People Are Not the Same is an excellent examination of the social and political experience of leprosy patients (Hansen's disease) in colonial and post-colonial Mali. Eric Silla's book is based on an extraordinary variety of oral and written evidence. The author conducted extensive interviews with "lepers," indigenous healers, African and European doctors and nurses, and missionaries. He also examined French colonial archives in Mali, Senegal, and France; Catholic missionary records in Rome; and selected Arabic manuscripts drawn primarily from the famous collection at the Centre de Documentation et de Recherche Ahmad Baba in Timbuktu. Silla synthesizes this rich variety of sources into a very readable and engaging account of the social, political, and medical history of leprosy during an extremely dynamic period of regional and global change.

Silla sets for his book the difficult task of examining both the patient's personal experience of leprosy as well as the broad political, administrative and medical histories that affected those personal experiences. He succeeds in this task and even reveals much about how individual lepers and leper organizations were able to influence government policies towards them, and to participate in broader historical events. But the double focus on the personal and institutional leaves its mark on this book. Much of it is organized by topics, such as the process of being diagnosed and socially labeled as a leper; the process of becoming a leper patient in indigenous and colonial health systems; the development of colonial medical institutions and the influence of administrators, missionaries, and the broader European medical establishment on those institutions; and finally the development of a leper community. These topics constitute mini-narratives of their own that as the reviewer of Choice magazine pointed out, interrupt the narrative flow of the book. For example, each of the middle chapters (3-5) begins in the early colonial period and ends in the late colonial period. Yet, despite this problem, Silla made the correct choice in organizing the book as he did. The processes that he examines in individual chapters would have been obscured if they had been buried in a single, broad narrative. The book's organization disrupts the chronological progression of the larger story, but it also enhances the coherence of its disparate elements.

Certainly the most compelling mini-narrative in People Are Not the Same is the first chapter, which tells the story of Saran Keita, a Malinke woman born sometime around 1915 in a rural village in Mali. Saran Keita contracted leprosy as a young woman and was progressively exiled from her husband's household and later his village. After returning to her mother's village, Saran lived for a time with her older sister Hawa, also a leper, in their mother's house. There they led lives of internal exile, unable to marry and enjoying little contact with others in the community. They were even segregated from family members, as they were forced to sleep and eat alone. Hawa soon left the village to seek treatment in a big town. Saran finally left home in 1939, after several years of treatment by local healers in and around her mother's village. She resettled in Bamako, the colonial capital, at the invitation of European administrators. In Bamako Saran became part of a leper community that formed around the Institut Central de la Lepre, and was reunited with Hawa, who had married a fellow leper in the community. Saran likewise married a patient and had children. Saran and her husband survived by farming a small plot of land obtained from a local chief associated with the colonial government. In the late 1960s Saran lost her husband and sister to the complications of leprosy. Later she suffered additional economic and personal hardships, some of which were the effects of rapid urbanization on Saran's small community.

The most important contribution of People Are Not the Same is its description of the process by which leprosy victims were labeled and marginalized, as well as their personal and collective efforts to resist, and to form families and communities. This process is best revealed in the personal histories of patients such as Saran Keita. But the chapter on Saran Keita is brief and leaves the reader hungry for more details about her life and struggles. Silla also paints brief portraits of a few other patients, chief among them Aldiouma Kassibo and Fousseyni Sow, who reappear, as does Saran Keita, in several chapters, helping to weave together the various narrative threads in the book. People Are Not the Same is extraordinary because it humanizes leprosy patients while also placing them in a broader history of large events and processes, but it also leaves the reader wishing to learn more of their stories. Africanist teachers are in particular need of detailed biographies and autobiographies, similar to Charles Van Onselen's study of Kas Maine and Mary Smith's edited version of Baba of Karo's life story. One would certainly welcome such a biography of one of the patients introduced in People Are Not the Same.

Another measure of the quality of this book is that it raises as many questions as it answers, effectively pointing the way for future research in the social and political history of illness. Although Silla's narrative of Saran Keita's life demonstrates some of the ways in which the experience of leprosy was shaped by gender, much more could be done along these lines. Did leprosy and migration affect women's view of their own femininity and their role in the family and society? How were they changed by their exposure to European doctors and missionaries? Also, precisely how did one's identity as a leper mediate one's occupational and ethnic identity? What significance did ethnic identity retain in the relationships among individuals within the multi-ethnic leper community? It seems that very few 'Moors' and Tuareg became part of the community around the Institut Central de la Lepre, and relatively few Songhay. Why was that? One would hope that Silla will continue to draw on his extensive interviews to answer these and other questions in future work on leprosy in Mali.

In summary, People Are Not the Same is an excellent and unusual study of the personal and political experience of leprosy in twentieth-century Mali. It should be of interest to anyone teaching graduate or advanced undergraduate courses on 1) West Africa, in history or the social sciences; 2) medical history or the social history of health and illness; 3) the history of colonialism and the role of secular and missionary medical policies in colonialism; and 4) the history of migration and urbanization in twentieth-century Africa.

Timothy Cleaveland
Department of History
University of Florida