After Damien

His famous leprosarium is dying of success

Pope Paul VI approved a decree this summer citing "the heroic virtues" of Father Damien, the first step on the road toward sainthood for the Belgian-born missionary. Famed for his devotion to victims of leprosy in Hawaii, Father Damien followed a calling that led to his death from the disease. Now the leprosarium that he made famous, Kalaupapa, is dying of attrition--and for the most welcome reasons: new cases of the disease have become rare among ethnic Hawaiians and part-Hawaiians, and leprosy can be treated so successfully today that newly identified patients soon become noncontagious. The savage isolationism of the past has been replaced by an enlightened open-door policy. To observe the striking changes, TIME Contributor Gilbert Cant visited the leprosarium where Damien labored. His account:

Except for what nature, in an eruption of volcanic anger, has left ugly and almost immutable, there was little visible to recall Kalaupapa's dismal history as the plane circled to land on a short but well-blacktopped strip. During the drive to the health department offices and the hospital with Dr. Leslie Charles Koch, chief of Hawaii's State Leprosy Control Program, who was making one of his twice-weekly visits to the colony, there were cheery waves and "Alohas" from patients.

At the hospital there were mercifully few patients requiring Koch's attention. Only half a dozen beds were occupied, none by patients with active leprosy. One patient had a febrile illness; another was having kidney trouble; a third was staying in the hospital because he was too emotionally disturbed to live alone outside. Outpatients dropped in during the morning for Koch to treat ulcers--most of them located on their hands and feet--that had originally been caused by leprosy and then complicated by other infections. Some came to have the doctor renew their prescriptions for medicine--not, in most cases, because their leprosy was active, but to keep their arrested disease suppressed.

Sister Wilmer, who directs a staff of four other nuns of the Third Order of St. Francis, plus two registered nurses and two practical nurses, contrasted the present scene with what she had found on arrival in 1945: then all 60 of the hospital's beds were filled by patients who were very sick, not only from active leprosy and its complications but also from tuberculosis and kidney diseases. But even at that time, she said, there had been, naturally, a vast improvement in conditions and in nursing and medical care over what Father Damien had found when he landed in the colony in 1873.

Leprosy was imported into Hawaii by Chinese laborers in the 1840s. The bacterium, Mycobacterium leprae, found a fertile field in the Polynesian population, which, with no prior exposure to the disease, had no natural defenses. Soon hundreds of new cases were being reported annually. The panic that had swept Europe during its epidemics centuries earlier was repeated in Hawaii. In 1865, King Kamehameha V ordered all lepers confined to the most desolate part of his realm, the volcanic, 14-sq.-mi. peninsula of Kalaupapa jutting northward from the coast of Molokai. The first 35 patients were landed in January 1866, with no more food and clothing than they could carry on their backs.

The royal government provided no housing materials and no food beyond a few rangy cattle. Patients had to tote water from a spring a mile away. The arrival of Father Joseph Damien de Veuster changed all that. He inspired and encouraged the colonists to build better houses and a primitive hospital on the sheltered side of the peninsula and to install a mile-long water line. How and where or when Damien contracted leprosy, which caused his death in 1889, can never be known. The disease can have an incubation period of ten or more years and the priest might have been previously exposed to contagious patients. Other than Damien, no one serving leprosy patients at Kalaupapa has ever developed a confirmed case of the disease. Neither has anyone at the other principal US leprosarium at Carville, La.

Ironically, Damien's fame and the cause of his death have stood in the way of public awareness that for most ethnic groups, leprosy is one of the least contagious of all diseases. Koch estimates that 90%, perhaps even as many as 99% of Caucasians could not catch leprosy if they tried--not even by living in marital contact with a patient for many years.

