HX13 Dr Leonard Sharp and leprosy control at Bwama Island, Lake Bunyonyi, Uganda

Abstract

In 1921, medical missionaries Dr Leonard Sharp and Dr Stanley Smith and their wives Esther McDonald and Lillian Sharp arrived in Kigezi, a mountainous area of southwestern Uganda. A mission hospital was established, with a 24-bed leprosy ward added in 1927. The high burden of leprosy prompted Dr Sharp to develop a voluntary leprosy colony on Bwama Island, Lake Bunyonyi. A review of original reports and historical sources was undertaken to examine the history, clinical practices and legacy of voluntary leprosy segregation at Bwama Island. By 1923, Kigezi Mission Hospital had treated 125 patients, including 30 with leprosy. Leprosy incidence was 8 per thousand, with 21.5% nodular and higher rates near the Mufumbiro volcano. Dr Smith considered hospital wards inadequate for infection control and noted that local communities did not view leprosy as contagious. This prompted Dr Sharp to develop a voluntary leprosy colony on Bwama Island, which he believed ‘most suited the conditions and the African temperament.’ This was funded by the Ugandan government (£800), British Empire Leprosy Relief Association (£500) and friends of the missionary (£737). The colony opened in 1931 with 25 patients and expanded to 300 by 1933, including many children. Treatment aimed to control leprosy and intercurrent yaws using bismuth potassium sodium tartrate injections and hydnocarpus oil preparations. Although hydnocarpus oil showed no demonstrable benefit, Dr Sharp observed a placebo effect. Life on Bwama Island emphasized hygiene, education and community organization. Reports from 1932 documented disease arrest or improvement in over half of cases. Leprosy surveys from 1951 showed that the regional prevalence declined from 25–30 per thousand to 6.1 per thousand. The colony closed in the 1980s, coinciding with improved leprosy therapeutics. Today, Bwama Island hosts a school, dispensary and 25-bed hospital. Bwama Island shows that voluntary segregation and structured community life effectively reduced leprosy prevalence.