Isolation, Control and Rehabilitation: A Social and Medical History of Leprosy

Treatment and Leprosaria in Cameroon, 1916-1975

A dissertation presented to

the faculty of

the Graduate College

Ohio University

In partial fulfillment

of the requirements for the degree

Doctor of Philosophy

Flavius M. Mokake

May 2018

© 2018 Flavius M. Mokake. All Rights Reserved. 2

This dissertation titled

Isolation, Control and Rehabilitation: A Social and Medical History of Leprosy

Treatment and Leprosaria in Cameroon, 1916-1975

by

FLAVIUS M. MOKAKE

has been approved for

the Department of History,

the Department of Social and Public Health,

and the Graduate College by

Steve Howard

Professor of Media Arts and Studies

Joseph Shields

Dean, Graduate College 3

Abstract

Mokake, Flavius M., Ph.D., May 2018,

Individual Interdisciplinary Program, Department of History, Department of Social and

Public Health

Isolation, Control and Rehabilitation: A Social and Medical History of Leprosy

Treatment and Leprosaria in Cameroon, 1916-1975

Director of Dissertation: Steve Howard

The purpose of this study was to examine the role of mission-operated leprosy settlements or leprosaria in the treatment, control and rehabilitation of leprosy victims in the part of Cameroon that was formerly under British administration between 1916 and

1975.

Disease control was a major social and welfare problem in former European colonies and protectorates in Africa. Colonial administrations grappled with the duality of providing basic sanitation and healthcare to the population as well as institute measures to prevent the outbreak or spread of infectious diseases. Leprosy constituted one of the infectious diseases that threatened the social, cultural, economic and political boundaries in colonial and postcolonial Cameroon. Despite the long and challenging history of disease in the country and Africa in general, African countries still grapple with the problem of managing highly-stigmatized infectious diseases suggesting the need to interrogate past disease control measures in order to inform and direct measures at tackling contemporary challenges. Public health stakeholders in Africa continue to isolate 4

patients of stigma-related disease which often lead to deleterious effects on the original

goal of disease control.

This project examines the place of leprosy settlements in the interconnection of the policy of isolation in the control, treatment and rehabilitation of victims of leprosy. In the literature on the social history of medicine in Africa, the agency of the patients is often neglected, if not silent. This study analyzes the policy of custodial care in the control and treatment of leprosy in former British Southern Cameroons and West

Cameroon. It describes the agency of patients in the effective operation of leprosy settlements and implementation of leprosy control policy. It also analyzes the economic, socio-cultural and religious tensions that ensued as a result of the adoption of patient isolation as the main measure at controlling leprosy. Finally, the study describes experience of patients in the settlement, and how that experience and encounter with leprosy transformed the lives of patients.

Data for the study was collected with the use of archival documents and oral interviews. The study demonstrates that until the establishment of leprosy settlements in the 1950s, the adoption and implementation of the policy of isolation against leprosy was misguided and half-hearted. Without the intervention of Christian missionary

organizations, the problem of leprosy might not have been arrested. It also brings to fore

the agency of patients in the negotiations and execution of public health policies and

regulations in both colonial and postcolonial Cameroon. The sustainability of the welfare

policies depended largely on the goodwill and resilience of patients underscoring the

agency of patients in the negotiation of power relations between Europeans and colonial 5

peoples on the one hand, and patients and healthcare providers on the other. Lastly,

changes in the political dispensation, anti-leprosy policy and benign neglect led to the deterioration and ruin of leprosy settlements and their feeder clinics.

6

Dedication

To my Mum, victims of leprosy –then and now – whose stories are narrated here, and the

selfless men and women who kept their HOPE alive!

7

Acknowledgements

Though this dissertation is an individual pursuit, I could never have reached the

heights or explored the depths without the support, guidance and efforts of a lot of

people. First, I am grateful to my supervisor, Prof. Steve Howard for his patience, and

whose expertise, understanding, generous support and guidance not only made this it

possible for me to pursue graduate studies at Ohio University, but also to research on a

topic that was of great interest to me. The last seven years since our first meeting has been fulfilling to me. I would also like to thank my committee members Dr. Gillian Ice,

Dr. Assan Sarr and Dr. Zelalem Haile for their guidance over the years.

I received assistance from a number of archives in Cameroon and USA in the course of research for this dissertation. I would like extend my deepest gratitude to the archivist, Mr. Primus Forgwe and staff of the National Archives Buea, and the archivist of the Regional Archives Bamenda who provided inestimable assistance in locating documentations at both institutions. I would also like to acknowledge the exceptional professionalism and assistance of the young archives assistant at the PCCCAL Buea,

Miss Mabel Mbokem. I also wish to acknowledge the remarkable assistance from Jackie

Howell (late) and Darlene Frueh of the North American Baptist Heritage Commission

Archives who were ready to respond to my unending inquiries. I am indebted to Dr.

Protus Tem and family who provided me with accommodation while in the field in

Bamenda. I extend sincerest thanks to all those interviewed and whose stories are

narrated here. I am grateful for them to let me document the high and low of their life experiences. The administrator of the Medical Institutions Manyemen, Mr. Shakespeare 8

Besong, and the long-serving Leprosy Inspector at Manyemen, Mr. Stephen Nemoh were also of tremendous help during fieldwork in Manyemen.

I especially wish to recognize Prof. Emeritus Lovett Z. Elango who read and provided insightful comments on the first draft of my dissertation proposal. His comments helped in shaping the original ideas of this dissertation. My sincere gratitude also goes to the following friends for their moral support and encouragement: Prof. Henry

K. Kah, Dr. Walter G. Nkwi, Ngane Dimitte, Dr. Abobo Kumbalonah, Francis Semwaza,

Jeremiah Asaka, Dr. Samba Camara, Bennett Lado, Hilary Adio and last, but not the least

Jude Chia.

The research described in this dissertation was carried out while I held a fellowship with the Osteopathic Heritage Foundation Graduate assistantship Program at

Ohio University Heritage College of Osteopathic Medicine. My doctoral studies and dissertation fieldwork would absolutely not have been possible without this fellowship which I held in the last four years. I would like to heartily thank Dr. Gillian Ice, Dr.

Sonsoles de Lacalle and Nadine Borovicka of the OUHCOM Office of Advanced Studies for the support in receiving and throughout my fellowship. Above ground, I am indebted to my family, whose love, support and value to me only grows with age. To them, I am eternally grateful!

The various forms of assistance notwithstanding, the shortcomings in style and interpretation of facts, and conclusions reached in this work are fully mine.

9

Table of Contents

Abstract……………………………………………………………………………………3

Dedication………………………………………………………………………………....6

Acknowledgement ………………………………………………………………………..7

List of Figures……………………………………………………………………………12

Abbreviations…………………………………………………………………………….13

Chronological Nomenclature of ‘Cameroon’ (Study Area)……………………………...14

Chapter 1: Introduction…………………………………………………………………..15

Background………………………………………………………………………15

The Argument……………………………………………………………………21

Historical Context………………………..………………………………………25

Methods and Sources…………………………………………………………….36

Participants and Sampling……………………………………………………….40

Research Design…………………………………………………………………41

Data Analysis…………………………………………………………………….41

Ethical Consideration…………………………………………………………….42

Organization of Study……………………………………………………...... 43

Chapter 2: Historical and Political Evolution of British Southern Cameroons………….47

Introduction………………………………………………………………………47

Early Europeans, Annexation and Partition of Cameroon……………………….48

The Advent of Christian Missionaries and Western Biomedicine……………….57

Leprosy: Etiology, Prevalence and History……………………………………...63 10

Conclusion……………………………………………………………………….71

Chapter 3: The Leprosy Menace and the Establishment of Leprosy Settlements (1916-

1954)……………………………………………………………………………………..73

Introduction………………………………………………………………………73

Leprosy and Anti-Leprosy Measures in German Kamerun……………………...73

Leprosy under British Administration: A Mismatch of ‘Words’ and Action (1916-

1940s)……………………………………………………………………………78

The Enugu Leprosy Conference (August 28-30, 19390 and the Formation of the

Provincial Leprosy Board………………………………………………………..88

Leprosy Legislation and Discipline of Lepers within ‘Controlled Areas’……….92

The Passage to Colonies in Nigeria and Repatriation of ‘Alien’ Lepers………...94

The Founding of the Manyemen and Mbingo Leprosy Settlements……………101

Conclusion……………………………………………………………………...120

Chapter 4: Lest We Forget: Tales of Misery, Hope and Resilience……………………122

Introduction……………………………………………………………………..122

Leprosaria as Institution for Patient-centered Care…………………………….122

Conclusion……………………………………………………………………...145

Chapter 5: Conclusion ………………………………………………………………… 147

References………………………………………………………………………………161

Appendix A: Questionnaire Guide for Former Patients………………………………..182

Appendix B: Questionnaire Guide for Leprosy Inspectors/Staff……………………… 186

Appendix C: IRB Approval…………………………………………………………… 188 11

Appendix D: PCC Authorization……………………………………………………… 190

Appendix E: NABHC Letter……………………………………………………………191

12

List of Figures

Figure 1. Photo of Robert in nursing uniform …………………………………………. 97

Figure 2. Foundation stone of Manyemen Leprosy Hospital ………………………….109

Figure 3. Arrival of first patients at Mbingo……………………………………………111

Figure 4. First five leper boys at Mbingo Settlement ……………………………….....112

Figure 5. Partial map of Basel Mission Leprosy Settlement Manyemen………………115

Figure 6. Map of Mbingo Settlement…………………………………………………...118

Figure 7. Church at Manyemen Settlement…………………………………………… 137

Figure 8. Settlement School Manyemen………………………………………………. 141

Figure 9. Chair made by a patient ……………………………………………………...144

Figure 10. Partial view of abandoned files at Manyemen……………………………...152

Figure 11. Manyemen (patient) ruined barracks………………………………………. 158

Figure 12. Abandoned and looted Leprosy Hospital Manyemen …………………….. 159

13

Abbreviations

ADO – Assistant Divisional Officer

BELRA – British Empire Leprosy Relief Association

DMS – Director of Medical Services

DMSS – Director of Medical and Sanitary Services

DO – District/Divisional Officer

HIV/AIDS – Human Immunodeficiency Virus and Acquired Immune Deficiency

Syndrome

HTTC – Higher Teachers Training College

HRC – Hanseniasis Rehabilitation Center

LoN – League of Nations

MO – Medical Officer

NA – Native Administration

NAB – National Archives Buea

NABHC – North American Baptist Heritage Commission

NABHCA – North American Baptist Heritage Commission Archives

PCCCAL – Presbyterian Church in Cameroon Central Archives and Library

RAB – Regional Archives Bamenda

SMO – Senior Medical Officer

UN – United Nations

USA – United States of America

14

Chronological Nomenclature of ‘Cameroons’ (Study Area)

- German Kamerun, 1884-1915

- Cameroons Province, 1922-1949

- British Southern Cameroons, 1949-1954

- British Southern Cameroons (Appellation for both British Southern Cameroons

and Northern Cameroons under British administration)

- Southern Cameroons, 1954-1961

- West Cameroons, 1961-1972

15

Chapter One: Introduction

Background

Between April and July 1936, Dr. E. Muir, leprologist and the then secretary to the British Empire Leprosy Relief Association (BERLA), toured Nigeria and other

British West African colonies, with the view to studying local conditions with regards to leprosy and seeing the various leper colonies or settlements.1 Although he did not visit

British Cameroons during this initial visit, the recommendations in his report were crucial to the introduction of schemes for the control of leprosy, otherwise known as Hansen’s disease, and the eventual establishment of leprosy settlements or leprosaria in British

Southern Cameroons.2 During the Nigerian lap of his tour, he computed the number of leprosy cases as at the very lowest 200,000, although later studies argued that his estimate was far from reality judging by the size of that British colony (with the Cameroons attached to it) and the population.3 Amongst the issues outlined in the report, Dr. Muir noted that leprosy was highly dreaded, although the dread was not from fear of death but

1 A ‘leprosy settlement or colony’ is a center for the segregation of leprosy patients with a properly equipped hospital, laboratory, and a resident medical officer; while a ‘leprosy segregation village’ is a center for the segregation of leprosy patients without a resident medical officer, laboratory, or a resident medical officer. 2 Kamerun was a German protectorate from 1884 to 1916, when Germany was ousted from the territory by British and French (with the support of Belgian troops) forces. The territory was provisionally partitioned on March 16, 1916 and formally partitioned on July 10, 1919 between Britain and France. Between 1916 and 1919, both European colonial powers established and operated a joint administration known as ‘the condominium’ over Cameroon. As an aftermath of the first global conflagration and the Paris Peace Conference of 1919 which was primeval in the creation of the League of Nations (which sanctioned the partition of former German Kamerun), Britain retained a meagre 1/5 of the territory while 4/5 was generously ceded to France as the League of Nations’ mandates. While France administered her section as an entity within her larger French Equatorial Africa community, comprising French colonies in central/equatorial Africa, Britain, for administrative expediency, administered hers as integral parts of her Nigeria protectorate. Britain further divided the Cameroons into two non-contiguous parts: Northern Cameroons, administered as part of Northern Nigeria and Southern Cameroons, administered as part of Eastern Nigeria, until 1953 that Southern Cameroons attained a semi-autonomous status. 3 C. E. B. Russell, “The Leprosy Problem in Nigeria,” African Affairs XXXVII, no. CXLVI (1938): 66-71. 16

from the long years of suffering that the disease condemns its victims. He further noted

that although the disease causes gnawing bodily pain, the chief suffering was that of the

mind as victims were despised, and were often driven out of the home and village with

the victims resorting to live by themselves in the bush.4 Further, Muir reported that out of

providence some early cases of leprosy get better without treatment, but once it gets a

firm hold in the body it becomes serious and difficult to cure. According to him, although

the disease was easy to prevent, it remained a generational burden in parts of British colonial Africa essentially because of the little knowledge and misconceptions surrounding leprosy.5 Overall, the content of Muir’s report is suggestive of the practicability of establishing isolation camps for lepers in each province in Nigeria. The functionality and beneficence of isolation in leprosy control and wellbeing of patients form the focus of this present study.

Three years after Dr. Muir’s tour, a Leprosy Conference was held at Enugu,

Nigeria, on August 28 to 30, 1939, with the intend to deliberate on modalities for training

in the administrative measures necessary to prevent the spread of leprosy in the Eastern

region of Nigeria, to which southern Cameroons was appended. Amongst the cardinal

resolutions adopted at the Enugu Leprosy Conference was the recommendation that

Provincial Leprosy Boards be established in each province, as proposed in the Cairo

Leprosy Congress Report, and for representative members to be hastily appointed in each

Leprosy Board with the task to formulate and implement schemes for leprosy control and

4 Cd 53, Dr. E. Muir, Leprosy Control: A Manuel for Teachers, Children and Parents (BERLA, London – England). 5 Ibid, p.3. 17

relief upon a provincial basis.6 At the confluence of Muir’s tour and the Enugu

conference, coupled with a mounting pessimism within the ranks of colonial

administrators in British Southern Cameroons, there was increasing consideration as to

the desirability of an imminent Provincial Leprosy Board for the territory with the

responsibility to initiate, develop and coordinate all anti-leprosy efforts.7

At the dawn of colonial rule in Cameroon, leprosy was one of the public health concerns that preoccupied both the German and later British colonial administrations.

Although records of the magnitude of the disease in the precolonial period are not available, some efforts were made by both indigenous healers and later the colonial administration to curb its spread. For instance, colonial administrators in the Grassfields area reported the use of native ointment (consisting of cashew nut, ground to powder and mixed with carbolic acid and shea butter) for leprosy treatment.8 Even the Nigerian

Medical and Sanitary Department is known to have tested indigenous substances to determine their supposed medicinal properties. The earliest documented attempt at controlling leprosy was made in 1910 by the German colonial administration.9 In that

year, the German administration conducted epidemiological surveys across the territory

to identify and map area where leprosy was prevalent in order to guide leprosy mitigating

measures. In the years that followed, some patients were isolated and given treatment at

special locations such as at the island of Mondoleh (Ambas Bay), off the coast of Victoria

6 Sc/a 1956/1, Leprosy Conference Enugu, November 18, 1939, NAB. 7 Sc/a 1956/1, Minutes on the Control and Relief of Leprosy in Nigeria held in Buea, NAB. 8 Kent Maynard, Making Kedjom Medicine: A History of Public Health and Well-being in Cameroon (Westport, Connecticut: Praeger, 2004), 186. 9 Harry Rudin, Germans in the Cameroons, 1884-1914: A Case Study in Modern Imperialism (New York: Greenwood Press, 1938), 348-349. 18

(currently Limbe) and Mokundange. The move to quarantine suspected leprosy cases in

far-off sites was the antecedent to the isolation of patients in full-fledged segregated leprosy settlements in Cameroon. Unfortunately, the policy adopted by the German colonial administration was interrupted by the ousting of Germany from Kamerun in the aftermath of the First World War, and the eventual partition of the territory between

Britain and France. After 1922 when the British instituted effective administration over

Cameroon, no serious plans were taken to control leprosy until almost two decades later.

Following the discussions on the prospects and the formation of the Provincial leprosy

Board in British Southern Cameroons, and the need to check the rising threat of leprosy

in the territory, in 1952 and 1954 the Baptist and Basel Missions respectively opened

leprosy settlements at Mbingo and Manyemen as treatment centers for the disease’s

victims.

This study focuses on leprosy settlements, particularly those founded by Christian

Missionary organizations in Southern Cameroons and examines the policy to isolate

lepers in segregated settlements by the colonial administration to control the spread of

leprosy, provide treatment and institutional support for the eventual reintegration of

victims in the society in the League of Nations mandated territory from 1916 to three

years after the demise of the federal system in independent Cameroon in 1972. Because

of its small size to other British West African possessions, the territory was neglected.

Consequently, leprosy patients received negligible attention from British colonial

government, thereby creating a void filled by voluntary agencies and Christian medical

missions. In this respect, this study focuses on the centrality of disease in public health 19

policy and social change in the nineteenth and early twentieth centuries, and the agency

of Christian (medical) missionaries in propagating the colonial agenda. In so doing, the study engages the historiography of colonial healthcare interrogating the policy of isolation and confinement in disease control and patient management. The experiences of

African patients with disease, Western biomedicine and the ways in which colonial

medical policies altered the lives of those they were meant to serve have received little

attention in historical studies of former African colonies, with colonial subjects treated as

medical artefacts of munificent and philanthropic European doctors and nurses.

This current study, however, has the dual purpose of highlighting the hitherto

neglected agency of African patients in the success of public health policy and capture

firsthand their voices through their personal narratives. By privileging patients’ voices in

the analysis of their experience with leprosy, this study agrees with Eric Silla’s view that

leprosy survivors are vibrant historical actors contrary to stereotypical portraits as pitiable

victims.10 The extent to which Africans isolated in the leprosaria proactively participated and influenced health care debates during the colonial and early postcolonial periods is under-documented in the historiography of Africa in general and Cameroon in particular,

and deserves attention. This study is an attempt to avoid the hierarchical top-down

approach that has overwhelmingly characterized the historiography of disease, healing

and medicine in its investigation of the role of quarantine and the efforts of Christian

missionaries in leprosy control in Cameroon. In British Southern Cameroons as in other

African colonies, the anti-leprosy campaign was not only central to Christian

10 Eric Silla, People Are Not The Same: Leprosy and Identity in Twentieth-Century Mali (Oxford: James Curry, 1998). 20 proselytization and other missionary engagements, but also in negotiating the interaction between the colonial government and voluntary agencies as well as the encounter and power relations between Christian missionaries and leprosy sufferers.11

The Eurocentric perception of Africa as the “Whiteman’s Grave’12 informed by the extraordinary level of deaths of Europeans in nineteenth century West and Central

Africa, seems to have cast an apocalyptic shadow, like the Black Death in fourteenth century Europe, that lingered beyond the colonial era. Known disreputably as the diseased continent, many communities in Africa in general and Cameroon in particular, are grappling with several health challenges. For instance, the recent Ebola crisis in three

West African nations underscores the urgency of African countries to figure out ways to control and contain the spread of highly infectious and stigma-laden diseases such as

HIV/AIDS, Tuberculosis and Leprosy as well as the stakeholders in such interventions.13

It is the hope of this study to show that the colonial experience with leprosy control had enduring strands that persisted into the postcolonial era, underscoring the ambiguities that straddled the transition between the colonial and postcolonial periods – particularly in

11 Shobana Shankar, “The Social Dimensions of Christian Leprosy Work among Muslims: American Missionaries and Young Patients in Colonial Northern Nigeria, 1920-40,” in Healing Bodies, Saving Souls: Medical Missions in Asia and Africa, ed., David Hardiman (Amsterdam: Rodopi, 2006), 281-305; Shobana Shankar, “Medical Missionaries and Modernizing Emirs in Colonial Hausaland: Leprosy Control and Native Authority in the 1930s,” Journal of African History 48, no. 1 (2007): 45-68; Shobana Shankar, “Christian Medical Missions as Muslim Charity: Paternalist Alliances, Maternal Alienation, 1928-1942,” in Who Shall Enter Paradise? Christian Origins in Muslim Northern Nigeria, ca. 1890-1975 (Athens: Ohio University Press, 2014). 12 F. Harrison Rankin, The White Man’s Gave: A Visit to Sierra Leone, in 1834 (London: Richard Bentley, 1836); Philip d. Curtin, “The White Man’s Grave: Image and Reality, 1780-1850,” Journal of British Studies 1 (1961): 94-110; Philip D. Curtin, Death by Migration: Europe’s Encounter with the Tropical World in the Nineteenth Century (New York: Cambridge University Press, 1989), 7-8; Philip D. Curtin, “The End of the ‘White Man’s Grave’? Nineteenth-Century Mortality in West Africa,” Journal of Interdisciplinary History 21, no. 1 (1990): 63-88. 13 Chernoh Alpha M. Bah, The Ebola Outbreak in West Africa: Corporate Gangsters, Multinationals and Rogue Politicians (Africanist Press, 2015). 21

relation to the provision of anti-leprosy policy in Cameroon. This study makes the argument that insights as to possible solution to disease control in contemporary

Cameroon, the effectiveness of isolating patients of contagious diseases, and the provision of psycho-social support to victims of debilitating diseases could be provided by retrospection on colonial health policies. On that note, it is important to understand how compulsory confinement and leprosy settlements transformed the landscape of healthcare, healing and medicine in colonial British Southern Cameroons and the federated state of West Cameroon. The health policies and stigma that characterize infectious disease control schemes in West African polities today may be sourced in the colonial era.

The Argument

Without doubt, the founding of leprosy settlements in British Southern

Cameroons in the 1950s greatly transformed the care leprosy victims received as well as public attitude towards the disease and its victims. This development occurred at a time when the territory was undergoing tremendous political and social transformation. In fact in 1953, Southern Cameroons’ politicians had just withdrawn from the Eastern Regional

House of Assembly, Enugu, Nigeria, - as fallout of what was known as the Eastern

Regional Crisis in Nigeria – and by October 1954, had formed a semi-autonomous state14

paving the way to ultimate independence by (re)unification with the Republic of

14 Victor B. Amaazee, “The 'Igbo Scare' in the British Cameroons, c. 1945-61,” Journal of African History 31 (1990): 289-293; Victor B. Amaazee, The Eastern Nigerian Crisis and the Destiny of the British Southern Cameroons, 1953-1954 (Yaounde: University of Yaounde Press, 2000); Victory Julius Ngoh, Southern Cameroons, 1922-1961: A Constitutional History (Aldershot: Ashgate Publication Ltd, 2001), 66- 69; Martin Lynn, “The Nigerian Self-government Crisis of 1953 and the Colonial Office,” The Journal of Imperial and Commonwealth History 34, no. 2 (2006): 245-261. 22

Cameroun. These twin developments, although unconnected, radically transformed the

nature and outlook of anti-leprosy policy, the level of interest in alleviating the suffering

of patients as well as the relationship between government, native administration and

Christian missions running the settlements. The establishments of the two settlements

meant that the policy of confining patients in segregated camps and institutions was

pursued vigorously with several hundred patients accepted and admitted. This

development also meant that the colonial administration, and by extension the Baptist and

Basel Missions henceforth, considered leprosy not only as an epidemiological, but most

of all, a cultural and social phenomenon; a development parallel to the lackadaisical

attitude of the colonial administration despite the devastating effect on the population

throughout the mandate period (1922-1945).

The social change triggered by unprecedented political developments in the

territory from a German protectorate to a British mandate and trusteeship (1945-1961),

and as part of a federal union with the Republic of Cameroun led to closures as well as

ruptures in the realms of disease, healing and society. According to Ndege, “the nature

and dynamics of health care give racial and cultural conflicts pride of place as critical

factors in the introduction, management, and development of Western biomedicine in

colonial Africa.”15 Indeed, the African environment faced many and varied changes as a

result of colonization and more so as young postcolonial states. Leprosy settlements not

only changed the landscape of the communities where they were located, but also

exposed the cracks of social structures and human relations as the territory transitioned

15 George O. Ndege, Health, State, and Society in Kenya (New York: University of Rochester Press, 2001), 1. 23

from a British protectorate to an autonomous state within the Cameroon’s federation.16

The isolation of patients in segregated settlements not only challenged the very social

fabric of African communities, but also transformed in an unprecedented manner the

lives of leprosy victims and settlement staff well after independence. Like in other

colonized societies, it is difficult to understand what sustained the lifespan of the stigma

and discrimination against leprosy and its victims in the different belief systems

reinforced by the stereotypes constructed by the ‘civilizing mission’ of the colonialists.17

Further, both settlements were the bases for the establishment of full-fledged

hospitals at Manyemen and Mbingo in 1960s, bringing healthcare closer to the

population. An understanding of institutional care is critical to appreciate the experiment

of confinement as a measure at leprosy control, and in mitigating the effect on emerging

infectious disease and stigma in contemporary Cameroon in particular and West Africa in

general. Yet, existing studies on leprosy in colonial Africa focus more on the role of

Christian missionaries or organizations in anti-leprosy work. It is the hope of this study to

reopen discussion on the history of leprosy in West Africa in general beyond the

dominant discourse on stigma, the bodies of lepers as objects, and the link between

poverty, poor hygiene and leprosy; and explore new terrains by highlighting the agency

of leprosy victims and the role of biomedical institutions in modernization.

16 Willard R. Johnson, The Cameroon Federation: Political Integration in a Fragmentary Society (Princeton, NJ: Princeton University Press, 1970); Neville Rubin, Cameroun: An African Federation (London: Pall Mall Press, 1971); Victor T. Levine, Cameroon Federal Republic (Ithaca, NY: Cornell University Press, 1971. 17 Waltraud Ernst, Biswamoy Pati and T. V. Sekher, Health and Medicine in the Indian Princely States: 1850-1950 (New York: Routledge, 2017), 45. 24

While there is general consensus in the literature that anti-leprosy work in both

Cameroons (both British and French territories) was predominantly in the hands of

Christian missionaries during the colonial period and a decade after independence, the extent to which the microcosms of patient communities trace broader historical change and inform changes marked by events such as colonialism, evangelism, technological transfer and migration has been largely ignored. In 1974, the Federal government in

Cameroon demonstrated its political will to combat leprosy by introducing a national system of coordination.18 This led to the first national survey in 1975. It is the assumption

of this study that to effectively appraise the milestones registered in leprosy elimination

since 1974 and contemporary steps towards institutionalized disease control, examining

their historical roots is essential.

This study makes three propositions about the policy of isolation, leprosy control

and patient rehabilitation. First, it argues that before both settlements were founded in the

1950s, leprosy control measures were arguably misguided and untailored, rested in the

hands of conscientious native authorities, and well-to-do families who could afford the

treatment fee or transporting their sick relative to either a traditional healer or a leper

colony in Nigeria. Generally, in the 1920s and 1930s patients received whatever care was

available in makeshift huts at the outskirts of native authority areas and villages.

However, this began to change parallel to the socio-political transformation of the

territory after 1953. Second, the success of the policy of isolation depended largely on the

willingness of infected persons to self-report at leprosy settlement and the diligence of

18 Dickson S. Nsagha et al., “Elimination of Leprosy as a Public Health Problem by 2000 AD: An Epidemiological Perspective,” PanAfrican Medical Journal (2011): 5. 25

African colonial auxiliaries such as the Native Authorities, Native Administration (N.A)

teachers, Leprosy Inspectors and the community in general. For instance, Native

Authorities reported itinerant leprous cases to the District Officers, organized NA

teachers to conduct surveys; the African Leprosy Inspectors conducted surveys in remote

villages, recommended cases for admission, and provide direct care too these patients;

while the acceptance by communities to have settlements constructed in their midst

facilitated the work of missionaries and other health officials.19 Segregated patients were

not mere torpid recipients of charity. Third, leprosy victims had a life far from the misery

resulting from their health condition. Although the disease altered the lives of its victims

in different and often unimaginable ways, the tenacity of hope and resilience as they

recount their stories may be attributable to the successes of the leprosaria. In response to

their predicaments, patients found in these settlements a platform to establish bonds and

build a sense of community as demonstrated in their survival before and after discharge.

Consequently, to understand the struggles patients confronted it is important to consider

their existence outside of their disease.

Historiographical Context

Works do exist that examine the triad of colonialism, disease, and missionary

medicine as it pertains to leprosy control in colonial Africa in general and Cameroon in

particular, but these are limited in number and focus. The majority of the studies

concentrate on the history of medicine and public health under the tutelage of the colonial

encounter between the munificent Europeans and ‘destitute African.’ A survey of the

19 John Manton, “Trialing Drugs, Creating Publics: Medical Research, Leprosy Control, and the Construction of a Public Health Sphere in Post-1945 Nigeria,” in Para-States and Medical Science: Making African Global Health, ed. P. Wenzel Geissler (Durham: Duke University Press, 2015), 78. 26 literature on the historiography of leprosy in the area under review points meekly to four postgraduate theses namely that of Wesley Agbor, Cajetan Akumbom, S. Titanjoh and

Christian Asongwe.20 While Agbor examines the Presbyterian Church’s medical institutions at Manyemen from when it was opened as a settlement for the segregation of lepers to its evolution to a general hospital, Akumbom and Tikanjoh’s theses examine individual leprosy work at the Bamenda New Hope Settlement village and leprosy settlement in Mbingo and Manyemen respectively.21 In yet another thesis, Asongwe examines the control of leprosy in British Southern Cameroons from the mandate to trusteeship periods providing a background to Christian missionaries’ involvement in leprosy control. The theses, however, focus cursorily on the strategies to control leprosy by the government and missionary organizations with little discussion on the welfare of patients who lived in the settlements, nor did any hinge its discussion on the policy of isolation as the theoretical scaffold of the research.

