease reservoirs, and theories about African intelligence and mental illness, all of which helped to uphold notions of white supremacy. Lee connects certain elements of contemporary African skepticism and resistance toward biomedicine to this legacy. While doing so, she also traces how biomedicine improved over time and cultural intermediators helped many Africans come to see biomedical approaches as one of many viable options. Lee's focus on the reality of medical pluralism helps her readers to understand why an AIDS patient may seek treatment from a spiritual healer, a traditional healer, and a biomedical doctor — each who may ascribe a different causal agent and treatment.
Given Lee's impressive grasp on this field of scholarship, one can easily forgive a missing thread or two. The first is one missing more generally from the field — the tendency to downplay or ignore the role African healers played in precolonial and anticolonial politics. Colonial rulers jailed and targeted healers through anti-witchcraft legislation, changing the way they practiced with real health implications. Second, while Lee is critical of pharmaceuticals and global health organizations, she does not incorporate the latest historiography that delineates how private-public partnerships between the Global North and South can often replicate former colonial relations. Africans cannot gain health sovereignty until they set their own health priorities and more African countries own and run state-of-the-art labs. Global health organizations are just beginning to reckon with this idea of decolonizing medicine. Lee's broad and readable text can help provide context for this movement by conveying the historical complexity around issues of African health, healing, and illness.
