Of Demons and Public Health

Mar 22008

Editors Note: A group of journalists set out to investigate reports of demons in rural Uganda, but they ended up learning a few things about public health.

As I sped down a narrow dirt road enveloped in a cloud of dust in Hoima District, Uganda, I must admit I wondered what in the world I was doing. I had begun a stint as a Knight health journalism fellow three weeks earlier, but here I was with a reporter and photographer from New Vision, Uganda’s largest newspaper, bouncing toward the isolated village of Kiziranfumbi about three hours west of Kampala. We were looking for demons – literally.

Juliet Katusabe and Lillian Kwikiriz, ages 10 and 11, recall their experience with demons in Kiziranfumbi, Uganda.

Two days earlier, as many as 100 students from Sir Tiito Winyi primary school had suddenly gone berserk, barking like dogs, crying, clutching their stomachs in pain, running, crawling on the ground, and throwing rocks at villagers and teachers who rushed to investigate. Townspeople had no doubt what was happening: demons, they said, had possessed the children. At the time, editors at New Vision were preoccupied with more weighty issues – including the latest wrangling in Parliament over land reform, which is the most contentious policy issue affecting Uganda today – but when I commented that the demon story sounded interesting, they laid down a challenge: see if you can get to the bottom of this bizarre event.

The adventure they offered was irresistible, but I admit I felt a little uncomfortable with the assignment. My mandate is to focus on health journalism, and that is a full time job in Uganda. In my short three weeks in the country, New Vision had done stories on e-bola, meningitis, cholera and, of course, malaria and HIV/AIDS. I had been sickened by Kampala’s air pollution, and been told that the city’s rapidly growing population is encroaching on the wetland that filters much of the city’s water supply. The staff and I wrestled with story ideas ranging from a severe shortage of doctors, nurses and supplies in hospitals to the apparently massive misuse of prescription drugs. In face of health problems like that, how could I justify spending time chasing demons?

Hysteria, I told myself, is a legitimate health issue. Just a few days earlier, an editor in Kampala had mentioned that mental health is a serious problem in Uganda, which has only 12 psychiatrists for its 28 million people. I was certain we could trace the children’s emotional problems to stress, which no doubt was a big part of the hard lives I was sure that they were living.

But when we got to Kiziranfumbi, we didn’t find many obvious signs that the town’s troubles were rooted in stress. We did learn a lot about demons, though. In interviews with children, parents, teachers and villagers, we discovered that the supernatural visitation arose from a very this-worldly problem – the same one that was tying up Parliament back in Kampala. The problem is land. Uganda’s population is growing, and conflicts over land ownership have become the burning issue of the day. Many townspeople blamed the demons on one of the village’s prominent citizens, Lawrence Mulubya, who had been at the center of a number of land disputes. They said he wanted to become rich, and had summoned the Gods to help him, but now these demons were hungry, and they were going after the village’s children to satisfy their appetites. We went into the bush in search of Mulubya, who had gone into hiding in fear of retaliation by frightened villagers. Amazingly, we found him. Not surprisingly, he had a different interpretation of events: He said neighbors who coveted his land had concocted the demon story to turn the town against him.

This was serious business. Mulubya said he feared for his life. And the villagers said they feared for the future of the school. Among the options they were considering was forbidding scores of afflicted children from coming to school.

An interesting story. But was it a health story? As I thought about it, I recalled an article I once wrote about how the public health department in Oakland, California, was devoting time and resources to community organizing. The department’s leaders were convinced that canvassing troubled neighborhoods to learn what concerns people, calling meetings to help them agree on solutions, and then working with them to put those strategies into effect would directly lead to improved health – even if those strategies focused on jobs, parks and other issues we don’t normally consider the responsibility of a health department. Health is based on much more than doctors, medicines and medical care, the public health officials explained. The most important determinants of health often are political, economic and social. When something is awry in these realms, communities lack cohesion, and health suffers. By the same token, solving those problems produces healthier communities, which in turn produce healthier people.

If that is true in Oakland, it’s just as true in Kiziranfumbi. Something is awry in both places, and the result is impaired health. Indeed, in Kiziranfumbi, the connection to health is especially strong. It is by now beyond debate that education leads to better health; educated people know more about how to care for themselves, and they have better economic prospects, which in turn translate into better nutrition, better medical care and healthier living. In threatening the school, Kiziranfumbi’s inability to solve its land problem is undermining one of the pillars of improved health. And, as often is the case, the first to suffer are the weakest and most vulnerable – children. The story by reporter Pascal Kwesiga summed it up in distinctly African terms. “As the saying goes,” it began, “When two elephants fight, it is the grass that suffers.”

Were Kiziranfumbi’s demons a valid health story? You bet.

To read New Vision’s story, click here.