Besides the theses on the topic in Southern Cameroons, few exceptions on the sparse historiography on leprosy in Cameroon exist. At best, leprosy and leprosy cases have barely been mentioned in travelogues, anthropological and general historiographical monographs. One exception is Frederick Migeod’s Through British Cameroons, in which the author narrates firsthand encounter with a medical officer in Bamenda, Dr. W. H.

Sieger, who gave him a reconnaissance tour around a leper village hosting sufferers from

20 Wesley N. Agbor, “Mission Through Healing: A Case Study of the Presbyterian Medical Institutions Manyemen 1951-1999,” BA Theology (2000); Cajetan G. Akumbom, “The Historical Evolution of the New Hope Settlement Village, Bamenda 1952-2009” (postgraduate Thesis: ENS Yaounde, 2010); S. Titanjoh, “The Manyemen Leprosy Settlement 1954-1992: A Historical Investigation” (postgraduate Thesis: HTTC Bambili, 2013); Christian Asongwe, “The Fight Against Leprosy in British Southern Cameroons 1922-1961: An Historical Evaluation,” (MA thesis, University of Yaounde, 2014). 21 Ibid. 27

remote villages.22 Noting that mostly female patients had presented themselves for

treatment indicated two things, namely, that the gender of the patient determined

markedly their tolerance in the community and the predominant female leper community

is explained by its members having been abandoned by their husbands, some of whom

were well-to-do.23 In yet another anthropological study, Egerton fleetingly described the

difficult circumstances of lepers in the leper villages in the grassfields area of French

Cameroons as well as challenges confounding the experience of public health personnel

and lepers in the early periods of colonial rule.24 Rudin’s Germans in the Cameroons

provides an overview of steps taken by the German colonial administration to investigate

the prevalence of leprosy and mitigate its spread.25

Similarly, whereas Iliffe pointed out that leprosy was a major public health issue

in colonial Cameroon which was confirmed by the existence of over twenty-five leprosy villages in the French part of Cameroon as of 1936, the disease has not attracted significant historical scholarship.26 According to a handbook in the geographical series by the United Kingdom naval Intelligence Division, there were several thousand leprosy patients in the Cameroons in the 1930s.27 It documented that in 1937, 3394 new cases of

leprosy were found in the Cameroons, and in that same year a total of 3150 patients died.

The total estimate of known cases that year stood at 7174, of which 5293 patients were

22 Frederick W. H. Migeod, “Bamenda,” in Through British Cameroons (London: Heath Cranton, 1925), 98. 23 Ibid. 24 Clement Egerton, African Majesty: A Record of Refuge at the Court of the King of Bangangté in the French Cameroons (New York: Charles Scribner’s Sons, 1939), 33-37. 25 Rudin, Germans in the Cameroons, 348-349. 26 John Iliffe, The African Poor: A History (Cambridge: Cambridge University Press, 1987), 221. 27 Great Britain, French Equatorial Africa and Cameroons (Oxford: Naval Intelligence Division, 1942), 174. 28

isolated in thirty leper colonies mainly in French Cameroons.28 Although this document

fails to provide information on the specific location and ownership of these leper

colonies, it highlights perennial problem of leprosy in the territories that made up former

German Kamerun. Beyond the merit of highlighting the existence of the disease in the

Cameroons, neither of these studies attempted to describe the routine predicaments of

leprosy sufferers. In a rancorous context where hospitals were few and far apart as well as

where healing cultures collided, African patients had the choice of choosing either to

patronize western biomedicine or local therapy of indigenous healers when confronted

with infirmities. In Making Kedjom Medicine, Maynard describes the local beliefs,

rituals, taboos surrounding leprosy in the grassfields village of Kedjom Keku, Cameroon,

demonstrating how patients exploited whatever help that could be provided by both

traditional medicine and Western biomedicine,29 arguing elsewhere that medicine was a

‘moral act’ which became ‘morally ambivalent’ with the sprouting of professionalized

healers with colonialism.30

Leprosy work in the colonial world was mainly in the hands of Christian

missionaries, constituting an integral part of evangelism in most parts of colonial Africa.

According to Iliffe, “the extent to which different cultures – and different individuals within them – have stigmatized leprosy and isolated its sufferers has varied greatly and is difficult to explain.”31 The ambivalence in responses to leprosy however finds clarity in

28 Ibid. 29 Maynard, Making Kedjom Medicine, 149-150; 30 Kent Maynard, “The Vicissitudes of Medical Identity in Cameroon: Kedjom ‘Traditional Doctors’ and an Ambivalent Clientele,” in Medical Identities: Healing, Well-being and Personhood, ed. K. Maynard (New York: Berghahn Books, 2007), 61-83. 31 Iliffe, The African Poor, 215. 29 the past, remotely into biblical times and anti-leprosy approaches in medieval Europe.

Even before the colonial governments partnered with Christian missions, the latter had taken the initiative to fight leprosy in most parts of colonial Africa. In the Residues of the

Western Missionary in Southern Cameroons, Awoh alludes to modest measures against leprosy taken by Catholic missionaries in the grassfields of Southern Cameroons.32

Leprosy settlements were tools not just to mend the sick bodies (individual body, social body, and body politic)33 of patients but also to save their souls through the teaching of the Christian gospel.34 Laura Reddig’s biography provides a compelling account of her contribution towards combating leprosy and the establishment of the New Hope

Settlement at Mbingo under the patronage of the North American Baptist Mission in

Cameroon.35 These studies generally shied away from an in-depth discussion on the gnawing pains and festering ulcers that characterized the nightmarish experience to patients.36

32 Peter Awoh, The Residues of the Western Missionary in Southern Cameroons. The Christian Village: A Sad Tale of Strife and Dissension (Bamenda: Langaa RPCIG, 2012), 206-207. 33 Nancy Scheper-Hughes and Margaret M. Lock, “The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology,” Medical Anthropology Quarterly 1, no. 1 (Mar., 1987): 7. The authors describe three bodies: individual body (understood in the phenomenological sense of the lived experience of the body-self); social body (the representational uses of the body as a natural symbol with which to think about nature); and body politics (the regulation, surveillance, and control of bodies, individual and collective, in reproduction and sexuality, in work and in leisure, in sickness and other forms of deviance and human difference. Under this category, there are different types of polity from foraging societies, chieftainships, monarchies, oligarchies, democracies, and modern totalitarian/colonial states). 34 Guenter Risse, “Hospitals as Segregation and Confinements Tools: Leprosy and Plagues,” in Mending Bodies, Saving Souls: A History of Hospitals (Oxford: Oxford University Press, 1999), 167-179; Charles M. Good Jr. “Christian Medical Missions and African Societies,” in C. M. Good Jr, The Steamer Parish: The Rise and Fall of Missionary Medicine on an African Frontier (Chicago: University of Chicago Press, 2004), 1-49; Elias K. Bongmba, “From Medical Missions to Church Health Services,” in E. K. Bongmba Routledge Companion to Christianity in Africa (New York: Routledge, 2016), 503-507. 35 Edward D. Hughes, Love Them for Me Laura (Sioux Fall, SD: North American Baptist Conference, 1985). 36 Kathleen Vongsathon, “Gnawing Pains, Festering Ulcers and Nightmare Suffering: Selling Leprosy as a Humanitarian Cause in the British Empire, c. 1890-1960,” Journal of Imperial and Commonwealth History 40, no. 5 (2012): 863-878. 30

Leprosy is one of few diseases that express themselves in metaphor and symbols,

compounding the plight of patients and inhibiting them from seeking proper treatment as

expounded by Sontag in her study on cancer.37 Different images and metaphors have

been used to describe leprosy across the world over the centuries.38 Sontag argues that

often stigmatized disease replete with mystifications and punitive metaphors. She writes,

“illness is the night-side of life, a more onerous citizenship. Everyone who is born holds

dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we

prefer to use only the good passport, sooner or later each of us is obliged, at least for a

spell, to identify ourselves as citizens of that other place.”39 To leprosy patients

worldwide, that ‘other place’ was the leprosaria spotted across the globe as a result of the

universal policy of isolation in prison-like institutions. However, the inconsistent nature of colonial authority in penal hospitalization engendered conflict, compromise and resistance.40 Leprosy has spectacularly encumbered the trappings of metaphor in historiographies pertaining to China, India, and the Atlantic and pacific islands.41 The fantasies inspired by leprosy in the last centuries are mainly consequent of the

37 Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York: Picador USA, 2001). 38 Liora Navon, “Leprosy’s Transformation into a Symbol of Stigmatization,” Korot 21 (2011-2012): 315- 338. 39 Ibid., 3. 40 Jane Buckingham, Leprosy in Colonial South India: Medicine and Confinement (New York: Palgrave, 2002). 41 Sanjiv Kakar, “Leprosy in British India, 1860-1940: Colonial Politics and Missionary Medicine,” Medical History 40 (1996): 215-230; Buckingham, Leprosy in Colonial South India; James Diamond, Converts, Heretics, and Lepers: Maimonides and the Outsider (Indiana: University of Notre Dame, 2007); Angela K. Leung, Leprosy in China: A History (New York: Columbia University Press, 2009); Dorothy McMenamin, Leprosy and Stigma in the South Pacific: A Region-by-Region History with First Person Accounts (Jefferson, NC: McFarland & Company, Inc., 2011); Biswamoy Pati and Chandi Nanada, “The Leprosy Patient and Society: Colonial Orissa, 1870s-1940s,” in The Social History of Health and Medicine in Colonial India, eds., B. Pati and M. Harrison, 113-128 (New York: Routledge, 2009); Jo Robertson, “The Leprosy Asylum in India: 1886-1947,” Journal of the History of Medicine and Allied Sciences 64, no. 4 (2009): 474-517; Navon, “Leprosy’s Transformation into a Symbol of Stigmatization,” 315-338. 31 misconstrued perception that the disease was intractable and capricious, “in an era in which medicine’s central premise is that all diseases can be cured.”42 Thus, over the years stigma has constituted the main metaphor in leprosy discourse. Harris argues that its negative effects of notwithstanding, stigma defines the organization of care given to patients, formulation of the social identity of leprosy workers and future interventions.43

Generally, the focus of historiographies on leprosy in the colonial world have predominantly beamed on imperial and colonial politics, and on state interventions to the neglect of the contribution of voluntary agencies even though the task to control the disease was primarily in the hands of Christian missionaries.44

Leprosy terrified humankind for centuries and the primary response was to isolate infected people from the healthy population. Overwhelmingly, scholarship on the history of disease and medicine in Africa tend to focus on those maladies (malaria, sleeping sickness, and tuberculosis) that were important politically, economically and socially to the colonial agenda to the neglect of the less urban disease, leprosy. This has not significantly improved in the postcolonial period. However, leprosy is equally worthy of historical examination, and as Iliffe had argued leprosy is not only a disease of poverty but also a cause of poverty exposing the scale and tenacity of African poverty, dedication to those relieving it and the courage of its victims.45 Drawing from the history of segregation in Africa, Iliffe argued that because of stigma and fear of contagion, the burden of care for lepers was shouldered by their peers, and even where rapid

42 Sontag, Illness as Metaphor, 5. 43 Kristine Harris, “Pride and Prejudice – Identity and Stigma in Leprosy Work,” Leprosy Review 82 (2011): 135-146. 44 Kakar, “Leprosy in British India,” 215-230. 45 Iliffe, The African Poor, 214-229. 32

urbanization mitigated against transmission, economic and political difficulties hampered

leprosy treatment. However, Vaughan rightly points out that the story of the fight against

leprosy is not primarily a tale of incarceration and segregation, with leprosy projecting

unto Africa a powerful Christian disease symbolism and a socially engineered ‘leper identity’ even as the colonial governments were unable to disburse the requisite financial resources, under the Grant-in-aid scheme, to enforce segregation.46 The operations of

leper settlements were highly ritualistic with certain rituals performed before and after

treatment, and a ‘certificate of discharge’ issued to patients to declare them cleansed.

Besides the dominant literature on disease and empire in Africa, there is a

growing literature on the partnership between the colonial state and Christian

organizations to combat disease such as leprosy especially in Nigeria. According to

Feierman and Jantzen, the history of leprosy treatment in Africa is a reflection of the

history of religion in a continent that experiences broad religious diversity.47 Treatment at

the segregated settlements was opened to all irrespective of their religious creed.

Worboys demonstrates how modern medicine was used as a proselytizing platform by the

colonialists to spread Christianity, and in the case of leprosy control in Nigeria, the

colonial world was a duality: the one being the mission to proselytize and the other to

consolidate colonial rule and promote a European material culture in Africa.48 He also

points out that protestant missions were quicker to embrace medicine than their catholic

46 Megan Vaughan, Curing their Ills: Colonial Power and African Illness (Stanford, California: Stanford University Press, 1991), 77. 47 Steven Feierman and John Janzen, The Social Basis of Health and Healing in Africa (California: University of California Press, 1992), 4. 48 Michael Worboys, “The Colonial World as Mission and Mandate: Leprosy and Empire, 1900-1940,” Osiris 15 (2000): 207. 33

counterparts, a reflection of the instrumentalist rather than fundamentalist stance to

conversion of the former. Leprosy settlements in Africa including Southern Cameroons

were owned by Protestants: Anglicans, Baptist and Basel Missions – and modeled on

agricultural or industrial settlements that were to be educative and self-supporting, a

model community for the outside world that was ideally the first stage to civilization.49

Many interests shaped leprosy campaigns in colonial Africa. In a study on the

social relations of medical work in the emirates of colonial northern Nigeria, Shankar

argues that the interaction among Europeans, Africans, Christians and Muslims, within

colonial circles and indigenous communities, was crucial to the success of leprosy control

efforts. He demonstrates how leprosy work was very dynamic and depended on highly

mobile young patients encouraged by Christian missionaries who perceived working

“among leprosy sufferers as a special calling.”50 Shankar advances further the necessity

of partnership in anti-leprosy schemes demonstrating how cooperative medical work in

northern Nigeria profoundly impacted the spreading of Christian mission culture, helped

minimize the spread of leprosy, but failed to consolidate competing sectarian religious

beliefs or medical power and “obscured a complex situation of competing priorities and

unexpected disaffection.”51

A few other studies have focused on specific leper colonies at Itu and Ogoja, in

Eastern Nigeria. John Manton has done quite extensive study on leprosy in colonial

Nigeria. In “Administering Leprosy Control in Ogoja Province, Nigeria,” Manton also

49 Ibid., 214-217. 50 Shankar, “The Social Dimensions of Christian Leprosy Work among Muslims,” 281-305. 51 Shankar, “Medical Missionaries and Modernizing Emirs,” 45-68; Shankar, “Christian Medical Missions as Muslim Charity.” 34

highlights the interactions between a Roman Catholic Mission and colonial and

international bodies in the control of leprosy in a community in post-Second World War

Eastern Nigeria.52 He discussed the technical aspects of framing and implementing

leprosy control policy during a period when the colony was undergoing rapid

constitutional change, Africanization, and decolonization. He argues that to understand

the problems faced and strategies employed by missionaries in the provision of welfare, it

is important to begin the analysis from an awareness of the evolution of missionary

services and institutions.53 In yet another study on leprosy in Eastern Nigeria, Manton

demonstrates the particular way in which the disease was presented, and the forms used

to communicate the ideas of stigma and taint within a fast changing socio-political

context.54 The stylized representation of leprosy in films and propaganda literature,

medical rectitude, and grateful reception of leprosy village program was an intensely

contested terrain. Consequently, the success of leprosy control rested squarely on the

negotiation and maintenance of a heavily administered space.55 The contributions of

these studies to our understanding of leprosy control in the colonial world and the pivotal

role of Christian missionary societies notwithstanding, considerable attention was not

given to patients’ perspective and experience in leprosy settlements whether in the

52 John Manton, “Administering Leprosy Control in Ogoja Province, Nigeria, 1950-1967: A Case Study in Government-Mission Relations,” In Healing Bodies, Saving Souls: Medical Missions in Asia and Africa. Ed. David Hardiman (Amsterdam: Rodopi, 2006), 307-331. See also John Manton, “Global and Local Contexts: The Northern Ogoja Leprosy Scheme, Nigeria, 1945-1960,” História, Ciências, Saúde Manguinhos 10, no. 1 (2003): 209-223. 53 Ibid., 309. 54 John Manton, “Leprosy in Eastern Nigeria and the Social History of Colonial Skin,” Leprosy Review 82 (2011): 124-134. 55 John Manton, “Mission, Clinic, and Laboratory: Curing Leprosy in Nigeria, 1945-67,” in The Secular in the Spiritual: Missionaries and Knowledge about Africa, eds. D. Maxwell and P. Harries (Michigan: Wm. B. Eerdmans Publishing Co., 2012), 313-334. 35

colonial or postcolonial periods. Also, despite being administered in large part from the

Eastern Region of Nigeria, none of the studies described the case of lepers in the

territory, at least before 1953.

However, it is extremely difficult to find the voice of Africans, the actual victims of leprosy, who had direct contact with colonial authorities, Christian missionaries and people from other ethnic groups as a result of their infirmity. In order to fully understand the impact of the past leprosy control policy, it is important to examine the very people whose lives were influenced by and who helped shape policies against leprosy in both colonial and postcolonial Africa. Generally speaking, historical documents that directly

record their experiences do not exist. Fragments of this suppressed narrative of leprosy

victims appear in impressive detail in Silla’s People Are Not the Same, a study on leprosy and identity in twentieth century Mali.56 The patient-centered approach Silla adopts

reveals a wider spectrum of medical beliefs, practices, and perspectives on how larger

developments affected leprosy victims and leprosy control in Mali. Disease often

coincides with major developments or social events. Specific historical developments

mark the transformation that leprosy victims underwent, developments themselves that

could be related to the disease itself or broader political life. Hence through support

groups and separate communities, leprosy victims exerted greater control over their social

identities and their lives.57

Generally, the reviewed literature has focused on: government policy, Christian

missionary leprosy work and the stigma associated with the disease. This study is an

56 Silla, People Are Not the Same. 57 Ibid., 26-27. 36

attempt to push the boundaries of the narrative to incorporate voices and experiences of

patients as well as the ambiguities and contradictions that characterize public health

policy and program implementation within a changing socio-political milieu using the experience of Cameroon. From the foregoing, it is evident that it was the leprosy settlements and not government policy that were at the fore of leprosy treatment, control and the rehabilitation of patients in Africa in general and Cameroon in particular, thus, the relevance of a study to investigate the role of leprosaria in managing the suffering of leprosy victims.

Methods and Sources

This is a historical study which uses primary data to examine the role of church- affiliated leprosaria in treatment, control, and rehabilitation of former leprosy patients.

Consequently, it utilizes the historical narrative and interpretive analysis of facts and themes. The goal is to produce a coherent narrative that captures the evolution of leprosy settlements and analyzes the challenges of living with leprosy in colonial and postcolonial English-speaking Cameroon.

The principal method of data collection for the study consists mainly of consultation of primary and secondary sources. Archival materials were collected in archives in Cameroon and the United States of America. Data were gathered between

May and December 2015, and intermittently in 2016. The first four months of this period were devoted to the collection of archival data at the National Archives in Buea (NAB).

This archive is a depository of annual medical reports, disease surveillance reports, monthly minutes of the administrative committees of leprosy settlements, solicitations 37

and petitions from leprosy sufferers and native authorities. The archive also provided

firsthand information on correspondences between medical, missionary and government

authorities, and information on the forces of social change in the colonial setting such as

churches, schools and health centers (clinics, dispensaries, hospitals, and leprosaria).

Apart from providing relevant information on the discussions between colonial officials

on the need to establish leprosaria in the territory, data contained in files at the NAB

provided crucial insights into the social and cultural factors that influenced the

transmission of leprosy in communities, the establishment of leprosy villages and

settlements, and the transactions between patients and medical officers.

Some of the documents reflect the tensions and conflicts over acquisition of land for building leprosy settlements, exposing the fault lines of bigger tensions between communities, and medical and religious cultural environments. Other documents describe the taboos associated with leprosy, the shabby treatment given to lepers, and the manner in which the bodies or cadavers of leprosy patients were handled or treated. The files at the National Archives Buea also contain letters and appeals written by leprosy patients desperate for help. As a source for historical reconstruction,58 the study used letters to

show that patients were not mere listless recipients of the humanitarian welfarism of the

colonial state and missionary charity, the level of involvement of leprosy patients, and

that the success of anti-leprosy work in remote communities and at the settlements

depended on the willingness of patients and native authorities to report new or suspected

58 Henry K. Kah, The Sacred Forest: Gender and Matriliny in the Laimbwe History (Cameroon), c. 1750- 2001 (Münster, Berlin: Lit Verlag, 2014), 51. 38

cases59 as well as the goodwill of some patients.60 As Walther argues in his study on venereal disease in Germany’s colonies, the colonial population to whom the new strategies were administered fully participated in that colonial encounter and “their behavior strongly influenced the efficacy and nature” of the audacious public health measures.61 Patients exercised agency beneficial to the recorded achievements of the

leprosaria at Manyemen and Mbingo.

Documents from the North American Baptist heritage Commission Archives

(NABHCA) in South Dakota (USA) were consulted. The archive contains treasured

records and artifacts of the people connected with the North American Baptist

Conference and their work as well as key historical records from NAB local churches and

materials related to North American Baptist missionaries in British Southern Cameroons.

Important information was collected from articles in the North American Baptist

Conference's key publications – Baptist Herald. The articles provided information on the

activities of North American Baptist missionaries who served in Cameroons in general

and at the Mbingo settlement in particular. Additional data was collected from the

reports, diaries, and biographies of missionaries, for example Laura E. Reddig, who

served at various stations in Southern Cameroons including Mbingo for over forty years.

She was at the center of the establishment of the Mbingo settlement and care of leprosy

59 T. F. Davey, “Leprosy Control in the Owerri Province, Southern Nigeria,” Leprosy Review 13 (1942); 34; Melissa Graboyes, “Medical Research Past and Present,” in The Experiment Must Continue: Medical Research and Ethics in East Africa, 1940-2014 (Athens, Ohio University Press, 2015), 6-7. 60 A. B. Macdonald, “Rehabilitation: The Industrial and Social Work of a Leper Colony,” Leprosy Review XIX, no. 2 (April 1948): 54. 61 Daniel L. Walther, Sex and Control: Venereal Disease, Colonial Physicians, and Indigenous Agency in German Colonialism, 1884-1914 (New York: Berghahn Books, 2015), 1-5. 39 care.62 Between October and November, data from reports on the activities of the

Manyemen settlement was collected from files at the Presbyterian Church of Cameroon

Central Archives and Library (PCCCAL) Buea. While additional data was collected in

December 2015 from the Regional Archives Bamenda (RAB). The data from this archive covers the experience of leprosy in the Grassfield areas in the Bamenda Province,

Southern Cameroons. Very little information was obtained from the Medical Institutions

Manyemen archives as the archives is in a sorry state with documents and files scattered on the floor and tables. This void could have been filled with information the Basel

Mission Archives, Basel, Switzerland, but for pecuniary challenges. This archives lodges medical reports on leprosy work at Manyemen, diaries and personal files of European missionaries such as Dr. Emilie Ode, and a collection of antiquarian photographs of lepers and the Manyemen leprosy center.

The study also gathered data through oral interviews. Between December 2015 and January 2016, personal interviews were conducted with a wide variety of informants who experienced the events discussed in this study and the measures that the community,

Christian missions, or the government took to control the spread of leprosy. The informants included former patients, former employees of government or missionary medical institutions, and serving or retired leprosy inspectors. These interviews were conducted principally at Bamenda, Manyemen, and Mbingo. Life histories of former patients and health staff provided the spectrum through which the study explored different areas of personal experience with the disease. Through this process, information was acquired on the areas that recorded high leprosy cases, how patients were admitted in

62 Hughes, Love Them for Me Laura. 40 the settlements, life at and outside the settlement, experience living or working with leprosy victims, the mobility of patients, the therapeutic choices that were available over time, the expansion of treatment as well as the changes in ideas about leprosy, its causation and infectibility, and attitudes towards Western biomedicine. These, together with information gathered from the colonial annual and medical reports from the territory for the period 1916-1975, surveys on leprosy prevalence, and the cultural environment in which leprosy flourished and their relationship with scholarly literature on disease and healing, and leprosy colonies in colonial Africa, constitute the bulk of primary and secondary data for the study.

Participants and Sampling

Participants for this study are former leprosy patients, who were interned at either

Manyemen or Mbingo leprosy settlements, leprosy inspectors, and persons who lived within the vicinity of the leprosaria and informed of their evolution and how that transformed perceptions towards leprosy and its victims. At the zenith of their existence, there were several hundred leprosy patients isolated in each of the leprosaria. Many of them are dead; others went back to their areas of origin or took residence in the communities adjacent to the leprosaria, while some still live in the leprosy villages and homes within the hospitals even after being discharged. However, the exact number of surviving former interned patients is unknown. The researcher applied for and received approval from the Baptist Mission and Presbyterian Church in Cameroon health boards to conduct interviews with former patients still residing within each leprosarium prior to commencing the study. For those residing in the leprosy villages or hospitals, the resident 41 leprosy inspector and the chief of the leprosy village assisted to identify potential participants for the study. This category of informants were recruited purposively. Others

(especially those outside of the former leprosaria) were be recruited through snowballing.

All participants are adults above fifty years (most were either admitted or born by leprosy parents in the leprosaria in the 1950s, 1960s, and 1970s), and only those with cognitive stability who were capable to remember the events following being diagnosed of leprosy, admission in the leprosarium or endure the rigor of such a study will be recruited. Issues that pertain to the study (privacy, risks, and rights) were discussed with potential participants. Data was collected from the participants via face-to-face interviews.

Research Design

Due to the direct focus on the research question on the evolution of leprosaria and the lived experience of leprosy patients, qualitative narrative and phenomenological design were used. The reason for the use of the aforementioned design was to shed light on the meaning and experience after being diagnosed of leprosy, and isolated in a leprosarium, as well as the role of leprosaria in leprosy control in Cameroon. This approach also helped to capture specific episodes in the lives of leprosy victims and medical officers who catered for them.

Data Analysis

All audio-recordings were be transcribed and data verified by reading through the transcripts while listening to the audio-recordings. After verification, the date was analyzed using the narrative and phenomenological approaches. In this light, data from the interviews with former leprosy patients and leprosy inspectors was qualitatively 42

analyzed to identify major themes and patterns on patients’ experience in leprosy

settlements and providing care to leprosy patients. Common themes were be identified

and effort made to identify transitions, parts of bigger stories, and emotional statements

in order to establish connections between the phenomena of being isolated in a leprosy

settlement. In addition, this combine approach allowed me to use the accounts and

experiences of participants to establish the sequence of from being diagnosed with

leprosy and isolated in a leprosarium, in the course of which ‘”mini-stories or sub-plots” of patients’ experience were identified and connections made in an attempt to identify how the evolution of leprosaria intersects with the broader socio-political history of

Cameroon.

Ethical Consideration

The information on the Consent Form was read and explained to all participants to get their oral or written consents to participate in the study. Participants were advised

on the anonymity of their participation and privacy rights. The study was approved by the

Ohio University IRB Board, and the Baptist Mission and Presbyterian Church in

Cameroon health boards. Authorization was also gotten from the North American Baptist

Heritage Commission in Sioux Fall, South Dakota, to use documents on Baptist

missionaries who served in the leprosy hospital in Cameroon. All audio-recorded

interviews were be transcribed, with all identifiers removed. Data from participants was

anonymized throughout the study. The transcribed data was stored in a password-

protected laptop computer and destroyed after one year.

43

Organization of Study

This study is divided into five chapters. Chapter one presents an overview of the

study. It provides a background of the study, situating its relevance within a

historiographical context. The chapter then presents the central argument of the

dissertation and the hypotheses that inform the research question. The chapter also

discusses the methods and sources of data collection.

Chapter one focuses on the historical evolution of British Southern Cameroons, from when Germany annexed the territory that later became Kamerun to when the

territory was ceded to Britain and France in 1916 and eventually became independent by

joining the independent Republic of Cameroun (former French Cameroon) in 1961. The

chapter also discusses political developments that contributed to trigger social change

after 1961, especially as those changes affected the functioning at full scale of

settlements. The chapter will also present an overview of the colonial administrative

context, and the enactment and introduction of colonial public health ordinances,

formulation of early medical policies that led to the involvement of Christian missionary

in healthcare in general and leprosy work in particular – to show that “biomedicine was not an accident to empire, nor can its particular forms be construed as accidental to the purposes of colonization.”63 Lastly, the chapter discusses the etiology, prevalence and

history of leprosy.

Our entry point into an examination of the debate on the necessity to implement

the policy of isolation as the primary measure to curb leprosy transmission is in chapter

63 Osaak A. Olumwullah, Dis-ease in the Colonial State: Medicine, Society, and Social Change Among the AbaNyole of Western Kenya (Westport, Connecticut: Greenwood Press, 2002), 23. 44

Three. Emphasis is on the preoccupying challenges floating leprosy cases constituted to the general health and wellbeing of the population in the towns and villages in Southern

Cameroons. The nonexistence of organized and regulated leprosy institutions in the territory meant that patients, abandoned or banished, had to travel to the leper colony at

Itu in Nigeria or receive spasmodic care at the bivouac in the bush they were forced to take residence. How was the colonial government going to solve the problem of the growing numbers of itinerant lepers, especially in the main stations? As part of the answer to this question, this chapter addresses the early efforts by the colonial administration and Native Authorities at controlling the transmission of the disease in

British Southern Cameroons during the mandate period. How did disease affect factors such as mobility, belief, or alter cultural norms and the colonial encounter? As part of that discussion, the chapter examines the incidence of leprosy in different districts and the surveys that informed the indispensability and location of the settlements in both the forest and Grassfield regions of Southern Cameroons.

The events leading to the establishment and the tension triggered by the choice of the area for the setting up of both leprosaria, is discussed in chapter four. Colonial administrators and missionaries had difficulties securing land for building leper settlements in the territory. Because of the fear and stigma associated with leprosy, communities were unwilling and resisted the setting up of a leper settlement in their community. In the case where the allocated land for the establishment of the settlement was intended to resolve a land dispute then two communities as was the case at Mbingo, the move nonetheless led to tensions between individuals and the Baptist Mission. The 45 chapter narrates and discusses these tensions over land tenure and how those exposed fault lines of bigger tensions between communities as well as between conflicting medical and religious cultural regimes.