Although physical and medical conditions at Kalaupapa improved steadily as the patient population reached its peak of 1,180 in 1890, most patients remained contagious and suffered the progressively crippling and deforming effects of the disease. Many appeared to lose their noses because the bone is absorbed into adjacent tissues. The same thing happened to the finger bones; the fingers do not become gangrenous and drop off, as many scare stories have it, but the bones are gradually broken down and absorbed until the hand is left with only short stumps where fingers and thumb should be. Foot drop--paralysis caused by nerve damage to the muscles that control lifting of the foot--is also a common feature of leprosy's ravages. The lepromatous form of the disease causes "lion's head," the most severe facial disfigurement.

Sister Wilmer reached Kalaupapa at a propitious moment. The first medications more effective than the Asian ancients' chaulmoogra oil had been developed by U.S. researchers, tested at the Public Health Service Hospital in Carville, and just released for use in Hawaii. The best-known and most widely used is dapsone (DDS). For those who also had tuberculosis, isoniazid was used. Still newer drugs include the potent antibiotic rifampin, and even thalidomide, which is administered to treat complications, but not for women of childbearing age. Collectively, these are indeed wonder drugs: when used promptly to treat newly discovered cases, says Koch, they can usually make the patient noncontagious within a week.

Though the new medications made it possible to release noncontagious patients from quarantine and isolation, politicians and the public were slow to recognize this. It was not until 1969 that the government of the fledgling state of Hawaii took the final bold step of abolishing isolation--in effect, flinging the prison doors wide open. The patients at Kalaupapa and at Hale Mohalu, a hospital and treatment center in Pearl City on Oahu, were free to leave or to come and go as they pleased.

More than 150, almost all at Kalaupapa, chose to stay where they were. Why? The answer was provided by Bernard Punikaia, 47, a man with an effervescent sense of humor who delights in entertaining visitors: "Because it's home for us. Some patients have been here 60 years. They have no family left--many of them changed their names when they were sent here, to save their families from embarrassment. They have no place to go. And the older ones, some with severe disfigurement, would have a hard time finding a place to live and fitting into the outside world."

Bernard's experience is typical. He was six years old when his illness was diagnosed.* He was taken from his parents and kept in Honolulu for five years, then shipped to Kalaupapa. He did not see his mother for ten years. At 17, he took a job as a patient-employee of the government, working as an orderly for the blind and later on roadbuilding. In 1973, Bernard was sent to Carville for surgery to correct his foot drop by the relocation of tendons, and again in 1975 for plastic surgery on his face and hands. Despite bouts of recurrent illness, by 1970 he had completed 20 years of service and retired on a modest pension. His housing in the patients' village is free, as are most patient necessities. Determined to better himself, Bernard got his high school diploma at the age of 43 through a government program. Now he writes Hawaiian songs, not with his clubbed hands, but by singing them into a cassette recorder, for a friend in Honolulu to transcribe as sheet music.

Some patients are reclusive and stay close to their village homes, old-fashioned cottages nestled in a dense growth of breadfruit and coconut and date palm trees. About half are married. One who feels no need to leave his house often is Monsarati Feliciaro, a Puerto Rican who has lived there since 1937 and now, at the age of 92, still does his own housework, yard work and vegetable gardening.

The more sociable patients gather after 2 p.m. at Mariano Rea's bar, where beer and wine are served. Earlier they tend to cluster around the porch of the general store, which features wholesale prices but is for patients only. It is operated by Gloria Marks, a handsome woman of Samoan parentage and the wife of Richard Marks, the colony's No. 1 entrepreneur. Marks runs a mule-train service from the airport on "topside" Molokai, down the slithery, switchback trail that gives the only land access to Kalaupapa.

The greatest concern of Kalaupapa villagers today is for their long-term future. Whereas the death rate in the 1880s ran as high as 10% annually, patients who have had up-to-date treatment have a life expectancy equal to the U.S. national average. The state of Hawaii would like to phase out Kalaupapa by 1985 or at the latest 1990, but no doubt there would still be patients remaining. So the government has promised never to evict them. A forceful campaign is under way to have the peninsula declared either a national or a state park, with a reservation for patients as long as the last one survives.

* Just how leprosy is transmitted from person to person is still unknown and the subject of scientific controversy. The only thing certain is that it passes most readily from a mother to a nursling or young child, and between spouses.

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