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[3] Leprosy.
A vile disease and the sight of a badly infected leper will move even the hardest heart to some display of emotion. People think of leprosy as a disease common in Bible days, but that nowadays hardly exists. The leper problem, on the contrary, presents an appalling problem in many parts of the world. It has been very largely due to the efforts of the British Empire Leprosy Relief Association in recent years that public conscience has been stirred in this matter. Numbers of medical men have been specially trained to deal with this disease and large areas have been surveyed and measures instituted which will bring about eventual control of leprosy.
Leprosy in Melanesia.
A pre-war count gave the number in the Solomon as about one thousand. This year--1949--a survey is being made in the New Hebrides. The figures are not available at the moment. There is leprosy in that part of Melanesia.
Why should the Melanesian Mission attempt to deal with this scourge?
The Mission is frequently short of staff and is always short of money; why does it not concentrate on its special business of "preaching the Gospel"? Let the answer be given in the words of a former Bishop of Melanesia:--
"Let us get one point quite clear. We do not believe that the Christian Evangel is solely concerned with, well, let's call it the 'hereafter'. We do not think that Christ was. He said very little--as far as we read--about life after death. He spoke of the many mansions in His Father's House, and, when He Himself faced the experience of physical death it was with the upward turning of His Eyes to the Father's Face and [3/4] with the words 'Father, into Thy hands I commend my spirit.' Physical death was to Him a going home and with that we should be content. This being so, you will readily understand that the Gospel which we preach--or perhaps we had better say, 'the stress, the accent' when we preach--is NOT on the hereafter.
"Our Lord was profoundly concerned with men's bodies and their minds. His Gospel was 'The Kingdom of heaven is at hand'--it was something urgent, a matter of to-day, to-morrow, here and now. With that spoken word came the healing of the sick, the casting out of devils, the cleansing of the LEPERS. That was the commission He gave to the Seventy, to the Twelve, to the Church. Therefore, we are not simply 'Preachers', but we are 'do-ers.'"
Leprosy is a disease of the unhealthy individual, and anything which produces an unhealthy state in the body is favourable to its spread. Factors which have a definite bearing on the incidence of the disease are:--
Age Diet Humidity Race. Children and young adults are more susceptible to the disease. This does not mean that Leprosy is hereditary, because it is well known that if children are separated from an infected mother at birth or as soon as possible afterwards, there is very little chance of their developing the disease. Further, certain areas where there is a moist, hot climate and where the diet of the people is insufficient, have more leprosy than other areas. And, again, the moister ones, generally speaking, have a relatively more virulent form of leprosy than the drier. This an important point, and, therefore, it is of the utmost value to survey areas so as to ascertain the place where leprosy is most prevalent and where the more active measures should be taken. It is no solution of the problem to say that every case of leprosy should be segregated. In the first place, the cost would be prohibitive, and secondly, certain stages of the disease are non-infective, and there is therefore no need to isolate these patients in leper colonies.
[5] The course of the disease.
Leprosy, like most diseases, is caused by a germ. This germ was discovered in 1874, but not until 1928 did methods of treatment improve to such an extent as to raise hopes of the possibility of cure. Leprosy is not easily acquired. It is not highly contagious. The evidence accumulated tends to show that the healthy person, provided that he does not come into close and prolonged contact with an individual who is in an infective stage of the disease, should not contract leprosy. Leprosy is essentially a disease of the unhealthy. Diseases which play the chief part in lowering vitality, and so predisposing towards infection are syphilis, malaria, and intestinal diseases. Malnutrition is, of course, another predisposing factor.
The germ may be introduced into the body in many ways, such as through cuts and abrasions of the skin and lining membrane of the nose; infection by swallowing the germs in food or water, plays no, or a very small part, in the transmission of the disease. If the germs enter the body and the conditions are favourable, they begin to increase; if not, they are either killed or else hide in some lymphatic gland, or other tissue space, until the conditions become more suitable, and then begin to increase. It is this property of being able to lie latent in the body that accounts for the varying incubation of the disease; that period may be anything from three months to twenty years or more, the average being two to three years.