Chapter four discusses the regulatory social regime within which patients received care in the settlements. Settlement rules and regulations controlled the activities of interns in the settlements and patient quarters were organized to nurture a strong bond of community. It has been argued that modern leper colonies were modeled on agricultural and industrial settlements that were to be educative and self-supporting – a model community for the outside world that was ideally the first stage of civilization.64 In the light of that argument, the chapter examines the conditions on which people with leprosy were admitted into the settlements, life at the settlement, social institutions and hierarchies that governed the comportments of the inmates, survival and the social services that were available to patients. The chapter also narrates the life histories of some patients showing how leprosy affected their lives, and social relationships and networks. The medical history and experience of individual patients from when each was diagnosed of leprosy, admitted in the settlement and discharged are discussed and analyzed to show how leprosy transformed the lives of its victims as well as their relationships with other members of their communities.

The conclusion starts with a panoramic view of the preceding chapters of the study. Next, it synthesizes the major themes and arguments that threads in the narrative

64 Worboys, “The Colonial World as Mission and Mandate,” 214-217.

46 and analysis from the introduction and the different chapters. As would be seen in the discussion that follows, major themes and periods overlap in the different chapters. The findings of the study are also discussed in this section with a reflection on the implications of the history of leprosy control on the formulation of strategies to confront current public health challenges in postcolonial Cameroon in particular and Africa in general. The conclusion identifies prospective areas for future research.

47

Chapter Two: Historical and Political Evolution of British Southern Cameroons

(1845-1915)

Introduction

Cameroon as we know it today is a German creation and a lost possession of

Germany; a spoil of war seized from Germany and partitioned between Britain and

France as a consequence of the German defeat during the First World War. Between the fifteenth century, when the first Europeans in documented evidence set foot on the soil of the coastal territory that will later become Cameroon, and the nineteenth century, when it was formally annexed by Germany in 1884, Cameroon has metamorphosed from a

German protectorate to British and French Mandates and United Nations’ Trusteeships.

During this period, pioneer European missionaries and later colonial medical men introduced Western biomedicine to treat common illnesses like dysentery, fever, leprosy, malaria, sleeping sickness, yaws, and yellow fever that menaced the health of the population in the territory. Before the introduction of Western biomedicine, the population solicited the services of local healers for their health problems. Collective memory holds that local healers who practiced traditional medicine registered successes as well as failed to provide patients the necessary help to ameliorate their condition in time of sickness. Different bands of Europeans visited the territory between the peak of the Age of Sail and European scramble for Africa: sailors, merchants, traders, missionaries, military, colonialists, and medical-men. This chapter examines the ‘birth’ of the Kamerun protectorate and its evolution, the advent of Christian missionary agencies, and the colonial origins of regulated healthcare in British Southern Cameroon. 48

Early Europeans, Annexation and Partition of Cameroon

The history of the territory later-to-be called British Southern Cameroons predates contacts and transactions with the Western world as traders, slave dealers, missionaries, and colonialists. Before the early contacts with Europeans, the people of this territory lived in small scattered centralized and confederal kingdoms engaged in fishing, hunting, agriculture, iron-smelting, and trade between communities isolated more or less from the rest of the world. The outlook of coexistence between these communities began to change when Europeans started visiting the coastline of this territory following the Portuguese exploration of the Gulf of Guinea in 1472. In the sixteenth century, Portuguese and later

Dutch merchants traded with people along the littoral, between Rio del Rey and the Port of Douala.65 The first Europeans who stopped along the coast traded European goods for fresh food.66 This later changed to the exchange of captured humans, to be enslaved in the New World, for European goods. With the opening of plantations in the New World,

European countries with strong maritime traditions exploited their navigation skills and engaged in the trade of slaves. The shift in the business interests of the European saw much of the coastline of West Africa, between Cape Lopez in Gabon, north and west to

Cape Palmas in Liberia, engaged in the slave trade for about three centuries, with the coast of the Cameroons and Fernando Po being major ports of call for slave ships and

65 Albert E. Calvert, The Cameroons (London: T. Werner Laurie Ltd, 1917), 1; Victoria Centenary Committee, Victoria, Southern Cameroons 1858-1958 (Victoria: Basel Mission Book Depot, 1958), v; Shirley Ardener, Eye-Witness to the Annexation of Cameroon 1883-1887 (Buea: Government Press, 1968), 6; Edwin Ardener, “Documentary and Linguistic Evidence for the Rise of the Trading Polities between Rio del Rey and Cameroons, 1500-1650,” in Edwin Ardener, Kingdom on Mount Cameroon: Studies in the History of the Cameroon Coast 1500-1970 (Oxford: Berghahn Books, 1996), 1. 66 Marjorie L. Richardson, “From German Kamerun to British Cameroons, 1884-1961. With Special Reference to the Plantations” (PhD diss., University of California, 1999), 23. 49

pioneer missionaries to West Africa.67 Strategically located at the Bight of Biafra, the

shores of the Cameroons were sites for intercultural and mercantile exchanges, with

Bimbia, Douala, and Rio del Rey being the principal exit ports for slaves.

By the turn of the nineteenth century, the trade in human chattel was dwindling at

the confluence of the rise in the trade of non-human goods like ivory, palm oil, and spices

– otherwise known as ‘legitimate trade’ – and the efforts of the Niger Expedition of 1841

that sought to cut off the slave trade at its source and usher the ‘civilizing’ mission into

the African heartland.68 From Man O’ War Bay, an area midway between the coastal

settlements of Bimbia and Victoria, provided a sheltered moorage for the men-of-war of

the British Naval Patrol tasked with the suppression of the nefarious traffic of slaves

along this part of the African coast.69 With increased effort to abolish the buying and

selling of humans, trade along the coast increased at an unprecedented rate but equally

dwarfed the prominence of the Bimbia and Rio del Rey, the former slave hubs. Their

importance in the trade along the coast70 was eclipsed by the rise of the Douala port and

the prominence of the Duala who occupied the banks of the Cameroons River (River

Wuri/Wouri) or Rio dos Camaroes (River of Shrimps), the name given the river by

Portuguese sailors because the river was rich in shrimp. The Duala ‘middlemen’

established hegemony and monopolized trade between the peoples of the hinterland and

67 Henry Roe, Fernando Po: A Consecutive History of the Opening of Our First Mission to the Heathen; with Notes on Christian African Scenery, Missionary Trials and Joys (London, 1882); Ibrahim K. Sundiata, From Slavery to Neoslavery: The Bight of Biafra and Fernando Po in the Era of Abolition, 1827-1930 (Wisconsin: University of Wisconsin Press, 1996). 68 Howard Temperley, White Dreams, Black Africa: The British Antislavery Expedition to the River Niger, 1841-1842 (New Haven: Yale University Press, 1991). 69 Victoria, Southern Cameroons 1858-1958, 16. 70 Lisa Aubrey, “Exposing Cameroon’s Connection to the Trans-Atlantic Slave Trade via Its Slavery Diaspora and Bimbia: Research Impetus, Methodology, and Initial Findings,” Annales of the Faculty of Arts, Letters and Social Sciences 15, no. 1 (2013): 205-210. 50

Europeans from the seventeenth to early twentieth centuries.71 This community of fishing villages and fishermen exploited their strategic geographical location at the estuary of the

Cameroons River and by the turn of the nineteenth century had mutated from fishermen to traders clouding the peoples further inland,72 and established a hegemony without control during the era of legitimate or free trade. From this enduring enviable geo- economic vantage point, the Duala challenged European annexation laying the foundation for nationalism and nationalist tendencies in the Cameroons especially when their hegemony was threatened.73

Apart from military-men, sailors and traders, other categories of Europeans visited the Cameroons in the nineteenth century. These include explorers, missionaries and naturalists. West Indian missionaries had begun visiting the Cameroons in the 1840s and by 1844, a band of Baptist missionaries visited the coastal village of Bimbia from the

Spanish island of Fernando Po. After that visit, further arrangements were made to visit the Cameroons from Fernando Po and in February 1845, English Baptist missionary,

Alfred Saker, sailed across to Bimbia to inquire from the people and make preliminary

71 Ralph A. Austen and Jonathan Derrick, Middlemen of the Cameroons Rivers: The Duala and their Hinterland c.1600 – c.1960 (Cambridge: Cambridge University Press, 1999). 72 The Duala (people) were concentrated within the location of the present city of Douala (place), The main towns in Douala in the nineteenth century were Akwa (Bonambela), Bell (Bonanjo), with less prominent ones being Deido (Bonebele), Joss (Bonapriso), and Hickory Town (Bonaberi). These towns straddled the banks of the Cameroons/Wuri River and its tributaries like Dibamba, Kwakwa and Mungo Rivers.

73 David Gardinier, Political Behavior in the Community of Douala, Cameroon: Reactions of the Duala People to Loss of Hegemony, 1944-1955 (Athens, Ohio: Center for International Studies Ohio University, 1966); Richard A. Joseph, “Settlers, Strikers and Sans-Travail: The Douala Riots of September 1945,” Journal of African History 15, no. 4 (1974): 669-687; Lynn Scler, “The Unwritten History of Ethnic Co- existence in Colonial Africa: An Example from Douala, Cameroon,” in Violence and Non-Violence in Africa, ed. Pal Ahluwalia, Louise Bethlehem and Ruth Ginio (New York: Routledge, 2007), 27-43; Lynn Schler, The Strangers of New Bell: Immigration, Public Space and Community in Colonial Douala, Cameroon, 1914-1960 (Pretoria: UNISA Press, 2003), 118-135 51

arrangements for the establishment of a Mission.74 Reverend Merrick assisted by

Reverend Joseph J. Fuller had established the first mission station on the coast of the

Cameroons a year earlier. Due to mounting pressure from the Spanish government

banning all forms of religious belief and the activities of the Baptist missionaries at its

West African islands of Port Clarence and Fernando Po, Saker was forced to immediately cease evangelism activities and depart from Fernando Po along with his family and

Christian flock.75 Alfred Saker later bought a piece of land from King William of Bimbia

and established the settlement of Victoria in 1858. This was the first area settled by

Europeans in the Cameroons which became the window to the spread of Christianity into

adjacent coastal villages and the hinterland, and the penetration of colonialism.

In the second half of the nineteenth century, the scramble for Africa by European

powers was at its peak. Belgium under King Leopold, Britain, France, Italy and Portugal

were the key European actors slicing the African continent among themselves. With the

suppression of the Trans-Atlantic Slave Trade and the blossoming of the commerce of

non-human commodities, different Europeans powers engaged in a mad race to occupy

bits and large chunks of Africa especially the West African coast. British, French and

German traders engaged in stiff commercial rivalries along the Cameroons coast in the

nineteenth century.

74 Emily M. Saker, Alfred Saker: The Pioneer of the Cameroons (London: The Religious Tract Society, 1908), 41-45. 75 T. Vincent Tymms, The Cameroons (West Africa): A Historical Review (London: Carey Press, 1915), 7- 13; Victoria, Southern Cameroons, 19. 52

Although there had been a stronger British presence in the Cameroons for well

over fifty years,76 it was the Germans that eventually annexed the territory in July 1884.

According to eyewitness accounts, the territory was considered to be under British

protection and the latter were persuaded that their possession would never be contested.

Despite the fact that the Cameroons River was governed by a Court of Duala chiefs and

the presence of two German traders alongside British traders, all disputes were referred to

the British Consul during his periodic visits.77 Victoria, to the west, was Baptist Mission

property and under British protection. As a result the people considered themselves

“English” due to the long acquaintance with English traders and missionaries, and

through some Duala chiefs petitioned the British Government to annex the territory. The

British crown responded to the letters by Duala chiefs with disappointing reluctance as it

was feared that an annexation of the territory would be an extra burden on British

taxpayers.78 The authenticity of such letters has, however, been questioned and

considered to be “fudged up by the traders of the Cameroons” to induce their home

governments to annex the territory with the ulterior motive of protecting their business

interest.79

The reluctance of the British crown to accept the invitation from the Duala chiefs,

despite increasing threats of a possible French encroachment from the west and south of

the territory and efforts by both British and German traders to get Britain annex the

76 William Hughes, Third Visit of the Rev. W. Hughes, Colwyn Bay, to the West Coast of Africa; Brief Account of the Cameroons, the Native Hymn and Tune Book, and the Native Churches of That Land With Correspondence (Wrexham, North Wales: Hughes & Son Printers, 1917), 3; Thomas Lewis, These Seventy Years: An Autobiography (London: The Carey Press, 1930), 69-70. 77 Ibid. 78 Ardener, Eye-Witnesses, 19-20. 79 Kenneth O. Dike, Trade and Politics in the Niger Delta, 1830-1885 (Oxford: Clarendon Press, 1956), 216-217. 53

territory, created a vacuum for a political coup by the German Chancellor, Bismarck.

Bismarck, a late comer to the colonial race succumbed to mounting pressure from the

German Colonial Society and changed his mind on German colonial aspirations.80

Bismarck was anxious to keep colonial affairs from the German parliament, the

Reichstag, which did not support with German overseas expansion. That anxiety greatly

influenced the nature of events that happened in German colonial circles in the early

years of the history of Cameroon.81 In early 1884 the British government appeared to

have a change of mind and instructed the British consul Edward Hewitt to the Bight of

Biafra while on furlough in Britain in May, to take over the Cameroons and arrange for

its formal annexation.82 Unfortunately for the British, Hewitt arrived the Douala few days

after Emperor Bismarck’s emissaries, Dr. Eugen Nachtigal and Dr. Max Buchner, with

the aid of the principal German traders in Douala, signed a treaty (Germano-Duala) on

July twelve and thirteen with Duala Chiefs (King Akwa and King Bell) with a German flag hoisted on July fourteen to symbolize the formal annexation of the territory. From the coast of the Cameroons River, the territory eventually extended over the area between the British colony of Nigeria and French Equatorial Africa. In the hinterland it stretched upward to Lake Chad and downward to River Congo covering a surface area of approximately 290,000 square miles with an estimated African population of 2,549,000.83

80 Harry Rudin, Germans in the Cameroons 1884-1914: A Case Study in Modern Imperialism (Archon Books, 1968), 29-43; Helmuth Stoecker, “The Annexations of 1884-1885,” in German Imperialism in Africa: From the Beginnings until the Second World War, trans. Bernd Zöllner (London: C. Hurst & Company, 1986), 21-38. 81 Great Britain, French Equatorial Africa and Cameroons, 243-244. 82 Tymms, The Cameroons, 16-17; Lewis, These Seventy Years, 70. 83 W. O. Henderson, The German Colonial Empire 1884-1919 (London: Frank Cass, 1993), 44. 54

Although the British and a cross-section of the African population strongly

opposed the treacherous move by Germany, the late arrival of Hewitt thwarted British

interest in expanding her colonial empire in West Africa. Not even a legal action by

Britain and protests by some Duala chiefs could overturn Bismarck decision. Through the

Germano-Duala Treaty, the local chiefs granted suzerainty and surrendered their rights of

sovereignty in the territory to the Germans making Douala the springboard for the

Germanization of the Cameroons and its hinterland. Like the circumstances surrounding

the letters allegedly written by the chiefs to the British crown, some of the chiefs such as

King Bell were enticed with bribes to sign the bogus treaty and the violation of some of

the clauses fomented political excitation for the objection of German annexation84

serving as a nursery of nationalist activities in Cameroon. Disappointed over Germany’s

annexation of the Cameroons, Consul Hewitt sailed to Victoria where he and fellow

British officers hoisted the Union Jack making the formal possession of the little piece of

land, with only ten miles of coast and a small township.85 The hoisting of the Union Jack

in Victoria not only sealed British possession of a territory purchased by the British

Baptist missionary but was also a challenge to Germany’s action in Douala days earlier

and a check to the latter’s expansion westward. The British eventually surrendered

Victoria to Germany following a peaceful settlement in 1887.86 Nonetheless, it was

84 Moses Levi, Mpundu Akwa: The Case of the Prince from Cameroon: The Newly Discovered Speech for the Defense by Dr. M. Lewis, ed. Elisa von Joeden-Forgey (Münster: Lit Verlag, 2002), 89-100. 85 Tymms, The Cameroons, 11-21; Lewis, These Seventy Years, 73. 86 J. A. Betley, “Stefan Szolc Rogozinski and the Anglo-German Rivalry in the Cameroons,” Journal of the Historical Society of Nigeria V, no. 1 (Dec., 1969): 101-136; 55 through political maneuvering that Germany obtained a foothold in the geo-strategic Gulf of Guinea region.87

German administration in Cameroon lasted thirty years, 1884-1914. In less than two years after the outbreak of World War one, Germany was ousted in Cameroon by

Allied forces and the former German territory was partitioned by Britain and France with

France getting a larger geographical share of the former German territory.88 France considered this as a regained lost opportunity to administer her sphere of Cameroon as part of the French Equatorial Africa territory. Unlike France, Britain for pecuniary reasons and convenience further divided her sphere of Cameroon into British Northern

Cameroons and British Southern Cameroons, with both British territories administered as appendages of the Northern and Southern (later Eastern) Regions of Nigeria under the colonial administrative system of indirect rule. This unusual ambiguous colonial administrative arrangement made Southern Cameroons a de facto substate of Nigeria, what some have referred to as “a colony of a region of a colony.”89 However, in retrospect the events of July 1884 were not just the basis for German rule in the

Cameroons, but marked a turning point in the history of the territory both in terms of the development of administrative apparatuses and healthcare. The rapid political events in

87 Calvert, The Cameroons, 2. 88 Great Britain (Foreign Office), Exchange of Notes Between His Majesty’s Government in the United Kingdom and the French Government respecting the Boundary Between British and French Cameroons (London: His Majesty’s Stationery Office, 1931), 3-26; Akinjide Osuntokun, “Anglo-French Occupation and the Provisional Partition of the Cameroons 1914-1916,” Journal of the Historical Society of Nigeria 7, no. 4 (June 1975): 647-656; Akinjide Osuntokun, “Great Britain and the Final Partition of the Cameroons 1916-1922,”Afrika Zamani 6-7 (Dec., 1977): 53-71; Peter J. Yearwood, “‘In a casual Way with a Blue Pencil’: British Policy and the Partition of Kamerun, 1914-1919,” Canadian Journal of African Studies 27, no. 2 (1993): 218-244; Lovett Z. Elango, “Anglo-French Negotiations Concerning Cameroon during World War I, 1914-1916: Occupation, ‘Condominium’ and Partition,” Journal of Global Initiatives: Policy, Pedagogy, Perspective 9, no. 2 (2014): 109-128. 89 Emmanuel Chiabi, The Making of Modern Cameroon: A History of Subsate Nationalism and Disparate Union, 1914-1961 (Lanham: University Press of America, 1997), 23. 56 the region discombobulate the future of the activities of Christian Missions in the

Cameroons especially of the Baptist Mission. Unlike her other colonies, German

Cameroon (Kamerun) was Germany’s most important colony in Africa which attracted most of the German emigration to Africa and was equally the main provider of resources, raw materials and human labor.90 Once Germany had firmly established her presence along the coastline, the expansion of their authority inland91 progressed in a manner akin to other colonies: the explorers followed by traders, then missionaries, and finally settlers. Missionary medicine tremendously aided annexation and advancement of the colonial project in the twentieth century. Advances in science, medicine and technology would, however, display their full potential and transformative possibilities only after the war of 1914.92 Without biomedicine, European expansion in many places in Equatorial

Africa would have been impossible and much costlier93 as medicine became a tool of empire.94

90 Karin U. Schestokat, German Women in Cameroon: Travelogues from Colonial Times (New York: Peter Lang, 2003), 1. 91 C. T. Hagberg Wright, “German Methods of Development in Africa,” Journal of the African Society 1 (1901): 23-38; P. Mullendorff, “The Development of German West Africa (Kamerun),” Journal of the African Society 2 (1902): 70-92; Elizabeth Dunstan, “A Bangwa Account of Early Encounters with the German Colonial Administration,” Journal of the Historical Society of Nigeria III, no. 2 (Dec., 1965): 403- 414; G. Osteraas, “The Best-Laid plans of Colonialism: German Cameroon Re-Examined,” Journal of the Historical Society of Nigeria VII, no. 3 (Dec., 1974): 571-577; Paul N. Nkwi, The German Presence in the Western Grassfields 1891-1913: A German Colonial Account (Leiden: African Studies Center, 1989); David Simo, “Colonization and Modernization: The Legal Foundation of the Colonial Enterprise; A Case Study of German Colonization in Cameroon,” in Germany’s Colonial Past, ed. Eric Ames, Marcia Klotz, and Lora Wildenthal (Lincoln: University of Nebraska Press, 2005), 97-112. 92 Melvin, E. Page, “Science and Technology (Africa),” in 1914-191-online. International Encyclopedia of the First World War, eds. Ute Daniel, Peter gatrell, Oliver Janz, Heather Jones, Jennifer Keene, Alan Kramer, and Bill Nasson (Berlin: Freie Universität, 2015). DOI: 10.15463/ie1418.10744. 93 Flavius Mokake, “Indigenous Perception and Resistance to Metropolitan Medical Therapy among the Littoral People of Colonial British Cameroons,” Tropical Focus: International Journal Series on Tropical Issues 11, no. 2 (2010): 108. 94 Daniel R. Headrick, The Tools of Empire: Technology and European Imperialism in the Nineteenth Century (Oxford: Oxford University Press, 1981), 52-81; Roy Macleod and Milton Lewis, eds. Disease, 57

The Advent of Christian Missionaries and Western Biomedicine

The history of Christian missionary activities or evangelization in British

Southern Cameroon is a sub-plot of the history of colonization in the territory. From the

outset Christian missionaries to Africa proclaimed themselves as the bearers of the ideals

of civilization. Perceiving Africa as a reflection of an earlier level of human

development, European colonial administrators and missionaries considered themselves

agents of inevitable changes that would eventually elevate Africans closer to the

European standard.95 The two principal tools for realizing this self-proclaimed mission were education and religion, through European-styled schools and Christian churches.

The spread of Christianity or evangelism was considered the foremost for the civilizing mission of the European colonialists. Africans were expected to adhere to the teachings of Christianity without question and to exchange one set of customs, beliefs and practices

fundamental to the African concepts of identity, religion and philosophy.96 Although

Christian missionaries predated the colonial state in Cameroon, the survival of both was

mutually reinforcing. Whereas in Europe religion followed the Crown in the

Christianization process, in many places in Africa and the colonial world the process was

the reverse, as was the case in colonial Cameroon.

Evangelization, conversion and other stock in the trade of Christian missionaries

was not always easy. Missionaries encountered enormous challenges: environmental,

cultural, health and above all stiff resistance from African rulers and their subjects; hence

Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion (London: Routledge, 1988). 95 Schestokat, German Women in Cameroon, 3. 96 Awoh, The Residue of the Western Missionary, 63. 58

specific conversion models were utilized – mainly education, healthcare and the

establishment of Christian villages (a nursery for new converts). Although strange

bedfellows from the beginning,97 the presence of the colonial state/power was critical to

the activities and progress of Christian missionaries in Africa in general and Cameroon in

particular.

The Christianizing mission in British Southern Cameroons dates back to the

arrival of the first batch of Baptist missionaries in 1842. At this time the territory was not

a colony of any European power but British presence in light of traders eclipsed other

Europeans. The early Baptist missionaries exploited the conviviality and friendliness of

European merchants to carry out their trade of preaching the gospel to the African

population whom they considered heathens. Groundwork for missionary activities dates

to the founding by Joseph Merrick of a mission station in Bimbia, a small village on the

Atlantic coast. A later batch of Baptist missionaries led by Alfred Saker visited the

Bimbia station in 1845 from the Spanish island of Fernando Po. While at Bimbia, they

deliberated on the possibility to visit the Cameroons (Douala) to the east; however ill-

health and death marred the initial plans of the missionaries.98 After the first visits of the

missionaries led by Saker, it would take almost a decade before Baptist missionaries

operating in the Spanish islands of Clarence and Fernando Po were informed by Don

Carlos Chacon, Commander of the Spanish Squadron and Governor-General of the

97 Renison M. Githige, “The Mission State Relationship in Colonial Kenya: A Summary,” Journal of Religion in Africa 13, no. 2 (1982): 110-125; Uoldelul Dirar, “Church-State Relations in Colonial Eritrea: Missionaries and the Development of Colonial Strategies (1869-1911),” Journal of Modern Italian Studies 8, no. 3 (2003): 391-410; Teresa Cruz e Silva, “Christian Missions and the State in the 19th and 20th Century Angola and Mozambique” Oxford Research Encyclopedia of African History. 28 Sep. 2017. http:// http://africanhistory.oxfordre.com/view/10.1093/acrefore/9780190277734.001.0001/acrefore- 9780190277734-e-182. 98 Saker, Alfred Saker, 42-44. 59

islands, of the Orders of the Spanish Crown proclaiming Catholicism as the only religion

on the island to the exclusion of every other religious practice.99

Persecutions became intolerable. The aggressive attitude with which the Spanish

authorities at the islands executed the order forced Saker and his collaborators to escape

to Bimbia. The expulsion of the missionaries offered them the opportunity to execute

their previously conceived plan to carry the gospel into the mainland. By June 1858

Saker accompanied by his Christian flocks set sail twenty miles across the sea between

Clarence and the settlement (piece of land in Ambas Bay bought from King William of

Bimbia) named Victoria, in honor of Queen Victoria of England.100 Over the years

Baptist mission stations grew steadily with additional stations opened in remote inland

areas with the arrival of more missionaries. Political changes (colonization of Cameroon)

and turbulence on the world stage (World War I) greatly affected the business and growth

of the Baptist Mission in Cameroon.101 The growth of the activities of the London Baptist

Society in the Congo and the annexation of Cameroon in 1884 force the Baptist to

abandon their work in Cameroon to another organization.102 The Basel Mission took over

most of the Baptist Stations, however differences in dogma, church organization and

discipline caused the Native Baptist Church to separate from the Basel Mission.103 The

Native Baptist preachers operated independently until a number of setbacks forced them

to solicit external help and in 1891 a missionary was sent to Victoria by the German

99 Ibid., 143-147. 100 Ibid., 149-153. 101 Hughes, Third Visit of the Rev. W. Hughes, 3; Eric Hallden, The Culture Policy of the Basel Mission in the Cameroons 1886-1905 (Lund, 1968), 15-70. 102 Victoria, 32. 103 Ibid., 39. 60

branch of the American Baptist Society, formed in 1890. After World War One, the

American Baptist missionaries nonetheless increased their presence in the territory

especially around Victoria and Soppo, near Buea, but by 1935 had opened a station in the

Grassfields region, specifically at Mbem.104 It was also at Mbem that the first Baptist

clinic was opened. From the clinic at Mbem, the missionary nurse, Laura Reddig, helped

establish a leprosy hospital in Bamenda when the North American Baptist Mission

accepted the request from the British colonial Administration in 1952.

The Germanization of Cameroon greatly changed the dynamics of missionary

activities in Cameroon. As soon as the Germans set-up effective administration in the

territory, German propaganda against English Baptist missionaries increased.105 German

newspapers published a cartoon of bearded Baptist missionaries in Cameroon accusing

them of inciting the African population and stirring trouble in the new colony. This

brewed tension between the Germans and British in Cameroon. The simmering tension

between the two bodies first erupted over the language to be taught in the schools in

Cameroon. The German colonial administration legislated that pupils should be taught

solely in German especially as schools were sites for acculturation and the propagation of

the colonial idea.106

As soon as the conflict between the Basel Mission and the German Reich was

resolved in the 1880s, Basel Mission took interest in establishing mission stations in

104 Hughes, Love Them for Me Laura, 30-33. 105 Lewis, These Seventy Years, 78. 106 Kenneth J. Orosz, Religious Conflict and the Evolution of Language Policy in German and French Cameroon, 1885-1939 (New York: Peter Lang, 2008). 61

Cameroon.107 In 1890 the Baptist Churches of Germany formed a Missionary Society known as the Basel Mission which eventually began mission work in Kamerun.108

German Basel missionaries visited the German colony from their mission station in

Accra. Their visit was not made public to the Baptist missionaries who only later found them at the Mission House at Bethel (Douala) one evening.109 The unannounced visit of the Basel missionaries emphasized the determination of the Germans to take total control of evangelization in the colony. Despite the surreptitious moves by the Germans, the

Baptist Missionaries, with the backing of the British colonial government, were not willing to relinquish their possession in Victoria easily.

After long negotiations between the Baptist Missionary Society and the German

Chancellor, Bismarck, the Germans agreed to purchase Victoria. However, the Baptist

Missionary Society agents were not shrewd negotiators and ended up receiving a minimal compensation for their property in Victoria.110 Bismarck approved the payment of four thousand pound sterling to be paid to the British Baptist Missionary Society on behalf of the German Empire for the former’s property in Victoria and the Cameroons which included landed-property, mission-houses, chapels and schools. The agreement equally provided for the “maintenance of full religious liberty and equality, the equitable treatment of all persons having business relations with the society or its agents, and a contribution towards a new chapel for Baptist Christians if they found the services of the

107 Hallden, The Culture Policy, 21-22. 108 Tymms, The Cameroons, 23-24. 109 Lewis, These Seventy Years, 87. 110 Tymms, The Cameroons, 20-21. 62

new Mission unacceptable.”111 With the British Baptist missionaries forced to leave and with the support of the German Reich, the Basel Mission took-over the mission-field in

December 1886 with much of their work mission centered in Douala. It is noteworthy to mention that until 1890s only the Douala area constituted the Cameroons; however, when

Buea was subdued in 1894 as a result of the Bakweri-German War and the transfer of the capital of German Kamerun from Douala to Buea in 1902 the expansion of the German territory began in earnest and gained traction within a short time.

