Colonialism, Tropical Disease, and Imperial Medicine: Rockefeller Philanthropy in Sri Lanka (review)

Soma Hewa has provided a fairly detailed account of health activities in Sri Lanka (Ceylon), from 1802, when the British established their crown colony, through the period when Tamil coolies were brought in to work the coffee, tea, and rubber estates, until after independence in 1948. His main emphasis is on the activities of the International Health Board (or Division, hereafter IHB), from their antihookworm campaigns in the tea estates (1915 to 1920) and mass-treatment hookworm campaigns and rural health units in the villages to the post-independence Colombo School of Nursing (1948). This account is doubly valuable because the author was able to go beyond the Rockefeller Archives to gain access to the Sri Lanka National Archives in Colombo.

To my mind, however, the study is undermined by an eighteen-page introduction that, rather than setting forth the questions to be answered, lays out a much-overstated and dogmatic account of the nature of European imperial medicine, and more particularly of the International Health Board. Taking E. R. Brown (Rockefeller Medicine Men: Medicine and Capitalism in America, 1979) as his mentor, the author states simply that the IHB’s entry was “necessitated by the self-interested concerns of the industrial capitalists of the United States” (p. 14) and was “inseparable from the capitalist pursuit of global and political domination” (p. 68). He notes, for example (p. 16n) that the programs of such capitalists were “channeled through” the IHB, thereby creating the impression that the powerful “medical barons” of the IHB (to use Robert Kohler’s term [Partners in Science, 1991]), were dupes of the Rockefeller family. Evidence suggests, however, that these barons did their own thing followed their own course, oblivious even to the wishes of the Rockefeller Foundation’s presidents. Rather than taking such statements as an absolute truth, the author surely has to show that the Health Board’s activities were geared to find a market for the multinational pharmaceutical industries, to gain a continuous supply of cheap raw materials for the United States, to provide investment opportunities for U.S. capitalists, and to influence the internal political affairs of the recipient countries (p. 17). Certainly they the IHB wished to spread the gospel of Western technological medicine and to set up a public health administration based on that of the United States, much of which can be criticized as inappropriate for these countries. I find it very difficult to believe, however, that Dr. Frederick Russell, perhaps the most powerful of the medical barons, took his instructions from the American pharmaceutical industry, which is what this author really seems to be saying.

The author ties himself into a knot over the first failed hookworm campaigns on the tea estates because he fails to understand the overriding policy of the organization: It was never (contrary to his claim) to cure hookworm—curative medicine was always the IHB’s bête noire. Because hookworm was curable, it was used in an attempt to gain political, medical, and popular support for the spread of sanitary ideas and public health activity into a community. But it was never the job of the IHB to erect latrines and pay for these sanitary measures—that would have looked like relief activity or charity, words much despised by the medical barons. The IHB was a public health investment agency that invested in a hookworm campaign on the understanding that the recipients would play their role and eventually take over the entire operation. If they refused—as happened in Sri Lanka, British Guiana, and elsewhere—the relationship was ended sooner than was planned.

By 1926 the Health Board had pushed the government into supporting health units modeled after those funded partially by the IHB in the American South. These were run, however, by Sri Lankan officials and financed by the government, not by the IHB, as the author seems to imply. Again, they represented the outcome of a public health investment...