When sleeping sickness epidemic killed 250,000 Ugandans

Soon after Uganda was declared a British Protectorate in 1900, it was hit by a sleeping sickness epidemic. The pandemic that reached its peak in 1910, claimed more than 250,000 lives. It was completely subdued in 1920.
Its fast infection and high mortality rates were a threat to the economy, and so controlling it became the top priority of the colonial government.
The British then invested in research on the pandemic and also instituted control measures which disrupted the way of living in the affected areas. The measures included forced relocation of people, restricted movement and a halt on economic activities.

Origin
Sleeping sickness was said to have been in existence around the Lake Victoria region of Uganda even before 1901 when it became a pandemic. The spike in numbers was blamed on increased trade and migration.
Writing in the 1903 London School of Tropical Medicine journal, George C. Low and Aldo Catelli M.D. said, “The 1901 epidemic was probably imported from the Congo region or from Sudanese soldiers who travelled east.”
Later in 1995, T. Koerner, P. de Raadt and I. Maudlin in a paper, The 1901 Ugandan Sleeping Sickness Epidemic Revisited, wrote: “The lack of previous epidemics in the region and the limited cultural notions of tsetse flies and their habitats indicated that prior to colonialism, the Ugandan region was relatively safe from infection.”
In 1903, the London School of Hygiene and Tropical Medicine sent the first team of researchers to Uganda.

Dr Cuthbert Christy, a member of the team, wrote in November 1903: “The distribution of sleeping sickness is connected in some way with the great lake or its waters. In no case has the infection spread far inland, 30 or 40 miles being its limit. It shows no spread along the Nile source or to other lakes or river. The nearer one approaches the shores of the lake the more prevalent the disease is.”

The colonial government had in 1901 set up a Sleeping Sickness Commission. In its report of 1903, the commission stated: “The epidemic began in the Busoga region of the lake, travelled to Entebbe, the seat of the government, and the islands near the mainland, especially the Sese Islands.”
It was through this commission that the colonial administration requested for help from the British Royal Society that sent two teams of experts in 1902 and 1903 from the London School of Hygiene and Tropical Medicine.
The first group had bacteriologist Aldo Castellani, pathologist George C. Low, and epidemiologist Cuthbert Christy.

This group successfully identified a pathogen existing in the spinal fluid of sleeping sickness victims. The second group led by Lt Col Dr David Bruce and Dr Davis Nabarro came in 1903, and discovered that the disease was transmitted by the tsetse fly and that the fly lived in the woody brush and vegetation along riverbanks, lakeshores, and on Lake Victoria’s many islands.
The Sleeping Sickness Commission had experimented with different treatment methods, but all had failed.

Their treatment was based on early symptoms such as flu and malaria. Symptoms during the late stages of infection included convulsion of the mind known as melancholia attonita, an impassive or motionless body, lack of control over bodily functions, inability to remain awake even when eating, and a general decline in mental clarity.
“The diagnosis in early cases may be exceedingly difficult, as the typical features of the disease are generally absent. The most important fact on which to base the diagnosis in this state is the evening rise of temperature and the increased pulse rate,” bacteriologist Castellani wrote in November 1902.
The two groups of scientists discovered that the disease was most concentrated on the islands and shores of Lake Victoria, and its tributaries.
Their findings heavily influenced the policies the colonial government formulated to fight sleeping sickness.

Government’s response
With no cure in sight, the colonial government resorted to tough measures to slow the spread of the disease.
Major emphasis was put on relocating people from the infected areas, and occupation of infected places was declared an illegal act.

Compulsory testing of people was introduced and those found to be infected were taken to isolated camps as they awaited treatment.
“By 1910, there were six declared infected areas in Uganda with a major concentration of infection within a two-mile-wide strip running the entire southern length of Uganda, along the Lake Victoria shore, through the kingdoms of Buganda and Busoga, including all Ugandan islands in the lake,” wrote Kirk Arden Hoppe in Lords of the Fly.

Six years after the outbreak, the colonial authorities in Entebbe published what they called “explanatory address on sleeping sickness to the natives of the Uganda Protectorate.”
The document was authored by the Busoga region medical officer, a one Dr Hodges. It was both in Luganda and English.
It stated in detail the mode of transmission of the disease, how to curb the transmission and the consequences of not observing the health regulations.
Soon after publishing the explanatory address, then governor Hesketh Bell announced measures to combat the disease. He ordered people to stay not less than two miles away from the lake shores and also to evacuate all the islands on Lake Victoria.
Bell also forbade fishing, selling and being in possession of fish. Firewood gathering and hunting of wild animals was also forbidden.

Locals accessing Kampala Port (now Port Bell) had to be medically screened.
“We must withdraw from the insects the source of their infection. The whole country must be depopulated. There seems to me to be no other course than to remove everyone from the reach of the fly for an indefinite period,” wrote Daniel Headrick, in Sleeping Sickness Epidemics and Colonial Responses in East and Central Africa.

In January 1908, George Wilson, then deputy commissioner of the Uganda Protectorate Government, issued a notice banning all fishing activities on Lake Victoria.
“All fishing upon the lake shores is illegal, any subject of His Highness found fishing would be liable to punishment,” the notice read in part.
In April 1909, the colonial administration passed a decree declaring all islands on the lake to be vacated.

Pronouncement
However, this was challenged by both natives and their leaders. Even after three months of the pronouncement, there was still resistance to forced removal.
Chiefs Weba and Mbubi of Sese and Buvuma islands respectively, demanded for a means of survival in their relocated places and how long they would stay away from their homes.

When the outbreak reached Tanganyika, the German government sent Dr Robert Koch, a German physician and microbiologist, in 1906.
He established a camp at Bumangi, one of the islands that make up Sese Islands, to be able to carry out experimental treatment for sleeping sickness.
Writing in the book The Colony as Laboratory, Wolfgang U. Eckart says Koch did as he wished with the victims of sleeping sickness.

“As a result, the Sese Islands became German’s East African sleeping sickness laboratory, and the natives became test subjects,” Wolfgang writes.
The German team used Atoxyl and other arsenic-based compounds on the native population as treatment experiments. According to Headrick, a few months after his experiments with the natives on the islands, “Koch reported to the German colonial ministry that the drug he found most effective and least toxic was Atoxyl, or aminophenyl arsenic acid.”

“The results were remarkable. Whereas in the years 1900 to 1904 at the height of the epidemic, 200,000 had died in Busoga region alone, two thirds of the population in Buvuma Islands alone succumbed to sleeping sickness. By 1910, the epidemic infection rates had fallen and Africans began returning to their former homes,” writes Headrick.

Key facts about sleeping sickness
1. Sleeping sickness is caused by parasites transmitted by infected tsetse flies and is endemic in 36 sub-Saharan African countries. Without treatment, the disease is considered fatal.
2. The people most exposed to the tsetse fly and to the disease live in rural areas and depend on agriculture, fishing, animal husbandry or hunting.
3. Human African trypanosomiasis takes two forms, depending on the parasite involved: Trypanosoma brucei gambiense accounts for more than 98 per cent of reported cases.
4. In 2009 the number reported dropped below 10,000 for the first time in 50 years, and in 2018 there were 977 cases recorded.