After the first station in Victoria, the Basel Mission subsequently opened stations in Buea (1891), Nyasoso (1896) and Bombe (1897), and Buea became the headquarters of the Mission from whence mission work spread to the rest of the Cameroons.112 In 1903

the first Basel Mission station was opened in Bali by Rev. Ernst to be followed by other

stations in the Bamenda or Grassfields region. The steady growth of the Basel Mission

was, however, disrupted by the outbreak of war in 1914 which equally led to the

expulsion or internment of German missionaries in places such as the Bermuda or the

British colonies of Sierra Leone before deportation to Germany via Britain.113

Allegations of ill-treatment of German subjects captured in the Cameroons were,

nonetheless, strongly refuted by the Colonial Office in London.114 With the eviction of

German missionaries, the work of the Basel Mission rested in the hands of an Australian,

Rev. Rhode and Rev. J. L. Ekese, the first African pastor ordained on the 14th April

111 Ibid. 112 Victoria, 33. 113 W. Stark, The Martyrdom of the Evangelical Missionaries in Cameroon 1914: Reports of Eyewitnesses (Berlin – Steglitz, 1915). 114 Great Britain (Foreign Office), Correspondence Relative to the Alleged Ill-Treatment of German Subjects Captured in the Cameroons (London: His Majesty’s Stationery Office, 1915). 63

1917.115 Although the German missionaries had been evicted as a result of the partition

of the German colony, in 1924 the Basel missionaries were allowed to return to the

British sphere of the Cameroons and revamp mission activities well beyond the Second

World War. When talks and negotiations for the establishment of a leprosarium in the

forest region in British Southern Cameroons had heated up, the Basel Mission agreed in

1948 to open one in Manyemen where it had a mission station.116

Catholic missionaries were also strongly present in the territory especially at

Bonjongo, Soppo, Buea, and Kumbo but for the purpose of this study we have limited our

discussion on the advent of Christian missionaries to the Baptist and Basel Missions, the

two Christian organizations that operated leprosy settlements in British Southern

Cameroons.

Leprosy: Etiology, Prevalence and History

Leprosy is a disease with a sensational and convoluted history first because of its

biological attributes and second the complexity of its treatment.117 In fact leprosy, its

epidemiology and treatment has perplexed humanity for centuries and more so in Africa.

Leprosy as a disease does not physically kill its victims, but when patients remain

untreated it causes distinctive physical deformities and unlike other infectious diseases

creates a category of the “socially excluded that is distinct from other forms of

‘untouchability’” in affected societies.118 Although leprosy does not often kill, there has been disturbing indifference from some who have not resided in countries where the

115 Ibid., 35. 116 Ndike, “Mission through Healing,” 13. 117 Silla, People Are Not The Same, 19. 118 James Staples, Peculiar People, Amazing Lives: Leprosy, Social Exclusion and Community Making in South India (New Delhi, India: Orient Longman, 2007), 1-3. 64

disease is or was prevalent to fathom how terrible is the scourge. Leprosy does not kill

but it maims, and it is a lingering disease that causes awful disfiguration of bodily

features, festering ulcers and in its advanced phase, excruciating pain and insomnia.119

Due to leprosy’s hypoesthesic effect its victims often lose fingers and toes making the

leper such a difficult sight inspiring more horror than pity to most people, even to their

nearest relatives causing the leper to drift to the margins of society in the worst scenario

or a leprosarium where available. Staples argues that marginalized people often make

meaningful choices without necessarily upsetting the structural causes of their

marginalization.120 Livelihood at the margins of society, in the case of living in isolated

leprosy settlements, provided leprosy sufferers with a space to challenge the social

structures that concurrently oppress and enable them. As such leprosy does not only

affect the body of its victims but also the self – the victim’s identity and personhood as a

result of the high stigma associated with it.

The biology of leprosy has left mankind bewildered for centuries. To this date the

medical world is still grappling with the challenge of understanding the disease,

compounding eradication efforts. Until very recently the etiology of leprosy has been

cloaked by myths engendering the stigma that surrounds it.121 Contemporary medical

literature describes leprosy as a chronic disease caused by the Mycobacterium leprae

119 The Fight against Leprosy being the Annual Report for 1929 of The British Empire Leprosy Relief Association (London, 1929), 7; Vongsathorn, “Gnawing Pains, Festering Ulcers and Nightmare Suffering,” 863-878. 120 James Staples, “Begging Questions: Leprosy and Alms Collection in Mumbai,” in J. Staples, Livelihoods at the Margins: Surviving the City (London: Routledge, 2007), 163-186. 121 James Diamond, Converts, Heretics, and Lepers: Maimonides and the Outsider (Indiana: Indiana University Press, 2006); Luke Demaitre, Leprosy in Premodern Medicine: A Malady of the Whole Body (Baltimore: John Hopkins University Press, 2007); Navon, “Leprosy’s Transformation into a Symbol of Stigmatization,” 315-335. 65

(commonly referred to as Bacillus leprae or Hansen’s bacillus) characterized by skin

lesions, mucosae, damaged nerves and deformities.122 Leprosy is also known as Hansen’s

disease named after Gerhard Hansen, the Norwegian physician who identified the

bacteria that causes it. Before this medical breakthrough, it was widely believed that

leprosy was either hereditary or cause by the wrath of God as punishment for sins.123

According to the medical ethnography of Africa, disease is grouped under three, although

not mutually exclusive, categories: illnesses of [caused by] people, illnesses caused by

the ancestors and illnesses of god/natural illnesses.124 The organism that causes leprosy

belongs to the same mycobacteria family responsible for tuberculosis. However, leprae

bacillus is distinguishable from the tubercle bacillus in terms of their arrangements, size

and structure.

Medical specialists have identified two forms of leprosy: the tuberculoid form and

lepromatous form. The tuberculoid form is the less aggressive type and it usually

manifests in people with well-developed immunity. In this form the bacilli affect one or

few sites on the skin and peripheral nerves causing swelling and early damage to the

sites.125 This form can heal spontaneously without treatment. The lepromatous form is the

more severe form and although it was less rampant, most of the cases treated at the

settlements in Cameroon were lepromatous cases. When the lepromatous bacilli attack a

person with weaker immunity, it multiplies and spreads as septicemia to all parts of the

122 Howard E. Thomas, “A Study of Leprosy Colony Policies” (master’s thesis, Cornell University, 1943), 18. 123 Diamond, Converts, Heretics, and Lepers; Demaitre, Leprosy in Premodern Medicine. 124 Robert Pool, Dialogue and the Interpretation of Illness: Conversations in a Cameroon Village (Amsterdam: Aksant Academic Publishers, 2003), 171-188. 125 Silla, People Are Not the Same, 20. 66

body causing widespread nerve and tissue damage.126 This form is characterized by

higher concentration of bacilli, more contagious and is therefore considered the common

source of the disease’s transmission. The lepromatous form also affects bones and organs

like the eyes, nose and testes.

The mode of transmission of leprosy remains controversial and an unresolved

puzzle to medical experts.127 Medical specialists disagree on how individuals contract

leprosy but speculate that the bacillus is ingested from nasal fluid through the respiratory

tract, the skin and possibly the gastrointestinal system. It is believed the risks of infection

increase “by living in close contact with an untreated person for a prolonged period of

time” as well as the ‘infectiousness of the leper.’128 However, it is also generally believed

that the infection spreads throughout the body basically by three known agencies: the

lymph spaces, blood stream and auto-inoculation. Despite the mild to severe damage leprosy causes on the body, the disease has a gestation period of between two to four years for an infected person to develop visible symptoms.129 It is known that some

individuals infected with the bacillus never develop any illness. Unlike past belief,

leprosy is not hereditary but family members of patients stand at greatest risk as a result

of sharing a common living space.130 Yet, person-to-person transmission is very negligible when compared with diseases like smallpox, measles or meningitis. Diagnosis of the disease is commonly based on clinical signs and symptoms. According to the

126 Ibid. 127 Paul E. M. Fine, “Leprosy: The Epidemiology of a Slow Bacterium” Epidemiologic Reviews 4 (1982): 163. 128 The Infectiousness of Leprosy, PCCCAL. 129 Silla, People Are Not the Same, 20. 130 K. George, K. R. John, J. P. Muliyil and A. Joseph. “The Role of Intrahousehold Contact in the Transmission of Leprosy,” Leprosy Review 61 (1990): 60-63. 67

World Health Organization (WHO) leprosy is diagnosed clinically through skin lesion

consistent with the disease and with definite sensory loss, with or without thickened

nerves, or positive skin smear.

Leprosy is an ancient disease, perhaps, one of few diseases mentioned in the

Bible. It has been one of humanity’s greatest health menaces since the early modern era.

Although it is generally believed that the skin conditions described in the Bible were all

not cases of leprosy, ancient Egyptian and Greek texts describe skin disease akin to

leprosy. Evidence on the existence of leprosy could also be found in literary texts and

folklores, especially in places like China and India where the disease has remained

endemic.131 In some instances, leprosy was confused with another skin condition,

elephantiasis, although it is believed the latter condition is not what we call elephantiasis

today. In spite, the confusion that surrounded the disease in the early period, it remained a

health nuisance for several centuries. However, the treatment victims received remained

unchanged throughout these centuries. The reaction towards people with leprosy was

always discrimination, isolation and in some cases persecution largely because of the fear

of contagion.

Whereas leprosy has been almost eradicated in Europe between the fifteenth and

seventeenth century, with the exception of countries like Iceland, England and Norway,

leprosy has remained a scourge in the developing world especially in Asia, Africa and the

131 Bryon L. Grigsby, Pestilence in Medieval and Early Modern English Literature (New York: Routledge, 2004), 1-11; Bassey Ebenso et al. “Using Indigenous Proverbs to Understand Social Knowledge and Attitudes to Leprosy among the Yoruba of Southwest Nigeria” Journal of African Cultural Studies 24, no. 2 (2012): 208-222. 68

Pacific Islands in areas where poverty level is high and sanitation low.132 The remarkable

rapid decline of the disease in Europe with the long history of the disease could be

attributed to the rigid regulations for segregations enforced across Europe.133 Historical evidence points to very draconian measures adopted in Europe in a bid to enforce strict regulations and the isolation of patients from the population.134 The ‘otherization’,

‘seclusion’, and ‘compulsory confinement’ campaigns together with cleansing rituals in

churches were the principal measures adopted to ‘purge’ European societies of the dual

nuisance of leprosy and lepers. While leprosy was dwindling in Europe, the disease was

introduced or increased in other parts of the world in consonance with the pattern of

European colonization of the world and mass movement of people across the globe as a

result of the revolution in the technology and transport sectors that facilitated

migration.135 By the turn of the nineteenth century, thanks to the power of modern

steamship transport, diseases, including leprosy, were transported around the world

“infecting and establishing new endemic centers” off their historic foci.136 The relocation

costs of European migration to other parts of the world were a higher burden, in terms of

disease, on the people in the destinations than on the European sojourners.

132 Illife, The African Poor, 214-224. 133 Risse, “Hospitals as Segregation and Confinement Tools,” 167-229. 134 Tony Gould, Don’t Fence Me In: Leprosy in Modern Times (London: Bloomsbury, 2005), 1-21; Kerri A. Inglis, Ma’I Lepera: Disease and Displacement in Nineteenth-Century Hawai’i (Honolulu: The University of Hawai‘i Press, 2013), 46-77. 135 Thomas, “A Study of Leprosy Colony Policies,” 11-16; William H. McNeill, Plagues and Peoples (New York: Anchor Books, 1976), 94-241; Headrick, The Tools of Empire, 3-16; Daniel R. Headrick, The Tentacles of Progress: Technology Transfer in the Age of Imperialism, 1850-1940 (Oxford: Oxford University Press, 1988), 3-17; Daniel R. Headrick, Power Over Peoples: Technology, Environments, and Western Imperialism, 1400 to the Present (Princeton: Princeton University Press, 2010). 136 Curtin, Death by Migration, 1-103; John Alberth, Plagues in World History (Maryland: Rowman & Littlefield Publishers, 2011), 61. 69

In the first decades in the colonial era new disease were introduced in European

colonies in Africa and Asia, or the disruption of social and environmental stabilities

triggered a steady rise disease outbreak in Africa.137 Currently one of six neglected

diseases in Africa, leprosy remains one of the most awful diseases in Africa and other

tropical countries.138 In the early nineteenth century, victims of leprosy were

discriminated against and forgotten people forced to live in the margins of society

because of their usually pitiable sight. It is difficult to historicize the prevalence of

leprosy before the twentieth century largely because of the absence of sources, however,

the existence of leprosy in Africa cannot be denied as some sources argue that the leprosy was brought to the Americas in the eighteenth century by Africans sold into slavery. It has equally been argued that leprosy is a disease of poverty and was therefore prevalent in areas with abject poverty in Africa as much as it engendered poverty especially in the hot and humid equatorial region.139 At a time when the miasma theory of disease was en

vogue, some leprologists associated leprosy with pollution and other chemical agents

produced by fermentation or atmospheric processes as well as other dietary and climatic

factors.140 Thus, it was suggested that an important factor in the causation of leprosy was

either hot and damp climate or cold and moist climate, typical of the Equatorial region.

Generally leprosy victims were shabbily treated and with intolerance in their

communities. However, the dread was not as a result of death but the long years of

137 See anthology edited by Mario J. Azevedo, Gerald W. Hartwig, and Karl D. Patterson, Disease in African History: An Introductory Survey and Case Studies (Duke University Press, 1978). 138 Peter Hotez, Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and their Impact on Global Health and Development (ASM Press, 2008). 139 Iliffe, The African Poor, 214-216. 140 Neel Ahuja, “‘An Atmosphere of Leprosy’: Hansen’s Disease, the Dependent Body, and the Transoceanic Politics of Hawaiian Annexation,” in N. Ahuja, Bioinsecurities: Disease Interventions, Empire, and the Government of Species (Durham: Duke University Press, 2016), 29-70. 70

suffering that it condemns its victims. The encounter between Africans and Europeans in

the twentieth century not only reinforced the fear of leprosy but arrogated to it extra

importance and status, making leprosy a disease apart – better still a separating disease as

leprosy asylums started mushrooming across the continent after the Second World War.

Victims were now defined by their condition and that transformed their lives and

relationships.

Besides the new identities that leprosy molded, there was a sense of

consciousness and community among its sufferers, and the community that emerged in

the missionary leprosy treatment centers “became the basis of new collective identities

distinct from those associated with a life of individual isolation in more rural areas”141 in

which victims were deprived of social and economic powers, regained in the leprosaria.

Such developments were recorded in leprosy endemic regions in colonial Africa

including German Cameroon. Apparently leprosy constituted a major public health

problem to the colonial administration in the territory forcing the administration to

conduct a leprosy survey in Cameroon in 1908 and began agitating for leprosy

settlements where patients would be treated and kept away from the health

communities.142 It was reported that between 1909 and 1910 there were about twenty thousand leprosy sufferers in the colony. Although the eviction of Germany from

Cameroon disrupted these pioneer efforts at controlling leprosy, it nonetheless set the

groundwork for the establishment of leprosy settlements to provide treatment and control

leprosy in British Southern Cameroons.

141 Silla, People Are Not the Same, 26-27. 142 Rudin, Germans in the Cameroons, 348-349. 71

Conclusion

This chapter has presented an overview of the events leading to German

annexation of Cameroon and those surrounding the coming of Christian missionaries in

Cameroon in the nineteenth and twentieth centuries. Although Britain had a strong

presence in mid-nineteenth century, it was Germany that took advantage of Britain’s reluctance to favorably honor repeated requests from the Cameroons and annexed the territory in July 1884. The annexation of Cameroon triggered a Germanization process through territorial expansion and effective government. As soon as the territory was acknowledged as a German protectorate and cartographed on the charts of European powers, the next question faced was the one of ruling the possession through effective administration. By the time the war broke out in 1914, German administration in

Cameroon had been installed as far as Mora in the north close to the border of Lake

Chad. Six German colonial Governors administered the territory from Buea, the administrative capital, before they were ousted by Allied forces led by Britain and France in 1915. However even before the territory was formally annexed, Christian missionaries operated mission station. Relations between the colonial state and missionaries were not always cordial. Changes in the administration and global events such as the First World

War greatly hampered the conviviality between colonial administrators and missionaries in Cameroon leading to the eviction of missionaries of denominations considered hostile by the administering colonial authorities at different periods. Their differences notwithstanding, both the colonial government and missionaries encountered similar challenges in dispensing their arrogated responsibilities in the colony. Disease and the 72 health of the population preoccupied both the colonial state and missionaries alike as both needed healthy colonial labor and converts to advance the colonial agenda. As such, despite the ensuing tensions, both organizations were condemned to collaborate at various times in order to ensure the health of the population at a satisfactory level especially against disease inimical to the health of the general public such as leprosy.

This common challenge led to the introduction of Western biomedicine, first by missionaries and later the colonial state, and the eventually establishment of leprosy settlements in British Southern Cameroons in the 1950s.

73

Chapter Three: The Leprosy Menace and the Establishment of Leprosy Settlements

(1916-1954)

Introduction

This chapter focuses on leprosy control efforts before and after leprosy settlements were established in the territory under British administration. It discusses the pioneer efforts taken by the colonial administration to control the spread of leprosy as well as manage the conditions of leprosy patients. The discussion in this chapter falls broadly under the periods 1916 to 1940, wherein the non-existence of leprosy settlements and institutionalized care lead to haphazard attention and deficit in care given to the disease and its victims, and 1940s to 1950s when talks and concrete steps were taken to establish settlements to provide regulated care to victims of leprosy. Specifically, the chapter examines the debates and concerns that informed the establishment of leprosy settlements; it highlights the role of the different actors (colonial administrators, missionaries, and native administration authorities) in the provision of institutionalized care to leprosy sufferers, as well as the manner in which the disease affected the administrative machinery in the territory.

Leprosy and Anti-Leprosy Measures in German Kamerun

The leprosy scourge predates British colonial rule in Cameroon. Leprosy was part

of the onerous baggage inherited by British colonial administration from the Germans in

Cameroon, just as the former’s healthcare policy and infrastructure were, to a large

extent, a continuation of the latter’s.143 Although to our knowledge there is no

143 Flavius M. Mokake and Henry K. Kah, “The Impact of German Colonial Policies on Public Health Initiatives in British Southern Cameroons, 1884-1961,” in Germany and Its West African Colonies: 74

documented evidence on the existence of the disease in precolonial Cameroon, existing

German documents indicate the presence of leprosy sufferers at the onset of German

administration in Kamerun and the disease was one of the causes of high morbidity and

mortality among the indigenous population. This implies that leprosy, like malaria,

smallpox, sleeping sickness, and yellow fever, accounted for the unsatisfactory health

conditions of the population in the territory that later became German Kamerun in 1884.

In the beginning of the twentieth century, it was observed that there was a steady decline

in the population attributed to the widespread of disease caused by factors such as the

activities of the ever-increasing number of porters (carriers) as a result of the deficient

transport (railway) network, which helped in the spread of devastating disease and

plagues like dysentery, sleeping sickness, venereal diseases and leprosy, as well as

practices that contravened hygiene, humanity and the activities of some indigenous

‘medicine-men’.144

Documented sources on the German period indicate that unbeknown to the

colonial administration, leprosy was widespread in the colony.145 Consequently, the

disease and its victims remained under the radar of the colonial administration as the

latter was busy expanding its administrative units within the territory. By 1910, however,

the gravity of the leprosy problem became more apparent causing the German colonial

administration to undertake a study on the disease in the territory. Even though the first

‘Excavations’ of German Colonialism in Post-Colonial Times, ed. Wazi Apoh and Bea Lundt (Berlin: LitVerlag, 2013), 93-118. 144 Robert Kuczynski, The Cameroons and Togoland: A Demographic Study (London: Oxford University Press, 1939), 33-34. 145 Rudin, Germans in the Cameroons, 348; Asongwe, “The Fight Against Leprosy in British Southern Cameroons,” 32. 75

survey on record was not thorough because of communication challenges and limited

number of personnel in a modest healthcare system, it was found that, besides the high

incidence of sleeping sickness, there were at least an estimated 20000 leprosy patients in

the entire territory.146 In spite of the cruelty and ruthlessness of German colonial

administrators towards Africans,147 German doctors, bacteriologists and epidemiologists were sent to Kamerun to study the etiology and epidemiology of the most life-threatening health problems. The increase in the budgetary allocation to combat leprosy from five thousand Deutsch Marks in 1910 to eleven thousand in 1912 was an indication of the gravity of the scourge in the territory.148 Although we do not have micro statistics of its incidence in specific districts, the location of the first leprosy camps (an isolated area for leprosy patients) in strategic localities is suggestive of the endemicity of leprosy in those areas.

Having evaluated the magnitude of the problem in her protectorate, in 1911 the

German colonial administration made appropriations for anti-leprosy campaigns.149 Upon

the discovery of the seriousness of the problem, the German satrap in Kamerun, Theodor

Seitz, informed chieftains and advised them on the urgency for the establishment of leper

settlements for the isolation and treatment of infected persons away from settled

communities. The principal measure taken was to erect small huts in isolated areas from

146 Kuczynski, The Cameroons and Togoland, 62-63. 147 Albert-Pascal Temgoua, “Souvenirs de L’epoque Coloniale Allemande au Cameroun: Temoignages des Camerounais,” in The Politics of Colonial Memory in Germany and Cameroon, eds. Stefanie Michels and Albert-Pascal Temgoua (Münster: Lit Verlag, 2005), 25-36. 148 Alfred Mansfeld, “Bezirksamtmann, 'Das Lepraheim in Ossidinge-Kamerun” Koloniale Rundschau (Dec., 1912), 788. 149 Rudin, Germans in the Cameroons, 349. 76

villages with money from both the colonial administration and the African population.150

The modesty of this scheme notwithstanding, by the close of the German era leper huts

had been erected in places like Baïgam (Foumban), Yaounde and Ossidinge (later known

as Mamfe). In fact, the first leper camps for the isolation of leprosy sufferers in the

section of German Kamerun, later administered by Britain, was established in Ossidinge,

perhaps because of the high prevalence of leprosy in that deep equatorial forest area as

shown by a survey conducted in 1909.151 The gradual Christianization of the African

population, the collaborative activities of the missionaries and the commodification of

European culture did little in changing the attitude of the population towards leprosy and

its control. If anything, it was observed that the message of the missionaries who

preached against the sin of nudity and a “gospel of redemption through clothing” led to

the urge for European-styled clothing especially among the littoral people of

Cameroon152 inimical to the efforts to control leprosy as it was noticed that some

Africans attempted to conceal their leprous condition with the cassock-like European

dress.153

The remoteness of Ossidinge from the main colonial government stations

necessitated the need to open other leper camps close to these stations to ease

administrative supervision. Although the over centralization of health facilities around

colonial administrative stations constituted a show of inequality, and laid the foundation

150 Ibid. 151 Alfred Mansfeld, Urwald-Dokumente: Vier Jahre Unter den Crossflussnegern Kameruns (Ernst Vohsen, 1908), 240; Mansfeld, “Bezirksamtmann, 'Das Lepraheim in Ossidinge-Kamerun,” 733-8. 152 Flavius M. Mokake, “The Kabba Dress: Identity and Modernity in Contemporary Cameroon,” in eds. Akanmu G. Adebayo, Olutayo C. Adesina and Rasheed O. Olaniyi, Marginality and Crisis: Globalization and Identity in Contemporary Africa (Lanham: Lexington Books, 2010), 71-80. 153 Rudin, Germans in the Cameroons, 380. 77

of persistent domination and control under the guise of disease control. Unsuccessful

attempts were equally made in the beginning of the twentieth century to quarantine

infected people at an isolation camp on the island of Mondoleh [Mondoli], otherwise

known as Leper Island, in the Atlantic Ocean off the coast of Victoria.154 The camp was

quickly closed because the population was unwilling to send members of their family away from them to the isolated island in which poor communication with the mainland restrained frequent visits. The leprosy control scheme during the German era was gaining

grounds but unexpectedly interrupted by the outbreak of World War One. As with other

German colonial projects in Kamerun that were prematurely abandoned, German colonial

health programs including the anti-leprosy scheme suffered severely155 jeopardizing the

hopes of leprosy patients.

The period between the outbreak of the war and the transitory period to British

rule was most unfavorable to the territory and its leprosy victims. The protracted

hostilities as a result of the war involuntarily muted energy towards the development of

the health and medical services in the territory. For example, the anarchy during this

period caused the lepers to vacate and abscond from the special huts/camps that had been

allocated them with the effect that sequestered sufferers became once more scattered

across the territory.156 Assuming the level of destruction of property during the war, it

can be assumed that limited medical facilities that could benefit the African patients of

various diseases were devastated in the course of the retreat of the Germans in their

154 League of Nations Permanent Mandates Commission Report of the Twenty-first Session (Geneva, 1931) 55. 155 Mokake, “The Impact of German Colonial Policies,” 103. 156 Kuczynski, The Cameroons and Togoland, 68. 78

various administrative stations in Kamerun.157 This disrupted the welfare schemes of the

British colonial administration and dashed the hopes of patients immediately the war

ended. It is difficult to assess the achievement of the fight against leprosy during the

German era because of the unavailability of statistics, but the rarity of leper colonies or settlement suggests minimal success in controlling leprosy. However, it is safe to conjecture that the anti-leprosy forerunner initiate was able to raise some degree of

awareness of the danger of living or communing with infectious or leprous cases.

Leprosy under British Administration: A Mismatch of Word and Action (1916 –

1940s)

The interregnum between the eviction of the Germans and the arrival of British

administration in the territory posed a major setback to social welfare services in general

and leprosy work in particular. The destruction, looting and plundering as a result of the

war and several months of relative inactivity put on halt the activities of the colonial

medical service in the territory. Between 1916, when the British instituted provisional

administration in the Cameroons, and 1922, when the territory formally became a British

mandated territory sanctioned by the League of Nations (LoN), there was limited

presence of the colonial welfare services especially in the remote areas where disease was

rampant. However, social policy as mandated by the LoN – and later the United Nations

Organization – was negotiated between different institutional and non-institutional actors

and translated generic institutional principles into regulations that managed the encounter

157 Ibid. 79

between the European administrators and the Africans.158 The unavailability of

documented evidence or colonial reports on leprosy control in the first years of British

administration speaks to the relative malignant neglect of the plight of leprosy patients by

the British administration. The absence of statistics of leprosy cases in the early colonial

reports was possibly because as families and communities banished lepers as the disease

become more obvious, these victims of the disease often retreated into the bushes and

enclaved areas rendering it difficult for the colonial administration to capture a relatively

accurate magnitude of the problem. As was characteristic of this period in the territory’s

history, Britain was busy grappling with the question on whether to allow non-British

citizens in any sector of the colonial service.

Although progressively the health of the colonial population moved up the agenda

of the British administration in Southern Cameroons, leprosy continued to be neglected

throughout the 1920s as evident in its footnoted status in the LoN Reports and the Annual

Medical Reports of the first half of that decade. The outbreaks of the Influenza in 1918

and Smallpox in 1923 was the first test of the seriousness of the British colonial medical

service in its nascent years. However, in the 1925 LoN Report mention was made of the

relative prevalence of leprosy across the territory at Banso and Mamfe in the grassfields

and forest areas respectively.159 Leprosy was, however, particularly endemic in the

Mamfe district reported by the Medical Officer stationed in the district. In a letter to the

Assistant Director of Medical Services at Calabar, Dr. Dyce-Sharp reported that leprosy

158 Caroline Authaler, “Negotiating ‘Social Progress’: German Planters, African Workers and Mandate Administrators in the British Cameroons (1925-1939)” in The League of Nations’ Work on Social Issues: Visions, Endeavors, and Experiments, eds. Magaly R. Garcia, Davide Rodogno and Liat Kozma (New York: United Nations Publications, 2016), 47-56. 159 Ba (1925) 6, League of Nations Report 1925. 80 was distressingly frequent with over a dozen leprosy patients receiving treatment each week at his station in Mamfe.160 Describing the endemicity of leprosy and the hopelessness of lepers in Mamfe, one District Officer wrote:

To us the real citizens of Mamfe, leprosy is counted as a group of Beasts of Prey

attacking a helpless band of travelers through a forest.

In 1928, for instance, it was estimated that there were about 200 lepers in Mamfe

Division and Dr. Libert, the M.O. then, noted the reluctance of infected persons accept treatment except they were guaranteed that they would not be isolated against their wish or benefit from tax exemption.161 In order to persuade lepers to come forth for treatment, the administration considered freeing segregated patients from the responsibility of paying tax. Those who stubbornly chose to remain in their community were obliged to pay taxes except those who presented a medical certificate stating their inability to pay tax on health grounds, although only male patients could benefit from this largesse.162

This possibly accounts for the gender disparity in hospital attendance for leprosy treatment in 1930s even though increasingly more women presented themselves for treatment in later years when the discriminatory policy was abandoned.

