Lep. Rev. (1 965),36,2, 59/67 Leprosy In the Luapula Valley, Zambia: History, Beliefs, Prevalence and Control P. GL YN GRIFFITHS, M.C., B.SC. , M.B., Ch.B., M.R.C.p. (London), M.R.C.p. (Glasgow) (Medical Superintendent, Liteta Leprosarium and Luapula Leprosy Settlement, and Leprologist, Republic ofZambia) The Luapula Valley This paper considers leprosy amongst the The Luapula River drains the swamplands of people living along the East bank of the Luapula Lake Bangweulu on the Central African Plateau River fo r the sixty-odd miles between Johnston (Map 2) , and, sweeping round to the North, Falls and the town of chief Kazembe of the flows into Lake Mweru, which at Pweto Lunda (Map I ) . empties itself into the River Luvua, a tributary of the great Congo River system. Population MAP I In this small area there is, fo r Zambia, an LAKE MWERU unusually high concentration of inhabitants. I inch . 16 miles The Census taken in 1963, and the Registration Altitude: �ooo ft. of electors in the same year, offer accurate population figures, and there are some 21,000 I persons over 21 years of age living in the area. I I This is a very different state of affairs fr om that I prevailing in the greater part of the rural areas I I of Zambia; fo r the most part the Zambian I rural population is very sparsely distributed, at <0,I ' only about eight per square mile, all ages. In KABALENGE" LEPROSY SETTLEMENT the 600 square miles under consideration here, \ 8� the adult population density is 35 per square mile! In fa ct, the population is much more concen­ trated than this suggests, as the people inhabit ZAMBIA I large villages, of a median range of 20 to 30 I houses, ranging up to 145 houses, and in the I case ofKazembe's town, over 1,000. Only about an eighth of the villages lie offthe main swamp­ margin road (Cunnison, 1959). As one travels along this road, which links Kazembe's town with Johnston Falls, village succeeds village along the road side, so that it is often difficult to know where one village ends and the next begins. I \ \ The North Luapula constituency is identical with the area chosen fo r this investigation; thus it was possible to check the register of voters line:1 of MUCHIN GA against the Census figures. Practically every ESC A RPMENT single person over the age of 2 1 years registered fo r the election (which was the first under Rainfall; LEPROSY CLINIC universal suffrage), so it is believed that the 1963 <0 about 46" annually. population figures used here are remarkably GOVERNMEN T RUPoAL � HEALTH CENTRE accurate. Riverside Population growth has been very rapid-from MISSION WITH MEDICAL -_- _- _- _ -_ -swampland @ FACILI T IES 27,154 in 1941 to over 51,000 in 1963 (all ages). Leprosy in the Luapula Valley 59 MAP 2 TANGANYI I(A CONGO Tanganyika ° 9 S __ �t-�--�--------------------&---�r--------+--------------- Kabalcngc Lepro�y Settlement Kazembe'$ Town Nort h Luapula Con�tltucncy MALAWI Copper bel t B r 0 ken Hi II • MOZAMBIQUE LUSAKA. ° 16 S __________ �����----------�------------------------�---------------- RHODESIA 60 Leprosy Review In 1963 there were 101 persons under 2 1 years (Cunnison, 1959), and some of those slaves to of age for every 70 over that age. whom Milroy refers may possibly have come About 25 per cent of the adult males are away from the Luapula, therefore. from the valley at any one time, as they go in In the same Report, Mr Bradshaw, Colonial large numbers to the Copperbelt to seek work. Surgeon in Sierra Leone, commented that Many stay away from their villages fo r very leprosy was particularly common in 'natives who many years; some leave the valley fo r only a come from the Niger and Congo neighbour­ year or two at a time. hoods'. The people are of the 'Luapula Type', The origins of leprosy remain a mystery; Kazembe Lunda (or Luunda), and Chishinga, Rogers (1924) connected the high prevalence who are groups of the Central Bantu, Northern rates in Central Mrica to an Egyptian record of Division (Mitchell, 1960). 1350 B.C. ofleprosy among negro slaves from the Historical Background Sudan and Dafur. But Feeny (1964) considers that early 'knowledge' of leprosy in Mrica was The date of the establishment of chiefKazembe's probably 'supposition'. Mc/>ller-Christenson overlordship in the Luapula Valley is known (1963) examined many thousands of mummies fa irly accurately. Lacerda visited Kazembe's and skeletons from ancient Egypt and Palestine, town in 1798, and recorded that the dynasty and fo und no evidence of leprosy earlier than had been there fo r about fifty years at that time about A.D. 500. (Cunnison, 1959). The Lunda chief Kazembe and his fo llowers Traditional Beliifs about Leprosy had come to the Luapula from the great That leprosy is, in fa ct, a disease long known Mwata Yamvo kingdom in the middle Congo ; amongst the