The Journal for Transdisciplinary Research in Southern Africa 
ISSN: (Online) 2415-2005, (Print) 1817-4434
Page 1 of 3 Book Review
Colonised medicine and transformative learning – 
Lessons from Downs’ book: Maladies of 
Empire: How Colonialism, Slavery, and 
War Transformed Medicine
Book Title: Introduction
Maladies of Empire: How 
1
Colonialism, Slavery, and War In an article that was published in the University World News: Africa Edition, Tomaselli  declared the 
Transformed Medicine task of reviewing books, a framework and building blocks towards a scholarly process. This, he 
argued, is a process that is likely to not only accrue benefits for the author and readers but also 
Book Cover: contribute to a flourishing career. Although Tomaselli does not labour this point, one assumes 
that if the book review is undertaken as an academic exercise, the reviewer cannot expert to 
reproduce what has been published by expert reviewers nor seek to undermine their efforts. To 
that end, a few months after I submitted my thesis, I accepted a call to review Jim Downs’ 
book,Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine.2 Everything about 
the title of the book was relatable to me as a gendered self – a black female in South Africa (SA), 
for we have been victims of a silent war. In post-apartheid SA, that war transformed and morphed 
itself to become a war on women and children.3
My brief was to determine whether Downs’ book should be included in our reading list as we 
embark on a plan to decolonise our curriculum offering in the School of Public Health at the 
Author: 
Jim Downs University of Cape Town (UCT). This was, after all one of the students’ demands during the 
2015–2016 #RhodesMustFall at UCT, which culminated in a nationwide #FeesMustFall students’ 
ISBN: protests in SA.4 Prior to the localised and nationwide university students’ protests, changes in 
ISBN: 0674971728 higher education institutions, particularly in the historically white institutions (HWI), were 
Publisher: limited to changes in enrolment targets in response to a policy directive that was issued by the 
Belknap Press, 2021, Ministry of Education.5 Although this yielded an increase in the number of black students who 
R462.88* were admitted to study in HWI, an observation that was made by Heleta6 was of macro boxes that 
*Book price at time of review were ticked whilst colonial structures remained untouched. As such, as reported by Otu and 
Mkhize in 20187, attrition rates among black students remained high as students took longer to 
Review Title: complete their degrees.
Colonised medicine and 
transformative learning – 
Lessons from Downs’ book: A prevailing perception was of students who were ill-prepared for university studies, particularly 
Maladies of Empire: How if they matriculated from poorly resourced schools in rural and underserved areas within SA. 
Colonialism, Slavery, and War What was overlooked was the impact of a teaching and learning approach that had not embraced 
Transformed Medicine the diversity of learning experiences, diversity of contexts, diversity of skills and a range of 
Reviewer: personal experiences derived and defined by spaces that were occupied by the learners prior to 
Nontsikelelo O. Mapukata1  them becoming university students8. Thus, beyond #FeesMustFall, the urgency was in defining 
initiatives to decolonise and facilitate the pursuance of a transforming curriculum.