Although the incidence of leprosy was seemingly higher in Mamfe, it was felt that it was premature to consider founding a segregation colony in the division as what was necessary was to build confidence among the African population in the segregation scheme. Reporting the practice of concealment by patients, the 1925 LoN Report went further to describe how the fear of segregation inherited from the German colonial era

160 Sc/a (1936) 3, Scheme for the Control of Leprosy in Nigeria, 12. 161 Sc/a (1936) 3, Memo from the District Officer Mamfe to M.O. Mamfe, 1st August, 1937. 162 Sc/a (1956) 1, Male Lepers and Tax Payment, 107. 81

deterred patients from seeking treatment. It was common for patients to cover their

leprous body or limps with gowns and wrappers to conceal their misfortune thereby

avoiding treatment. The non-practice of compulsory segregation in the districts where

leprosy was prevalent and the liberty with which patients lived freely among the rest of

the population increased the risk the propagation of the disease.163 It was reported that in

some clan areas lepers were isolated from the rest of the community and food

occasionally brought to them by relatives whereas in other areas lepers roamed about

freely in the community.164 Although leprosy was generally attributed to poverty and poor hygienic condition among the population, ecological and social destabilizations as well as increased mobility triggered by colonialism are equally culpable for the increase in leprosy cases in Southern Cameroons.165 Colonialism generally had injurious

consequences as its political and economic systems disrupted the lives of the colonial

people, created inequalities and laid the groundwork for damage.166 The establishment of

colonial plantations led to movement of people, at an unprecedented scale, especially

163 Ba (1925) 6, League of Nations Report, 1925. 164 Sc/a (1926) 4, “Report on Lepers in Bamenda Division” in Leprosy Control Policy. 165 Md/e (1952) 1, Petition from Sama C. Ndi to Mr. Gilbert Schneider, Cameroon Baptist Mission, Belo, 27th March, 1952. 166 Helen Tilley, “Medicine, Empires, and Ethics in Colonial Africa,” AMA Journal of Ethics 18, no. 7 (2016): 745. 82

from the Grassfields to the coastal plantations167 leading to severe health consequences

on the population in both the supplying and receiving districts.168

With the increasing arrival of colonial administrative and medical personnel in the

territory, efforts at controlling leprosy equally received a boost. To attend to the needs of

the several deserted leprosy patients loitering the communities around the Bamenda area,

the British under the Native Administration (NA) system opened the first leper

camp/colony (later called settlement) in April 1928 at Bafreng, one and half mile from

Bamenda, including a subsidiary colony at Kumbo (Nso) started in 1931.169 By June

1928, there were thirteen resident lepers at Bafreng with shacks constructed and farmland

provided for the cultivation of foodstuffs and the farm produce sold in local markets. By

the end of 1932, there were eighty-two and twelve leper inmates at the Bamenda and

Kumbo colonies respectively. The leper colonies cultivated crops in adjoining farms and

were self-sustaining. Although there were talks to open a leper colony in Victoria (now

Limbe), Kumba and Mamfe, it took five years before another leprosy colony was opened

in the territory. In 1929, the medical officer in Victoria suggested that a voluntary leper

settlement be opened at Mondoleh [Mondoli] Island, where the Germans formerly

isolated lepers, on the grounds of its availability and suitability for a quarantine station

167 See the following works for the migration of labor from the grasslands and Mamfe areas: Edwin Ardener, Shirley Ardener and W. A. Warmington Plantation and Village in the Cameroons: Some Economic and Social Studies (London; Oxford University Press, 1960); Mark W. Delancey, “Plantation and Migration in the Mount Cameroon Region,” in Kamerun: Strukturen und Probleme der Sozioökonomischen Entwicklung, ed. Hans F. Illy (Mainz: von Hase and Koehler, 1974), 181-236; Simon J. Epale, Plantations and Development in Western Cameroon, 1885-1975: A Study in Agrarian Capitalism (New York: Vantage Press, 1985); Stefanie Michels, Imagined Power Contested: Germans and Africans in the Upper Cross River Area of Cameroon, 1887-1915 (Münster: LitVerlag, 2004). 168 Mark W. Delancey, “Health and Disease on the Plantations of Cameroon” in Disease in African History: An Introductory Survey and Case Studies, eds. Gerald W. Hartwig and Karl D. Patterson (Durham, NC: Duke University Press, 1978), 153-79. 169 Sc/a (1926) 4, “Report on Lepers in Bamenda Division” in Leprosy Control Policy. 83

for suspected leprosy infected passengers aboard seafaring vessels especially from

neighboring Nigeria.170

However, after an inspection by the Divisional Engineer and Assistant Divisional

Officer (ADO) Victoria it was rejected because of the unavailability of water supply,

shortage of arable land and difficulty in accessing the island by the medical officials

during the wet season.171 In 1932 the second major leprosy colony was opened at Bulu in

Victoria Division172 in disregard of the advice of the NA of the division.173 The decision

to open a leper camp in Victoria Division was to curb the risk of patients migrating to

leprosy colonies in faraway Nigeria for treatment, several miles away from their

relatives.174 It was equally reported that one leper dresser on NA payroll operated and

supervised a small leper camp with twelve inmates in an adjoining area next to the

government hospital in Kumba.

The rejection by the NA authorities for a colony at Bulu was because to their judgment it was unnecessary considering the existence of the hut that served as a ‘leper ward’ at the African Hospital Victoria and ongoing steps to construct a permanent building of six beds to replace the temporary one. When brought to their attention, the

NA authorities equally showed no enthusiasm for the scheme and expressed their fears

that it would find disfavor among the leprosy patients citing the mistrust that the

compulsory German camps had left on the population.175 They advised that any similar

170 Sc/a (1924) 1, Quarantine, 1. 171 Sc/a (1926) 4, Minutes of the Provincial Leprosy Board held on 6th October, 1931. 172 Ba (1932) 5, Report for League of Nations, 1932. 173 Flavius M. Mokake, “Public Health and Public Health Administration in British Southern Cameroons, 1922-1961: The Case of Victoria Division” (master’s thesis, University of Buea, 2011), 74. 174 Sc/a (1934) 3, Leprosy Control, 254. 175 Ibid., 212. 84

enterprise even if announced as voluntary would not achieve desired result. However, the

Senior Medical Officer (SMO) at Victoria, Dr. Pasqual was of the opinion that

segregation was more important than treatment as open cases constituted the greatest

dangers to the health of the public. The intransigent colonial administration, however,

went ahead and opened the Bulu leper camp with fourteen houses and a dispensary

erected, and farmland also made available.176 Unfortunately the scheme backfired, threatening the continuous operation of the hospitals at nearby Buea and Victoria which drastically reduced hospital attendance for fear of being detected of leprosy and quarantined at Bulu.177

It was noticed that the patients were adverse to segregation, at any rate until an

advance stage of the disease, and invariably demanded subsistence. The existence of the

camps, with little or no financial support from the colonial government, strained the

budget of NAs who were tasked with providing subsistence to lepers who unable to assist

themselves as was the case with many at the Bamenda colony. Being a disease of

poverty, leprosy engendered poverty among its victims178 rendering many to live like

paupers and pushing them to the margins of society. Even though effort was made to

render the leper colonies attractive by providing for the residents, stringent budgeting

rendered that unsustainable. Amidst the difficulties to sustain operation, a year after it

was opened, the Bulu colony was closed leaving leper colonies at Oji River and Uzuakoli

in Nigeria as the last option for Cameroonian leprosy patients.

176 Ba (1932) 5, Report for League of Nations, 1932. 177 Sc/a (1956) 1, Lepers in Victoria Division, 25. 178 Iliffe, The African Poor, 224. 85

The 1930s saw increasing calls being made on the need to introduce an organized scheme to control leprosy in the Southern Province of Nigeria, from where Southern

Cameroons was administered. With the increasing focus by the colonial administration on leprosy control scheme in Nigeria and the support from the British Empire Leprosy

Relief Association (BERLA), requests were made to the Leprosy Relief Association for the provision of a grant to assist the Victoria NA in the erection and maintenance of semi- permanent buildings based on the erroneous assumption of the unavailability of land in the division and the consequent inability of the ‘stranger’ population residing in the division to maintain themselves and their houses if they fall sick.179 To see that concrete measures were adopted towards the control of leprosy, the colonial administration under the aegis of BERLA encouraged each province in Nigeria to setup a Provincial Leprosy

Board leading to the formation of a board in the Cameroons in 1931. The board that had as members the Senior Resident of Cameroons Province, Divisional Officers (DO),

Assistant District Officers, Medical Officers, Divisional Engineers met monthly and had no African in its membership to discuss pertinent issues that directly concerned the

African population.

To ensure the proper organization and smooth takeoff of the leprosy control scheme in the British Protectorate of Nigeria, Dr. E. Muir, the leprologist of BERLA was dispatched to Nigeria to study conditions of leprosy, observe the activities of existing leprosy colonies as well as to decide on steps to be taken towards the formation of leper settlements.180 Dr Muir arrived in April. He had done similar work in other West African

179 Sc/a (1926) 4, Minutes of the Provincial Leprosy Board held on 6th October, 1931. 180 Sc/a (1956) 1, Letter from J. H. Thomas to Cameroons Province of 20th February, 1936. 86

colonies like in the Gold Coast and suggested recommendations for the furthering of

leprosy work in that British colony.181 After his research across the territory of Nigeria

including Southern Cameroons, Dr. Muir in his Report recommended for the colonial

administrative authorities to conduct leprosy surveys in each province in order to

ascertain the actual incidence and distribution of leprosy in order to inform decisions on

the establishment of leprosy settlements in districts with most need.182 Muir’s Report was

distributed to all Residents, District Officers and NAs in 1938 was the blueprint for

leprosy work during the Mandate period.183 Unfortunately, the copies that were

distributed were written in Hausa incomprehensible to most, if not all, of those who

received copies in Southern Cameroons. Nonetheless, in April 1936 the Director of

Medical Services (DMS) Southern Province, urge provincial Residents to evaluate

conditions for the practicability of forming provincial leper settlements as advocated by

Dr. Muir, and advice on areas of need and availability of suitable land.184 However, the

slowness by District Heads in the furnishing of data that reflected the incidence of

leprosy in their districts frustrated immediate action towards establishing a provincial

settlement in Cameroons Province.

The centrality of reliable statistics of leprosy cases in each NA area was further

emphasized by circulars to Native Authorities in each division. In a memo to district

heads across the territory, District and Divisional Officers impressed on chiefs to furnish

181 Ernest Muir, “Leprosy in the Gold Coast: A Short Report on Anti-Leprosy Work in the Gold Coast with Suggestions for its Further Development” Leprosy Review (n.d). 182 Sc/a (1956) 1, Scheme for the Control of Leprosy in Nigeria. 183 Sc/a (1934) 1, Memo from William E. Glover, Director of Medical Services, Lagos, to the Honorable Secretary, Southern Provinces, Enugu, 11th November, 1938. 184 Sc/a (1956) 1, Memo from P. S. Selwyn-Clarke (DMS) to G. B. Walker, the Senior Health Officer (SHO) Enugu, Southern Province, 23rd March, 1937. 87

their offices with the number of leprosy cases in the areas under their jurisdiction. The

District Heads in Victoria Division, equally weary of the leprosy scourge in the

communities, responded albeit timidly. The District Head in Buea, Chief Endeley, after a

consultative meeting with village heads reported that there were forty-five lepers in the

district as of April 1937,185 while his counterpart in Muyuka, Chief Fritz Mukete,

provided the administration with the names, ethnicity and origin of leprosy sufferers in

the Balong district.186

Whereas Chiefs Endeley and Mukete were quick in providing the administration

with statistics of lepers in their respective districts, Chief Manga William of Victoria was

forced to delay because the village heads under his jurisdiction failed to forward to him

the figures from the villages. It took repeated dispatch of messengers before these

statistics were sent to him. It would appear some of the village heads did not understand

the relevance of epidemiological data in health policy formulation or intervention

programs. However, by the end of May 1937 Chief William reported that there were in

total forty-six cases in Victoria district, Likomba village, Tiko and Missellele areas combined.187 The D.O. then forwarded the information he had collected to the medical

officers at Enugu through the M.O. Victoria. According to the report to the Senior Health

Officer (SHO) Enugu, 105 cases were reported in Victoria Division (Victoria, Bakweri

and Balong districts put together) alone.188 In his forwarding note to the S.H.O at Enugu,

the M.O. Victoria was cautious that it was inadvisable to form a leper settlement in the

185 Ibid., Letter from Chief Endeley, District Head Buea, to the D.O. Victoria, through the Acting D.O. Buea, 26th April, 1937. 186 Ibid., Letter from Chief Fritz Mukete, District Head, to the D.O. Victoria, 6th May, 1937. 187 Sc/a (1956) 1, Letter from Chief William to D.O. Victoria, 10th June, 1937. 188 Sc/a (1956) 1, Letter from D.O. Victoria to M.O. Victoria, 14th June, 1937. 88

division, citing once more the lethargic legacy of compulsory segregation from the

German period.189 He stated that people still remember the traumatizing experience and

are anxious about the mere idea of segregation and would not chose voluntary isolation as

due to the relatively small numbers of registered cases, the administration could not

entertain the hope that the camps would never be sufficiently large to enable the lepers to

forget that they were being segregated. This, therefore, postponed hopes of the establishment of a settlement in Victoria Division.

The Enugu Leprosy Conference (August 28-30, 1939) and the Formation of the

Provincial Leprosy Board

Seventy-two hours before the outbreak of the global conflagration that would usher in the era for social and welfare reforms in the colonies, the colonial and medical authorities in Nigeria met at Enugu, Nigeria to discuss practical administrative measures and prepare the personnel to fight leprosy in Nigeria.190 The conference was partly

inspired by the need to organize a systematic intervention against leprosy in the provinces

of Nigeria. Delegates from Southern Cameroons attended the conference in which it was

resolved that it was expedient for each province in Nigeria to constitute a Leprosy Board

immediately as recommended by the report of the Cairo Leprosy Congress. At the end of

the conference, it was resolved among other things that regulations be enacted for the

effective control of areas surrounding a leper settlement, that the form of financial and

statistical returns adopted by the Nigerian Branch of BERLA be used in all leper

settlements, non-quarantined cases constitute a public health hazard and should be

189 Sc/a (1956) 1, Letter from the M.O. Victoria to the S.H.O. Enugu, 24th May, 1937. 190 Sc/a (1956) 1, Letter from C. J. Pleass, acting Secretary Eastern Province to the Resident, Cameroons Province, Buea, 18th November, 1939), 47. 89

prevented from contact with healthy persons – especially children, advocated for the

adoption of the Propaganda-Treatment-Survey System in accordance with Dr. Muir’s

suggestion, and stressed the importance of research on leprosy. It was also recommended

that other stakeholders such as the Education Department be represented on the

Provincial Leprosy Board and be kept informed periodically of the development of

leprosy work with leprosy incorporated in the subjects taught at teacher training centers,

and that facilities be provided for leprosy lay-workers as need arises and for the lay-

workers to be given special training under the various administrative departments

(Agricultural, Forestry, Public Works, Health, and Veterinary).191

After the conference, the colonial authorities in Southern Cameroons were

charged with the responsibility to implement the resolutions amidst reports that little were

being done to address the problem of leprosy in the major districts. In the months

immediately after the conference, the Resident of Cameroons Province convened a

meeting in May 1940 with the sole purpose to discuss the modalities and appointment of

the constituent members of the Provincial Leprosy Board.192 Among the outcome of the meeting was the formation of a Provincial Leprosy Board tasked with the formulation and execution of an effective leprosy control scheme, and formation of a legal framework to regulate leprosy control policy. The attendees reviewed the problem of leprosy and found that leprosy constituted a serious health problem with the province registering almost 2000 cases, and perceived that the population exhibited no special horror of the disease and therefore allowed lepers to have an unrestricted part in the social life of the

191 Ibid. 192 Ibid., 51. 90

community in addition to the reluctance to submit to segregation until a time when they

are irretrievably disabled, suggesting that it would be impractical to operate large scale

settlements with a degree of compulsion.193 It was noted that public opinion about

leprosy was disturbingly limited and sensitization on leprosy in communities was

necessary in other to put the disease under check. Thus administrative authorities were

asked to increase leprosy propaganda when on administrative tours in the districts.194

In addition, the delegates strongly recommended the establishment of leprosy

settlements as the principal center for the examination and treatment of patients as well as

for the training of anti-leprosy personnel in the province. One issue that resonated in the

discussions was the question of suitable land for the establishment of settlements195 and

the problem of finance especially for the Divisional Leprosy Board in Bamenda,196 a perennial issue throughout since the existing disorganized leper colonies in Southern

Cameroons were not in receipt of grants from BERLA.197 The suitability of a piece of

land for a settlement was based on a number of considerations: availability of water

supply and arable land. However, villages were not so enthusiastic allocating land for

settlements largely because of the fear and stigma associated with the disease. Thus

colonial authorities were indulged to talk Native Authorities into freely allotting land for

settlements.198 It was noted that without the support of the Native Authorities any scheme

193 Ibib., Minutes of the Provincial Leprosy Board Meeting, held June 28, 1940. 194 Ibid., Letter from D.O. to the Senior Resident, Cameroons Province, 29th December, 1939. 195 Ibid. 196 Sc/a (1946) 2, Letter from A. F. B. Bridges, Resident Cameroons Province, to the secretary, Eastern Provinces, Enugu, 18th June, 1946. 197 Sc/a (1934) 3, Letter from L. Sealy-King, Acting Resident Cameroons Province, to the Honorable Secretary, Eastern Provinces, Enugu, 15th July, 1939. 198 Sc/a (1956) 1, Letter from the Acting D.O. Victoria to the Native Authorities, Victoria, Bakweri and Balong, 12th August 1940. 91

to control leprosy was doom to fail. It was expected that Native Authorities would use

their powers as stipulated in the Native Authority Ordinance to compel infected persons

in their community to present themselves for institutional treatment. The Board also

suggested that settlements to be established along clan lines in order to encourage

patients from each clan and reduce running cost.199

For this to be realized, surveys needed to be conducted by Sanitary Inspectors in

each clan to determine the magnitude of leprosy per clan. Clan-based settlement would

provide the extra advantage of maintaining social order as it was felt it would enforce the

policy of segregation by local public opinion rather than by repressive laws.200 While the

New Hope Settlement at Mbingo would eventually organize patient’s camps along clan

lines to ease interaction among inmates, the camps at the Manyemen Settlement had a

mixed patient community in the available accommodation although male patients lived in

separate wards from their female counterparts. Thus at the New Hope Settlement camps

are either named after clans or prominent medical missionaries who served at Mbingo,

for instance, Wum camp (now Wum Quarters for hospital staff) and Schneider camp in

honor of Gilbert Schneider, onetime Field Superintendent for Cameroon Baptist Mission.

Where it was possible the Sanitary Inspectors were to be assisted by ex-patients of the

Provincial Leper Settlement thoroughly trained in the recognition and treatment of

leprosy. This was the case of a village in Mamfe Division where an individual formally

199 Sc/a (1946) 2, Letter from P. J. Caffrey, S.M.O, Victoria, to the Senior Leprosy Officer, Udi, 21st June, 1940. 200 File No. 1193, Confidential Memo titled “Nigeria Leprosy Service: Recommendations for a Scheme of Leprosy Control in Nigeria to be Implemented during the Period 1950/55,” from R. H. Bland, Senior Leprosy Officer, Oji River, to the Honorable Director of Medical Services, Lagos, 21st March, 1949. [PCCCAL]. 92

discharged from the Itu Colony in Nigeria helped in the distribution of Sulphuric drugs to

active cases.201

Leprosy Legislation and Discipline of Lepers within ‘Controlled Areas’

To ensure effective implementation of the leprosy scheme, Leprosy Boards were

to enact laws and actions taken discretionally as provided by the Public Health and

Leprosy Ordinances. The segregation laws and legislations enacted restricted the

movement of persons suffering from leprosy into a ‘controlled area’202 although the

restriction of mobility was temporal until the plan of a provincial settlement became

operational.203 For instance, it was noted that the overcrowding of lepers from other

districts at the Bende leprosy clinic would be brought under control once their districts of

origin received the attention of the authorities and if they were maintained by their

families through their respective NA as the native Authority Ordinance provided.204

Whereas the authorities were excited about the possibility of using regulations to control

leprosy, in the enclaved districts in Bamenda local administrative officers were against

the use of strict laws as it was judged counter-productive to the desire to attract patients present themselves for treatment at the clinics in the rural areas. Rural clinics, which served as feeders to the big settlements, were critical in the expansion of the leprosy service in a territory with poor communication system.205

201 Personal communication at Mutengene on September 27 and December 23, 2015. 202 A controlled area was an area within which leprosy control had been established after the following preconditions; facilities for leprosy treatment free of cost to patients provided, intensive leprosy survey haven carried out, and contagious cases of leprosy must have been segregated. 203 Ibid., Letter from G. B. Walker, acting D.M.S., Lagos, to the Secretaries, Northern Provinces (Kaduna, Eastern Provinces (Enugu), Western Provinces (Ibadan), 11th October, 1941. 204 205 Ba (1958) 7, United Nations Organization Annual Report, 1958. 93

The use of colonial legislations to restrict the movement and activities of lepers

translate to what Inglis described as the ‘Criminalization of leprosy’ as patients who

contravened the provisions of the laws risked strict punishment as would healthy people.

Inglis argues that this attitude of paternalism and condemnation falls into the larger

framework of the use of isolation and confinement as tools for social order and control.206

The implementation of such laws, for instance, restricted lepers from selling foodstuffs in

the market or bathe in the stream that runs through the town of Victoria.207 The strict enforcement of leprosy-related regulations not only deprived infected persons who infringed the laws their social status, but also disengaged lepers from indulging in certain occupations and participate in community life, although it was believed the deprivation of the social privileges of the lepers would instill discipline and obedience to the wishes of the colonial and local authorities.208

The impudence with which some authorities executed the laws saw the

continuous detention of persons diagnosed of leprosy serving time at the Provincial

Prisons Buea and Divisional Prison Mamfe in 1930s.209 While touring the Provincial

Prisons Buea in May 1940, the Chief Manga William of Victoria found two lepers incarcerated for various charges including burglary, theft, and possession of stolen property.210 In a letter to the D.O. Victoria, Chief William noted that he not only found

the two detainees, Peter Mbo and Johannes Dioto, suffering from leprosy, but they were

206 Kerri A. Inglis, Ma‘i Lepera: Disease and Displacement in Nineteenth-Century Hawai’i (Honolulu: University of Hawai’i Press, 2013), 54-56. 207 Sc/a (1956) 1, Letter from District Head, Victoria, to D.O. Victoria, June 14, 1939. 208 Sc/a (1956)1, Discipline of lepers within Controlled Area, 105-106. 209 Sc/a (1936) 3, Letter from the District Officer, Mamfe, to the M.O. Mamfe, 5th August, 1937. 210 Sc/a (1956) 1, Letter from J. M. William to D. O. Victoria, 29th May, 1940, 61. 94 isolated, without any medical care and were unhappy. Chief William expressed concern over the health risk of their continuous detention in deplorable conditions and interrogated the possibility of transferring them to a leprosy colony in Nigeria for treatment. The continuous detention of Peter and Johannes, although justifiable for their felonious deeds, was double punishment in their pitiable health condition.

The Passage to Colonies in Nigeria and Repatriation of ‘Alien’ Lepers

Despite the obvious need, the continuous absence of a Provincial leprosy settlement in Southern Cameroons led to the increasing numbers of patients traveling to the Church of Scotland leprosy colony at Itu, Nigeria, for treatment. In the deliberations of the Provisional Leprosy Board, it was decided that NA should be obliged to provide subsistence for pauper patients. Before the settlements at Manyemen and Mbingo were opened in the 1950s, patients who could afford the admission fee went for treatment at Itu or Uzuakoli Colonies even though fear of contagion complicated chances of finding passage to Nigeria by sea. Patients generally had to procure clearance from the M.O.,

District Officer or their local Native Authority to be admitted at any of the settlements in

Nigeria, although some personally presented themselves or requested to be sent to

Nigeria demonstrating the agency of the patients in improving their health and in the control of leprosy. Failure to secure the administrative clearance from the M.O. or D.O. in one’s NA area resulted to instant rejection or denial of admission by any of the settlements in Nigeria since payments of the fees to be guaranteed.211 For instance, in

October 1937 the District Officer of Mamfe wrote on behalf of a certain Robert Agbaw to

211 Sc/a (1936) 3, Letter from the Chairman D.R.C Mission to Makurdi Leprosy Settlement, Mkar, 17th November, 1939. 95

the M.O. of the district on the possibility of sending Robert to Itu for treatment.212 After

examination of the case, the M.O. concluded that Robert was a suitable case to be sent to

Itu Colony; especially after proposals to open a settlement at Mamfe was unapproved by

the Resident pending the completion of the provincial leprosy survey.213

In a couple of weeks the M.O. contacted the Manager of the Itu Settlement with

the case and inquired on the necessary fee to be paid in order for him to make the

necessary arrangements with the NA of Robert’s area of origin for payment.214 A

payment of three pounds five shillings was made being charges for the first two years of

his stay at Itu with subsequent payments of an annual fee of one pounds sterling to be due

in the future. In a letter in December 1937 to the D.O. Mamfe, Robert informed him of

his elation to be admitted and anticipated his discharge after three years.215 However, less

than a year at Itu Robert informed the D.O. of the insufficiency of his monthly feeding allowance of two shillings and requested for an increment. Unfortunately, extra money could not be found to honor his request and considered the option of asking Robert’s family pay for his subsistence. Although he faced recurrent hardship, by June 1939

Robert’s condition had improved satisfactorily from treatment of Hydrocarpus injections

until he was retained by Dr. MacDonald, Manager at Itu Settlement, to train in the

diagnosis and administration of drugs for leprosy treatment as well as engineering. Upon his discharge and completion of training, Robert requested for NA Mamfe to pay his

212 Sc/a (1936) 3, Letter from the District Officer Mamfe to the M.O. Mamfe, 4th October, 1937, 34. 213 Sc/a (1934) 3, Correspondence between the Acting Resident, Cameroons Province, and the District Officer, Mamfe, 15th September, 1942. 214 Sc/a (1936) 3, Correspondence between the D.O. Mamfe and the Manager, Itu Leper Settlement, 14th October, 1937. 215 Sc/a (1936) 3, Letter from Robert Agbor [Agbaw] to D.O. Mamfe, 1st December 1937. 96

passage back to Mamfe but the D.O. rejected on the grounds that Robert was earning

enough money as an engineer to save up and pay his own passage. In the same token,

patients discharged upon completion of treatment for leprosy were retained at Itu Colony

if they were diagnosed with other illness as was the case of one Andreas Fomum from

Batibo, Bamenda Division, who in 1958 stayed on at Itu Colony in order to be treated for

diabetes and until the point where his family could raise enough money for his

transportation to Southern Cameroons.216 From the volume and tone of letters between

Itu Colony and administrative authorities as well as Native Authorities between 1930s

and 1950s, it is apparent survival and sustenance was generally tough for Cameroonian

patients receiving treatment at Itu217 as the increasing costs of food, medicines, materials,

wages and salaries meant that it was no longer possible for the colony to continue low admission fees.218 The return of treated former patients from Itu Colony boosted the

confidence of patients within the Banyang (Mamfe) NA area who increasingly sort

treatment or paid their way to the leper colony.219

216 NW/Sd (1958) 1, Letter from R. M. Macdonald, Manager of Itu Colony, to the Resident, Bamenda Province, 5th June, 1958. 217 Sc/a (1956) 1, Control of Leprosy. [2] Leprosy Board Cameroons Province. 218 Sc/a (1943) 2, Letter from A. B. Macdonald, Superintendent, Itu Colony, to the District Officer, Bakweri, Buea, 20th January, 1951. 219 Sc/a (1934) 3, Letter from the District Officer Mamfe to the Senior Resident, Cameroons Province, 25th August, 1942. 97

Figure 1.

Photo of Robert in his Nurse Uniform (December 1939). Source: Sc/a (1936) 3.

Correspondence Concerning Leprosy

The anxiety to control disease in British Cameroons fostered relations between

neighboring colonies in Africa. Disease and medicine constituted an intricate relationship

nurtured among colonial powers in the management of the health of colonial peoples.220

Disease control increased cooperation, blurred the ambiguities of territoriality and

increased the artificiality of colonial boundaries as well as deterritorialized colonial

220 Deborah J. Neill, Networks in Tropical Medicine: Internationalism, Colonialism, and the Rise of a Medical Specialty 1890-1930 (Stanford: Stanford University Press, 2012). 98

healthcare.221 Although Southern Cameroons and her neighbors (Nigeria and French

Cameroons) were on different path and phase of their political development, the scourge

of disease formed commonalities and fostered integration among the colonial

administrations in the application of prophylactic regulatory measures to forefend the

adverse effects of disease on their economic interests in the various colonies. This

cooperation took various forms: exchange of technology and biomedical ideas and well

as the strict enforcement of health regulations. One of the challenges the colonial

administrative and medical officials confronted in Southern Cameroons was the urgency

to restrict and control the movement of infected persons in the major towns. Inasmuch

various colonial administrations in both Southern Cameroons and French Cameroon

shared similar vision to control disease, there were sometimes discordance in approach.

The French colonial administration in Duala [Douala] lamented and called on the practice

of patient repatriation and beckoned on the goodwill of their British counterparts to

restrain allowing patients of contagious disease from crossing the frontier without a clean

bill of health from health authorities.222 It is important to reiterate that the agenda of the colonial medical service was not colonial humanitarian activity, but rather was for facilitating the administration of the territory and increase its economic productivity.

In the plantation districts of Victoria Division, for instance, the fear of a valetudinarian labor force necessitated surveys exposing the nationality of some leprosy patients. The survey revealed that several of the lepers were either from Nigeria or

221 Flavius Mokake, “River of Pestilence: Sleeping Sickness and Trans-frontier Cooperation in the Cameroons, 1925-1947” in ed. Pierre Fandio, Popular Culture and Representations in Cameroon: The Journey across the Mungo (Kansas City, MO: Miraclaire Publishers, 2013), 126-127. 222 Sc/a (1934) 3, Memo from the British Consulate-General, Duala, to the Resident, Buea, 24th March, 1944. 99

French Cameroon and it was decided that such ‘undesirable elements’ be repatriated to

their areas of origin.223 Some, like one Ogbonna Akiyi, had come to gain employment in

the plantations or took advantage of the fluid borders to crossover into Southern

Cameroons but unfortunately took ill few years later. Efforts to deport such cases were at

times futile for various reasons. It was either difficult to identify their family or NA

expected to pay their passage back to their hometowns, some NA refused to pay for such

passages, some families were too poor to sponsor the repatriation, and some cases that

were sent deported to neighboring French Cameroons smuggled themselves back and

remain public nuisance in the town of Victoria and an apprehensive burden on the NA.224

Yet, others were refused passage by the helmsmen of canoes over Mungo River because

the lepers failed to obtain the health pass or medical certificates from the competent medical authority.225 To overcome this problem, the D.O. Victoria recommended that

relatives of lepers should be identified and asked to personally transport their patients

back home. Also, in an exchange on the case of one Joseph Ngombe, the M.O. Victoria

advised on the possibility of grouping a number of patients and arrangements made for a

launch to take them all at once in the company of a nurse was considered.226 This option

got rid of the problem of dealing with the passage of single patients and shrank the

expenses of NA in dealing with the issue.

