ENG 100 TR 12:00

8 December 2009

The Effects of Leprosy on Hawaii

What would we do if we heard that people were being taken and thrown off a boat into open sea? Struggling to swim to shore and to survive? Well, this really did happen to native Hawaiians in the past; the story of the Lepers in Hawaii that were forced to reside in Kalaupapa. Just imagine; a five year old boy living care free in beautiful Hawaii. One day he runs to his mother to hug her, but trips on a rock and falls badly causing blood to pour out of his toe. His mother becomes astonished that her son didn’t cry or even seem to notice the wound, so she takes him to the doctor to see if anything was wrong. Little did she know that the doctor would find Leprosy in him and call the Board of Health to take the boy. People came, unexpectedly, to their home and took the boy from his mother. They sailed him to an ocean near a small isolated place called Kalaupapa. They threw him off of the boat into the cold water forcing him to swim for his life to the shore. Sadly, Things like these really did happen to ordinary Hawaiians who were just unfortunate to get the Disease, Leprosy.

In 1823, there was the first unconfirmed report of leprosy in Honolulu. The very first documented case of leprosy in Hawaii was observed in Kamuli, a Hawaiian woman living at Koloa, Kauai in 1835 (whirledwydeweb). Leprosy, which is also called Hansen's disease, is a mildly infectious disease (meaning a communicable infection that is not severe, nor acute) that attacks peripheral nerves (see fig. 1). It is caused by a bacillus, Mycobacterium leprae. Dr. Armauer Hansen first discovered the leprosy bacillus in Norway in 1873. He is credited with identifying one of the first bacteria known to be a human pathogen. Today, leprosy is often called Hansen's disease (hhmi).

Fig. 1. A picture shows young boys during early years at Kalaupapa with Leprosy (Hansen's Disease Patients at Kalawao and Kalaupapa).

Leprosy was spreading at an alarming rate among the native Hawaiians, so on January 3, 1865, King Kamehameha V signed An act to Prevent the Spread of Leprosy. The execution of the law was put in the hands of the Board of Health and authorized the setting apart of land specifically to isolate and treat leprosy patients. There were 2,764 people on the islands that were reported to be lepers. Under the new act of prevention, segregation was started and plans for a separate hospital began. Land was purchased in Palolo Valley in the Island of Oahu, but when the neighborhood came to know of what they were planning, objections were so strong that the effort was abandoned. A site was then secured at Kalihi, near Honolulu, well separated from the other habitations, and in November, 1865, the hospital was established there. Although they finally found a place for the lepers, a year later the need for a larger and more permanent settlement was declared. A settlement isolated for those declared to be lepers, to be operated in connection with the Kalihi Hospital, where efforts would continue for the cure of cases in the early stages. In locating a site for the leper settlement the search was soon directed to the Molokai Peninsula, so well protected by the sea in front and by the towering cliff behind. Kalawao, on the Kalaupapa Peninsula, was set aside. On January 6^th, the first patients took up residence at the Kalaupapa Settlement (whirledwydeweb).

Kalaupapa was and still is a cut off area from the rest of Molokai by 1600-foot sea cliffs. The area was void of all amenities. No buildings, shelters nor potable water were available. Folklore and oral histories recall some of the horrors: the leprosy victims, arriving by ship, were sometimes told to jump overboard and swim for their lives. Occasionally a strong rope was run from the anchored ship to the shore, and they pulled themselves painfully through the high, salty waves, with legs and feet dangling below like bait on a fishing line. The ship's crew would then throw into the water whatever supplies had been sent, relying on currents to carry them ashore or the exiles swimming to retrieve them. These first arrivals dwelled in rock enclosures, caves, and in the most rudimentary shacks, built of sticks and dried leaves (visitmolokai). Some cattle and sheep were also sent to Molokai. For Kalihi Hospital and the Molokai Settlement, the amount of expenses in 1866 totaled to $10,012.48.

The number of past Kalaupapa residents is shocking. Following the first group of 12 patients that arrived at Kalawao on January 6, 1866, up to 8,000 people were sent to the Kalaupapa Peninsula. Each one of these people left behind friends and family, perhaps spouses and children, when they were exiled. The Board of Health records over the years reveal how the disease knew no racial or ethnic boundaries. In the Board of Health’s annual report for 1903, the records show the total patient population at Kalaupapa to be 888—541 males and 347 females. Of that number, 459 were Hawaiian men, and 338 Hawaiian women. Among the other major racial groups represented were forty Chinese men and three women; twelve Portuguese men, two women; and seven "American" men and one woman. In 1924, the patient population had been reduced by almost half. Among the 485 patients, the largest racial groups represented were 169 Hawaiian men, 101 Hawaiian women; fifty three part-Hawaiian men, forty three women; twenty eight Japanese men, four women; and twenty four Filipino men and one woman. Today, the numbers of former Hansen’s disease patients living at Kalaupapa are dwindling (Hansen's Disease Patients at Kalawao and Kalaupapa).

