to the general question, “What is medical research?” most elders over sixty remarked on how strange and unusual it was. In Swahili, it was jambo geni sana (a very foreign thing), a thing of ajabu (wonder), and involved learning about vitu mbalimbali (faraway things).24 Interview responses indicated that people’s general understanding of research was still mostly descriptive and relied on associating research with specific people and their jobs (doctors, witch doctors, government employees), places (laboratories), and tools (microscopes, needles). Many people also described research in terms of the transactions researchers engaged in: they desired blood and bodily samples, and gave pills and injections in return. Residents rarely, if ever, identified research as the testing of new drugs or procedures. During only a handful of interviews was it mentioned that research could result in the development of new medicines. Only one man questioned how new therapies were produced. In the midst of discussing the smallpox vaccine, he told me residents in his village were happy to be vaccinated, but then went on to ask himself, “But where was it tested first? Perhaps in another place?”25 In fact, most of the individuals I formally interviewed believed research was being conducted in order to help or treat them.26 As one woman told me when opining that a healer was the same as a researcher, “even this mganga [healer] is a researcher because he investigates your disease and then he cures you.”27 What is important is that she specifies that a mganga researches your disease (ugonjwa wako) and then he cures you (anakutibu). By her definition, research identifies and cures diseases in individuals.
The rest of this chapter presents information from interviews and archival accounts that focus on how medical research and researchers were, and are, understood. I begin by discussing who researchers are associated with and what research is compared to, and provide some concluding thoughts about modern misunderstandings, including therapeutic misconception.
Who Are Researchers?
Many people explained the act of researching by trying to figure out who a researcher was or to whom he might be similar. Comparisons were made among healers (mganga, pl. waganga), biomedical doctors (daktari, pl. madaktari), other “experts” (mtaalam, pl. wataalam), government officials, and witches (mchawi, pl. wachawi). Occasionally people recognized the differences between the work of researchers and doctors or healers. As one man explained, “a researcher looks at things to discover if they are there, a doctor cures the things that are there.”28 Another man, when asked whether doctors and researchers did the same work, responded, “Without the researcher, a mganga can’t cure you. . . . Doctors can’t start to cure you without the researcher.”29 In the case of these responses, researchers were discoverers, and there was a symbiotic relationship between the work of researcher as discoverer and that of mganga/healer as curer of disease.
One way to piece together local perceptions of medical research is to look closely at the words being used. At the turn of the century, there was no specific word in Swahili capturing either the substantive act of research or the verb “to research.” Currently, most people use one of three words to describe the work of researchers, translatable as: to search or seek; to examine; and to spy. Table 2.1 shows the three major root verbs that are and have been used to discuss medical research.30
Table 2.1. Swahili words for “research” and translations
In a simple sense, the sets of words describe increasingly intensive forms of searching as you read down, in addition to having a more negative connotation. Kutafuta is the least value-laden, and is used widely to describe looking for objects, people, or more esoteric ideas, such as a better life.31 Kuchungua implies that the person has used an element of prying in order to gather information. Both kutafuta and kuchungua connote that the search for information is overt and even public, even if it is not appreciated. Kupeleleza, however, invokes a sense of criticism, almost always implying that this form of investigation involves a degree of furtiveness and covertness. For example, a Tanzanian assistant involved in medical work reported how “It was this spying on houses [kupeleleza vyumba] that upset” the public.32
Moving back up the table, mtafiti continues to be a word of choice when talking about researchers. Still, although relatively benign, it too hints that an acceptable activity has been carried out on the wrong scale: searching is fine, but searching too insistently is frowned upon. One man explained, “A researcher [mtafiti] is an important person because he indeed is the one who discovers everything [anayegundua kila kitu].”33 This supports the dictionary definitions of who a mtafiti is, yet there is a hint of excess since a researcher knows not just about disease, or bugs, but about “everything.” Even when one of the most neutral words, mtafiti, is used, the subtext of prying and invasiveness remains. There is one other word I heard used to describe researchers, and it is the only term that was positive: mtaalam, which can be translated as “expert” or “specialist.” Mtaalam (or mtaalamu) is connected to the term elimu, which is “knowledge or learning.” Someone who is referred to as mtaalam is educated, learned, and well-informed; he is a scholar or sage.34 When researchers were referred to in this way, it was less of a direct description of their work and more of a general commentary on their education and expert knowledge.
Healers and Harmers
There were two competing narratives about researchers that emerged, each focusing on very different aspects of their work. In the stories told by Mama Nzito and others, the focus was on blood theft and the murder of innocent Africans. Researchers were powerful experts who were sanctioned by the government and feared by locals. They were unsavory characters bent on making money, even if it meant sacrificing human life. In contrast, another set of stories—which appeared in nearly every interview, frequently alongside or intertwined with the first, malignant narrative—described benevolent researchers.35 In their positive descriptions of researchers, East Africans noted the similarity between researchers and doctors: they both gave out medicine and helped the sick recover.36 These behaviors meant research was described as kitu kizuri—a good thing.37 These starkly different characterizations of medical researchers were put forth by most of my interviewees, who saw no inherent contradiction between researchers as potential murderers and researchers as benevolent distributors of drugs. Researchers could be involved with both curing and killing. This willingness to maintain two contrasting impressions of researchers is likely tied to the fact that one of the figures a researcher might be compared with—a mganga—is commonly thought of as a powerful individual who can both harm and heal. As a variety of ethnographies from across East Africa have shown: “In the eyes of ordinary people both good and bad aspects of the doctor can be found in the same person. The mganga has power to protect and harm. . . . The common epitaph is ‘How can s/he cure witchcraft, if s/he is not an expert in it!’”38
The Zaramo of coastal Tanzania recognized that, “in practice, a mchawi [witch] may also be a mganga,” and, on the coast, both uchawi (black magic) and uganga (white magic) “may be practiced by the same individual.”39 Thus, the very ability to heal requires knowledge of how to harm. In some cases, a mganga is considered an actual witch, since “although he seems to be using his powers to help others, one cannot be sure about all his activities.”40 Only by understanding what causes illness (or, how to cause illness) can cures be discovered. And while a good mganga should always use his power in a positive way, there is always the potential for that ability to be abused. The mganga is treated, therefore, with a mixture of respect, caution, and fear—not so different from the way researchers were viewed.
For most of East Africa, the Swahili word mganga (or its analogue in other Bantu languages) is a broad term that can reference the healing performed through magic, the