In any disease which runs a long protracted course such as this, it is of the greatest importance to be able to recognize the early signs if we are to arrest and prevent its development. What, then, are the early signs? There are generally signs that the nerves are being attacked, and this is shown by the appearance of:--
1. Areas of depigmentation, or loss of colour--not white spots, but light-coloured patches.
2. Areas of anaesthesia or loss of feeling.
The signs at first may be so slight that they are unnoticed, a little loss of colour of some part of the skin, or a slight loss of feeling, and that is all.
[6] It is at such a stage that the disease can be treated with most success, and, further, one should bear in mind that at this early stage it is not contagious. Unfortunately, such cases are frequently missed, either because the patient does not seek advice, or because the disease is unrecognized.
If the disease is untreated, it continues to advance, and before long its true nature becomes apparent to the individual, who then endeavours to hide his complaint. The worry of knowing he is afflicted with this grave malady lowers his resistance still further, and the disease passes from a localized one with nerve manifestations, to a generalized skin disease. During this stage large raised patches may appear in which abundant germs are found, or else crops of nodules may break out, and these often ulcerate, discharging large numbers of germs. Periodic attacks of fever supervene, which make the patient ill. While leprosy is not painful as a rule, many of the reactions produced during the course of the disease are associated with much pain.
At this stage, when the whole body is attacked by the disease, the individual resistance is at a very low ebb, and therefore sufferers may more readily die from tuberculosis, intestinal diseases, or some acute infection. Some die as a result of weakness and debility produced by periodic attacks of fever associated with this stage of the disease.
Should the patient survive this period, as many do, the bodily resistance gradually increases, and signs of the disease begin to disappear. As the disease subsides secondary changes take place in the body, and it is these changes that produce the disfigurement and deformity so often seen. For example, in the endeavour to destroy the germs which have attacked the nerves, fibrous, or scar tissue is formed in the nerve sheath. By a process of contraction this strangles, as it were, the germs in the sheath of the nerve, but also in its relentless grip destroys the nerve. So, in destroying the germs of leprosy, the body destroys itself to a large extent, for when the nerves are destroyed many things happen; fingers become deformed owing to muscular paralysis, ulcers form, and if uncared for, extend to the bone, which [6/7] dies and is thrown off. The disease has now run its course, leaving the individual wrecked and mutilated beyond description. It is because of these disfiguring results that leprosy has through the ages been considered the most dreadful of all diseases, and its victims so often debarred from all social intercourse with their fellows.
As the result of recent investigations, it can be said that if the disease is diagnosed early enough, the majority of cases should become healed, and the late infective cases should, in the course of time, be brought to a state of non-infectivity.
The modern treatment.
Modern treatment does not consist only of injections of the derivatives of hydnocarpus (chaulmoogra) oil. Leprosy being a disease of the unhealthy body, anything predisposing to ill-health must be combated.
All possible predisposing and intercurrent illnesses have to be inquired into and treated, and then the more special remedies have a better chance of success.
Great advances have been made in recent years along the line of the special treatment of leprosy. Chaulmoogra, or more accurately, hydnocarpus oil, has been known for centuries as a remedy for leprosy. In India it has been in use for thousands of years. Its discovery is reputed in legend to be due to an Indian prince, who was stricken with leprosy and escaped in shame and disappeared into the jungle; the gads directed him to a special tree, and after eating the fruit he became healed. This legend indicates that the remedy for leprosy has been known in the East for many centuries. The difficulty had been that, taken by the mouth, hydnocarpus oil is nauseating, and large quantities cannot be tolerated in big enough doses. As a result of superior methods of preparation and manufacture, remedies have been made which are capable of "injection". The methods of injection are intravenous (plain oil cannot be used by this method), intramuscular, subcutaneous, or intradermal. For descriptions of these methods larger pamphlets must be consulted. The injections are given [7/8] once or twice a week until all active signs and symptoms have disappeared, and according to the severity of the disease, treatment along the above line is carried on from one to three years after the patient is healed.
