East African Doctors: A History of the Modern Profession (review)

Iliffe's remarkable study focuses on the training and practice of East African doctors duringBritish rule and after independence in Uganda, Kenya, and Tanzania. His objective is not simply to write a kind of "collective biography of African doctors," but also to provide the reader with the background information for understanding their crucial contribution to the development of strategies to combat the spread of AIDS.Despite its focus on African doctors, the book provides insights into the world of paramedics who played an important role as intermediaries between Europeans and Africans prior to the training of doctors. To undertake this vast task, Iliffe has drawn on a wide range of archival materials and newspapers in the three former British colonies and in England, and he has interviewed many informants.

The book is organized in chronological order, the introductory section followed by four chapters covering the periods 1870-1914, 1914-23, 1923-49, and 1949-60; the remaining five chapters cover the 1960s through the 1990s. In chapter 1, Iliffe shows how Africans started as apprentices before obtaining formal medical training at Makerere College in Uganda and achieving professional power and status over medical policy.Of special interest here is the initial entry into modern medical practices of freed slaves and lower class young men as assistants to missionary doctors, a trend observed elsewhere in Africa during the colonial period.In chapter 2, Iliffe builds on the work of these "pioneers" and argues that it was the herbalists "who provided a model and set of expectations for many of the first young people who studied modern medicine" (10) in terms of learning trade through apprenticeship.

Chapter 3 analyzes the recruitment of more indigenous medical staff. The author contends that the first World War created an opportunity for the recruitment and training of "tribal dressers," hospital attendants, and other paramedics as medical services expanded into the countryside. The tribal dressers played an important role as intermediaries between Europeans and Africans owing to their ability to explain to their countrymen "the difference between Christian medicine and witchcraft, and wherever possible to explain the reason for any particular treatment" (49). Here, Iliffe ably demonstrates the strengths and weaknesses of indigenous medicine, though he does not identify the health problems doctors faced in the nineteenth century as they tried to recruit Africans. He is certainly sympathetic to missionaries' assessment of their own ability to cure disease.

Chapters 4 and 5 deal with the training of doctors at Makerere College and their pursuit of professional status equal to that of European medical officers in the 1940s and 1950s. The author underlines the social and ethnic diversity among medical students and explains the resistance they encountered in their struggle for professional status centering around four issues: the conversion of medical certificates into diplomas; the right to be licensed for private practice; pay increases and conditions of service; and the recognition of their qualifications by the General Medical Council (93). This transformation coincided with the growth of nationalism, prompting some doctors to enter politics and take over the institutions of colonial medicine once the three colonies achieved independence.

The remaining chapters analyze the challenges that doctors faced after independence: the disintegration of the state in Uganda (chapter 7), capitalism and corruption in Kenya (chapter 8), socialism in Tanzania (chapter 9), and the AIDS epidemic (chapter 10). Iliffe argues that neopatrimonial rule in Uganda and Kenya "presented doctors with dilemmas which divided the profession." Doctors' strikes over pay increases and health policy alienated them from the state. The socialist experiment in Tanzania, with its rural-centered health policy, negatively affected the doctors' working and living conditions.But Iliffe acknowledges that the available evidence does not allow him fully to assess the doctors' reactions to the socialist experiment of the 1970s and 1980s as well as to the liberalization of the health system since Tanzania...