3. Public health
The administration did little about the spread of contagious diseases from 1890 to 1920. The war against the Sayyid Muhammad Abdulla Hassan made any investment in hospitals and clinics or the undertaking of campaigns of control of diseases, impossible in that period. There were only three clinics at Sheikh, Zeila and Berbera that served primarily soldiers. Medical expenditure in this period averaged about Rs.1,254 a year (Foreign Office Report, 1899). In the post-Sayyid period, however, the administration expanded medical services for utilitarian and political reasons. The administration was anxious, first, to control the spread of diseases and improve the health of the people. Second, to “develop the resources of the country” (Summer, 1924) and raise surplus revenue. Third, to neutralize the anti-colonial legacy of the Sayyid Muhammad Abdulla Hassan (Kakwanzire, 1986, p. 669). Fourth, to make the people responsive to colonial rule through cultural and educational institutions and not through a “demonstration of (naked) power” (Summer, 1924). As Sir Gerald Summers, the Governor of Somaliland from 1922 to 1924, put it, “(t)hough by nature the Somalis are very unresponsive, there is no reason to conclude that by the progress of administration and the personal contact of British officers with the people themselves… and by the extension of medical treatment and other means, a far better relationship may not be established between the British administration and the people than exists at present” (Summer, 1924). In sum, colonial medicine had the object of imposing “regulatory controls: a bio-politics of the population” (Foucault, 1978, p. 139), a politics in which the health, the productivity, the disciplining and the controlling of the population were intertwined. Colonial medicine was, after all, both a `tool’ of imperial conquest (Headrick, 1981) and a crucial “dimension of the knowledge and power complex” of colonial rule (Vaughan, 1991). Hence, public health programs were often “administrative as much as medical in their presentation” (Vaughan, 1991, p. 43).
However, it must be added that in the early colonial period the role of colonial medicine was limited by the lack of funds for the improvement of public health. As Table 3 indicates the amount spent on public health was minuscule. In addition, the administration focused mainly on urban centers, rather than the rural areas, where the great majority of the public lived. The urban centers were focused upon, first, because they were administrative centers and hence the public health staff had direct and often daily contact with them. Second, they were considered as the source of various contagious diseases. The medical staff was weary of the growth of the towns and their population because diseases achieve endemicity in urban centers with a permanent and often large population. The regulatory controls the administration imposed on urban centers were essentially limited and often primitive. The aim, above all else, was the prevention of diseases. The first modern hospital was opened at Berbera in 1925 with great fanfare. Less sophisticated hospitals were also opened at Hargeysa and Borama in 1925. In 1928 a new hospital was built at Erigavo; in 1929 a new lunatic asylum and a leprosarium was opened at Berbera; in 1930 a ward for tuberculosis patients was added to the Hargeysa hospital; in 1932 a ward for female patients was added to the Borama hospital and in 1935 the leprosarium at Berbera was expanded. Moreover, venereal disease clinics were added to all the hospitals in all the main towns from 1925 to 1930. In the post-Sayyid period, therefore, medical expenditure increased as Table 3 shows.
The first medical issue the public health department addressed in the post-Sayyid period was venereal diseases, particularly syphilis. The disease, as Table 2 shows, affected very few people in the urban centers. Nonetheless, the medical department was anxious to stop the spread of the disease and at the same time use its intervention against the disease as a way of imposing controls and surveillance over the pauper class in the towns. The politics of power and knowledge were deeply intertwined in the campaigns waged against venereal diseases in the post-Sayyid period. So focused was the medical department in gaining the latest methods of classifying and controlling venereal diseases, that Major Keene, the VD advisor to the East African Protectorates, was invited to visit Somaliland in 1923. Major Keene stayed in Somaliland for one month, 16 September to 16 October 1923, and toured clinics in Odweina, Hargeysa, Burao, and Berbera. He advised the department on how to classify the disease and recommended the widespread use of NAB injections as a remedy against syphilis. The department then supplied all the clinics and hospitals with NAB injections and publicized in all the towns the dangers of the disease, the announcements stressed the inherent danger of impotency and the effectiveness of the NAB injections. The injections were not free. Each injection cost Rs.10. The NAB injections were fortunately effective against the disease and consequently became `very popular’ (Syphilis Report, 1930). Even people who were not infected with the disease began beseeching clinics and hospitals for the magical bullet against the disease. Moreover, an old (Arab) traditional doctor of syphilis who practiced in Berbera and used to advise his patients to wash in the sea and then lie buried in the hot sand dunes left the country for the lack of practice (Syphilis Report, 1930).
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