The Covid-19 narrative in Malawi can best be imagined as a series of government initiatives and the resulting backlash from the citizenry. On March 20, 2020, Malawi declared Covid-19 a national disaster and announced restrictions aimed at reducing the spread of the disease. This announcement was the first of many that would follow in subsequent months. The restrictions that were announced included limiting public gatherings such as funerals, weddings, religious ceremonies, and meetings to 100 people. Schools, colleges, and universities were also closed. Security forces were deployed to enforce the restrictions.
“The tensions and interactions that take place when a colonized country faces a pandemic or epidemic show that health is much more than a biomedical issue.”Power is always an inevitable part of health practices. One only has to look at how governments enact ordinances and policies to limit the spread of epidemics and pandemics, but also how space and movement come under the control of authorities. These dynamics become accentuated in a colonial setting, where two different understandings of disease collide in a time of crisis. There have actually been times when medicine has been seen as a political tool.1Nancy Elizabeth Gallagher, Medicine and Power in Tunisia, 1780–1900 (Cambridge: Cambridge University Press, 1983), 1. The tensions and interactions that take place when a colonized country faces a pandemic or epidemic show that health is much more than a biomedical issue.
Based on our recent research on how colonial Malawi (or Nyasaland, as it was then known) handled pandemics and epidemics, we argue there are lessons to be learned from this history. These lessons include effective policies to adopt and to avoid. Our focus is, therefore, on the extent to which power interplay between government authorities, health practitioners, and local inhabitants affects responses and practices during pandemics and epidemics.
Malawi’s history has witnessed such tensions, especially in the administration of power during the early twentieth century. At the time, the country was under British rule. In the context of the diseases that devastated the country during the early colonial period, administrators put in place measures to stem epidemics and pandemics. Some of these measures were successful, whereas others only escalated the situation. What all the measures had in common was how they were all centered on the power interplay between different stakeholders.
This essay examines the following themes: the colonial government’s stance on disease control, communication during pandemics and epidemics, forms of resistance, and successful practices to be gleaned 102 years later. Our particular focus is on the years 1918–1922, when the Spanish influenza and smallpox devastated the country, although cases of smallpox had already been reported in Nyasaland as early as the nineteenth century.
Malawi confronts Covid-19
Eleven days after Malawi declared the pandemic a national disaster, the Malawi Department of Civil Aviation suspended all flights to and from Malawi except for those bringing returning citizens as well as essential goods. On April 2, the first three coronavirus cases in the country were announced. The first Covid-19 death in the country was on April 7, 2020.
“The lockdown was accordingly suspended. However, other Covid-19 measures were strengthened and enforced.”On April 14, the government announced an impending lockdown, which was supposed to start on April 18. However, there was a backlash to this announcement, especially from small-scale entrepreneurs, which led to sporadic demonstrations. Moreover, civil rights groups led by the Human Rights Defenders Coalition (HRDC) obtained an injunction against the lockdown, arguing that the proposal was unconstitutional and that, in the absence of government support, a lockdown would lead to the starvation of thousands of citizens. The lockdown was accordingly suspended. However, other Covid-19 measures were strengthened and enforced.
On February 2, 2021, President Lazarus Chakwera announced that his government had finally secured doses of the AstraZeneca vaccine to help immunize “as many citizens as possible.” On the same day, the Malawi government, through its Ministry of Health, announced its Covid-19 vaccine roll-out plan. March 5 saw the arrival of 360,000 doses of vaccine, which has a population of over 19 million. This was prior to a vaccination campaign, which commenced six days later.
What played out in between the announcements underscored how society and government in Malawi were grappling with the pandemic. The announcements coming from the government were often met with resistance, misunderstanding, or misinformation, attesting to the newness and strangeness of the pandemic. And yet this was not the first time the country had faced a health crisis. There have been similar incidents in the past that required lockdowns and quarantines, such as the Spanish influenza of 1918 and smallpox at various points during Malawi’s history.