What has the Mission done?
In 1929, when a doctor came to the Solomons to work in the Mission, a sum of money came sufficient to build a Hospital. Dr. Maybury set about this at once. On the south-west cost of Malaita is a deep depression, Coleridge Bay. A site was chosen in the corner of this bay and by 1930 the Hospital was far enough built to be able to admit patients.
Then the doctor chose another site, about ten minutes' walk from the Leper Colony there. The site is called QAIBATA, after the river which runs beside it. The Colony was called "The Colony of St. Francis for Lepers". In those early days a group of rather badly built native houses formed the lepers' living quarters. (Malaita men are not good house-builders.) There was a small wooden dispensary, the cost of which was given by B.E.L.R.A., and a wooden ward in which ill lepers were nursed. A tiny Chapel was built by the lepers themselves. There were then thirty-five patients in residence. Two healthy women, wives of two patients, refused to let their men enter the Colony alone and came with them. Each leper on admission was given bedding, eating utensils, and red calico for loin-cloth or skirt. Some typical inmates were these: Narihai, a heathen who looked perfectly fit until he turned round and the tell-tale patches on his back were visible. Talina, an advanced case, with typical nodules all over his face and body, but always cheery and smiling. Batista, whose toes and fingers had all been eaten away. He kept his spirits up and in time the disease was arrested. But, what future for one in that condition? Fafale, a boy of seven, already with one deformed hand. Iromeno, a heathen boy of fourteen with the dread patches all over his body and several fingers partly gone. One man was chosen from the patients to act as a dresser and he did the work splendidly.
[9] The Doctor had placed a white assistant in charge of the Colony and some sort of order and discipline was imposed and maintained. It was found that the lepers were very inert and indolent and this proved a great stumbling block to most of them. With much sympathetic encouragement they were eventually enabled to realize that an effort was needed to help themselves, and in time good gardens were made, well planted with native food and fruit trees.
In these early days a golden opportunity for evangelism was found. A Maravovo schoolboy, who seemed incapable of taking in instruction was, at his own request, employed at the Mission Press. He was anxious to serve the Mission in some capacity. He was discovered to be a leper and was sent to the Colony. Nothing daunted, he seized his opportunity with both hands, and, while under treatment, became the teacher for the Colony. He built a Chapel and held daily prayers for the patients. He taught them daily and soon seven of them were baptised by Jack Talofuila, the native priest of the district. Jack, as and when his other duties permitted, celebrated in the little Chapel. What a joy the leper schoolboy found in his affliction. "Who going through the vale of misery use it for a well." His name is Barnabas Babau. Truly a son of Consolation. The Colony grew. The people lost their fear and suspicion and more patients appeared than could safely be housed. Residence in the Colony restricted movement and the native loves to be a rover. Much patience was needed as the treatment lasted so long without very many signs of improvement in the patient's condition. Methods were new to the people and open to very grave suspicion from their angle.
These obstacles were broken down in those early days and every credit is due to those who pioneered this effort.
A quotation will not be out of place here. It is from A Doctor in Paradise, by S. M. Lambert, M.D.:--
"Whenever colonists mentioned the Melanesian Mission doctors they usually said, 'Wonderful work!' I was not disappointed when I saw the Mission Colony, [9/10] order in the midst of green chaos: a hospital and church built of concrete, the leper colony too near for safety. . . . I was astonished at first when I found that two of the orderlies were arrested cases of leprosy; then I realized the stringent economy under which these devoted men and women work in order to keep their Mission enterprise on its feet. Educated and gently reared, they slaved out their lives in genuine Christian cheerfulness. Some of them, I fancied, had not had a square meal for years. I had lunch with them. . . the Missionaries chatted gaily over the poor things that came on the table. I know it was the very best they had, for we were their guests. Around the Qaibata mission station I wish to put a bright red mark of approval. Striving against heavy odds, it has done the Lord's work in a practical way and every year has shown improvement. Its workers . . . reveal the missionary at his classic best; a civilizer, a healer, and a defender of the helpless."