Affiliation: 
1Department of Public Health 
Medicine, School of Public In preparing for this review, I submitted a request to our librarians to purchase a physical copy of 
Health and Family Medicine, Downs’ book. In no time, I was informed that an e-book was available on short loan. Within a few 
Faculty of Health Sciences, minutes of downloading a PDF copy of the book, I made three observations. Firstly, I did not need 
University of Cape Town, 
Cape Town, South Africa the 3 days – the book was a page-turner. Secondly, Downs’ peer-reviewed book is an asset to 
novices as well as public health experts as it provides a detailed historical timeline of three major 
maladies of the empire, namely, slavery, colonialism and war. The third aspect caught me off 
guard. As I turned each page, I became increasingly upset by the power and patriarchy that 
Read online: dominated the pages and the violations that were metered on children, the very vulnerable and 
Scan this QR 
code with your Corresponding author: Nontsikelelo Mapukata, ntsiki.mapukata@uct.ac.za
smart phone or How to cite this book review: Mapukata NO. Colonised medicine and transformative learning – Lessons from Downs’ book: Maladies of 
mobile device Empire: How Colonialism, Slavery, and War Transformed Medicine. J transdiscipl res S Afr. 2022;18(1), a1287. https://doi.org/10.4102/
to read online. td.v18i1.1287
Copyright: © 2022. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
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Page 2 of 3 Book Review
disenfranchised communities. Down’s book validated the education outcomes and link this to policy initiatives such as 
struggle of women scientists who are often overlooked and the feeding scheme in South African schools and, more 
disregarded. Not only that, I was also shocked by the myriad recently, the Social Relief Distress grant that is administered in 
of ethical dilemmas. I had no choice but to pursue a value- terms of section 32 of the Social Assistance Act No. 13 of 2004, to 
based approach. provide relief to unemployed citizens beyond the global 
pandemic. A debate that can be pursued would allow selected 
Taking into consideration our historical perspective, the groups to examine the involuntary effects of inedia (fasting) 
demands of the student body I referred to earlier and the and the incidence of malnutrition and kwashiorkor in 
efforts to decolonise curricula in post-apartheid SA, in underserved and rural communities. Students can contrast 
reviewing this book, I had no intentions of reproducing the this to the practice of intermittent fasting as a lifestyle weight 
work of the experts. Bearing in mind the role of public health management plan for the middle class. Alternatively, groups 
as a transdisciplinary offering that is concerned with can explore the incidence of overnutrition and sedentary 
preventing disease, prolonging life and promoting health lifestyles and its contribution to the burden of chronic diseases. 
through organised efforts of individuals and their families; The session can be concluded by introducing students to 
communities; public and private organisations9, I had to research as an instrument for mediating population challenges 
demonstrate that Down’s book met the criteria to fulfil UCT’s in low- and middle-income countries. Downs’ book offers 
commitment to transform teaching and learning. Not only many other opportunities that are likely to facilitate 
that, although I approach this review from my teaching base transformative learning in the examples I present below.
in the Faculty of Health Sciences, there are opportunities to 
engage students in other faculties such as Commerce, The role of journalists in exposing 
Engineering and the Built Environment, Humanities and 
Law at UCT and other universities in keeping with Winslow’s war crimes
definition of public health as an art and a science. Two Educators can use this exercise to encourage students to 
exploratory questions informed my approach: reflect on instances where investigative journalism has 
• What aspects of the book were likely to add value to the exposed inefficiencies in the delivery of health care. Within 
curriculum of health sciences students in their first year, the South African context, students have an opportunity to 
fourth year and final year? reflect on the crisis of personal protective equipment (PPE), 
• What aspects of the book were likely to create opportunities the impact thereof on frontline health care workers and 
for undergraduate and postgraduate students to pursue potential threats to the implementation of universal access to 
context-specific research in public health? health care. Students can conclude the discussion by 
reflecting on their role in advocating for equitable access to 
Contextualising teaching, learning health care. In a transforming democracy, such debates can be pursued by students across disciplines to curb corruption 
and research and promote ethical leadership. In a group exercise, students 
The first chapter in Downs’ book proved to be a great resource can explore differences between colonialism and imperialism. 