The colonial government’s stance on disease control
Government officials in Nyasaland had their own ideas of prevention and treatment of epidemic diseases. In the case of smallpox, they believed that vaccination using calf lymph from England was the best way treatment. This was despite the fact that the lymph was considered ineffective by some medical officials. When a medical health officer argued that it might be better to use lymph from South Africa because of the distance as well as the time it took to procure vaccines, he received the following terse response from Principal Medical Officer Hearsey:
Your requests for calf lymph from South Africa are obviously made in ignorance. This lymph was employed from a period of over fifteen months during the war, and not in a single instance was any reaction obtained from it. You say that this lymph can be delivered here in fourteen days, but exposure to the prevailing temperatures during its transit from Chinde to port Herald will render it inert in as many hours. The lymph obtained from England is the only kind that will withstand the adverse conditions to which it is unavoidably subjected. I trust that this will be the last of your requests from lymph from South Africa, either to me, or in the form of a Departmental complaint to the Governor or the Secretary of State.2Principal Medical Officer 21st November 1919, Central African archives s1/325/19, Malawi National Archives (hereafter MNA).
Statements such as the one above came about because colonial administrators wanted their understanding of disease in the colony to prevail. Alternative treatments were not entertained, whether these came from European medical staff or from Africans. Africans had suffered from smallpox prior to colonialism and had their own understanding of how to treat the disease.3Edwin Msewa, “A Study of the Incidence of Smallpox (nthomba) Epidemic: African Response vis-à-vis Government Reaction in Lilongwe District between the Years 1920 and 1921” (paper presentation, History Seminar Series, University of Malawi, January 21, 1997), 7–12. Also see Megan Vaughn, Curing their Ills: Colonial Power and African Illness (Redwood City, CA: Stanford University Press, 1991). For example, among the Lomwe, an ethnic group of Southern Malawi, smallpox was treated using inoculation. This was because they believed that their method of inoculation was superior to any smallpox treatment developed in Europe. The inoculation practiced by the Lomwe involved extracting variolous matter from smallpox patients and applying the matter through incisions made on healthy individuals.4Correspondence between Resident, Port Herald and Chief Secretary, 28 June 1919, MNA s1/1243/19. British inoculation, on the other hand, relied on the use of lymph from calves. However, after colonization, all those who took part in Indigenous forms of inoculation were arrested, fined, or both, if discovered. Similarly, court records show that in Dedza district, village headmen were taken to court for the offense of inoculating persons with smallpox.5MNA s1/1072/19. These examples show how there was a dominant discourse on the appropriate way to deal with diseases such as smallpox, and this discourse was monopolized by representatives of the colonial government.
However, the colonial government did not necessarily speak with one voice on how to handle pandemics or epidemics. The letter above is a case in point, where a district medical officer held different views from his superior on the right vaccine. Other examples include disagreements over the use of quarantine as a preventive measure. The official position was that every village in which some inhabitants had been infected should be quarantined, whereas district residents insisted that vaccination was more effective. There were also disagreements about who got to make particular decisions. Hearsey was reprimanded by the secretary of state for advising district residents to stop using smallpox police—a group of African policemen employed by the colonial government to ensure that residents of a quarantined village did not leave the area. The decision to stop the smallpox police was supposedly only to be made by the office of the governor. These examples highlight how bureaucracy prevented junior officers from carrying out decisions they felt were appropriate for their jurisdictions.
Inadequate communication with Africans
“The colonial administrators would order African chiefs to take care of patients without finding out what the role of an African chief was in society.”While colonial administrators communicated amongst themselves about both the Spanish influenza and smallpox, they did not involve Africans. We can divide communication about pandemics and epidemics into three parts. First was the Epidemic and Contagious Diseases Ordinance of 1903, which was applied whenever health crises occurred. This ordinance was applied during both Spanish flu and smallpox outbreaks. It was written in English, and expected to be translated to the local inhabitants, most of whom were illiterate. The ordinance, which already created a gap in terms of language, was further interpreted subjectively by the principal medical officer. For example, at the onset of the Spanish flu, the principal medical officer, Hearsey used the ordinance to prescribe quarantine for Africans and bed rest for Europeans.6“Diseases: Spanish Influenza Outbreak (1919).” Notice from the chief secretary’s office to all officers in Zomba, 4 September 1919, MNA s1/1329/19. The second part involved reports from the government to health officials and vice versa. In these exchanges, decisions would be enacted and squabbles might take place. The third part involved specific orders to Africans regarding what needed to be done, despite the structures that Africans may already have put in place. Thus, the colonial administrators would order African chiefs to take care of patients without finding out what the role of an African chief was in society. African chiefs were, in this case, reduced to caretakers, with reports usually including a statement that the patients were being “looked after” by the chiefs.7MNA s1/1128/10.