Changes.
Dr. Maybury left the Solomons in 1932 and a new man came. For various reasons connected chiefly with a Government long-term policy it was decided to close the Leper Colony. In any case the response from the lepers had been such that the Colony was overcrowded. Money and supplies were short. Dr. James came in 1935 and another effort was made, this time with some classification of patients according to the stages of the disease. This arrangement made two sites necessary and a special appeal was made for the Huts in which the lepers were to live. Many were given, at a cost of £15, and a good lady in South Australia gave £1,000. These huts bear the names of the donors or a name which the donor whished to be remembered.
It is necessary to point out here that there are three types of lepers:--
(a) Those which while suffering from the disease, have their infective germs shut up inside their bodies so that none escape. These are mostly nerve cases, and amongst them are the most hopeful cases from the treatment point of view.
[11] (b) Those in which the germs are not shut up, but are discharged from the patient--mostly from the nose--and these patients are infectious and must be isolated.
(c) The "burnt out" cases. These correspond to say, the person with the paralysed leg due to a previous infantile paralysis. He has not the disease now, but just the remains of it--the result of its ravages. These lepers suffer with ulcers and need a certain amount of attention, and their disabilities improved as far as possible. They are not, however, infectious and so need no isolation. On the other hand, they are often deformed from their previous nerve involvement and sometimes they present most hideous appearances. To put them among the non-infectious patients in the colony would depress the ones that should come for treatment, and so, after doing what is possible for them, they are best left in their homes with dressings for their ulcers, and visited now and then by the doctor.
Non-infectious Lepers.
These are maintained in the colony not far from the Hospital. It is in an airy site well up on the hill inland. The huts are sixteen feet by twelve and accommodate four people. Thus, a non-infectious patient may bring his wife and children with him to live in the colony. The roof is iron as this is more durable and cleaner than thatch. The walls of palm tree wood, grown locally. The floor of concrete, this being clean and hygienic. A little verandah has a roof of native thatch. There is a two-foot square window at each end of the hut, covered with a push-out. The door in front is of sawn timber. The height of the roof is eight feet, which is ample for coolness. The huts are placed in a line each twenty-five feet apart. A second line is thirty-six feet from the first and the huts are placed opposite the gaps in the first line. Kitchens (cook-houses) are provided for each line of houses. There are good gardens, planted and cared for by the lepers themselves. Because of the great necessity of raising their nutrition to the highest pitch and maintaining it there, the patients need their garden food, and [11/12] as well, a regular issue of food such as is given to the general hospital patients, though in varying amounts according to circumstances. It will be remembered that the clearing of the leper's body from other infections, and the supervision of his diet so that his general vitality is increased to its utmost are more important parts of the treatment than are the injections of chaulmoogra preparations. Leprosy is very like tuberculosis in this respect.
Infectious Lepers.
These are placed in a settlement about two miles away across the bay. These are the patients in whom the germs are not shut up. They must, therefore, be isolated. Except for the presence of relatives the conditions prevail here as in the other section of the Colony.
Dr. James was succeeded in 1939 by Dr. Thomson and the work as above was maintained and developed up to the time of the Japanese invasion in early 1942. Then it was essential to evacuate the patients, who went to their various homes or hiding places. The Hospital staff retired into the bush and carried on whatever work was possible there until the Japanese were driven out. During this time, the ravages of white ants and weather in the unoccupied huts reduced them to a very poor condition.
As materials and labour again became available the work was resumed and lepers again came to the Colony. Progress with building was extremely slow because timber and iron were not obtainable in any useful quantities. In 1946 Dr. Hemming, priest and doctor, joined the Mission and the Colony entered upon a new era of usefulness.
