In recent years, historians of colonial medicine have provided the analytical framework for understanding the role, authority, and influence of colonial policies on biomedicine and the changing relationship with the people these policies were meant to serve. In addition, historians have brought into the orbit of analysis the tension between the “medical occupier” and the “colonized.” The theme of tension has formed a primary motif in the new social history of the interaction and change that accompanied the way Western biomedicine was received in the colonial context. Indeed, a host of scholars have correctly pointed to the limitations of imperial authorities, as well as biomedicine, as a factor in acculturating the masses to the Western biomedical order. Building on this theoretical foundation, this study discusses how Africans perceived and critiqued Western biomedicine and yet continued to embrace and institutionalize its presence in Kenya.

I initially intended this monograph to focus on the political economy of health care in colonial Kenya. However, that intention was left behind as I delved into a wide array of archival materials, field interviews, and secondary sources. I became aware that a full understanding of the health care system, both in the colonial and postcolonial periods, went far beyond the boundaries of political economy and encroached upon areas of social and cultural history. I was intrigued by the controversies that surrounded the introduction and development of Western biomedicine, particularly the meanings and interpretations given to its shortcomings and successes by Africans in Kenya. I have striven to explore the controversies from many perspectives ranging from political economy and racial attitudes to indigenous culture and production of knowledge, while paying attention to the specific intervening factors that have shaped the developmental course of health care in twentieth-century Kenya. A major objective has been to create a narrative based on the role of Africans as proactive participants in the health care debates. I have attempted to avoid the shortcomings of the top-down approach, which views the issues of health care and medicine only through the eyes of the colonial rulers. But in the same vein, I have also shied away from the “view from the bottom” that takes account only of the perspectives of the conquered. Thus in the chapters that follow, I argue that beneath the strands of tension and conflict there also existed a world of compromise, accommodation, and coexistence between African and Western biomedical practices.