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Okot Nyormoi is a long time advocate for peace in Africa, was active in student politics at Indiana University in Bloomington, returned to Africa to teach at the School of Medicine at Makerere, now teaches Biology at North Carolina Central University
Every now and then the world is struck with a mysterious new malady. In the 14th century Black Death (now known to have been caused byYersinia pestis bacterium) almost wiped out the entire population of Europe and Asia. At the height of European expansion in the middle of the 16th the indigenous populations of the Americas were decimated by new diseases introduced there by Europeans. At times as in the case with small pox, this was a deliberate act designed to wipe out the local Indian population. In Africa, sleeping sickness, a disease before unknown in Africa, was introduced by European explorers as they traveled across Africa in quest of fame and fortune. As many as 500,000 Congolese and 300,000 Ugandans died as a result. In recent times, AIDS and systemic acute respiratory syndrome (SARS) are some of the major new diseases.
Over the years Uganda has had more than its share of subjection to emerging new diseases. Towards the end of World War I Cerebro-spinal meningitis introduced by colonial soldiers returning from the war killed over 4,000 people in Lango alone. Onyong Nyong was another viral disease that mysteriously wreaked havoc. First appearing in northern Uganda in 1959 it spread like bush fire throughout eastern and southern Africa. Then in 1980s came the mighty AIDS virus that today is still ravaging the population. Sometime in the early 2000s Uganda Army (UPDF) Soldiers returning from their Congo and South Sudan exploits most likely brought with them the dreaded Ebola virus that wrecked terrible havoc in Northern Uganda. The outbreak of the disease coincided with their movements and presence in the region. Dr. Mathew Lukwiya, the Medical Superintendent of St. Mary’s Hospital, Lacor most memorably and courageously died fighting the virus.
Now here comes the Nodding Disease, the latest in the series of mysterious new maladies attacking Uganda, specifically Northern Uganda. Although the exact time of its first diagnosis is disputed, many people acknowledge that the disease first appeared in Uganda in the late 1990s following the onlsaught of the army and the subjection of the local population, but certainly by 2003. In Tanzania in the 1960s a similar disease was also diagnosed and in South Sudan in 1996.
Of the known cases, 95% of the disease affects children 5-15 years old. With the exception of Tanzania, the disease in Northern Uganda and South Sudan appears to occur in war affected areas. Symptoms of the disease include nodding of the head, seizure like condition, stunted growth and mental retardation. Trigger factors include cold temperature and familiar food. There is no evidence to suggest that the disease is communicable.
The cause of the disease is unknown. However, many factors are suspected individually or in association with others to have caused the disease. Among these factors are environmental, food, occupational exposure, contaminated water, exposure to munitions, wild root consumption, vitamin B-6 deficiency, Onchocerca volvulus (a parasitic worm) infection and Claviceps africana (sugary disease or ergot of sorghum). So far there is no compelling evidence for any of these factors. Currently the US Center for Disease Control, the World Health Organization and the Uganda Ministry of Health are collaborating on a search for the causative agent.
Without knowing the cause of the disease, the most that can be done is to treat the symptoms of the disease with anti-epileptic drugs, provide psychological and social support. Other treatments include ensuring that patients do not hurt themselves during epileptic seizures or when they become despondent or suicidal because of their conditions. Again, without the knowledge of causation, it is impossible to provide any method of prevention.
So far the prognosis of the disease is poor. Although there are claims of a few survivors, it appears that the disease causes permanent damage. Affected children appear to be completely and permanently stunted physically and mentally in their growth. At least 400 of 7,000 affected children have died. One thing is for sure, without going to school, the future of these children is bleak, which is not only a serious loss to the individual children and their families, but also to the whole society.
Since the cause of the disease is yet unknown, it is understandable that no specific treatment or preventive measures can be instituted. However, it is important to understand, appreciate and acknowledge the conditions in which the disease emerged. History informs us that generally, new diseases arise naturally due to mutations, bird migration, flood, earthquake etc. Alternatively, they can emerge due to conditions created by humans. For example, the building of the Aswan Dam brought an increase in Bilharzias in Egypt.
It is a no brainer to realize that the environment and the people of both South Sudan and Northern Uganda which had wars lasting more than 20 years, were terribly disturbed. War increases the level of stress, exposure to toxic chemicals and nutritional deficiencies. More specifically, people are forced to hide in the bushes where they are more likely to eat unusual food to survive, thus predisposing them to unusual infections and exposure to chemical poisons. They often do not eat adequately or nutritionally balanced meals. Sometimes in war, people who are defined as enemies may be deliberately poisoned or infected. From this perspective, it is not farfetched to argue that the nodding disease in northern Uganda has its origin in the wars of the Uganda Government and the various rebel groups fought in the area. While more than one condition may facilitate the emergence of the nodding disease, neither the Uganda government nor investigators of this disease should be so quick to exclude war as a serious contributing factor to the emergence of the nodding disease
When the disease was first observed, Government Officials ignored it and took no action. It took considerable efforts in Parliament by Legislators like Anywar and other Members of Parliament who brought carloads of patients physically to the Capital as indisputable proof of the existence of the diseasein the country. Even when Government finally acknowledged the existence of the disease, it took no action. It was not until the NGO, Health Watch Uganda and two Members of Parliament filled law suits in respect of the matter that Government finally responded and acknowledged Nodding Disease as a serious health problem. So why was the Uganda Government so reluctant to move against a major health crisis and help those afflicted?
To understand and appreciate the agonizingly slow Government response to Nodding Disease, one has to look at the history of the NRM Regime in relation to Northern Uganda. The Regime has been at war with Northern Uganda for its entire duration, just that the means and methods of war have varied at times. In reality the war against the North is still going on, but in a subtler mode. The callous attitude towards the Nodding Disease and its victims follow a similar pattern of Government conduct of the 26 year war against the North. They seem guided by and informed by President Museveni’s 1969 thesis on violence as a University of Dar-es-Salaam student,
To transform a human being into an efficient, uncouthly, and completely subservient slave, you have, as a pre-condition, to completely purge him of his humanity, manhood, and will. Otherwise, as long as he has some hope of a better, free future, he will never succumb to enslavement. To become an efficient instrument of oppression, you have to radically de-humanize yourself by forgoing many qualities that are normally found in balanced human beings. You purge yourself of compassion, altruism, consideration of other people's suffering and the capacity to restrain your greed….
The full import of this thesis has already been visited upon the people of Northern Uganda, especially upon the Acholi people. The present leadership of Government in Uganda has in the past described the people of Northern Uganda in a variety of insulting and dehumanizing terms: biological substances, grasshoppers, primitives etc. It vowed to teach the North a lesson it will not forget and will not recover from. The Nodding Disease appears to be a consequence of that pledge and now that it is here, it appears to have been turned into the means to enforce it as well. Why else would a Government in broad daylight ignore the sufferings of its own people? A few years ago the same Government was quick to mobilize and rush emergency aids to Western Uganda (the Presisent comes from there) when cattle disease broke out there.