223 Sc/a (1956) 1, Repatriation of Leper Ibak Merigini. See Letter from District Officer Victoria to District Officer Bende, 29Th July, 1943. 224 Sc/a (1956) 1, Letter from D.O. Victoria to Monsieur Le Chef de Region de Wouri, Duala, 7th May, 1943. 225 Sc/a (1956) 1, Letter from D.O. Victoria to the Resident, Cameroons Province, March 1943. 226 Sc/a (1943) 2, Letter from M.O. Victoria to the Senior District Officer, Victoria, 22nd September, 1948. 100

The 1940s was a turning point in the efforts to control leprosy in Southern

Cameroons. Faced with the growing numbers of lepers roving around communities, the

option to establish leper settlements in the main stations was once again revisited. After a

meeting of the Provincial Leprosy Board held at Buea in June 1940, proposals were made

for the opening of a settlement in Victoria Division. The Federated Council of Victoria

met and suggested the site for the project should be at Mokoko mwe Esambe in

Mokundange Plantation.227 In that meeting, Chief Endeley of Buea was concerned

whether the area had sufficient water and arable land, to which Chief Manga Williams,

President of the Federated Council, admitted to the abundance of water. The Council

requested financial assistance from the colonial government for the camp to be built

pledging the willingness of the NA for its maintenance. The chosen land belonged to the

plantation and, therefore, had to be paid for by the colonial government. However,

financial difficulties of both the colonial government and NA necessitated the scheme

was to remain in abeyance until a leprosy survey was made in each division in order to

inform the area to be chosen for one or two Provincial settlements in the Cameroons

Province.228

After administrative tours in the Cameroons and Bamenda Divisions, it was

recommended that a centralized treatment center was needed as a system of leprosy

control, with village clinics to serve as feeder (or out-patient) clinics. Perplexed by the sight and plight of the deformed bodies of lepers, the administration toyed with the

227 Sc/a (1940) 4, Letter from the District Officer, Victoria, to the Honorable Senior Resident Cameroons Province, Buea, 28th November, 1940. 228 Sc/a (1940) 4, Letter from A. E. F. Murray, Resident, Cameroons Province, to the S.M.O. Cameroons Medical Division, Victoria, December 1940. 101

consideration to handover leprosy work to the Mission organizations operating in the

territory. This was also strongly recommended by Dr. Jeffrey during his visit to Bamenda

Division suggesting that if NA were unable to finance a leprosy survey by a qualified

leprologist, the alternative scheme to engage Miss Laura Reddig of the American Baptist

Mission serving in the division to be trained, at government expense, at one of the large

leprosy settlement in Nigeria and to be authorized to operate a Provincial settlement upon

her return.229 Patients treated at the colony in Nigeria were expected to report with their discharge certificates to the NA of their area of origin or local District Officer to confirm successful completion of treatment.230

The Founding of the Manyemen and Mbingo Leprosy Settlements

The last half of the 1940s was a defining moment for the territory of Southern

Cameroons and the fight against leprosy. Constitutional developments in Nigeria in

1940s231 and the Eastern Regional constitutional crisis in 1953 led to Southern

Cameroons been granted a semi-autonomous status with self-government the following year.232 The special status given to the territory after the 1947 Constitutional changes in

Nigeria and its subsequent semi-autonomous status were opportunities for the local

administrative authorities to chart a new future for leprosy control and in alleviating the

sufferings of leprosy patients. Efforts towards founding a provincial settlement in the

territory received new vigor in late 1940. Leprosy surveys conducted mostly by NA

229 Ibid. 230 NW/Sd/a (1958) 1, Letter from the Fon of Uwah Village to the District Officer, Bamenda, 17th June, 1958. 231 Julius V. Ngoh, Southern Cameroons, 1922-1961: A Constitutional History (Aldershot: Ashgate, 2001). 232 Victor B. Amaazee, The Eastern Nigerian Crisis and the Destiny of the British Southern Cameroons, 1953-1954 (Yaounde: Yaounde University Press, 2000). 102

teachers between 1944 and 1949 revealed that of a population of approximately 6000 in

the Southern Provinces, there were on record about 17500 leprosy patients receiving

treatment at various clinics and settlements in Nigeria, with several hundreds of the

patients originating from Southern Cameroons.233 This increased the calls from Native

Authorities as well as pressure groups in Southern Cameroons, such as the Cameroons

Youth League (CYL) which had been formed by the first crop of Cameroonian students

and intelligentsia in 1940 as the mouth-piece of the people234, on the urgency of a leper

settlement in the territory to be incorporated in the Five Year Plan to control leprosy in

Nigeria. In October 1944, P. M. Kale, the Secretary of CYL wrote to the Provincial

Secretariat at Enugu on the urgent need for austerity measures to be taken to arrest the

spread of leprosy in the Cameroons.235 Five years after this call, the decision to

commence leprosy control work in the Cameroons under the Five Year Plan was still

pending awaiting the approval of the plan by the Secretary of State for Colonies,

London.236 However, preoccupied with diseases such as malaria, sleeping sickness and yaws, as well other more compounding issues unfavorable to the economic exploitation of the territory, the government turned to the Baptist and Basel Missions for support in leprosy work. The role of Christian organizations in leprosy eradication is as old as disease itself as the show of compassion and care for the sick were virtues of the religion.

233 Sc/a (1934) 3, Correspondence between J. W. P. Harkness, Director Medical Services, Enugu, to the Chief Secretary to the Government, Lagos, September 1943. 234 Ikoyn, “Politics and Personalities in the Cameroons,” West African Review XXVI, no. 328 (Jan., 1955): 18-20. 235 Sc/a (1934) 3, Letter from the Secretary, CYL, to the Resident, Cameroons Province, 5th October, 1944. 236 File No. 1193, Letter from J. H. Pottinger, Acting Deputy Director of Medical Services, Enugu, to the S.M.O. Victoria, 25th October, 1949. 103

In 1941 the Senior District Officer in Bamenda wrote to the American Baptist

Mission about the possibility and availability of Miss Laura Reddig, a nurse in one of the

Baptist Mission stations, to conduct a survey in order to ascertain the number of leprosy

cases in Bamenda Division.237 Laura was to be sent to Oji River Settlement in Nigeria for

a course on leprosy diagnosis and physiotherapy; however that could not be realized as

projected because of acute shortage of Baptist missionaries in the entire territory.

Increasingly aware of its responsibility to control leprosy and the role missions could

play in meeting the spiritual needs of the patients, the colonial government persisted in

soliciting Mission help. In 1950 the Medical Department once again contacted Dr. Leslie

Chafee of the Baptist Mission to determine the Mission’s interest in taking charge of

leprosy work in the Bamenda Province. Of a population of approximately 250 people,

there were 2500 registered cases of lepers in the division.

Later that year, Drs. Chaffee and Paul Gebauer of the Baptist Mission met with

the head of Nigerian Leprosy Service, Dr. Bland, to discuss once more the possibilities to

accept government’s request. There were other meetings held and by the end of 1951,

upon consultation with home churches in America, the Baptist Mission accepted to take

up leprosy control service in Bamenda Division out of pity for the suffering patients. The

following year, Dr. Davey and wife visited from Nigeria to inspect the site the Baptist

Mission had earmarked for the settlement and advised on the execution of the project.

Although an impassable bridge at Bamenda caused their late arrival at Mbingo, The

impressionable Davey was able to meet with the Baptist missionaries at Mbingo to

237 Bamenda New Hope Settlement: The Leper Camp of the Cameroons Baptist Mission in Africa. (Forest Park, Illinois: NABGC, 1953. [NABHC] 104

discuss the project.238 They also saw it as an opportunity in line with their evangelical

duty to heal the soul and the body of their flocks.239

The plight and suffering of leprosy patients could not leave other voluntary agencies operating in the Southern Cameroons indifferent. Survey reports had shown that the incidence of leprosy was high in and around Kumbo. Being a fief of the Roman

Catholic Mission, the latter considered some measures to provide care and treatment to patients within the circumference of the locality. As early as 1947, Reverend father

Stokman had advocated for the operation of the small leprosy camp at Kumbo, near the present daily market, to be transferred to their mission at Shisong.240 He intended to hire

doctors and nursing sisters specialized on leprosy to provide regular care, supervision and

ensure a regular supply of drugs for its treatment. During church sermons and meeting

with the Christian population, Father Stokman explained to them that leprosy was

treatable medically and was in favor of locating the Catholic leper colony in Kinkari

where arable land was in abundance. Unfortunately, because of the lack of funds, the

unwillingness of the community to lease the land, and the absence of a well-designed

plan, the scheme had a stillbirth. It is noteworthy to mention that the Catholic Mission

generally did not devote serious attention to the development of medical services in the

territory as their protestant counterparts. Such surveys were conducted routinely across

238 Mildred M. Schneider, “Mbingo: The Founding of Bamenda New Hope Settlement 1952-1961” (Portland, Oregon: 2000), 19. [NABHC] 239 Hughes, Love Them for Me, 76; Patricia N. Ndamukong, “Christian Missionaries in the Bamenda Grassfields 1903-1961” (postgraduate thesis, Higher Teachers Training College Yaounde, 1981). 99. 240 Awoh, Residue of the Western Missionary, 270. 105

Bamenda Division with new cases discovered in Bambalang, in Ndop in 1960s241 and village Fons were notified of results.242

While the Baptist Mission was finalizing the takeoff of the leprosy settlement

project at Mbingo for lepers in the Grassfields region of Bamenda, the Basel Mission

accepted government’s request to operate another provincial settlement at Manyemen for

lepers from the forest region called the Hanseniasis Rehabilitation Center (HRC)

Manyemen.243 In June 1950, the Basel Mission Secretary, Cameroons/Bamenda

Provinces, confirmed the readiness of the Mission to participate in the leprosy control

service and the choice of an area near Kokobuma, fifty miles from Kumba on the Kumba-

Mamfe road although the final decision as to the best location for settlement was to be

made after consultation with the colonial government and the Medical Department.244 In a letter to the Assistant Director, Leprosy Control, Oji River, the Basel Mission

Secretary, Bamenda Province, informed the former of the decision of Basel Mission

Home-board authorizing the local Mission in Southern Cameroons to undertake the responsibility of leprosy control in the Cameroons Province (i.e. the forest region).245

Earlier in 1945, Dr. C. Wilson, SMO, had suggested that two settlements be opened in the Grassfields and Forest/Coastal parts of the Cameroons on the grounds that differences in climatic conditions and customs would affect the flow of patients from

241 NW/Sd/a (1969) 1, Memo from the M.O. i/c. Grandes Endemics Services, Bamenda, to the D.O. Ndop. 22nd July, 1969. 242 NW/Sd (1936) 9, Memo from the M.O. i/c. Grandes Endemics Services, Bamenda, to the Chief of Bambalang, 4th June, 1969. 243 File No. 856, “Manyemen Leper Settlement.” Letter from the Secretary, Basel Mission, Southern Cameroons, to the District Officer, Kumba, 1st March, 1955. 244 File No. 1193, Correspondence between Basel Mission Secretary and the Commissioner, the Cameroons Province, 28th June, 1950. 245 Sc/a (1951) 5, Letter from Secretary, Basel Mission, Cameroons – Bamenda Province, to the Assistant Director, Leprosy Control, Oji River, 24th May, 1951. 106

either of these transitory geographic areas to the settlement outside their accustomed ecozone.246 In his correspondence to Oji River, the Basel Mission Secretary further

informed the Assistant Director that although their hope of hiring the German Jewish

doctor, Dr. Barasch was futile, the Basel Mission Secretary for Africa was in

correspondence with a Dutch medical officer. He also conveyed the Secretary’s worry

whether the colonial government would allow the Mission appoint a suitable German

medical officer in the case where a qualified Swiss or Dutch doctor could not be found.247

Although Dr. Barasch had the necessary qualification and considerable experience in

tropical medicine having worked with Dr. Albert Schweitzer in Lambarene for a couple

of years before the start of World War Two, seven years working with the French

Protestant Mission in French Cameroons and was in 1950 serving as a French

Government doctor at Dschang, French Cameroons, and had then acquired French

nationality, his status as a German refugee worked against his hiring as a leprologist for

the Basel Mission because of the hostility and suspicion that the war had generated

against German nationals.248

Nonetheless, the Manyemen Settlement was opened and admitted its first patients in 1954, two years after the Mbingo Settlement. The first staffs were mostly Europeans, although eventually Africans were recruited and trained as leprosy inspectors especially for the settlement’s out-patient and field work. The first manager of the settlement, Dr.

246 Sc/a (1934) 3, Correspondence between Dr. C. Wilson and the Resident, The Cameroons, February 1945. 247 Due to the mistrust as a result of Germany’s guilt during World War Two, the colonial government was reluctant to accept the employment of personnel of German nationality in the territory for fear of stirring pro-German sentiments among the population. 248 File No. 1193, Letter from Rev. Raaflaub, Basel Mission Secretary to Mr. Angus, Christian Council of Nigeria Secretary, Lagos, 18th May, 1950. 107

Frommherz Symark (a German), arrived early 1954.249 Other European staffs at

Manyemen over the years included Dr. and Mrs Voute, Dr. Emilie Odé, and the long-

serving African leprosy inspector, Stephen Nemoh. Both Mission agencies agreed to take

up leprosy work on the agreement that government make annual grants-in-aid to

subsidize their work from the Colonial Development Welfare Funds.250 For instance, in

expressing the readiness of the Basel Mission in assuming the responsibility of leprosy

control service, the Basel Mission Secretary at Buea, Rev. Fritz Raaflaub, informed the

Commissioner of the Cameroons that the extent of their involvement depended largely on

the amount of grant the government was willing to offer annually.251

Government was also to supply free drugs for leprosy treatment to both the

Manyemen and Mbingo settlements as part of her own end of the government-mission

arrangement as well as money for the construction of the permanent buildings.252 The

colonial government’s assumption of the responsibility to make subventions to the both

settlements in 1959 greatly relieved Native Authorities who, hitherto, were making

annual contributions to the functioning of these institutions.253 Although the liability of

financing leprosy control was taken off the NA in the 1950s, NAs were to ensure the

success of rural leprosy clinics through assistance towards transporting the leprologist

249 File No. 1039, Letter from the Leprosy Adviser, Eastern Region, to the Principal Immigration Officer, Lagos, 13th November, 1952. 250 Sc/a (1959) 2, Memo from A. K. Wright, Permanent Secretary, Ministry of Social Affairs, to Rev. Keller (Basel Mission, Buea) and Dr. Gebauer (Field Superintendent, Baptist Mission Bamenda), 13th October, 1959. 251 File No. 1193, Letter from the Basel Mission Secretary to the Commissioner, the Cameroons, 28th June, 1950. 252 File No. 1193, Leprosy Control in Cameroon. (PCCCAL). 253 Sc/a (1959) 2, Memo from A. K. Wright, Permanent Secretary, Ministry of Social Affairs, to Rev. Keller (Basel Mission, Buea) and Dr. Gebauer (Field Superintendent, Baptist Mission Bamenda), 13th October, 1959. 108

and nursing staff, support of leprosy outstations staff, maintain pauper patients at the

settlement who were unable to work, and where possible maintain severely deformed

cases without family support.254 Nonetheless, NAs continued to include in their annual

budgets an allocation for the aid of leprosy patients and paupers.255

Government’s insistence on NAs to pay for paupers was partly to commit the

latter to help ascertain who could be identified as a pauper and also to have NAs develop

effective outpatient clinics and possibly segregation villages which would in effect

institute a successfully working control system linked to the Mission-operated

settlements.256 However, over the years, both Mission organizations suffered from

financial difficulties and complained of delayed release or cuts in the expected annual

subventions even money meant for the wages of the African Leprosy Inspectors as was

the case with the continuous delay in 1950s in the payment of the salary of A. T. Tanyi,

3rd Class Assistant Leprosy Inspector serving at Manyemen.257

Although the spasmodic flow of cash was sometimes caused by delays in

transactions between government treasury and the account of the settlements, it remained

a major setback to settlement operations deteriorating even further after 1960 with the

cessation of the Colonial Development and Welfare Funds – from which eight thousand pounds sterling annually to both the Baptist and Basel Missions – when the territory became independent by joining the Republic of Cameroon forming a federal state. The

254 Sc/a (1951) 5, Confidential Memo: ‘Leprosy Adviser’s Touring Notes’ by Dr. Davey to the Residents Bamenda and Cameroons Provinces, 7th May, 1952. 255 Sc/a (1952) 4, Letter from the Medical Superintendent, Mbingo Settlement, to the District Officer, Southeastern Federation, Bamenda, 25th March, 1959. 256 Sc/a (1959) 2, Letter from the Field Secretary, Basel Mission, Southern Cameroons, to the Permanent Secretary, Ministry of Social Services, Buea, November 1959. 257 File No. 570, Correspondence between E. M. R. Stuart, M.O. Kumba, and the Principal Medical Officer, Victoria, 11th June, 1956. 109

persistence of this problem, for instance, led to the closure of an account the Manyemen

Settlement was holding with B.I.C.I.C Bank, Limbe, and all funds directed to the

institution’s account with the bank’s Kumba branch in April 1974.258 The initial plan to have 500 patients at each provincial settlement could not be adhered to as time progressed,259 each settlement had close to 900 inmates receiving treatment because of

the ever-increasing need, thereby, further straining the service.260

Figure 2.

Foundation Stone of Manyemen Settlement. Source: Author

The Baptist began preparing the site for their settlement in March 1952 and by

August that year, the first batch of leprosy patients from the old Bamenda leper Camp at

258 File No. 5669, Correspondence between the Presbyterian Treasury Department and the Manager, B.I.C.I.C, Victoria, 26th April, 1974. 259 Bamenda New Hope Settlement: The Leper Camp of the Cameroons Baptist Mission in Africa. (Forest Part, Illinois: NABGC, 1953B). 260 Personal communication at Manyemen, January 14, 2016. 110

Bafreng were transferred to Mbingo261 as it was becoming expensive to maintain by

NAs.262 Families of these patients were asked to pay between four to six pounds sterling

for admission and maintenance per patient.263 The decision to transfer the leper village at

Bafreng (near Bamenda Station) to Mbingo was made in May 1955 during a meeting of

the Bamenda Leprosy Board.264 The reasons for the transfer were: to keep the patients

under constant care and supervision of Dr. Jones of Mbingo Settlement so as to speed up

the recovery of the patients responding to treatment; and to free Bafreng of the leper

village and so enable the proposals for a township there to be put into effect. Judging

from the closeness of the Bafreng leper village to the Bamenda Station, it is probable that

the desire to expand the urban space and land use was the cardinal reason to get rid of the

long sacred sanctuary of the lepers in Bamenda. One W. B. Yonke, the Africans Leper

Attendant at the camp, became redundant following the closure of Bafreng and could not

be alternatively hired at Mbingo because he lacked the requisite qualifications for

consideration for training as a Leprosy Inspector and there were to be no post as Leper

Attendant at the new dispensation.265 The preference for leprosy inspectors created a new social class in the colonial hierarchy.

261 Bamenda New Hope Settlement: The Leper Camp of the Cameroons Baptist Mission in Africa. (Forest Part, Illinois: NABGC, 1953B). 262 NW/Sd/a (1954) 2, Meetings by R. T. Ashwell, Secretary Bamenda Provincial Leprosy Board. 263 Sc/a (1952) 4, Letter from Gilbert D. Schneider, Manager Bamenda Settlement, to District and Divisional Officers in Bamenda, 22nd August, 1955. 264 Sc/a (1952) 4, Letter from A. Sprilyan, Acting District Officer, Bamenda, to the Village Head, Big Babanki, 8th June, 1955. 265 Sc/a (1952) 4, Memo from J. J. Phillips, M.O. Bamenda to the Senior District Officer, Bamenda, 13th October, 1956. 111

Figure 3.

Arrival of First Patients at Mbingo. Source: File No. 1953B, Bamenda New Hope

Settlement

The Mbingo settlement, otherwise known as the Bamenda New Hope Settlement, received its first patient on August 10, 1952. However, the Baptist missionaries had earlier started administering the Sulphone treatment twice weekly to patients at the

Bafreng camp. In the first two years, it was reported that there were 154 patients admitted at the Mbingo Settlement. That number increased steadily to over 1700 patients by

1960.266 The increase in the numbers without attendant increase in annual grants and infrastructure overwhelmed the staff and services offered at the settlement. In order to carter to an ever-increasing patient population, supervises rural clinics, train local supervisory staff as well as further extend outpatient work in the Bamenda area, the

266 Field Report 1952: Progress in Leprosy Work – 1952-1960 [NABHC]. 112

Cameroon Baptist Mission in November 1958 requested for additional Mission doctor to

be attached to the Mission’s leprosy service.267

Figure 4.

First Five Leper Boys at Mbingo Settlement. Source: File No. 1953B, Bamenda New

Hope Settlement

Having decided to take over leprosy work and assured of government support, the

mission bodies were confronted at the instant with the problem of land acquisition for

Settlements. Both the Baptist and Basel Missions operated Mission Stations in Bamenda

and Kumba Divisions but did not have land for settlements readily available to them and

had to apply for land to be leased to them for the purpose. When negotiations for a

leprosy settlement in the forest region started in 1948, the people of Manyemen were

267 Sc/a (1958) 9, Memo from the Director of Medical Services, Victoria, to the Permanent Secretary, Ministry of Social Services, Buea, 28th November, 1958. 113

brave enough offer an area called ‘Anem Kiyang’, translated loosely as the evil forest, to

Basel Mission to establish the settlement.268 Neighboring villages such as Mambanda,

Mbakwa Supe and Nguti in the Kumba Division refused to offer a land for the project,

even though they had fertile land and provided easy accessibility to patients across the

division, for fear of leprosy and the erroneous belief that it was contagious. Earlier in

1940, when talks were underway to establish settlements on clan basis, the Mbonge clan

of Kumba Division were eager to lease land for the scheme as well as help in the

construction and maintenance of the houses and farms in an area situated on the Ekumbe

Bonji-Bekondo road, approximately ten miles from Kumba.269 Meanwhile, at

Manyemen, the allocated area was cleared of its vast forest. Despite its less fertile soil,

Manyemen was well-watered and midway between Kumba and Mamfe Divisions, and its

central location had the advantage for reducing travel time for patients from either of the divisions. This provided an ideal location for the isolation of leprosy patients. After consultations with his subjects, the chief of Manyemen (whose son was among the few lepers at Manyemen decided to offer approximately 5600 square miles of land for the settlement with villages forfeiting farmland.270

Among the first patients admitted at the Manyemen Settlement, one Godlove

Njikang (current chief of the settlement) still lives in the hospital premises.271 The

willingness of the community to provide land was also a demonstration of their

acceptance and practice of Christianity, and foresaw the positive socio-economic benefits

268 Ndike, “Mission through Healing,” 13. 269 Sc/a (1934) 3, Correspondence between District Officer, Kumba, and the Resident, Buea, August 1940. 270 Ibid., 16. 271 Personal communication at Manyemen, January 15, 2016. 114

and health benefit of the settlement to the community. To demonstrate that the land was

freely offered, the community performed rituals and blessed the land before the project

took off invoking the ancestors for guidance, protection and preservation of the land for

common good. By the end of January 1954, the first 1200 acres of land had been

demarcated and a Certificate of Occupancy issued to the Mission to thwart boundary

disputes272 as some disgruntled people in the Upper Balong Council Area contested the

limits of the northern boundary which covered part of the Manyemen cocoa farms and

village holdings.273 Whereas the first patients were admitted in 1954, the settlement

began in earnest after it was officially opened in January 1955 by Rev. J. C. Kangsen

(then Minister of Education, Health and Social Affairs) and a visit by Dr. E. M. L.

Endeley, Premier of Southern Cameroons.

272 File 1039, Correspondence between Rev. P. Scheibler, Basel Mission Secretary, British Cameroons, and the District Officer, Kumba, 19th January, 1954. 273 File 1039, Letter from A. J. Cordy, District Office, Kumba, to the Resident, Cameroons Province, 24th June, 1953. 115

Figure 5.

Partial Map of Basel Mission Leprosy Settlement Manyemen. Source: File No. 1039,

Site Maps Manyemen [PCCCAL]

Whereas Basel Mission procured land for the settlement at Manyemen with relative ease, the case of the Baptist Mission was different. The Baptist Mission acquisition of land for the settlement at Mbingo challenged land ownership and communal use of land. Immediately land requested by the Baptist Mission for the setting up of the leprosy settlement and farm project was leased out to the Mission, dispute erupted between two neighboring villages, Kedjom Keku and Kom. The land of approximately 4000 acres covered with grassland, montane forest, waterfalls, and basalt 116

rock outcroppings was, hitherto, traditional hunting ground for both villages274 was

offered by the Fon of Kom, Fon Ndi in 1951. Initially it was difficult for the Mission to

find land for the scheme and their request was at least denied by one village for fear of

contagion.275 However, to resolve his land ownership claim by both Kedjom-Keku and

Kom, Fon Ndi of Kom honored the request of the Baptist Mission and offered them land

at Mbingo. The land was surveyed and construction authorized by the competent

administrative authority since the settlement was also to operate as a farm project.

According to oral tradition, the Fon’s decision to offer the land, even though both

Kom and Kedjom-Keku had very few lepers, was partly to resolve its contentious

ownership and because of the fear of the strange disease. It was his calculation that if the

settlement was setup on the land, the fear of leprosy would scare villages of the opposing

village to attempt to claim the land.276 The offering of the land led to the stop of certain

customary economic activities such as hunting preciously carried out around the area.

However, the major setback to the commencement of construction work on the land was

petitions from some individuals against Baptist Mission for trespass, destruction of

property (farmland, crops, and other economic trees particularly raffia palm which was of

a major economic importance), refusal to harvest their crops or involuntarily displaced.

Throughout 1952, while construction had commenced, some individuals wrote petitions

against the Mission to the Kom Native Court and to the administrative authorities in

274 Mildred M. Schneider, Mbingo: The Founding of Bamenda New Hope Settlement 1952-1961 (Oregon, 2000), 1. [NABHC]. 275 Maynard, Making Kedjom Medicine, 150. 276 Personal communication at Mbingo on December 9, 2015. 117

Bamenda.277 Particularly vociferous in their expression of dissatisfaction against the

Mission was one Sama Ndi, an elected member from Wum area. In the numerous

petitions he wrote, he argued that leprosy settlement was necessary as a treatment center

for lepers it was not an adequate remuneration to the Kom people who had been

clamoring for a road, mercantile firm or a maternity home from the colonial

government.278

After several months of investigation and deliberation, it was resolved that the

complainants (Johnny, Audu Bande, Mbeng afui, Tom Yuh, Fineboy Munange, Fineboy

Toh, Tonyi, Annas Nkor, Ngongwi, and John Kisang) be compensated to the tune of one

thousand four hundred and fifty pounds sterling.279 However, villages, especially of

Chesingi and Balingi, continued to criticize the Mission and government for non-payment

of compensation for expropriated land.280 The inability of the Mission to make financial

compensation to all those whose properties were trespassed or destroyed as authorized by

the administrative authorities was not only because of their lack of funds, but it was

incomprehensible to Mission authorities how they were expected to compensate the

people whom they thought the services of the settlement would, directly or indirectly,

serve their community. The quarrel could have been forestalled if the Fon had not taken a

unilateral decision with little or no consultation. The construction of the settlement on

disputed land, however, increased the reluctance of some people especially from Kedjom

277 Md/e (1952) 1, Kom Native Court Area – Complaints and also Including Mbingo New Settlement. 278 Md/e (1952) 1, “Clarification by Sama C. Ndi of Bikom” in Kom Native Court Area – Complaints and also Including Mbingo New Settlement. 279 Md/e (1952) 1, Memo from Acting Resident, Bamenda Province, to the District Officer, Wum Division, 3rd September, 1952. 280 Md/e (1952) 1, Extract from the Minutes of a Kom Local Council Meeting Held at Laikom on 5th August, 1952. 118

to patronize the medical institution throughout the 1950s besides the practice at the

settlement hospital, as part of the proselytizing tool, to interrogate patients of their

religion.281 This discouraged non-Baptist Christians and non-Christians to by-pass the wonderful services of rendered at the Mbingo Settlement.

Figure 6.

Map of Mbingo Settlement. Source: File No. 1953B, Bamenda New Hope Settlement

With the recorded success of the Manyemen and Mbingo Settlements, an attempt was made to open another settlement in Victoria Division at the end of 1959. In October

281 Maynard, Making Kedjom Medicine, 252. 119

1959, the Victoria Divisional Council expressed her willingness to transform the rural

leprosy clinic in the division to a full-fledged settlement provided the government accepts

to offer annual grants for its running.282 In 1959 the Victoria Divisional Council

complained that they were paying more in subvention to the Manyemen Settlement than other forest area NAs although they were not benefiting as much as the other NAs threatening to hold back their annual subsidy to the facility if the situation is not rectified or take a unilateral action of opening its own settlement in the division.283 The D.O.

Victoria stated that it was unfair for Victoria to continue to contribute the sum of three

and fourteen pounds sterling against one hundred and fifty pounds sterling for the other

NAs whereas there were more patients from the Kumba and Mamfe NA areas.

However, the Victoria Divisional Medical and Health Committee met and decided

that the government should takeover and operate the leprosy clinic in an abandoned

plantation land at Batoke, Isongo or Momnago and the Native Authorities reimburse

government’s expenses. The Victoria Divisional Council rejected the proposal stating

that the government was financially viable than the Native Authorities to fund leprosy

control services at the scale of a settlement in the division. The colonial administration

was not so enthusiastic about the proposed scheme because they judged villages in

Victoria and the West Coast area were small and characterized by exceptionally heavy

rainfall which was not good for the general health and wellbeing of lepers or ideal for a

282 Sc/a (1959) 2, Memo from the District Officer, Victoria Division, to the Permanent Secretary, Ministry of Social Services, Buea, 17th November, 1959. 283 Sc/a (1959) 3, Memo from A. K. Wright, Permanent Secretary, Ministry of Social Services, to the District Officer, Victoria, 18th July, 1959. 120

leprosy settlement until after World War Two.284 The failure for the proposed scheme to

takeoff meant patients from or residing in the division continued seeking treatment at the

two provincial settlements at Manyemen and Mbingo, or their tributaries of rural or

outpatient clinics in different NA areas in the four divisions that made up Southern

Cameroons. After the New Hope Settlement Mbingo and HRC Manyemen were

established, the small NA leprosy villages were ordered to close although subsequently

both settlements organized and operated routine surveillance and treatment in the

auxiliary rural leprosy clinics and outpatient stations strategically located in different NA

area across Southern Cameroons.

Conclusion

This chapter has examined the humble beginning of leprosy work and the

founding of leprosy settlements in British Southern Cameroons. Unlike other tropical

diseases that plagued the people in this British territory, leprosy persisted through the

German and British administrations. The initiative undertaken by the German colonial

administration backfired and failed to arrest the problem of leprosy in the territory and

was bequeathed to Britain in 1916. Although on several occasions the British colonial

administration considered opening at least one provincial settlement for the isolation and

treatment of leprosy patients, that dream was only finally realized three decades into

British rule thanks to the benevolence of Christian missionary organizations operating in

Southern Cameroons. Because of their virtues of care and compassion, the Christian

missionaries considered leprosy work as a doctrinal obligation. Hitherto, patients either

284 Sc/a (1934) 3, Correspondence between the District Officer, Victoria, and the Resident, Cameroons Province, Buea, 29th May, 1943. 121 had to travel to Nigeria for treatment or took refuge in any of the small leper camps scattered across the territory. The founding of the settlements not only helped tremendously in the control of the disease and transformed attitudes towards patients.

