PLAGUES are described as unusually large numbers of insects or animals infesting and causing damage, but I think specific groups of people should also be included. In our parts of Africa, church pastors and shylocks fulfil that definition. The uncontrolled plethora of pastors include apostles, brothers, ‘reverents’ and self-appointed bishops.

The most successful pontificate from substantial churches, with ATMs for credit cards near the main entrance and cameras inside to record those euphoric congregants rash enough to stand up during a Sunday service and pledge large sums – the latter can expect a follow-up to jog their memories. Several are based in roomy and ornately decorated tents which are moved to greener pastures if the faithful prove to be stonier ground than expected. A few rant loudly on street corners every weekday, their preaching mainly based on the Old Testament but with occasional deafening critiques of the fashions of passing female pedestrians.

Shylocks or moneylenders require no self-advertisment, in these straitened economic times. However they do need a bodyguard to be nearby, hardly suprising as the reaction of the debtor when told to hand over his/her ID card, passport and credit card may not be friendly. I recall a similar situation in Glasgow when the obstetric Flying Squad was summoned to a home delivery that had gone wrong; our registrar was manhandled by the crowd of neighbours who assumed that because he was wearing a three-piece suit and carrying a big black briefcase (containing emergency drugs and delivery instruments), he could only be a rent collector.

For Europeans, the most infamous plague was the Black Death, spread by the majestically named Pasteurella pestis bacteria which lived happily in fleas who in turn hitched lifts on rats. From the 14th century onwards, it wiped out about a third of the entire population. Fortunately for the English, the Great Fire of London in 1666 put a stop to it. We still see the odd case of bubonic plague in Africa, but it responds to antibiotics.

The main concern in Uganda, now and in the future, is Ebola haemorrhagic fever, a plague that has been erupting in West, Central and East Africa since the 1970s and probably earlier. Fruit bats are known carriers of Ebola, the hypothesis being that wild game scavenge the infected partly-eaten fruit, they themselves then being killed either by the virus or by hunters, and sold as bush meat. I first became aware of the latter’s popularity while exploring Nsambya Hospital’s huge shelter and communal kitchen in Kampala. Peering into a cooking pot, I recoiled in horror. It was hurriedly explained to the now very pale mzungu that the patient’s wife was not boiling a newborn baby but cooking a small monkey for her husband who was recovering from surgery.

When I was studying tropical medicine at Johannesburg’s Witswatersrand University in the nineties, it was Professor Margaretha Isaacson who brought home to us Ebola’s severity. She was in the medical team that was flown in from South Africa to a remote village in the Congo rainforest where people were dying. Nobody in the village, mission clinic, school or convent was found alive, only decaying bodies. The specimens they took back confirmed the then almost-unknown Ebola virus. The mortality rates in the ten or more outbreaks since then, including the huge one in West Africa a few years ago, show a range between 35% and 80% – coronavirus’s rate, when the dust has settled, will likely come in at less than 1%.

For any of you who’ve been in the midst of a cholera outbreak, you’d probably agree that it qualifies as a plague. A major one in southern Mozambique spilled across the border – spilled being an apt description as many folk were carried off the cross-border buses outside our clinic at Simunye, naked from the waist down and sitting in plastic buckets, a practical solution for the diarrhoea pouring out of them. One old lady, wizened and toothless but a fighter, received 26 litres of intravenous fluid in 24 hours, an amount I would not have believed possible.

During that first precarious day, Eduarda insisted on keeping a woollen cap on her grey head. It was fluorescent green and somewhat soiled but no nurse was allowed to remove it. Her daughter explained why when she came to take mother back to Maputo. The patient in the next bed was a man – at their peak, cholera epidemics don’t allow the luxury of separating the sexes – and Eduarda confided to her child that no male, other than her late husband, was going to see her bare-headed in bed.

Dr David Vost studied medicine at Glasgow University and is currently working at a hospital in Swaziland. He and his family live on a small farm in Northern Uganda near the Albert Nile.