Fig. 2. A photomicrograph of Mycobacterium leprae, the bacteria that causes leprosy, taken from a skin lesion (Kugler).

It is still uncertain, to this day, how leprosy was spread to the native Hawaiian people and how it is spread today. The Community Health Administration states that leprosy is probably spread by close contact with people infected with Mycobacterium leprae (see fig. 2). The bacteria may enter the body through the nose and broken skin. Untreated leprosy patients have millions of bacteria in the mucus from their noses. The people back then thought that if someone had leprosy, they were dirty, cursed or were infected by sexually transmitted diseases, or STD’s. So everyone back then thought it was good for the lepers to be thrown into isolation for being sinful. They really shouldn’t have forced the lepers out into exile; instead they should’ve tried to understand what this was that was affecting their bodies. From the discovery of leprosy in 1873, we know now that if we see something weird or unnatural on someone’s body, there is a medical explanation for it. Now we will not be so quick to judge, but to examine and discover.

Father Damien deVeuster arrived at Kalaupapa at the age of thirty three in 1873. He was a Catholic missionary priest from Belgium; he served the leprosy patients at Kalaupapa until his death. A most dedicated and driven man, Father Damien did more than simply administer the faith: he built homes, churches and coffins; arranged for medical services and funding from Honolulu. He became a parent to his diseased wards and even established an orphanage for boys and girls (visitmolokai). In December of 1884, Father Damien discovered he had contracted the disease when he spilled extremely hot water on his foot and did not feel any pain (Adamski). On April 15^th, 1889, it was reported that Father Damien had died of leprosy at age forty nine. Once the bacterium enters the body, it begins destroying the nerve endings, leading to a loss of feeling and pain. This loss of sensation causes the victim to endure injuries since they have no way of knowing that their tissues or bones are being damaged until it is too late. These injuries can lead to infection or other complicated conditions (Dunder).The New York State Department of Health reports that anyone can get leprosy, but children seem to be more susceptible than adults.

In 1946, Sulfone drugs were introduced in Hawaii. Hansen's disease was put in remission and the sufferers were no longer contagious. Sulfone drugs is any of various organic sulfur compounds having a sulfonyl group attached to two carbon atoms, this compound was formerly used as a drug to treat leprosy or tuberculosis. The fewer than 100 former patients remaining on the peninsula were declared free to travel or relocate elsewhere, but most chose to remain where they have lived for so long. The multi-drug therapy or MDT, which is a combination of rifampicin, clofazimine, and dapsone, was introduced to Hawaii in 1981; this MDT made a more rapid cure possible (whirledwydeweb). The combination of the three medicines can cure leprosy in as little as six months and can prevent disabilities if treatment is given early (hhmi).

The amount of people around the world who have Hansen’s disease today is not known for sure. The World Health Organization reports that “According to official reports received during 2008 from 118 countries and territories, the global registered prevalence of leprosy at the beginning of 2008 stood at 212,802 cases, while the number of new cases detected during 2007 was 254,525 (excluding the small number of cases in Europe). The number of new cases detected globally has fallen by 11,100 cases (a 4% decrease) during 2007 compared with 2006. Access to information, diagnosis and treatment with multidrug therapy (MDT) remain key elements in the strategy to eliminate the disease as a public health problem, defined as reaching a prevalence of less than 1 leprosy case per 10,000 population. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.”

Today, Kalaupapa is the Kalaupapa National Historic Park, in which few former patients still live today. Mary Adamski, a reporter for the Honolulu Star Bulletin reported after visiting the residents of Kalaupapa that “eleven residents of tiny Kalaupapa village are among the last 20 surviving "historical" Hansen's disease patients who were separated from their families and isolated at the settlement because of the disease. The state ended the quarantine policy in 1969, giving residents the choice to live out their lives on the quiet peninsula.” Today, visitation to the colony is strictly limited, and unless you are invited by a resident, tours must be arranged through Damien Tours or the Hawaii Department of Health. People without pre-arranged reservations will be denied access to the park (Kalaupapa Leper Colony). Some of the people who lived at Kalaupapa spoke about experiences that they had:

One of the worst things about this illness is what was done to me as a young boy. First, I was sent away from my family. That was hard. I was so sad to go to Kalaupapa. They told me right out that I would die here; that I would never see my family again. I heard them say this phrase, something I will never forget. They said, ‘This is your last place. This is where you are going to stay, and die.’ That’s what they told me. I was a thirteen-year-old kid.