The voice of the chiefs and other local inhabitants was thus missing from the reports, and what the chiefs received were instructions that had already been agreed upon elsewhere. Local inhabitants were not given a chance to act on decisions that directly affected them, and were not given explanations that would have made them understand the pandemics and the actions that were being taken.
Africans’ covert resistance
Africans were not passive recipients of these colonial discourses. In addition to inoculation, they had other forms of treatment and would refuse Western remedies, even while knowing that there were penalties for this refusal. In the outbreak of epidemics, the official procedure was for the chief to report to the district resident for further action. However, in some areas, local inhabitants concealed the disease, choosing to treat themselves with local remedies.
During the Spanish flu, some inhabitants from Mulanje refused to take the prescribed medication, opting for sugar and paraffin to the extent that the missionary hospital where most of these cases were treated ended up complying and supplying what the patients demanded. An Anglican missionary in Zomba gave a report on two villages that refused to get any medication from the hospitals when the Spanish flu broke out. Some people in these villages believed that the flu was caused by evil spirits.8Nyasaland Diocesan Chronicle, April 1919, 34.
Local inhabitants also negotiated with vaccinators, Africans employed by the colonial administrators to administer vaccines in African communities, as to how the vaccine could be administered; instead of getting the prescribed number of jabs, they would ask and receive a reduced dosage. This was their way of negotiating the process on their own terms: exposing themselves to Western treatment without necessarily committing to it.
Moreover, some Africans took advantage of the gaps and contestations in the colonial discourse and furthered their own interests. Examples include how the pandemic police9Pandemic police are used here as a general term to refer to Africans employed to enforce quarantine measures for any epidemic disease. would keep a village under quarantine long after there was no infection in the village. During a pastoral visit in Mchinji, Father Denis of Kachebere Mission came across a village that had been on quarantine for 18 months after the pandemic had ended.10MNA s1/1073/19. In some cases, while the villagers were on this enforced quarantine, their livestock and other property was taken by the pandemic police.
There were also cases of bribery, especially by vaccinators. Some vaccinators would assure villagers of increased physical mobility at a fee. This shows that even though the authorities had instituted quarantines, there was a way to negotiate space within those restrictions.
Some vaccinators would falsify numbers, claiming to have administered vaccines to a number of people. In March 1920, a medical officer reported on how he had physically examined the arms of villagers, only to find that the recorded number of vaccinated cases did not tally with the evidence. The medical officer attributed this to the local inhabitants’ objection to the vaccine, and the vaccinators’ deference to this objection. He also felt that it was due to slackness on account of there being no inspector.11MNA s1/325/19.
Thus, whereas the authority had power in the policing of disease, this power was not absolute. What was on paper did not automatically translate into reality.
Successful practices
Historians have touted Nyasaland as a success story for its response to the Spanish flu.12Sandra Tomkins, “Colonial Administration in British Africa during the Influenza Epidemic of 1918–1919,” Canadian Journal of African Studies 28, no. 1 (1994): 60–83. Also see Africa Centre for Strategic Studies, “Lessons from the 1918–1919 Spanish Flu Pandemic in Africa,” Spotlight, May 13, 2020. While locals might have benefited from the useful government services mentioned below, the government did not fully succeed in earning the locals’ trust because of the top-down approach inherent in the practices. Below are some of the practices that the government used to control the Spanish flu.
Collaboration between government and mission hospitals
The Nyasaland government did not have many healthcare facilities. Some districts did not even have a medical health officer. The authorities realized early on the importance of working with the missionaries. The government provided medical supplies to mission hospitals during the Spanish flu pandemic. Moreover, the missionaries used their publications to encourage the use of Western medicine, reinforcing the discourse on the importance of treatment prescribed by the government.
“Even though the government was overwhelmed by the pandemic, the missionaries helped in the fight against the Spanish flu.”Thus, even though the government was overwhelmed by the pandemic, the missionaries helped in the fight against the Spanish flu. A missionary’s report in Likwenu in 1919 points to how missionaries spent their time taking drugs to villages and ministering to severe cases.13Nyasaland Diocesan, April 1919. In the same report, there is an acknowledgment of the drugs given to the dispensaries.