to introduce undergraduate students to research and the On the one hand, postgraduate students have an opportunity 
application of two research methodologies, namely, the to explore the role of imperialism in advancing epidemiology 
unobtrusive research methods and the mixed methods as a scholarship. Multidisciplinary studies can be pursued 
approach, that have informed processes in this chapter. that explore the role of imperialism in perpetuating the 
Later, Downs introduces the narrative, yet another dominance of the ruling party. For example, health sciences, 
methodology. Tracing the historical context of epidemiology, humanities and law students can analyse the impact of 
Thomson makes critical observations about Africans and Guptacare on the health outcomes of people residing in the 
introduces four concepts that can be explored with students North West Province. On the other hand, multidisciplinary 
in group activities. groups can investigate the effect of arson attacks as weapons 
of war and the impact thereof on oncology services at the 
The first one is resilience and self-determination in cases of Charlotte Maxeke Johannesburg Academic Hospital. In a 
human trafficking. This section defines the role of healthcare country with high levels of youth unemployment that have 
workers in managing prisoners of war (asylum seekers) not spared university graduates, another group can evaluate 
who embark on hunger strike. Two local cases, Steve Biko’s costs that are borne by families and students pursuing 
death10 and the Life Esidimeni tragedy,11 could be referenced professional training in teaching hospitals as well as sunk 
in discussions on human rights violations in the public costs and opportunity costs to service providers.
sector.
Florence Nightingale as a revered 
Secondly, groups can explore insufficient nourishment as the nurse who is silenced as an 
cause of disease as Thomson deduced that Africans could 
survive without food in crowded and unventilated epidemiologist
environments for 10 days. Using the poverty cycle, students Drawing on Nightingale’s efforts in advancing the practice 
can trace the impact of undernourishment on health and of record keeping and its value in monitoring and evaluating 
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Page 3 of 3 Book Review
the emerging threats and patients’ response to interventions, Ethical dilemmas in practice
students across disciplines have an opportunity to evaluate 
the role of social media in advancing access to information In introducing students to ethical dilemmas in practice, the 
about a contagion. The coronavirus disease 2019 (COVID-19) violations that are metered against children can be explored 
is a realistic reference for this task. Educators can challenge in discussions that are guided by the South African Bill of 
12
students across disciplines to explore the role of descriptive Rights  and related legal provisions such as the Children’s 
statistics in contributing to policy formulation and the use Act of 2005
13. In Downs’s book, three critical points of 
of implementation science as a practice approach to address reference include the use of children as research objects, 
public health challenges. In addition to that, students could children as vaccine intermediaries, as well as orphaned and 
pursue collaborative inter-faculty partnerships and address marginalised children as the property of physicians. As a 
emerging problems that are likely to impact health outcomes transdisciplinary activity, students can carry out an audit of 
such as the 2018 water crisis that had implications for published research to evaluate the role of research 
people living and working in the Western Cape province. committees and institutional commitment in protecting the 
Other opportunities that are likely to contribute to interests of children when they are enlisted as research 
transformative learning may include an exploration of the participants.
shift from case finding to protocol development as a faculty-
mediated response to the recent mental health crisis, a In conclusion, Downs’ book offers many opportunities for 
malady that is not limited to the students of health sciences educators across disciplines to engage a diverse group of 
but one that has affected university students across students in discussion as they explore a range of context-
disciplines. In a country that is overburdened by crime and specific topics in public health. As we embark on a range of 
gendered forms of violence, educators can encourage curriculum transformation initiatives, Downs’ book creates 
students to explore the benefits of making a shift from opportunities for students to appreciate the role of the three 
curative approaches to implementing salutogenic maladies of empire in contributing to transformative 
approaches such as hiking and walking clubs, thereby learning.
creating safe spaces for university students as they pursue 
practice-based research. References
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Race and racial differences Conversation: Africa Edition. 2021 [cited 2021 Apr 21]. Available from: https://www.universityworldnews.com/post.php?story=20220418043931171
A critical component in Downs’ book that is relevant to SA’s 2. Downs J. Maladies of empire: How colonialism, slavery, and war transformed 
medicine. Harvard University Press; 2021.
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and 19th centuries. Watching the 1998 documentary on the life African Medical Journal. 2018;108(5):382–385.
and times of Sarah Baartman should instil an appreciation of 12. Nthai SA. A bill of rights for South Africa: An historical overview. Consultus. 
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learning. Health. 2009;21(2):iii–vi.
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