Acquiring land for settlement was a horrendous challenge and when finally acquired, challenged ancestral land ownership, customary land use, and relations between communities and the Mission organizations on one hand, and communities and NA as well as administrative authorities on the other. Settlements provided a controlled space accessible to patients with a resident doctor or nurse to cater for the needs of patients, and although it separated patients from their families and communities, it offered new hope to the suffering patients whose experiences are examined in the next chapter.

122

Chapter Four: Lest We Forget: Tales of Misery, Hope and Resilience (1950-1975)

Introduction

Effective treatment, management of cases and control of leprosy began with the

establishment, by Christian missionaries, of the Hanseniasis and Rehabilitation Center

and Bamenda New Hope Settlement at Manyemen and Mbingo respectively. Both

settlements did not just provide a sanctuary for outcasts, controlled and contested space

for institutionalized psycho-social care to patients, but constituted a community for

patients to interact and reinvent themselves against the social pressures that hit them as a

result of their health condition. This chapter narrates the life experiences of patients from

when they were diagnosed of leprosy, admitted and discharged from the settlement

highlighting how leprosaria provided a space for the growth of a sense of community and

a unique subculture – with shared traditions, values and meanings among leprosy patients

interned at the settlements, what has been adequately described as a “patient culture”.285

It focuses on how disease affects one’s life, relationships, and identity as well as the

metaphors that surrounded leprosy in Cameroon. The focus in this chapter is to describe

tales of fear, endurance, hope, heroism as well as monument the strength and character of

the resident lepers at the Mission-operated institutions.

Leprosaria as Institution for Patient-centered Care

The founding of leprosy settlements in the 1950s to combat leprosy coincided

with developments in biomedicine in general, and healthcare delivery practices and

285 Charles Langlas, Ka‘ohulani McGuire and Sonia Juvik, Kalaupapa is Us: The Kalaupapa Community in 2002-2005 (Hilo, Hawai‘i: Pili Publications, 2013), 55. 123

leprosy treatment with the development and adoption of sulphuric drugs in particular.286

By the turn of mid-twentieth century, medicine had grown significantly in its ability to

diagnose and treat multiple pathological conditions. Doctors and nurses could boost of

their triumph and ability to eradicate or control once fatal infections or prevent others.

However, and as was observed with leprosy control in Africa, despite impressive

technical progress the colonial medical personnel who encountered patients of stigma- related disease such as leprosy lacked the human capacities to recognize the plights of their patients, to empathize towards their suffering with pain or to join honestly and courageously with patients in their struggles towards recovery or facing death.287

Consequently, the decision to open settlements in the territory dragged on through the

Mandate period and the first decade of the Trusteeship, nonetheless restored hope to an

otherwise despondent social group. The leprosy control policy adopted and executed

through segregated settlements reflected a vertical approach to health program as the

specific objective targeted the single condition of leprosy and leprosy patients. Poverty, a

struggling colonial medical service and a flourishing disease environment accounted for

the adoption of this approach which comprised a highly regulated intervention strategy,

monitoring and intervention as well as intervention delivery in the fight against leprosy.

Immediately the institutions were founded, the primary objective was to provide

adequate medical and psycho-social care to the suffering patients in an attempt to prepare

286 L. H. Wharton, “Preliminary report on a New Sulphone Drug ‘Sulphetrone’,” International Journal of Leprosy 15, no. 3 (1947): 231-235; T. F. Davey, “Leprosy: A Changing Situation in Eastern Nigeria,” British Medical Journal 2, no. 4984 (Jul. 1956): 65-68; Loh K. Seng, “‘Our Lives are Bad but Our Luck is Good’: A Social History of Leprosy in Singapore,” Social History of Medicine 21, no. 2 (2008): 291-309; Manton, “Trialing Drugs, Creating Publics,” 78-99. 287 Rita Charon, Narrative Medicine: Honoring the Stories of Illness (Oxford: Oxford University Press, 2006), 3. 124

discharged patients back to society. Leprosy settlements had specific functions: detect

leprosy cases, provide treatment to isolated cases, lead research on leprosy, provide

training to ancillary African staff as well as organize and supervise routinely the

provision of care to patients at leprosy clinics in rural communities through the rural

clinic scheme. Segregation settlement was also a tool to execute the policy of isolation

and implement social control. In narrating the harrowing tales of victims of a stigmatized

disease such as leprosy, we perceive the disease as both a pathological reality and a

multidimensional or social construction framed in an intersection of history, politics,

culture, medicine and the relationships among poverty, power and disease.288 Thus to tell

a complete story of patients and their agency, it is necessary to highlight the

multidimensionality of a separating disease like leprosy and how isolation in a settlement

affected patient experience with disease and medicine. It is also important to mention that in narrating sickness, the former patients interviewed are seen as the best historians one can imagine as from their stories one learn not just about their physical problems but also about where they come from, their spiritual life, and how disease affected their social life.

And as been noted, patients lost all the rights and privileges of a person once he or she became a leper.289

Settlement life was highly regulated and relatively organized, and was a function

of bylaws that composed patient’s existence and behavior in the settlements and their

violation attracted mild to severe punishment. Although the Manyemen and Mbingo

288 J. N. Hays, The Burdens of Disease: Epidemics and Human Response in Western History (New Brunswick, NJ: Rutgers University Press, 2009). 289 C. N. Ubah, “Hope for the Despondent: A Colonial Health Care Scheme at Uzuakoli, Eastern Nigeria,” Transafrican Journal of History 21 (1992): 52. 125

Settlements served the two main geographical regions of Southern Cameroons, patients

came from different clans making the institutions a melting pot of cultures. The co-

existence of people from different ethnic groups and in some cases very different cultural

backgrounds caused some of the conflicts reported in the patient camps. It was, therefore,

necessary to regulate the activities of patients, although surviving reports reveal that there

were several recalcitrant patients. The institution was a very controlled social space and

punishable offences ranged from trespassing, theft, lies telling, promiscuity, unauthorized

exploitation of settlement farm produce to refusal to perform communal work. The

leprosaria were also complex structures with special camps reserved for female and male

patients. It was expected that male patients remain in the male reserved quarters and

similar expectation was accorded female patients. However, there were situations where

patients ignited amorous relations and were forced to sneak themselves to the quarters of

the opposite sex for nocturnal visits.

After the first batch of patients were admitted in the Settlements, subsequent

admissions were based on well prescribed principles. According to the recommendations

by the Divisional and Provincial Leprosy Boards, admission was based on a quota system

in which each NA was allocated a number of places at the Settlement annually and each

patient was expected to pay a fee of six pounds sterling.290 In the first year of its

operation, the Manyemen Settlement reserved ten places for each of the three Divisions

(Bamenda, Wum and Nkambe) of the Bamenda Province. The government committed

NAs to subsidize the fee for patients from their council areas. Two pounds sterling from

290 File No. 856, “Admission to Leper Hospital at Manyemen”, Memo from the Senior District Officer, Bamenda, to the Basel Mission Secretary, Buea, 11th March, 1954. 126

the fee per patient was deposited in the Settlement Bank for the upkeep of the patient,

refunded by monthly installments of five shillings.291 Patients were to feed themselves

from the food crops and proceeds from the cash crops cultivated in the Settlement farms.

Therefore, it was recommended that patients seeking admission must be physically able

to work and patients too feeble to endure physical labor were rejected except when they were beneficiaries of the pauper scheme.292 Thus, preference was given to infectious cases and children.

The problem, however, arose on how to distinguish or classify a patient as a

pauper. The task of identifying patients to be classified as pauper was, therefore, given to

NAs as it was felt that only people in a given area from which the patient came from

could accurately identify their need.293 To resolve the contentious issue of subsidizing

paupers and ensuring that only real pauper patients were admitted free of charge, it was

agreed that Missions should not admit pauper patients except where the native authority

oblige to pay the fee. However, NAs were always incapable of paying the fee for all

patients and families who could afford paid for their sick patient. The payment of

admission fee was used as a means to bond patients and keep them escaping prior to

completing treatment as well as to supplement the grants-in-aid that Settlements were

receiving from the government and other foreign voluntary organizations. Admission fee

increased in the 1960s after independence and reunification with the Republic of

Cameroon forming the Federal Republic of Cameroon in 1961. In 1965 the entrance fee

291 File No. 856, Memo from Rev. P. Scheibler, Basel Mission Secretary, to the District Officers of Bamenda, Wum and Nkambe, 22nd March 1954. 292 File No. Sc/a (1946) 2 {432C}, Memo from P. J. Caffrey, S.M.O., Victoria, to the Resident, Cameroon Province, Buea, 3rd May, 1946. 293 File No. 2088, Minutes of the Manyemen Leprosy Board Inaugural Meeting. 127

at the New Hope Settlement had risen to two thousand eight hundred Francs from one

thousand four hundred in the previous years.294 However, the patient was expected to

make only one payment irrespective of his or her duration at the Settlement. The adoption

of patient fees at Mission hospitals affected patient turn out to Settlements in the 1970s

even though measures were taken by government to keep the fees levied low in order to

ensure that healthcare was accessible even to the poor and needy.295

Although the Settlement staff went out on routine survey through which cases were detected and recommended for institutionalization, patients made use of their agency and self-reported their health condition to settlement authorities. The popularity of treatment at a leper settlement and increased confidence in the treatment offered increased passive diagnosis in the 1950s as patients who had travelled to Itu Colony returned cleansed of leprosy.296 On an increasing basis, patients wrote letters to the

Settlements requesting information on the modalities and expenses to benefit from the

services being rendered especially with the increase of Africans among Settlement staff

which erased mistrust against a European-only staff. For example, in November 1953,

one D. E. Essim wrote the Basel Mission Secretary at Buea inquiring among other things when the Mission would begin accepting patient at the Manyemen Settlement as well as the conditions for admission.297 Many of such letters were written by patients desperate

to seek treatment and ameliorate their health condition amidst the stigma in their

294 Dr. Eugene R. Stockdale, “C.B.M. Report on Bamenda New Hope Settlement (Leprosy) 1965. [NABHC] 295 Sc/a (1963) 2, Letter from N. van der Stoep, Basel Mission Secretary to the Delegate and Regional Inspector of Labor and Social Insurance, Buea, West Cameroon, 17th December, 1971. 296 Personal communication at Mbingo on December 10, 2015. 297 File No. 856, Letter from D. E. E. Essim, Likomba Plantation – Tiko, to Basel Mission Secretary, 10th November, 1953. 128

communities. Unfortunately, patients could not be accepted in 1953 until a doctor was

permanently stationed at the Settlement.

The duration of treatment lasted three years or more depending on the severity of

the condition of the patient.298 Thus the long period of living a solitary life away from

family caused patients to get into relationships with their counterparts of the opposite sex

to satisfy their canal needs. There were cases where violators where caught forcing the

settlement administrators, in strict application of the bylaws, to expel violators. It was

equally strictly forbidden for settlement workers to have love affairs with patients and

violators were dismissed immediately or asked to resign. Besides of spreading disease,

amorous relationship between patients and healthy settlement staff was strongly

discouraged because it was professionally unethical. In June 1960, the functioning of the

activities of cooks at the kitchen at Manyemen almost went to a standstill after a member

of staff had to be replaced by a newly discharged patient. During the monthly Committee

meeting in June, it was reported that a female cook by name Elisa Nja was having an

affair with a patient in the Settlement.299 The Settlement Executive Committee not only recommended her immediate dismissal, but recommended she be replaced by a former patient, Elisa Ngoe, who had just be discharged indicating the intolerance of the

Settlement administration towards staff who failed hold up expected professional ethics

298 Sc/a (1952) 4, “Bamenda New Hope Leper Settlement January 1954 News Bulletin” by G. D. Schneider and Laura Reddig. 299 File No. 1616, Minutes of the Executive Committee, Basel Mission Leprosy Settlement, held on 17th May, 1960 129

even though the institutions were also in shortage of staff, a major setback to the optimal

operation of the Settlement.300

In another case, Oscar Ndike, Assistant Overseer, serving at Manyemen was

dismissed on charges of adultery with a patient. Ndike, a former patient, who had been

discharged, was at the time of his dismissal in March 1962 serving as an Assistant

Overseer supervising communal work by patients.301 He had put a female patient, Frieda

Elomba, in the family way and although it was discovered that all the patients were aware

of this, all the European staff were ignorant of the fact. As such he continued the illicit

relationship and nightly visits to Frieda’s home in secret. Unfortunately, they could not

remain discreet eternally and the matter was brought to a heard as a result of fight

between both lovers over a blanket Oscar had bought Frieda. Keeping to the rules of the

Settlement, the matter was frowned and judged seriously in order to deter other

Settlement staffs from indulging in such unacceptable practice. During deliberation,

members of the jury argued that him being a former patient Ndike knew the rules and

therefore had a greater responsibility as he had abused his power vis-à-vis a female

patient. Thus, he was summarily relieved of his duty without the statutory one month

notice while Frieda was transferred to the leprosy rural clinic at Konye in order not to

serve as bad example to other patients. This severe decision did not only penalize the

culprits but was expected to have a deterrent effect on other patients nursing such

nefarious plans as it was the first in more than two years. Settlement administrators felt

300 File No. 834, Correspondence between Dr. Emilia Ode, M.O. in-charge of Presbyterian Leprosy Settlement, Manyemen and Dr. T. C. Nchinda, D.M.S. Victoria, 4th April, 1970. 301 File No. 1613, Minutes of the Executive Committee, Basel Mission Leprosy Settlement, held on 29th March, 1962. 130 that to guarantee the optimal functioning of the facility and optimize leprosy control strategizes it was absolutely necessary for social tranquility to reign among the patient community.

Even though measures were taken to prevent patients or staffs from having romantic affairs with patients, the Settlement administration encountered a perennial problem of pregnancy among female patients. This was so recurrent and a source of strain to an already overworked staff. To resolve the problem, it was suggested that expectant non-infectious female patients be sent back home in the sixth month of the pregnancy and if infectious, the patient should pay a fee of four pounds sterling and remain at the Settlement or choose from the options of being sent to a leprosy clinic near their place of origin or personally find a place to reside close to a clinic.302 Such patient could only return after the baby has been weaned and the patient who still needed to complete treatment was not allowed to return with the baby. The Chairperson of the

Executive Committee at Manyemen Settlement was, however, disappointed that pregnant patients were anxious to pay the extra fee and remain at the Settlement. Although in the

1960s it was conventional knowledge that leprosy was not hereditary, it was equally known that children were susceptible to the infection. There were, however, special cases wherein infected nursing mothers were admitted but isolated in special quarters in the available dormitories. In the 1960s, the pressure on segregated institutions was so high to the extent that the control of the sexuality of patients through punitive measures against transgressors of Settlement bylaws were a means to expunge undesirable patients and create space for those in critical need for treatment.

302 File No. 834, Minutes of the Executive Committee, Basel Mission Leprosy Settlement, April 1960. 131

Settlement Council maintained order and the strict enforcement of settlement statutes. Settlement council articulated patients’ grievances and governed the behavior of community members giving Settlement staffs the opportunity to care for the medical and spiritual needs of the patients. The shortage of staff made it practically impossible for regular staff to personally police the patients. Members consisted of respectable elderly patients who had stayed at the settlement for a long period.303 In 1954, five of the over fifty patients at the Bamenda New Hope Settlement were among the eight members who served in the governing body at the settlement. The Council was headed by an elected chief who presided over adjudications of petty to serious offences as well as in settling interpersonal disputes within the patient community. Those who were found guilty of offences were fined or asked to pay indemnities in kind in the provision of drinks (palm- wine) or do community work. The Council avoided imposing heavy penalty on patients since most were poor and paupers depending on the goodwill of donor organizations.

However, to ensure strict compliance of the law, offenders were made to respect the decisions of the governing council. Those who refused to observe the terms of judgments were reported to the administrators of the settlement. For instance, in the July 1961 minutes of the Executive Committee of the Manyemen Settlement it was reported that one Albert Ebone [Ebune] was illegally harvesting palms that belonged to the institution.304 He was found guilty but refused to pay the fine imposed on him by the

Settlement Council. In order to compel him to respect the clauses of the judgment, it was suggested and approved that the medical staff ceased administering treatment to him until

303 Personal communication at Manyemen on January 15, 2016. 304 File No. 1616, Minutes of the Executive Committee, Basel Mission Leprosy Settlement, held on 25th July, 1961. 132

he completely pays the fine. The decision to cease giving treatment to Albert shows the

extent to which the administrators of settlement were willing to go to maintain order even

if the health of a patient was sacrificed. The hierarchy created by this system regulated

the interaction of patients with hospital personnel and reflected a traditional African

village model as well as engendered a sense of community among patients.

The mobility of patients was equally restricted with patients expected to obtain

permission before living the Settlement into adjoining community. Besides the drug

treatment administered to patients at the institutions of isolation and during outpatient

work in rural clinics, the control of the movement of leprosy patients was thought to be

one of the most effective prophylactic measure. As in other leper colonies across the

world, before the sulfone drug therapy was introduced strict application of rules and

colonial ordinances were used to maintain segregation between patients and non-patients

ostensibly to prevent contagion.305 Rules that restrict the movement of patients beyond the confine of the Settlement limited the space and activities performed by patients.

Although it was common knowledge by the 1950s that leprosy was not contagious, colonial ordinances and settlement bylaws constituted a set of social barriers between segregated patient and non-patient in the community. Contact with the outside world was limited to patient and staff encounter as well as visiting relatives, which were few and far

between. To regulate the problems associated with visits, the management at Manyemen

introduced visitor’s permit to control the frequency and velocity of visits.306 It was

305 Langlas, Kalaupapa is Us, 14; Ted Gugelyk and Milton Bloombaum, The Separating Sickness Ma‘i Ho‘oka‘awale (Bangkok: Darnsutha Press, 1979). 306 File No. 1616, Minutes of a Meeting of the Executive Committee, Basel Mission Leprosy Settlement, held on 25th July, 1961. 133 noticed that some visitors break the rules and visited patients without obtaining of a permit. To ensure that movement was controlled and curb the risk of uncontrolled interaction between the patient and healthy members in the community, it was decided that the issuance of permits be sustained and enforced rigorously. Over the years, as treatment for leprosy became more effective and more former patients declared free of the symptoms and discharged, the relocation of former patients in the communities in which Settlements were located indicates a fall in the level of stigma and acceptance in the community.

Restriction of the interaction between patient and community helped to perpetuate the mystery and stigma surrounding leprosy. Despite the measures taken to restrict the mobility of patients, there were complains of resident patient boycotting Settlement curfew and stray into the community. The criminalization of leprosy justified the penalization of two school boys, Philip Mbiapa and Elias Eyasa, both at the Settlement school in Manyemen in July 1960. Both students were dismissed from the school and

Settlement after they went into the Manyemen village without permission to consult a traditional healer.307 Schools were opened, with grants from the government, for the education of young patients admitted at the settlement or those delivered by resident leper parents. The dismissal of Philip and Elias created unease in the Settlement community as the father of one of them went about threatening the housefather at the school dormitory for reporting his son and had to be called to order by Settlement administration.

It was difficult for an extremely troublesome patient who had been dismissed to be readmitted in the Settlement. Settlement managers were resolved not to give the

307 File No. 834, Minutes of the Executive Committee, Basel Mission Leprosy Settlement, June 1960. 134

impression that readmission was possible despite the gravity of offences. Except for

patients who were still infectious and therefore considered public health risk, it was only

on extraordinary occasions wherein a patient dismissed for breaking regulations were

reinstated. In February 1960 Dr. Stockdale, M.O. at the Bamenda New Hope Settlement,

drew the attention of the District Officer Bamenda, in-charge of Tikari NA, of the intention to expel a certain patient named Lengoh [Lengo].308 Dr. Stockdale reported that

Lengoh, who was brought to Mbingo against his will, was unruly and unwilling to obey

regulations ever since his arrival. According to the Medical Officer, Legoh was:

very uncooperative . . . . refuses to obey the Settlement Rules, will not listen to

orders from anyone, and is a very bad influence for the rest of the patients. As a

result, he has had very little treatment for leprosy since he has been here. In

addition he has paid no admission fee in spite . . . he is well able to do so. He

makes mats and supports himself very well. The Settlement offered to buy his

mats as a price above what he would get elsewhere, but he would not sell to the

Settlement and pay his fee in this way.309

Because of his disruptive behavior and failure to pay the fee, Settlement

management was not going to tolerate Lengoh further and was eager to expel his

immediately or, if possible, send him to far-off Oji River in Nigeria, where they had a penitentiary system to deal with difficult patients. Less than two weeks after been briefed of the matter, the District Officer informed Dr. Stockdale of his intend to bring the matter before the Caretaker Committee of the Bamenda Tikari Council in March pending update

308 Sc/a (1952) 4, Letter from Dr. E. R. Stockdale, M.D. Bamenda Settlement, to the District Officer Bamenda, 12th February, 1960. 309 Ibid. 135

on the Committee’s decision.310 Rather than allow him return to his village and expose many other healthy people, the District Officer was in favor of sending Lengoh to Oji

River, but requested that he be held for a little longer pending the Caretaker Committee’s decision. However before a decision could be made, Lengoh escaped from the New Hope

Settlement and all efforts to track him down in Bangolang, which was assumed to be his place of origin, failed.311 After weeks of desperate search, it was discovered that Lengoh

was not an indigent of Bangolang, but of Bamessing, and was receiving care at the

Bamali leprosy clinic. Informed of the possibility of finding Lengoh at Bamali, the

officials of the Tikari Council solicited the help of the resident Leprosy Inspector at

Bamali to bring Lengoh to Ndop in order for arrangements to be made for his onward

transfer to Oji River.312

Unlike the case of Legoh, the Bamenda Settlement was willing to readmit a

certain Sylvalius Shawa, also from the Tikari Council Area. Admitted in May 1955,

Sylvalius became notorious for causing considerable trouble by refusing to comply with

regulations until management invited the police to evict him from the Settlement.313 The

uniqueness of Sylvalius’ case was not him being escorted by a police, but he had

attempted suicide in protest for his continuous retention at the Settlement. The misery of

living far away from the family or without routine family visits caused psychological

breakdown in some patients. When he was evicted from the Settlement, Sylvalius was

310 Sc/a (1952) 4, Letter from the Secretary, Bamenda Tikari Council, to the M.O. Bamenda Settlement, 20th February, 1960. 311 Sc/a (1952) 4, Extract from Minutes of the 15th Meeting of the Bamenda Tikari Council Caretaker Committee held at the Federal Centre, Ndop, on 9th April, 1960. 312 Sc/a (1952) 4, Letter from the Secretary, Bamenda Tikari Council, to the Leprosy Inspector, Bamali, 31st May, 1960. 313 Sc/a (1952) 4, Letter from Dr. E. R. Stockdale to Mr. A. B. Nyoh, Secretary, Bamenda-Tikari Council, Ndop, 30th March, 1960. 136 owed the Settlement three pounds sterling, yet because of the headache he caused management was eager to allow him leave without making good his financial obligation with the institution.

A month after his eviction, Sylvalius approached the Tikari Council with a letter from the District Officer asking whether the Council could consider providing financial aid to him in order to facilitate his readmission in the Settlement.314 The Council agreed to subsidize his treatment on the conditions that he report to the Council for confirmation that he is an element of Nsaw (Nso) and to sever payment if he continued to be a torn on the side of Settlement management.315 Out of pity for his deteriorating condition, Dr.

Stockdale was willing to accept Sylvalius again on probationary basis if payment of the three pounds sterling was effected and an extra three pounds sterling deposited in the

Settlement account so that finances should not be the source for future problem. Dr.

Stockdale also advised on the need for Sylvalius to engage in remunerating work at the

Settlement in order to be self-supporting as it was his refusal in the past to do so that stirred most of the troubles.

Besides the medical care patients received in the Settlements, missionaries used the facility as a site for evangelism. Missionaries spared no effort to preach the Christian gospel to patients and the chapel was an integral part of Settlement in line with Paul’s philosophy of missions as captured in 1 Cor. 16:8-9. Even though settlements were

Mission operated, religious belief was not a factor in the admission of patients. However,

314 Sc/a (1952) 4, Letter from the Secretary, Bamenda Tikari Council, to the Medical Officer, Bamenda Settlement, Mbingo, 28th April, 1960. 315 Sc/a (1952) 4, Extract from Minutes of the 15th Meeting of the Bamenda Tikari Council Caretaker Committee held at the Federal Centre, Ndop, on 9th April, 1960. 137 once admitted patients were expected to conduct themselves spiritually in accordance with the teachings of the gospel of Christ. Missionaries involved in leprosy work in

Africa believed that the healing of the body was incomplete without spiritual healing.316

The association of leprosy with the Bible was a justification for voluntary agencies to act as a bridge between clinical and compassionate care. The existence of chapels, usually at the center of the Settlement, had the profound effect of popularizing the Christian missionary culture and the advancement of the Christian doctrine beyond the confines of the facility.

Figure 7.

Church at Manyemen. Source: Author

316 Shankar, “Christian Medical Missions as Muslim Charity,” 73-74. 138

According to the missionary nurse at Mbingo, Laura Reddig, the greatest joy was

“over the precious souls who have come into a newness of life during [their] years at

New Hope” settlement. 317 She reported the baptism of sixty-five patients in 1957 and

revealed that the Mbingo Baptist Church had one hundred and forty-eight registered

members in the same year. Other Christians at Mbingo Settlement were Basel Mission

converts also jointly fellowship at the chapel. Evangelism at the Settlement was

democratic so as not to deter patients of other Christian denomination or non-Christians.

Missionaries organized catechumen class and Sunday school classes conducted in

different local languages with the aid of baptized patients or catechist who were mostly

former leprosy patients. Weekly meetings were jointly held by women in and out of the

Settlement thereby demystify the fear people had for leprosy patients. Sunday worship concluded a busy schedule of patients punctuated by routine medical checkup, reception of treatment and community work, and did extra work to earn their own Bible. Over the years Cameroonians were ordained as pastors and took over the ministry of the gospel in the settlement. In October 1966, a former patient, Ngong, was ordained pastor rekindling the spiritual atmosphere off the settlement through his Sunday messages and Wednesday lessons, visitation, and work with hospital patients.318

There were also special Bible teaching clubs for young children and severely

disabled patients who could not make it to the church.319 Such gatherings and meeting

served as platform for acculturation. A devotional period preceded every treatment

317 Laura Reddig, “Bountiful Blessings at Bamenda New Hope Settlement,” in Annual Report for 1956. [NABHC] 318 Report by Dr. Jerome C. Fluth, “Cameroon Baptist Mission Report – Bamenda New Hope Settlement (Leprosy) 1966. [NABHC] 319 Personal communication at Manyemen on January 14, 2016. 139

session for the leprosy patients and was an opportunity for personal contacts between the

European missionary and African patient.320 Medical missionaries used the used of God

to control patients’ actions and quell patient protests as was the cases in 1953 when angry

patients at Bafreng agitated demanding that the bi-weekly dose of Dapsone pills be

increased from two to four threatening to leave the camp if their demand was not met.321

All effort by Laura to convince the protesting patients to accept two pills reiterating the

toxicity of the drug and the risk of administering four pills without a resident doctor was

futile. Such patient protest and resistance encountered by colonial medical personnel was

partly as a result of the distrust Africans had for the European medical personnel. After

long unfruitful negotiations for the patients not to jeopardize the scheme, Laura prayed

and asked the patients to pray over the issue pledging to grant their demands if it were the

will of God. It is worthy to note that the patients were been given the dosage directed by

the manufacturer of the drug.322

Apparently Laura’s appeal to the consciences of the patients worked and the

following morning one of the protesting patients came to her house early in the morning

to inform her of their decision to accept two pills. One of the older patients lamented:

“Please Ma, we made very bad, very big mistake. We will take the two pills todays if you

will give them to us. We are sorry. Forgive us.” Similar stories of symbolic spiritual

victory were recounted by a former pastor at the Manyemen Settlement. When cast in

doubt and misery, patients often relapsed into self-pity and needed counseling to rekindle

320 Report by Dr. Jerome Fluth, “1961 Bamenda Settlement Hospital and Leprosy Control Statistics.” [NABHC] 321 Hughes, Love Them for Me, 77. 322 Ibid., 78. 140 their morale. Upon discharge some of the patients returned to the community and became vectors of the Christian doctrine. Although having completed treatment returnee former patients preaching the gospel were not always accepted especially in those communities that were very remote from the Settlement to appreciate its relevance.

Even though more villages in the Grassfields area had accepted Christianity and missionaries in the 1950s, some were hostile to spiritual leaders of denominations operating leper settlements and who were former patients at a leper settlement because of its history of stigma. For instance, leprosy stigma affected the growth of the Baptist

Church in the village of Weh, Wum Division, in the Grassfields region. The Baptist church opened in the village could not survive largely because of the fear of leprosy as its founding members constituted discharged patients from Mbingo.323 The fear and stigma of leprosy even resulted to reluctance of villages to accept former patients. Some of the old members of the church recount how fellow villagers avoided their social gatherings and in public spaces. The original church built with sun-dried bricks was left to dilapidate as it was considered ‘the church for lepers’ by the healthy members of the community.

The Baptist Christians at Weh were forced to abandon the church and construct anew a permanent building in order to increase fellowship at the church but the engrained memory of stigma was low to be erased.

With the increase in the number of young patients and children delivered at the settlement, the administrators of both Settlements decided to open schools to provide education to the young residents as well as provide remedial adult education classes to older patients. In 1955 it was reported that of there were at least fifty children and youth

323 Personal communication at Bamenda on December 2, 2015. 141 less than eighteen years residing at New Hope Settlement.324 The schools were to prepare the young patients to find jobs and contribute to society upon discharge. It was agreed that for learning to be effective at the schools, the government through the head of social services provide annual subvention. The curricula of the schools were the same as other schools in the territory and pupils sat the same national examination, but had special focus on hygiene, disease prevention and health propaganda. Four years after Basel

Missionaries commenced leprosy work at Manyemen, a school was opened.

Figure 8.

Settlement School Manyemen. Source: Author

The school opened its doors in 1958 had mostly male pupils as students.

