The health of prisoners: historical essays

Hewa presents IHB objectives in vigorous terms as the same as "imperial tropical medicine": to protect the health of the colonisers; to maintain the health of the "colonised" as far as their health posed a threat to colonial rulers, or to the viability of colonial economies. Such activities also demonstrated Westem cultural superiority and the backwardness of the "colonised" regarding health and sanitation. However, Hewa shows the problems of the transfer of medical policies and technologies from first to third world countries. The initial IHB anti-hookworm campaigns between 1916 and 1921, while successful in the short term in identifying the sick and curing infection, failed to eradicate the disease as the neglect of improvements to basic sanitation led to rapid and high rates of reinfection. In 1926 a different, less narrowly medical approach was taken by the IHB, again borrowing from American experience. This was the establishment of "health units" which aimed to provide a range of preventive measures, including child and maternity clinics, malaria eradication, sanitary reform and health education, with many agencies using Sri Lankan rather than British or American staff. Such measures enjoyed popular support and the expansion of health and welfare services was used by post-independence rulers to win legitimacy and support. Hewa's account, despite the author's best efforts otherwise, shows that medicine was something more than a tool of cultural imperialism used by administrators, capitalists and experts. While this perhaps dominant feature should not be overlooked, the story Hewa tells also shows, what many other studies have recently revealed, the contradictions and ambiguities of medicine in the colonial context, and how these changed over time. Given the critical views taken of Rockefeller work, it is surprising that the IHB's concentration on a single disease has been followed in this study. It would be nice to know the other causes of morbidity and mortality in Sri Lanka in this period, and the changes in the relative importance of these economically, socially and politically over time. Also, if the total cost of the "health units" in 1931 was only 3 per cent of the annual budget of the colony's Department of Medical and Sanitary Services (p. 135), it would have been instructive to know how the other 97 per cent was spent. The activities of the IHB showed the weaknesses as well as the strengths of Western medicine, and the gap between promises and results was increasingly recognized by Sri Lankans and undermined Western authority and the legitimacy of colonial rule.