Medicine: Indolent Isolation

Rows of pineapple plants trace intricate geometric patterns in the soil of Molokai’s terraced hills. Herds of piebald cattle loll contentedly in its balmy tradewinds, and speckled deer cluster quietly under kukui branches to seek shelter from tropical showers. Hawaiians call moccasin-shaped Molokai the Friendly Island and regard it as an affable relic of the bustling new state’s past. But to the 220 men and women who live at Kalaupapa—a tiny, low peninsula that juts like a useless sixth finger from the island’s northern shore—Molokai is a dreary dead end, a desolate retreat from a world they fear to face and a society that has cast them off. They are lepers.

Kalaupapa was a place of horror when Father Joseph Damien de Veuster, a Belgian Catholic priest, landed there in 1873. Resigned to their gruesome, painful fate, the unfortunate victims of leprosy lived in squalid huts or roofless stone buildings, and died without medical attention in a lonely room furnished only with their waiting coffins. In 16 years of selfless devotion—which ended with his death from leprosy in 1889—Father Damien made many improvements, including a water system constructed largely with his own hands.

Softball & Wild Pigs. Now the leprosy colony is a well-ordered community of freshly painted homes and apartment buildings, complete with airfield, post office, slaughterhouse, meeting hall, churches, wide-screen movie theater and general store (which the state operates at a loss). Residents work at a variety of jobs (pay scale: 55¢ to 75¢ an hour), play Softball and hunt wild pigs on the forbidding, 2,000-ft. cliffs that isolate the peninsula from the rest of Molokai. They cool off afterward with bottles of beer bought at Choy’s, Kalaupapa’s own state-licensed liquor store.

Life at Kalaupapa is leisurely and uncomplicated in the best Hawaiian tradition. But it is also depressing. There are no schools—because there are no children. Pregnant women among the colony’s 56 housewives are usually sent to Honolulu’s St. Francis Hospital to give birth; their babies remain with relatives or in foster homes on Oahu. Patients speak a sort of prison argot: out of the colony is “on the outside,” and release from medical isolation is “parole.”‘

New Hands & Eyebrows. Kalaupapa’s biggest problem today, as in a prison, is rehabilitation. Sulfone drugs—introduced in 1946—usually arrest the disease long before disfiguration can occur. Even in severe pre-sulfone cases, physical disabilities (like clawed hands and lost eyebrows) can be repaired with physical therapy and plastic surgery. But leprosy often leaves grave psychological scars, and many cured patients refuse to sacrifice Kalaupapa’s indolent security for the uncertainties of life on the outside. Says one: “I don’t have a trade. I don’t even have a place. People here are used to feeling hopeless.” In 1955, a benevolent Hawaii legislature compounded doctors’ problems, passed a law which says that no Kalaupapa patient can be discharged except by his own written request. Last week only 81 of the colony’s 220 patients were in medical isolation; the rest were classified as cured.

The Public Health Service’s Dr. Leroy E. Burney visited Kalaupapa last year to see whether the 95-year-old leprosy colony should be amalgamated with the only continental U.S. leprosarium, in Carville, La. Burney’s conclusion: both should continue, for the time being. But Kalaupapa’s life, at least as a leprosy settlement, appears limited. Hawaii has reported only 16 new cases of leprosy thus far this year (as compared to 94 in 1920), and less than half required hospitalization. Says Dr. Ira D. Hirschy. director of Hawaii’s leprosy program: “As soon as the medical aspects are cleared up—and we can see that day coming—the medical administration is going to leave Kalaupapa. This is becoming a welfare problem rather than a health problem.”