Dormitory for students were adjacent to the classroom building. The school at Manyemen had four classes and prepared its pupil for the First School Leaving Certificate (FSLC) examination to mark the end of primary education. The pupils were taught by teachers

324 Report by Gilbert Schneider, “Annual Medical Field Report 1955. [NABHC] 142

who were ex-leprosy patients.325 Discipline was strictly enforced in the school with

truants severely punished. Besides school rules, pupils were expected to strictly comply

with Settlement rules. The school was closed in 1980s after its last pupil wrote and

passed the FSLC and the classrooms are currently occupied by a private college while the

dormitory serves as housing for some Manyemen hospital staff. At the Mbingo

Settlement, literacy classes were held three times weekly in the 1950s and two patients

served as teachers.326 By 1965 the school at Mbingo began Class seven with seven students in the class, some of whom having had all their education at Mbingo.327 From a

modest beginning, at the end of 1965, seventy-four students were attending the Mbingo

Settlement School while receiving treatment and at the end of the school year in August

1965, nineteen of the total enrolment was discharged as symptom free. Students who

attended Settlement Schools were provided food prepared by the kitchen staffs and

education was free of charge.328

The collection of money for any purpose was discouraged as it Settlement school

was classified as an ordinary village school. Children were supposed to deposit their

money with the administrative officer of the Settlement to avoid theft and the big ones

were given the opportunity for gainful employment in order to earn extra money.329

Settlement Schools provided the opportunity for education to young patients and children

of patients which they otherwise would not have gotten if they were not Settlement

325 Personal communication at Manyemen on January 14, 2016. 326 Sc/a (1952) 4, Bamenda New Hope January 1954 News Bulletin. 327 Report by Dr. Eugene R. Stockdale, “C.B.M. Report on Bamenda New Hope Settlement (Leprosy) 1965. [NABHC] 328 Ibid. 329 File No. 1616, Minutes of the Executive Committee, Basel Mission Leprosy Settlement, held January 1960. 143

inmates. A special ceremony was organized in order to discharge patients and the

discharge certificate was very symbolic as it represented a license to the outside world

and all its trappings. The discharge certificate declared a patient healed, a return to

wholeness of the body and soul, as well as announced the return of former patients as

respected members of the society. The excitement on the faces of patients as they receive

the discharge certificate has been compared to the coronation ceremony of Queen

Elizabeth, and the certificate the equivalent of the crown.330

Rehabilitation was a special aspect of the services provided by the Settlement.

Whereas some of the inmates got to the Settlement with handicraft skills, others became apprentices in various handcrafts.331 Work and physical exercise were considered critical

in the recovery process of a patient and were encouraged to engage in several types of

handwork as such weaving, carpentry, cobbler, masonry, and other industries. Items

made by patients include leather crafts, mats, rug, and baskets. Patients were able to

generated income by selling the items and self-sustain themselves at the Settlement.332 To

encourage craft and the patients, many of their produce were bought by the Settlement for

re-sale in markets in neighboring towns. Patients learned the trades of carpentry and mason for free, and with acquired skills assisted in the construction of some of the

Settlement buildings. In 1965, the Mbingo Hospital tailor was a discharged leprosy

patient who was trained at the settlement. Competition was encouraged and occasional

handwork contests were organized in order to help patients maintain interest in arts-and-

crafts as well as for the sharing of knowledge. The skills acquired at the Settlement

330 Hughes, Love Them for Me, 91. 331 Ibid. 332 Sc/a (1952) 4, Bamenda New Hope January 1954 News Bulletin. 144 helped discharged patients in their reintegration in society as the income generated relieved them from becoming a burden and dependent on relatives. Throughout the decades of 1970 and 1980, shoes needed by patients with ulcerated and deformed feet were produced and supplied by a former patient at Mbingo. He currently supplies shoes around Bamenda and is a prominent businessman.333 Figure 9 presents an example of a chair made in 1966 by a patient for the Settlement Chaplain.

Figure 9.

Chair Made by a Patient. Source: Author

333 Personal communication at Bamenda on January 13, 2016. 145

Conclusion

As the preceding paragraphs have shown, the aim of the Settlement was more than the segregation of leprosy patients. The patient had to be cured and the progress of the disease stopped in order to render the patient non-infectious. During the long period of treatment, specific measures had to be taken towards the rehabilitation of the patient.

The physical, spiritual, and psycho-social care patients received was meant to make life worthwhile again. Extra measures had to be taken so that severely deformed or disabled cases are prepared to return to an independent existence in the community, only then were the patients judged to be fully ready for discharge.334 While it was expected that upon discharge and declared symptom free the ex-patient would leave the settlement, some patients remained at the settlement. The reasons for voluntary confinement are as follows. Some former patients did not have a family to return to. Fear and stigma of leprosy made family members to sever relationships and abandon patients at the mercy of the settlement.335 Those who became blind, crippled or otherwise disfigured and had nobody to take care of them also had reason to remain at the settlement after discharge.

Others with relapse and stubborn ulcers remained in order to receive care for opportunities diseases that developed as a result of the leprosy infection. Another reason why discharged patients remained at the institution was because after long stay completion of treatment, patients developed a strong sense of community of people suffering from similar challenges, and were not certain how they would be received outside. To many of the former patients, Settlement provided a protective environment

334 Report by Dr. Kennett Jones – “Present Plans for Leprosy Control.” [NABHC] 335 Personal communication at Bamenda on January 5, 2016. 146

that superseded the highly controlled life. Also the limited and controlled interaction in

the Settlement with outsiders did not prepare patients adequately for imminent

reintegration in rapidly transformed social-scape in the communities.

The prospects of Settlements notwithstanding, the institution encountered several

challenges including a perennial financial hardship, troublesome patient population,

transportation difficulties as well as unethical staff some of whom stole drugs and

Settlement property. Former patients narrate tales of long suffering and psychological

torture, marriage disappointment, abandonment, family rejection, loss of property and

entitlements, accusation of witchcraft, and inability to find or keep a job. However, the

former patients interviewed did not only recount stories of pain and misery. Some have

highly cherished memory of Settlement life as the friendship and community developed

at the facility helped fight stigma and rejection. Rejected by family and society,

Settlement residents took to farming and other trade to support themselves and the

institution. The healthcare and social support provided at the Settlement helped patients

overcome stigma and many returned to serve their community in various capacities. In fact, contrary to their experience before admission patients experience with issues of stigma was minimal with institutionalized care similar to the experience of victims of tuberculosis.

147

Chapter Five: Conclusion

The dissertation entitled “Isolation, Control and Rehabilitation: A Social and

Medical History of Leprosy Treatment and Leprosaria in Cameroon” is an examination of

the leprosy scourge in the Anglophone region of Cameroon from 1916 to 1975, but more

importantly it is the story about the people who contracted the disease – and how through

their connectedness to each other within a highly-controlled space, to their families, to

their communities, and how leprosy affected their connection and daily lives. As Inglis

notes in his study on disease and displacement in Hawai‘i, “the greatest challenge in the

history of leprosy . . . is finding the voices of those yet largely unheard; the sufferers of

the disease.”336 The historiography on disease and medicine in colonial territories has

generally focused on disease as a colonial burden, medicine as a tool of empire, the

triumph of medicine over Africa’s disease environment, and the humanitarian welfarism

and charity spirit of colonial medicine-men.

Inasmuch as those themes enrich the historiography of Africa, their over- centralization elbows the agency of the African beneficiaries of colonial medicine into the doldrums of the continent’s social and medical history. This study was therefore an attempt to discuss the nexus between the policy of isolation in the control, treatment and rehabilitation of leprosy victims in Cameroon with the cardinal purpose to underscore the role played by custodial care in leprosy control and patient experience with the disease.

The dissertation is organized to mimic the progression of the medical and health policy encounter from when the British colonial administration took over leprosy work, the establishment of leprosaria to the declaration of leprosy as a public health problem in

336 Inglis, Ma‘I Lepera: Disease and Displacement, 6. 148

1974. This initiated the rapid decline of the Settlement in the management of the health

and lives of leprosy victims as increasingly the institution faced numerous challenges

including financial hardship as a result of that decision and the government’s reluctance

to remit annual subvention as the manager of the Bamenda New Hope Settlement

lamented against the frustrating non-payment of government grant for 1974/1975 and

1975/1976 respectively.337

Each chapter addresses an episode in the evolution of the territory and leprosy control. The study is divided into five chapters including the introduction and conclusion.

Chapter one of the study is the general introduction of the dissertation. It laid out the background, the argument, historiographical context, and the method as well as sources consulted in the development and analysis of the study. Chapter two discussed the political evolution of the territory from when the coast of the territory became trading grounds for the first European commercial agents in the eighteenth century to its annexation in July 1884 by Germany, and eventual takeover and partition by Brain and

France in 1916. Although the partition of the former German territory was finalized in

March 1916, the Milner-Simon Declaration that constituted the legal instrument of that

partition was only promulgated in July 1919 following the LoN decision.338 The chapter

also examined the arrival of European missionaries, in part, as a parallel development to

the colonization of the territory as well as its corollary of the introduction of biomedicine

that would constitute the bedrock of the eventual establishment of leprosaria in Cameroon

in the 1950s.

337 “Cameroon Baptist Mission Field Report Bamenda 1975.” [NABHC] 338 Osuntokun, “Anglo-French Occupation and the Provisional Partition,”; Osuntokun, “Great Britain and the Final Partition,”; Yearwood, “In a casual Way with a Blue Pencil,”. 149

In chapter three of the dissertation, the discussion focused on the debate and deliberation that informed colonial leprosy policy and the decision to open leprosy

Settlements in Southern Cameroons. The chapter also highlighted the historical vignettes that swayed between the Mandate and Trusteeship eras arguing that leprosy policy in

Southern Cameroons before the Trusteeship period lacked focus and adequate attention with the brunt of that disorganization on the thousands suffering patients. Half-measures taken by the colonial administration and the role played by various actors, particularly

Native Authorities and NA auxiliaries, in the control of the disease were equally discussed. The business of chapter four was to discuss Settlement life and experience of the patient highlighting the tales of pain, suffering, courage, hope and resilience, capturing the patient not merely as victims, but as active participants in both the disease and Settlement experience that affected many. It also examined the organization, mechanism and functioning of the Settlement vis-à-vis patient admission, management, care, discipline and control. The last chapter, which is the conclusion, synthesizes the major arguments and themes that thread the narrative in the preceding chapters. It is also a discussion of the major findings of the study and points to prospective areas or themes for future research on the subject of leprosy and disease control in colonial and postcolonial Cameroon.

In the development and analysis in this dissertation I made use of multiple sources and methods in data collection. Essentially a historical study, in order to portray the connection between the past and present of former leprosy patients incarcerated at both the Manyemen and Mbingo Settlements, I applied a narrative and interpretive analysis of 150

the facts and themes that emerged in the variety of primary sources consulted. Besides

secondary sources, the attempt to find the voice of the patient was achieved by the

consultation of archival and photographic data as well as the conduction of interviews

with multiple stakeholders, particularly former patients isolated or still living at a the

Settlement, Leprosy Inspectors and members of the community directly or indirectly

affected by leprosy or the establishment of the leprosaria in their community. Although I am of the view that patients are better historians as they best tell their story on their experience with disease, the non-existence of autobiographies or a commissioned biographies by patients from either of the Settlements left one with no choice but to resort to archival records and documents in other to construct the history of how the policy of isolation adopted to control leprosy affected the lives of the disease’ victims. In the development of this dissertation, I gathered pieces of information from letters, personal journals, newspaper articles, medical documents, minutes by various Leprosy Boards and

Settlement Executive Committees, and reports concerning leprosy in Cameroon. The multiplicity of sources helped us to highlight personal stories and details in an engrossing prose of a hitherto overlooked heartbreaking chapter in the history of Cameroon.

In telling the story of leprosy of a changing society’s reaction to it and of the consequences of that experience, interviews with former Settlement inmates helped elucidate social history of custodial care from the last surviving inmates of both the

Manyemen and Mbingo Settlements. Being that several of the discharged former patients are scattered across Cameroon and several others were dead, it was a challenge to identify the principal interlocutors for this study, which I overcame by limiting my survey 151

to the few surviving patients who opted for voluntary isolation after discharge for various

reasons or former patients who were relocated in the community outside the Settlement.

It was discovered that acceptance level for former patients was higher in the communities

in which Settlements were located and their vicinity explained by continuous

sensitization and increased awareness. This was not the case in those areas far-off from the Settlements and that had very few ex-patients returned to them. Whereas I was able to fill the gaps left by rapidly deteriorating archival material, and in one case disorganized archival system (at Manyemen) with information gathered through oral tradition, limited time and resources in combination with the impracticability of locating more surviving former Settlement inmates restricted my intention to catalog a far more comprehensive account of patient experience. This could have been developed further if I had explored the still-to-be declassified material wasting in the archive at the Medical Institutions

Manyemen or those found at the Basel Mission Archives, Basel, Switzerland.

152

Figure 10.

Partial View of Abandoned Files at the Medical institutions Manyemen. Source:

Author

When Britain took over administration of the territory that was part of former

German Kamerun in 1916, one of the many challenges British colonial administrators and their auxiliary had to grapple with was the numerous diseases including the then highly dreaded and stigmatized leprosy. There is little documentary evidence suggesting serious anti-leprosy work during the period when Britain had provisional administration

(1916-1922) over the territory despite having inherited a modest healthcare system and infrastructure from the German colonial service.339 However, the gradually changed in the confluence of grounded colonial administration and prescription for social welfare provision in mandated territories by the LoN. Between the Mandate and Trusteeship periods, considerable efforts were made to control the spread of the disease but little was

339 Mokake and Kah, “The Impact of German Colonial Policies,” 93-117. 153

done to provide treatment to people already affected by it. During this dormant period,

NA were more active in leprosy control variously by reporting cases to the

administration, paying for their passage to a leper colony in Nigeria or in one of the small

NA leprosy villages, and by delegating NA teachers to conduct leprosy surveys in various

districts. The goodwill of NAs to ameliorate the health of the population and check the

spread of disease notwithstanding, perennial financial hardship restrained the number of

patients that could have benefitted from the available care and services in the 1940s.

The 1950s marked a turning point in the history of leprosy control in Cameroon.

The popularization of the use of sulphone drugs in late 1940s and the founding of leprosy

Settlements brought hope to the several patients who otherwise would have languished to

death as outcasts or travel to Nigeria for treatment. Settlements not only provided

optimism to patients but were the tool to implement the isolation policy adopted by the

colonial government. It is worthy to mention that the isolation of people suffering from

leprosy was not new to the Africans. In fact, the history of segregating lepers dates back

centuries in those parts of the world where leprosy was a problem. Patients were

ostracized in Cameroon before the establishment of leprosy Settlements in the 1950s and

in some cases reduced to words. However, the change this development brought was that patients could now live and be treated in a controlled space. Thus, beyond the melancholy of ostracism to the margin of the community which sapped the life of leprosy sufferers

and portrayed them as neither living nor human, the establishment of custodial care

gradually became a welcome initiative to the patient as it restored their perception and

meaning to life. The sense of community that flourished in the Settlement was 154

empowering to the inmates spunky to survive beyond the misery imposed by a

debilitating infectious disease.

The ‘criminalization’ of leprosy through the enactment and exacting enforcement

of colonial edicts meant that in the institution, the patient was observed and monitored.

Colonial medicine has been criticized for objectifying the African body among other

ethical ambiguities, with the practice of medicine postured as a sort of colonial violence

and discipline of the colonial body.340 Over the years the medical missionaries who

served at Manyemen and Mbingo conducted laboratory research on the bodies and tested

new drugs on inmates fulfilling one of the cardinal missions of the Settlement – as an institution for leprosy research. Besides providing a relatively convivial environment to the patient, the overly restrictive rules of Settlements sapped the life of the patient rendering him or her less human. Nonetheless, with the delightful increase in the effectiveness of the sulphone drugs in the 1950s and later the Multi-drug Therapy (MDT) of the 1980s with the administering of Dapsone, Rifampicin and Lamprene combination, the appeal for custodial care in a Settlement intensified. Unfortunately, the available accommodation and staffing were overwhelmed. Yet the popularity of the Settlement and its network of village leprosy clinics helped control the mobility of patients, reduce risk for indiscriminate transmission, and altered public perception towards leprosy and its victims. As far as leprosy is concerned, victimhood straddled beyond the patient to the

340 Nancy R. Hunt, A Colonial Lexicon: Of Birth Ritual, Medicalization, and Mobility in the Congo (Durham: Duke University Press, 1999); John Rankin, Healing the African Body: British Medicine in West Africa, 1800-1860 (Columbia, MI: University of Missouri Press, 2015); Melissa Graboyes, The Experiment Must Continue: Medical Research and Ethics in East Africa, 1940-2014 (Athens: Ohio University Press, 2015); Nancy R. Hunt, A Nervous State: Violence, Remedies, and Reverie in Colonial Congo (Durham: Duke University Press, 2016); Tilley, “Medicine, Empires, and Ethics,” 746-748. 155

effect of affecting the lives of Settlement staff and family members of patients. Former

staffs narrate stories of rejection and were despised in some communities merely for

working with leprosy patients and the fear of the disease.341

The raison d’etre for the adoption of the policy of isolation and segregated

treatment of leprosy patients was to have patients in a confined area within which

treatment could be administered and patients monitored for progress, but also to bring to

barest minimum the movement of potentially infectious persons in the society. Even

though the quarantine of leprosy patients was unpopular in some communities as patients complained that it was restrictive of their interactions and resisted being ‘fenced in’342;

leprosy itself was a separating disease343 that punctured and punctuated the lives of the

patient robbing them of a social existence. Biomedical attitudes toward leprosy is

explained by the uncertainties of its origin, spread and cure, inherited from a beleaguered

experience in sixteenth and seventeenth centuries Europe, and crystalized by a highly

racialized colonial experience in the early twentieth century. Thus, the isolation of the

patient in a segregated Settlement was a defensive response to the fear and dreadfulness

cast by the disease and the need to control a racially inspired dangerous section of the

colonial population in Cameroon.

When this policy was first initiated to the British territory of Southern Cameroons during the Mandate period, there was evidence of a cross-cultural difference regarding the level of stigma associated with leprosy as colonial official reported the incomprehensible practice of free mixing of infected persons with healthy family

341 Personal communication at Bamenda on 14 January, 2016. 342 Gould, Don’t Fence Me In. 343 Gugelyk and Bloombaum, The Separating Disease, 1. 156

members and in the community. Living in a Settlement was, therefore, a privilege to the

several thousands who were able to gain access in the almost three decades of the

existence of the institutions at Manyemen and Mbingo. Although it could be argued that

isolation of patients was another display of the unbridled power of colonial and Mission

authorities over subjugated people, the optimism and fulfillment of the settlement scheme

is reflected in Cameroon Baptist Mission report which states among other things that:

Each patient must not only be healed but must return to his society that cast him

out, as one who contributes to the communal life. Some return as teachers: some

as evangelists. Some come home as carpenters, carvers, masons, farmers, traders

and nurses. All have learned something to help them to an honest support it is no

wonder that these healed outcasts become the leaders in the tribes that once

condemned them to the life of beasts in the bush.344

Indeed Settlement helped transformed the lives of many of its inmates in satisfaction of

its rehabilitatory mission. Besides being treated for the disease, many of the patients

overcame the stressor of leprosy and went on to live successful lives outside the center of

segregation. In fact, some former patients went on to pursue careers outside skills

acquired while at a leprosy colony or Settlement as was the case of one Dickson M.

Frambo, onetime NA teacher in Mamfe Division, who in 1937 was referred and

sponsored to Itu for treatment.345 Although the disease caused him to forfeit professional

training at the teacher Elementary Training Center, Kake, in Kumba Division, upon

344 Paul Gebauer, “‘. . . Heal . . . and Say . . .’: The Story of Our Medical Work in Cameroon, West Africa.” (Illinois: North American Baptist General Conference, n.d), 4. [NABHC] 345 Sc/a (1934) 3, Memo from L. Sealy King, Pro tem Resident, Cameroons Province, to the Secretary, Southern Provinces, Enugu. 157

return from Itu after treatment Frambo not only began administering leprosy drugs to

patients in Mamfe, but later became a polygamous successful businessman346 and an

elected member of government in the Southern Cameroons House of Assembly whose

decision to turn his political coat and vote in May 1960 dramatically changed the course

of the political future of Southern Cameroons.347 Although many former patients

encountered were not successful in politics as Frambo, many excelled in other areas evinced by their ability to provide for themselves with little or no family or organizational support.

1961 was a very trying year for Southern Cameroons. In that year, the people of the British-administered Trust territory had to vote and decide their political future following Nigeria’s independence in January the previous year. In a United Nations organized plebiscite in February 1961, the people of the territory voted to gain independence by joining the Republic of Cameroon (former French Cameroon) against joining the Federal Republic of Nigeria.348 The decision from the outcome of the vote

took effect on 1st October 1961 with the territory joining with the Republic of Cameroon to form the federal Republic of Cameroon, which was eventually dismantled in favor of a

Unitary State in May 1972.

The swift political changes that occurred between 1961 and 1972 had a significant

impact on the functioning of leprosy Settlements in the former British Southern

Cameroons and the welfare of leprosy patients. Increasingly, the federal government in

Yaounde, unlike its colonial counterpart in Buea, was quiescent in disbursing subvention

346 Personal communication at Mutengene on September 27, 1915. 347 Bongfen Chem-Langhee, “The Frambo Affair,” Revue Science et Technique IV, no. 1-2 (1986): 71-77. 348 John Percival, The 1961 Cameroon Plebiscite: Choice or Betrayal (Bamenda: Langaa RPCIG, 2008). 158

to the Settlements. The change also led to government assuming the responsibility and

running of all rural leprosy clinics affecting the numbers of outpatients.349 The

administrative bottlenecks that became traditional under the federal government further

compounded the already struggling nature of the Mission hospitals in the federated state

of West Cameroon (former Southern Cameroons) and both institutions that had no choice

but to turn to the goodwill of the public to support the poor patients.350 Although the

public responded impressively, their generosity could not sustain the project and when the government on 1974 integrated leprosy into the general public health services decentralizing leprosy treatment to any health facility in the country, the fast decline of

Settlements and the convivial patient community began in earnest.

Except for New Hope Settlement that still being inhabited by former patients, by

the dusk of the 1980s the Hanseniasis Rehabilitation Center Manyemen had shut its doors

to new patients and is in total ruin with surviving buildings either abandoned or looted.

Of the last surviving patients at Manyemen, nine still live within the premises of the

Medical Institutions Manyemen while others were resettled in the community outside of

the defunct Settlement. Yet, resettlement was equally a challenge to some as was the case

with one Martin Mbock, son of the late chief of Manyemen village, who faced relocating

difficulties because the piece of land bequeathed to him by his late father was contested

by his regent uncle, thus preventing him from completing the construction of his new

home.351 Nonetheless, the termination of the government policy of isolating patients in

349 Geraldine Glasenapp, “Annual Report – Bamenda New Hope Settlement – 1968.” [NABHC] 350 Sc/a (1963) 2, Mission Hospitals. 351 File No. 851, Correspondence between Dr. H. J. Hartman, Basel Mission Leprosy Settlement, and Rev. W. Bachman, Synod Buea, 28th May, 1963. 159 ghettoized Settlements failed to completely upset public perception of leprosy and its victims.

Figure 11.

Manyemen (Patient) Settlement in Ruin. Source: Author

160

Figure 12.

Section of the Abandoned and Looted Leprosy Hospital Manyemen. Source: Author

Despite the intent to examine comprehensively the policy of confinement in segregated settlements as a measure towards leprosy control and patient experience in isolation, a study of this nature is nonetheless limited because of the challenge of identifying many former patients.352 However, it is the hope that the issues examined in the pages of this dissertation would help open new vistas into research on the social history of medicine in general and leprosy control in particular in Cameroon. Possible areas or themes for future research could rim around the subjects of the medical missionaries and other actors who were involved in disease or leprosy control; on the use and effectiveness of rural leprosy clinics; the life history of individual (ex)-patient; or the

issue of stigma as encountered by patients and its psycho-social effects.

352 Several of the former patients are either dead or moved for locations far away from the settlements. 161

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182

Appendix A: Questionnaire Guide for Former Patients

1. How and when were you diagnosed with leprosy?

2. What is the name for leprosy in your dialect and what does it mean [in English]?

3. When were you brought/admitted to the leprosy settlement/colony?

4. How were you admitted or brought to the settlement?

5. What were the conditions/modalities for admission?

6. Was admission free or an admission fee was required?

7. What was your marital/family status before admission and discharge?

8. How did leprosy affect your married life?

9. How long have you been in this settlement/camp/colony/village?

10. When were you discharged?

11. How were you discharged? Was there a ceremony?

12. Why did you not return to your family/village/community after being discharged?

13. Did you benefitted from any form of ‘traditional’ treatment before being admitted

to the settlement?

14. Who provided that treatment and how was it administered?

15. If yes, did it help?

16. How was the settlement/camp/colony/village organized and ran?

17. How was security taken care of in the camps?

18. Was there an administering authority or council/chief in the

settlement/camp/village?

19. If yes, how was it constituted and what role did this authority/council perform? 183

20. Were male and female patients living in the same or different quarters?

21. Were there restrictions to patients visiting patients in other quarters/camps within

the settlement?

22. What happens if a patient was caught visiting or in the quarter/camp of the

opposite gender?

23. What were some of the activities in the camps/settlement for/by patients?

24. Were patients politically active (i.e. allowed to vote) and participate in local and

national politics?

25. Did politicians and government people (authorities) visit the settlements? What

was their message(s)?

26. Did you own any property before coming to the settlement? Did leprosy affect

your ownership of that property of any property or

successorship/entitlement/kinship?

27. How was your relationship with your family/friends while at the camp/settlement?

28. How did you sustain yourself while here?

29. Were you allowed to farm? How was work in the farm(s) organized and what

crops did you cultivate/plant?

30. What did you do with the crops after harvest?

31. Was there a market in the settlement and were non-leprosy patients allowed in the

market?

32. Did you get any form of support from your family? 184

33. Did patients benefitted from any form of support from individuals or

organizations apart from those provided by those operating the facility/institution?

34. When and why were you (patients) relocated/moved from the old site/settlement?

35. Was relocating easy/difficult? How/why?

36. What were the challenges you faced in or being a resident at the settlement/camp?

37. How was the relationship of patients in the camps with people outside the

settlement?

38. When patients allowed to move out of the settlement into the community?

39. What were the taboos that were associated with the disease?

40. What sort of survival schemes were provided at the settlement before discharge?

41. What social/welfare services were provided to patients and their children in the

settlement?

42. Were you able to go to school at the settlement? How was your experience

studying among other children?

43. Are you Christian? Were you one prior to your admission at the settlement?

44. If you attended church service at the settlement parish, how was the service? Was

it different from church service out of the settlement?

45. Were leprosy patients allowed to sit beside people without leprosy?

46. Did you witness the death or funeral of fellow patients in the settlement?

47. How were funerals organized? Were there special funeral or burial sites for dead

patients?

48. What more can you say about the funerals? 185

49. How did the witnessing of the death of fellow patients affect you or

view/acceptance/attitude towards dead?

50. How did it help with your reintegration or rehabilitation after discharge?

51. How easy or difficult has life being since being discharged? (Challenges with

adjusting with life outside settlement?)

52. What memories do you have living or having lived in the colony/settlement?

186

Appendix B: Questionnaire Guide for Leprosy Inspectors/Staff

1. For how long did or have you been working as a leprosy inspector or in the

leprosy settlement/colony?

2. Were you trained to work with leprosy patients? Where/when?

3. What motivated you to be trained and work with leprosy patients?

4. What were the specific functions of a leprosy inspector?

5. How were patients recruited/admitted into the settlement?

6. What treatment options were available to patient?

7. Did it change with time?

8. How effective was the treatment?

9. What was the duration of the treatment, and how did that affect acceptance or

resistance levels?

10. Were there cases of resistance and relapse?

11. What was done to ensure that patients complete treatment?

12. How effective was patient isolation in leprosy control?

13. How did it affect patients, and their relationship with people outside the

settlement?

14. What do you think was their greatest challenge?

15. How were infection levels determined in communities?

16. If through surveys, how were they organized and to what success?

17. What were the challenges of such surveys?

18. How was life like working with the? 187

19. What were the challenges you faced working as a leprosy inspector?

20. How did your profession/career affect your social life?

21. What was the perception of the population towards leprosy patients or the

settlement?

22. What do you think influenced those perceptions and how did they affect levels of

interactions between patients in the settlement, caregivers, and non-infected

people in the community?

188

Appendix C: IRB Approval

Project Number 16-X-159

Project Status APPROVED

Committee: Social/Behavioral IRB

Compliance Contact: Rebecca Cale ([email protected])

Primary Flavius Mokake Mayoa Investigator:

Project Title: A Medical and Social History of Leprosaria, Leprosy Treatment and Cont Isolation and Rehabilitation

Level of Review: EXPEDITED

The Social/Behavioral IRB reviewed and approved by expedited review the above referenced research. The Board was able to provide expedited approval under 45 CFR 46.110(b)(1) because the research meets the applicability criteria and one or more categories of research eligible for expedited review, as indicated below. IRB Approved: 06/09/2016 12:07:03 PM

Expiration: 06/09/2017

Review Category: 7

Waivers: Waiver of signature on consent form If applicable, informed consent (and HIPAA research authorization) must be obtained from subjects or their legally authorized representatives and documented prior to research involvement. In addition, FERPA, PPRA, and other authorizations must be obtained, if needed. The IRB-approved consent form and process must be used. Any changes in the research (e.g., recruitment procedures, advertisements, enrollment numbers, etc.) or informed consent process must be approved by the IRB before they are implemented (except where necessary to eliminate apparent immediate hazards to subjects). The approval will no longer be in effect on the date listed above as the IRB expiration date. A Periodic Review application must be approved within this 189

interval to avoid expiration of the IRB approval and cessation of all research activities. All records relating to the research (including signed consent forms) must be retained and available for audit for at least three (3) years after the research has ended. It is the responsibility of all investigators and research staff to promptly report to the Office of Research Compliance/IRB any serious, unexpected and related adverse and potential unanticipated problems involving risks to subjects or others. This approval is issued under the Ohio University OHRP Federal wide Assurance #00000095. Please feel free to contact the Office of Research Compliance staff contact listed above with any questions or concerns.

190

Appendix D: PCC Authorization

191

Appendix E: NABHC Letter

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