- Male, part-Hawaiian, c. 1977-78

Olivia Robello Breitha, a current Kalaupapa resident, also spoke about an experience that she had there:

The administration office…had a railing around the ‘boss’ (administrator) and there was a bench set against the wall where the patient sat. When Mr. Judd [Lawrence Judd, former Governor of Hawai`i who later became a Kalaupapa superintendent] came, the first thing that came down was the railing in his office. Then came the chain link fence in the caller house at the visitors’ quarters. That gave us a feeling that we, the patients, almost belonged to the human race again. You cannot imagine how much a simple thing like a fence and a railing coming down meant to me. I’m sure it had the same effect on all the patients (In Their Own Words).

Most of the 8,000 people forced into isolation at Kalaupapa lie in unmarked graves, but a law signed on March 30^th, 2009 by President Barack Obama will allow them to be remembered publicly. A monument will be raised in Kalaupapa in memory of the 8,000 people who were sent into forced isolation because they contracted leprosy. Valerie Monson, secretary of Ka Ohana o Kalaupapa, said that the 1,300 graves that do have identifiable headstones are mostly of people who died since 1930. About 90 percent of those who died in Kalaupapa were of Hawaiian ancestry. "The monument will make sure that everyone will be remembered, not just Father Damien. The people of Kalawao were inspired by Damien, and I think Damien was inspired by the people of Kalawao," she said. United States Senator Daniel Akaka said the monument will honor the patients' resolve and help bring closure to their descendants. He said, "It will keep the memory of this tragic chapter of Hawaii's history alive for future generations to learn from (Adamski, New federal law creates monument at Kalaupapa)." I hope Mr. Akaka is right when he says that. Hawai’i must have learned a great deal from this experience. I hope we all learned something, every native Hawaiian. We might feel angry, sad, frustrated, and/or shocked about what happened. The only thing that we can do from this experience is to take it and use it to make better decisions in the future. Also, from this experience, everyone can come closer together. It’s my hope that nothing like this ever happens again in the state of Hawaii, or in the whole world.

Works Cited

Adamski, Mary. "New federal law creates monument at Kalaupapa." 31 March 2009. Honolulu Star Bulletin Web site. 3 December 2009 <http://www.starbulletin.com/news/20090331_New_federal_law_creates_monument_at_Kalaupapa.html>.

—. "The Last Survivors - The bonds of Kalaupapa." 7 October 2009. Honolulu Star Bulletin Web Site. 3 December 2009 <http://www.starbulletin.com/specialprojects/09/saintdamien/20091007_The_bonds_of_Kalaupapa.html>.

—. "The life of Father Damien." 07 October 2009. Honolulu Star Bulletin Web site. 19 November 2009 <http://www.starbulletin.com/news/>.

Dunder, Jonathan. Articles/Health/Diseases and Disorders/Leprosy. 19 November 2009 <http://www.freeinfosociety.com>.

"Featured Infectous Disease: Leprosy." 2009. Howard Hughes Medical Institute. 2 November 2009 <http://www.hhmi.org/biointeractive/disease/leprosy/index.html>.

Grauer, A. L. "Understanding Hansen's Disease (Leprosy)." 2 November 2009.

"Hansen's Disease Patients at Kalawao and Kalaupapa." 31 August 2009. National Park Services Web site. 3 December 2009 <http://www.nps.gov/kala/historyculture/patients.htm>.

"In Their Own Words." 17 August 2009. National Park Service Web site. 3 December 2009 <http://www.nps.gov/kala/historyculture/words.htm>.

"Kalaupapa Leper Colony." 2009. Atlas Obscura Web Site. 3 December 2009 <http://atlasobscura.com/places/kalaupapa-leper-colony>.

Kugler, Mary. "Leprosy (Hansen's Disease): Old scourge can be cured." 15 May 2009. About.com, a part of The New York Times Company. 7 December 2009 <http://rarediseases.about.com/cs/infectiousdisease/a/071203.htm>.

Leprosy. 2 November 2009 <http://tharunaya.info/1/5208/Leprosy.htm>.

"Leprosy (Hansen's disease)." June 2004. 2 November 2009 <http://www.health.state.ny.us/diseases/communicable/leprosy/fact_sheet.htm>.

"Leprosy (Hanson's Disease) Fact Sheet." May 2002. Maryland Department of Health & Mental Hygiene. 2 November 2009 <http://www.edcp.org/factsheets/leprosy.cfm>.

"Leprosy Today." 2009. World Health Organization (WHO) Web site. 3 December 2009 <http://www.who.int/lep/en/>.

Leprosy. 1 January 2009. 10 November 2009 <http://web.ebscohost.com>.

"Moloka'i: Kalaupapa." Visit Molokai. 12 November 2009 <http://visitmolokai.com/kala.html>.

Remembering Kalaupapa: Historical Chronology. 12 November 2009 <http://www.whirledwydeweb.com/kalaupapa/chronology.html>.

Wilcox, Leslie. "Long Story Short – Meli Watanuki – On Location at Kalaupapa." 20 October 2009. Long Story Short with Leslie Wilcox – PBS Hawaii. 3 December 2009 <http://www.kmeb.org/wordpress/?p=71>.

Bibliography