Record keeping
The colonial government was conscientious about record keeping. Chiefs were required to submit a record of the number of infections and deaths in their villages to the District Resident who would, in turn, submit them to the governor in Zomba. This meant that every district had a record of cases. Such record keeping did not start with the onset of epidemics. It had been there before, as a way of keeping track of taxpayers, farming practices, and court cases. The pandemics were thus recorded as part of an existing practice. These records informed healthcare practices in Nyasaland. For example, according to a Life and Work editorial,14Life and Work in Nyasaland, no.1 (July 1918–June 1919): 1–2. statistics of mortality cases due to the Spanish flu among Europeans and Africans were very high in November 1919; 14 Europeans in Blantyre and 40 in Zomba. Among Africans, it was estimated that six to seven percent of those infected succumbed. Using such statistics, and noting how the military medical officers had come to the rescue of the Nyasaland Protectorate Medical service, many in the country, including missionaries, successfully pushed for the formulation of a workable public health policy for the protectorate.
Non-state initiatives
Although, thus far, the focus has been on government power, there were some initiatives that did not emanate from the government. These included the decision by missionaries to use their power to force cattle owners in Livingstonia to provide food for the sick, which was used for soup. This went a long way in helping fight the pandemic, especially when it was accompanied by narratives of food scarcity.
Lessons
There are certain activities present-day Malawi has already put in place that both resonate with and depart from the past. One of the mistakes, replicated by Malawi, that the Nyasaland government made was to adopt a top-bottom approach and to expect that this approach would not be questioned. Yet it was questioned through the actions of chiefs and local inhabitants.
Malawi has also at times employed the top-bottom approach in communication. An example is the series of announcements referred to at the beginning of this essay, including the one regarding the lockdown. The fact that the lockdown was successfully contested points to a lack of consultation with stakeholders and reflects how power continues to be negotiated and challenged during health crises.
Related to this is how the Nyasaland government dismissed alternative remedies from Africans. However, as we have seen, such dismissals did not mean that the Nyasas stopped using the remedies. If anything, it seemed to fuel African resolve to use remedies that they could “own.” Similarly, Malawians have come up with a number of alternative remedies during Covid-19. The claimed benefits include symptom relief as well as cure. Among the purported cures are herbal remedies such as a local herb known as namoto (verbascum Thapsus), ginger, garlic, lemons, and inhalation of eucalyptus leaves. These have been used despite government press releases warning of the dangers that such remedies could cause to internal organs. This shows how people will always have their own understanding of disease, and governments need to find better ways of incorporating and accommodating alternative remedies.
“Many in Nyasaland believed that the Spanish flu was the work of evil spirits.”A challenge for both the Nyasaland and Malawi governments, leading to the escalation of the pandemics, was that of rumors and belief systems. Many in Nyasaland believed that the Spanish flu was the work of evil spirits. There are records of villages where people refused to go to the hospital, believing that they would be cured if they appealed to the right spirits. In such villages, the fatality rates were high. A similar problem hounds Malawi today, with certain sectors in society referring to religion as part of the Covid-19 discourse. There have been reports that those who accept the vaccine are aligning themselves with the Anti-Christ, and that those who use masks are showing a lack of faith in God’s protection. When the Ministry of Health released a statement encouraging people to go and get vaccinated, reactions on social media focused on how Malawi is “a spiritually rich” country and questioned the use of vaccine certificates. Misinformation spread so rapidly that several church groups had to issue statements to reassure their members that there was nothing sinister regarding the vaccine.
In addition, misinformation about hospital staff killing people under the pretext that the patients have Covid-19 spread. This has led to situations in which some people refuse to go to the hospitals, even for other illnesses. In cases where they do go to the hospitals, it is usually too late.15Report, Presidential Task Force on Covid-19 (Malawi Ministry of Health, 2021). Belief systems tend to be rigid. There is a clear need to develop a strategy that deals with the sensitive issues of belief and misinformation in pandemics.
Although the quarantine in Nyasaland was full of irregularities, it was still effective in stemming the flu pandemic. Given that Covid-19 is spread through social contact, like the Spanish flu, quarantine has also proven effective in controlling the pandemic in Malawi. Cases in which people have observed quarantine and isolation have tended to result in a reduction of incidences of the disease, whereas reports of areas in which quarantine measures have been flouted have been followed by an escalation of the disease.
Conclusion
The past has provided Malawi with triumphs and defeats during pandemics. It has also shown that the way in which power is administered has a direct effect on the handling of pandemics. A recognition of both formal and informal power structures, which includes effective communication and consultation, becomes vital when dealing with disease. Such recognition can contribute to practices that help in fighting pandemics in present-day Malawi. The enduring effective practices will, hopefully, form part of solutions for the future.
Banner photo: MONUSCO/Flickr.
