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on Bussu Hill, situated about a mile south of the Jinja-Iganga road and about two miles from Iganga. The selection of a site in Usoga presented several difficulties. Owing to the number and character of the numerous streams which pour into the Victoria Nyanza in this part of the country, tsetse fly are found much further inland in Usoga than elsewhere. t is, of course, essential that a segregation camp should be well out of fly range, but, on the other hand, our experience with the first camp at Buwanuka proved to us the unwisdom of placing a camp too far from the sleeping sickness endemic area.
The mbwa fly are also very numerous in many parts of Usoga and, except in certain areas, food has been very scanty.
However, the site at Bussu seemed eminently satisfactory and camp construction began at once, the labour being supplied by the local chiefs.
Kyetume was selected for the site of the Chagwe Camp. Kyetume lies three miles south of the Kampala-Jinja road about twenty miles from Kampala and near Mkono. Food is plentiful in this part of Chagwe, the place is easy of access, and not too far from the sleeping sickness area.
Kyetume also has the advantage of being within reach of the islands of Buvuma, where sleeping sickness is very prevalent, and numbers of these Buvuma have already come to the camp for treatment.
The arrival of the first temporary medical officer on August 6th enabled Dr. Collyns to go to the Busiro Camp and, after learning the work, to set free Dr. van Someren. Dr. van Someren started work at the Kyetume Camp on August 19th.
GENERAL REMARKS.
Judging entirely by our first camp at Buwanuka, Busiro, which has now been in existence nearly a year, it cannot be said that a native who is suffering from sleeping sickness is very eager to present himself for treatment at such a place. The healthy native thinks that by going to a camp full of sleeping sickness patients he runs a great risk of contracting the disease himself, so that the original idea that all sleeping sickness patients should go to camp accompanied by their healthy relations, who would, by their labours, provide food and necessaries for the sufferer, has not been a very popular one from the healthy relatives' point of view. The result has been that a large percentage of those who have come to the Busiro Camp have been in a very advanced stage of the disease and this has necessarily meant a high death-rate, for whatever the value of medical remedies may be for a patient in a fairly early stage of sleeping sickness, it is quite certain that really advanced cases of this disease soon die in spite of medical remedies. The fact that numerous deaths occur at any camp can hardly be kept secret and the fact being known to natives who are perhaps in a quite early stage of the disease makes them unwilling to go to such a place until they feel that they have not long to live.
I do not think, however, it is quite fair to judge of the success or otherwise of future camps by our first camp at Buwanuka. Buwanuka is a long way from the sleeping sickness area (20 miles) and patients simply will not take the trouble to go there of their own accord. Among the local natives Buwanuka has also had a bad name from the violence of the thunder storms there.
DETAILED ACCOUNT OF CAMPS.
Total admission to camp up to November 30th, 1907
Busiro Camp, Buwanuka,
'1,179
Dr. Wiggins started this camp in December, 1906, and by the time his leave was due in April, 1907, had about 300 patients under treatment. Dr. Wiggins was relieved by the late Dr. Densham early in April. On the 3rd of June news of Dr. Densham's tragic death was brought in and Dr. van Someren, who fortunately happened to be near Entebbe at the time, was at once sent to take charge of the camp. On August 19th Dr. van Someren leit start the camp for Chagwe at Kyetume and gave over charge of the Busiro Camp to Dr. Collyns.
1906-
Month.
December
1907-
Admissions.
Don the.
136
6
January
71
February
41
10
March
78
10
April
41
16
May
32
June
24
July
28
August
28
September
16
10
October
16
16
November
14
Totals
-525
125
These patients have come from the following sazas :—
Kiadondo
Busiro
Bulemezi
Singo
Maokota
$
Busi
Busuju
Chagwe
Usoga
Unyoro
Buvuma
Butembala
Gomba Bwekulas
§ -===GREES
182
158
25
22
21
10
1
74
4
1
4
3
2 1
The above figures show a more or less constant decrease in the number of admissions to the camp ever since it was first started in December, 1906.
It is a fact that this particular camp has never been popular among the natives in the country around. This fact has been brought to the notice of the Adminis- tration on several occasions, but they have been powerless to help the Medical Department in the matter. When patients, and healthy friends too, once get to the camp they are happy enough and practically never run away; they sometimes ask for a week or more's leave which is always given and in practically every case such persons return. It is obvious, then, that the unpopularity of this camp at Buwanuka has nothing to do with a fault in camp administration. So far, no sort of com- pulsion has been used in getting patients to go to our camps for treatment, and when they once get to camp no sort of measures are taken to make them stop there. It is quite certain with regard to the latter statement nothing is necessary, the camps are very popular with their actual inmates and desertions practically never now occur. The death-rate is high from the fact that so many of the cases on admis- sion are in an advanced stage of sleeping sickness.
In the first six months, out of 399 cases admitted to the camp, 64 had died— a death-rate of 16 per cent.
In the second six months, out of 459 cases, made up of those remaining from the previous six months and of fresh admissions, 72 died, which is also just 16 per
This gives a yearly death-rate of 26 per cent.
cent.
Bussu Camp, Usoga.
On July 25th camp construction began on Bussu Hill, near Iganga. The native chiefs supplied labour very readily and a camp was soon built under Dr. Baker's supervision. Lieutenant Archibald, R.A.M.C., joined Dr. Baker on October 26th.
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