Orderlies have been trained, usually men who are lepers, and they carry out the routine treatments under supervision. The health of all the lepers is very satisfactory. The dispensary provided by BE.I.R.A. for Qaibata was re-erected here and is still in use. The grounds are clean again and well kept. Leper teachers take prayers regularly, morning and evening, and classes are held in preparation for Baptism and Confirmation. The work goes ahead. The lepers are more or less self-governing and they are a very happy crowd--in fact it [12/13] would be hard to find a happier community anywhere in the islands, or a more grateful lot of patients. Considerable financial assistance--amounting at least to £3,500 up to the end of 1946--was given by New Zealand Leper Trust Board. This sum was not intended for capital expenditure--new buildings, etc.--but for the maintenance of the more recreational side of the patients' lives. Later, the Leper Trust Board willingly changed its policy and allowed a proportion of their annual grant to be available for buildings, and (it was hoped) for a special launch in which doctor and dressers might visit the Malaita coast--at least--and attend to isolated lepers.
The New Hebrides.
As indicated above, it is impossible to say what number of lepers there may be in this group. The Mission has long had a small colony situated close to the general hospital at Lolowai--the "Godden Memorial". There are at present only four cases resident there. Generally, the routine there is as at the much larger Colony in the Solomons.
What is the result?
From time to time patients are discharged "cured". Strictly it is wrong to say cured. The disease is arrested. Research continues and it is hoped that the improved methods of treatment resulting will effect "Cures" in ever increasing numbers.
Lepers find a new interest in life and are relieved of the depressing sense of uselessness that formerly caused so much mental suffering. They are part of a community that joins in productive work and finds a joy in it.
Lepers find new friends, and the kindness and care of the medical staff brings a new hope and encouragement. They feel that someone cares. They no longer walk alone.
Lepers find a new unity in prayer and worship. Though put last, the religious side of the work is by no means the least. The religious sense of the native is far greater than we sometimes imagine. He is cradled in a sense of the reality of the spirit world. His whole life is enwrapped and bound up outwardly and inwardly by belief in the [13/14] spirits and with the superstitions that ensure. A hospital that cares only for the physical side is dealing only with a part of these people. In the Mission Hospital the Healing Christ reaches out and touches the whole man--body, mind, and spirit. In such a community the love of God is made real to heathen hearts, and the Healing Hands stretched out are "Mighty to Save".
_____________ "As an object lesson of the spirit of Christianity the ministry of healing is unexcelled; as a road maker for Christ's entry into the hearts of suffering men and women its effectiveness is proved in every field."
Will YOU help?
The Government of the British Solomon Islands Protectorate--assisted by a special grant of £5,000 from the LEPER'S TRUST BOARD (NEW ZEALAND)--is expected shortly to produce a scheme for a wider application of modern knowledge of anti-leprosy treatment within the Islands. The Government scheme, which has not yet reached any practical stage, will leave ample room for the continuance of the Mission's special leprosy work. Indeed the mission has been pressed to continue it and generous grants have been made for new buildings and equipment by the Lepers' Trust Board.
The Mission needs, however, an annual sum of at least £1,000 in addition to its normal income if the work is to be continued at the present high level of effectiveness.
Maintenance.
Each leper patient costs £20 per annum and our appeal is made chiefly for this purpose.
"Every man according as he purposeth in his heart, so let him give, not grudgingly or of necessity; for God loveth a cheerful giver."
[15] The Melanesian Mission
33 Southhampton Street,
Strand,
London, W.C.2.N.B.--For valuable informative literature on the general subject of leprosy apply to:--
B.E.L.R.A.
167 VICTORIA STREET.
LONDON, S.W. 1__________ QUESTIONS 1. What is the cause of leprosy?
2. In what conditions is the disease most easily contracted?
3. Describe the three main types of lepers.
4. How did the Mission tackle the problem in 1930?
5. Why MUST missionaries deal with leprosy?
6. Why was the Qaibata Colony closed down?
7. What further effort was developed in 1935?
8. What was the next set-back?
9. What has been done since the end of the war:--
(a) In the Solomons?
(b) In the New Hebrides?
10. What would you consider to be the three chief factors in the treatment of leprosy?
11. How is this work to be paid for?[20]
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Church Army Press, Cowley, Oxford.
Project Canterbury