The Politics of Disease Control. Mari K. Webel

FIGURE 1.1. Camp of the Sick near Bugala. Courtesy of the Robert Koch Institute, Berlin. This photograph from Robert Koch’s expedition photograph album shows dwellings of the sick on Bugala Island. The area’s elevation and vegetation indicate that the “camp” sat nearer to the shore of Lake Victoria and at a distance from Bugalla village, similar to the “little houses” set aside for bamongota by Ssese islanders. Source: Robert Koch Institute Archives, Fotoarchiv 6105, Fotoalbum Koch in Sese, 6105036 (1906-07).

      After these early moves to gather and isolate people showing signs of mongota, approaches and capacities to deal with mongota began to shift. Fr. Reynès, journaling his July 1904 itineration around Bugala Island between Bumangi and Bugoma, walked past village upon village filled with the sick, visiting some in their homes; the disease, he found, was widespread.¹²³ Reflecting on the fourth year of the epidemic in 1905, Reynès noted that people preferred to be at home, and could find devoted care even among distant relatives; though the mission provided patients with salt, fish, and sometimes meat, patients would forego such “little treats” to be in their home and among kin.¹²⁴ For many, then, care concentrated in the home, with family and networks of kin in established domestic spaces. Caring for stricken relatives initially corresponded with gender and age. Patterns of early infection suggest that men, particularly younger and more mobile men, were first affected, followed by adult women. Thus, missionaries reported women caring for both a spouse and male relative, children caring for older siblings and fathers, and, ultimately, entire families coping with illness among adults and children.¹²⁵ Mongota’s effects cascaded to touch more and more of the Ssese population, as the disease struck ever more adults whose livelihoods and social roles (as fishermen aiming for trade, or as women fishing to provide a household with food, for example) exposed them to the parasite’s fly carrier.¹²⁶ As more people sickened, too, fewer were available to care for the sick, to cultivate crops, or to produce food. Missionaries at Bumangi, where five “improvised nurses” cared for patients in the hospital, reflected, “The disease still raging with the same intensity, we look with dread to the moment coming, sooner or later, where the survivors who are still healthy will not be able to feed and care for the sick, at least if God does not end this scourge soon.”¹²⁷ Missionaries on the Sseses noted that the islands’ population had gradually diminished, either because of mortality from the disease or people fleeing from it to the mainland. Fields around Bugala Island lay fallow by late 1905, though not wholly abandoned; months-long devotion to caring for increasing numbers of sick drew labor away from preparing fields and cultivating crops, necessary work to sustain households into the future. The islands, one priest observed, “resembled a great battlefield after a long struggle.”¹²⁸

      Place-centered ideas about illness and health shaped new relocations and local mobilities on the islands. On an itineration around Bugala, Fr. Reynès found a man affected with sleeping sickness caring for his elderly mother, aunt, and wife (who was apparently also affected by smallpox), also sick, sheltered under a large tree.¹²⁹ Reynès assailed the local village chief’s “inhumane” expulsion of a sick family out of their village, but I read here a shift in tactics and evidence of a sharp narrowing of the possibilities for coping with the sick within existing social relationships. For this family, separation from their village meant not a “little house” attended by an elderly relative among others similarly affected, but removal from hearth and home. To be sent away from home and village and into the forest in such a manner may have reflected a chief’s efforts or a medium’s advice to safeguard remaining villagers by encouraging abandonment of a home to which death had come—consistent with responses to visitations of kaumpuli in past generations. Removal also suggests a heightened gravity of the disease; the priest’s presumption about the drastic measures of the village chief begs the question of whether anyone remained to care for the ailing family. Within lived experience of other grave diseases in the area, particularly those attributed to Kaumpuli and for which abandoning home was a practiced strategy, the possibility also remains that the family, too, played a role in leaving their home in an attempt, however desperate and futile, to evade illness and death that was understood to attach to domestic spaces.¹³⁰ Indeed, as illness became widespread, more radical moves occurred. A Bumangi priest noted that “those who it has spared have fled toward the beaches, thinking, as they do, them to be less murderous.”¹³¹ The Ssese abandoned homes and farms temporarily and perhaps permanently as the crisis widened.