The Politics of Disease Control. Mari K. WebelЧитать онлайн книгу.
of Isaya’s illness came to the Weatherheads from other mission youth, who raised the alarm with a story of Isaya putting a pot on to boil and inexplicably falling asleep. Recognizing the signs of sleeping sickness, the Weatherheads sent Isaya away to his relatives. Soon, both Henry and Aileen Weatherhead reported, Isaya’s relations on Bugala Island had “built a little house on an open space near the shore where others who have the disease live,” and had designated an elder female relation to care for him.108 This arrangement lasted for some time. Aileen Weatherhead journaled to her relations in England that they had sent Isaya a book to write in and some fishing line, that he might stay occupied; Henry Weatherhead later noted, “it took him six months to die.”109
Ssese communities moved sick people out of households, Isaya’s case suggests, relying on familial responsibility for each individual. Parallel sources on Bugala also indicate that efforts to avoid the spread of the illness coordinated at the village level as well. Fr. Ramond of the White Fathers Bumangi mission noted in May 1903 that “each of the major villages has an average of ten patients set apart to prevent contagion. Each patient has his separate hut where he was treated and fed by his relatives during the long months that the disease lasts until inevitable death comes to end his miseries…. During the last months of his painful existence the patient seems to lose the use of his faculties—he vegetates rather than thinks.”110 Ramond’s account corroborates other contemporary accounts of the epidemic’s initial demographic impact on younger members of the population, whose parents or relatives might yet have survived to help care for them. The villages that he and the Weatherheads described had apparently become a commonplace around Bugala Island at the time. At Buninga on the island’s northern peninsula in the summer of 1903, the White Fathers’ Bumangi diarist recounted that there were a number of such villages where “the bamongota were placed a little apart; everywhere they [the Bassese] built huts outside the villages.”111 Coordinated efforts to isolate the sick at the village level were likely the consequence of regulations issued by the kabaka’s powerful regents in May 1902, who ordered chiefs to
gather together all sick people…. Take them away to a place half an hour away from their house and build a shed on high ground to put the sick men in and set fire to the scrub near the house where the sickness was, one hundred yards on each side…. Food and water is to be taken to the sick people…. You, the chiefs must build the houses for the sick people to go in. Every chief is to see that someone gets to look after the sick…. Don’t eat fish.112
This regulation from Kampala preceded British scientists’ confirmation of the causative parasite and fly vector of sleeping sickness to colonial officials in April 1903, as well as concurrent suggestions to gather the katikiro (Luganda, chief minister) and principal chiefs to disseminate information to affected populations.113 It significantly predated British colonial efforts to institute widespread bush clearance measures, depopulate fly areas, or control travel on the lake.114 It provides, then, a sense of how Ganda authorities located the spreading epidemic within the existing political and public health landscape, with overlapping colonial, missionary, and Ganda responses to matters of health. The 1902 regulations asserted particular chiefly powers and obligations to maintain and care for the sick, balancing the management of those ill with the protection of those still well. Placing responsibility for providing food and water to the sick onto political authorities suggests that the regents recognized that chiefs might need to step in to ensure resources for sick people whose families could no longer provide for them, or whose social world had been changed by their illness. Regulations also speak to a sense of the spatial dimensions of the epidemic: where people lived, how they managed the environment around them, what spaces demanded attention, and what measures might be undertaken in place to impact the spread of disease. We gain, here, a sense of the practical distance that authorities could place between the sick and the well—a half-hour’s walk away—and of connections made between the growth of bush and scrub around homes and the health of people living within them. The regulations fit within the historic aspects of chiefship to safeguard the kingdom’s wider health, as well as within the prerogatives of the kabaka and chiefs to allocate labor and the use of land. Pertinent to the Ssese Islands, as we will see, was the injunction to move the sick to “high ground.” This, along with a prohibition against eating fish also included in the regulations, targeted chiefly attention to people living around the lakeshore or along waterways. Further, the injunction against eating fish—which would effectively have had the impact of keeping people away from riverbanks and lakeshores—would have constituted a significant burden for Ssese islanders in both food security and economic activity.
Ssese approaches to mongota changed over time, particularly in the initial years of the epidemic, and both drew upon and expanded from historic precedents for mitigating illness. Initial accounts also indicate that Ssese populations, as with elsewhere in Buganda and the lake littoral, addressed mongota within frameworks defined by experience with other serious illnesses. Strategic separation from the sick was one aspect of Ganda approaches to those stricken with the spreading, swollen lesions and open wounds of bigenge, for instance.115 During an outbreak of kiddukano (a diarrheal illness) in late 1904, affected people left their houses for the forest and markedly avoided the Bumangi mission and its sick people.116 Distancing the well from the sick echoes how people had historically left places of illness temporarily during a visitation of Kaumpuli’s power. But resituating bamongota, as occurred on the Ssese Islands, was not congruent with recorded responses to other widespread illnesses, suggesting innovation amid its widening impact. Strategies similar to those that might have arrested bigenge or kaumpuli ultimately would shift to more drastic measures as mongota continued to spread in the early twentieth century.
Let us take the Weatherheads’ descriptions of how the relations of the sick on Bugala Island ultimately settled the sick near to one another, but also nearer to the lakeshore, as a starting point. Many Ssese islanders spent time on the shore regularly and men may have had shelters to use while fishing or drying their catch there—indeed, the lakeshore’s ideal tsetse habitat of abundant moisture and thick vegetation had likely exposed many to fly bites and thus the disease’s causative parasite. But permanent homes were typically in the islands’ interior, on higher ground.117 To locate the sick in smaller homes nearer the lake was to set them apart, but not to maroon them without access to basic necessities like food and water. Indeed, the designation of an elderly relation to care for the sick boy Isaya immediately signals recognition of diminishing capacity and the need for sustained care and indicates that families or kinship groups addressed the degenerative progress of the illness as they shifted allocations of time and labor that their sick kin now needed. The grouping of several “little houses” together might have allowed kin to share time, labor, and resources as they managed the needs of the sick or enabled people in different stages of the disease to assist one another. But, importantly, these “little houses” were places apart from more permanent homes. A photograph from 1906 of a “camp of the sick near Bugala” matches missionary descriptions of the kinds of habitations that Ssese islanders built for the sick.118 Compared with contemporary photographs and descriptions of typical homes around Lake Victoria, these “little houses”—later marked as a “camp” by German scientist Robert Koch—differed markedly in their layout and emplacement from a typical family home.119 While the exact location of this small settlement is unknown, several aspects suggest its remove from social and domestic spaces in Ssese society. Firstly, the houses are clustered tightly together and some are constructed roughly, of differing sizes; materials used to build them are scattered in front of their doorways. Piles of brush and low trees or shrubs appear to circle the group of houses and a well-worn path crosses in front of it. The settlement sits at the margins of clumps of trees and grassland, with ground rising away in the background in one direction; in the other, the lakeshore is also visible. Accounts of Ssese isolation practices are not consistent with regard to the distance that people might be set apart, nor do they discuss the meanings or implications of that distance, but this camp near Bugala appears to fit the instructions of the kabaka’s regents to the topography and environment of Bugala village, and appears also to accord with past approaches to illness that affected many members of a community. Its remove from the settled geographies of village life sought to keep illness from affecting others. But its exposed location and its temporary