Friday, 8 October 2010

Leprosarium in Malaysia

Book : A review of Diseases in Malaysia
Writer : Lim Kean Ghee
Publisher : Pelanduk Publication

I bought this book last month when i was stranded in KL waiting for my delayed flight to Penang. Its an old book full of facts, even though this was published in 1993 and of course its doesn't provided the latest facts but its still interesting because it give a historical fact on certain disease.
I pick chapter randomly , chapter 13 : on Leprosy. The disease which is rare nowadays in Malaysia, (but not in the country i currently study ).

Historian generally believes that leprosy is a very old disease although in the past the word leprosy or lepra or its Indian equivalent kushtha which give rise to Malay word kusta may have been used to describe skin lesions, probably including malignancies, other that what we know now term Hansen's disease. Leprosy has been perhaps the most badly misunderstood disease for a long time and leprosy patients have suffered much for it. There are pointers to suggest that leprosy was present in Portuguese occupied Malacca but it is not conclusively evident. The earliest leprosy specifically mentioned during early days of British Strait Settlement. As early as 1828, the senior surgeon's report to the Governor had proposed isolating leprosy sufferers found in Penang Settlement on smaller island of Pulau Jerejak. However it was on Pulau Serimbun, off Malacca, that the first 'leper colony' in Malaysisa was founded in 1850.

A person with head covered passes a sign to a leper colony in Malaysia.
The Era of Segregation
Leprosy was perhaps one of the disease that health authorities and administrator were most aware of in early days of Strait Settlement that bring establishment of ' pauper hospital ' in Penang, Singapore. There was are strong desire to remove all leprosy sufferers 'out of sight'.
Pulau Serimbun, which was started by local authorities in Malacca had 21 patients in 1862 and impressed Senior Surgeon visiting it who found patients 'cheerful and content' and 'passing their time fishing and cultivating vegetables' . It was perhaps this success that led to establishment of Pulau Jerejak off Penang as leprosy asylum in 1871. Soon it became the center for the Strait Settlement. By law it was made compulsory for leprosy patients to be detained. Pulau jerejak was solely for men there was a female camp in Jelutong in Penang. Brazilian Leprologist de Souza Aroujo wrote : 96 were admitted in 1924, of whom 77 was transferred, 6 escaped, and 12 died. It was clear that treatment for leprosy was not on voluntary basis. with the British influenced over the Malay states after 1874, and the passing of government enactment on detention and isolation of known leprosy patients, came to the establishment of isolation Centres for these states. In KL this was in Setapak (1900), in Perak Pulau Pangkor Laut became the centre in 1930 while Tampoi and Tumpat became centre for Johor and Kelantan respectively. Each of the states could count about 100 new cases a year but many were transferred to Pulau Jerejak leaving only about 20 in each of these places. A new approach to the treatment of leprosy came with the establishment of Sungai Buloh Settlement in 1930.

The earliest part of the settlement

It was clear that treatment for leprosy was not on voluntary basis
The end of Segregation
Armaur Hansen of Norway had isolated the 'lepra bacillus' in about 1872. Following that it had become known over the years that leprosy had very low infectious rate since St. Maur Mourizt made known this fact when he experimented with inoculating healthy person with mycobecterium in Hawaii in 1885 who failed to be infected. It was said in place like Philippines that isolation showed no evidence in reducing the incidence of the disease. It was pointed out that Tuberculosis was at least 5 times as infective and carried a higher mortality rate , yet tubercular patient were not segregated. As a result of airing of views provision for domiciliary treatment and voluntary segregation were placed by in 1933. The second world war which hit Malaya very suddenly had an equally sudden impact on treatment of leprosy. It led to drastic reduction at both leprosariums. A large number of patient dispersed to their homes. Tho who remained behind were later stages reduced to eating tapioca and snails. The death rate climbed back up to 30%. At the end of war there were 640 left at Sungai Buloh and 360 at Pulau Jerejak.

In the planned colony, the occupants lived in virtual isolation from the outside world for almost four decades. Brought together by a common disease, this community was a melting pot of different races, cultures, and nationalities.

The leprosarium had its own rules and regulations, its own currency, school, places of worship, social clubs, fire brigade, police force and a prison too. At one time, the colony even had its own currency(Sungai Buloh's own ten-cent note printed in 1936)
The Sulphone Era
The big impact on leprosy treatment was by the drug diamino - diphynil - sulphone or dapsone from the USA. It began to be used locally from 1948 an slowly displaced other agents. This era was also one of much research from Sungai Buloh 'Reseach Unit' was set up in 1950.

Leprosy control programme In 1969, Malaysia launched th National Leprosy Control Programme in Peninsula. The Sungai Buloh Settlement also redesignated The National Leprosy Control Centre in 1969. with the program came the registration of patient and valuable epidemiological data was obtained for the first time. Registration showed that in west Malaysia, 56% of patients were Chinese, 33% Malays and 10% Indians. Other formed 1%. In Serawak 40% were Chinese, 32% Ibans and 17% Malays. In age distribution 54.5% were between 15 - 44 years old. 40% were above 45 years and children under 15 accounted for 5.5%. About 45% had lepramatous leprosy, 13% were borderline, 40% were the tuberculoid type and 3% indeterminate.

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