people of the Luapula Valley they conquered peoples such as the Bwile and appears to be confirmed by the many words in Shila whom they fo und living in the valley. their language which they use to describe it. The Congo (Leopoldville), from which (Lunda, which is akin to Bemba, is the language Kazembe and his people came, has a high mostly in use.) prevalence of leprosy. There were 2 75,000 cases Thus there is a word fo r leprosy in general: under treatment in the Congo in 1956, or 20 'tembwe', almost a euphemism; this word per 1,000 of the population (WHO, 1959). covers all manifestations of the disease. A single In the fascinating Report on Leprosy pro­ patch of diseased skin caused by leprosy is duced by the Royal College of Physicians of 'chibashi'. Skin thickening due to leprosy is London in 1867, Gavin Milroy, Secretary of the 'mamombo'; the nodular fo rm is 'mapumba' ; College's Leprosy Committee, contributed a the blistering often noticed early in the course 'Sketch of the Geographical Distribution of of the disease is 'mavovela' or 'matutulu'. Leprosy'. (It was this report which discredited 'Kaswandala' describes the patient with only entirely the belief that leprosy was contagious, one or a few skin patches, with or without and was regarded by the Editor of The Lancet coincident loss of the fingers. 'Mamombe' rather (1867) as 'the authority' on leprosy of the time!) more definitely defines as leprosy the skin Milroy wri tes : patches, and 'mumba' identifies lepromatous 'The chief seats of leprosy in recent times skin nodules, with the connotation (associated continue to be the same regions of Africa and with others of these disease-names) that it is a Asia where it was originally seen, and where it disease which leads inevitably to gross deformity was known to have been most common in remote through the loss of fingersor toes. ages.' There is a proverbial saying: 'Nsala ni He mentions that slaves brought to the West mamombo tayalila apepi' . hunger is like Coast of Mrica from the interior 'are frequently leprosy, it doesn't kill quickly'. affected with the disease'. There is a considerable volume of fo lk-lore There is no doubt that slaves were taken from and traditional belief associated with the disease: the Luapula Valley to the West Coast; many of The disease was often believed to be a these slaves were obtained by Portuguese and punishment (how reminiscent of Mediaeval Arab slave-traders with the aid of Kazembe Europe!) : Lepros.;v Luapula Valley 61 in the (a) It might be caused by theft, especially by Remedies used by the village herbalists (the stealing an animal or a fishtaken fr om someone 'shinganga') are many. For a localised patch else's trap. The owner of the trap would put a (tuberculoid type) multiple scarification with special 'medicine' into the trap to cause leprosy the application of a caustic is commonly in the thief. carried out; fo r more widespread types, such as (b) Or it could be caused by adultery; the the lepromatous type, lotions and also herbal aggrieved husband could, by arrangement potions are used. Often enough no actual with a worker-of-spells, cause leprosy to attack 'practitioner' is called upon, as many of the the offender. older people know which kinds of herb, bark, etc., are usually used to make up these 'cures'. (c) Eating the fleshof certain animals, especially Diagnosis of leprosy is usually very promptly the hippopotamus, caused leprosy in some people. made by the older people in a village community This was sometimes thought to be due to the and is often made also by the 'shinganga' if spirit of a person dying with leprosy having someone goes fo r treatment with some ailment taken up residence in the hippo. (This belief not yet knowing that he has leprosy. Surprisingly, spreads as fa r South as to the Feira District on rarely are the people wrong in their diagnosis. the Zambesi, where the Chikunda people live, All too often I see patients who knew well that and I have had patients from Feira who believed they had leprosy, but could not persuade the their leprosy was due to eating hippo.) Kazembe staffat hospital to accept the diagnosis! Many himself never ate any of the larger animals such of the older generation of , shingang as' (who, by as elephant, hippo, or eland, because they were the way, are very fa r fr om being 'witch­ his 'fellow-chiefs of the bush' (Cunnison, 1959). doctors') are very honest practitioners, and Witchcraft was believed to be an important accept no fe e in the event of their fa iling to cause of leprosy, but was thought to be incurred effect a cure ; some of them around the Liteta sometimes by such fo olish behaviour as insolence area send any new leprosy which they see direct to an old and respected member of the com­ to the Leprosarium fo r treatment! Some, again, munity.