Leprosy Laws “Iron Curtain Of Makogai”

Press, Volume XCIX, Issue 29237, 22 June 1960, Page 20

Leprosy Laws “Iron Curtain Of Makogai”

The “iron curtain of Makogai," hiding what he describes as “the tragic farce” of Fiji’s leprosy isolation laws, is again attacked by a New Zealand patient on the island in a second letter to the editor of “The Press."

The patient’s first letter, with a reply by the Fiji Medical Department, was printed in “The Press” on April 26.

“I emphasise every statement in my previous letter," he says. "Every reference can be substantiated by medical authority, and the experience of hundreds of patients, past and present. I have not, as the Fiji Medical Department accused me, analysed the situation from my own point of view, and dismissed -the public health aspect. “A perusal of the existing systems in surrounding countries should convince the average person that the Fiji Medical Department is not living in this era,” the patient says. “The bogy of leprosy infection the stock-in-trade argument of the Fiji authorities, has reached its climax when more than 1 per cent, of the total recurrent expenditure for the colony is accounted for by the out-of-date system to isolate about 300 patients,” he says.

“When the Burns Commission in its report suggested that ‘a breath of realism’ be introduced into Fiji policies, it implied precisely this. It did. not know the details of the leprosy problem in Fiji, but what it saw in other spheres was sufficient to convince it what was lacking generally in the colony. “With institutional treatment estimated as costing 100 times as much as that based on modern knowledge, the financially-embar-rassed Government of Fiji supports a system of leprosy control which has been tossed out by governments quite capable of bearing the expense of outdated whims,” the patient says. While the Fiji Medical Department was mumbling about “studying and culturing the causative agent” of leprosy, the rest of the world had already taken advantage of knowledge at its disposal, and profited by it. “The Fiji Medical Department is waiting for every detail of leprosy research to be perfected before it starts on knowledge that was available for the taking 10 years ago,” the patient says. “The department says ‘the aim in Fiji is to eliminate leprosy completely.' If this is accomplished under the present system, then the Fiji medical service will have achieved something that the collective brains of the whole world of leprosy have failed in." Observations and experiments made by specialists who had made a life study of leprosy had shown that with just moderate isolation of the infectious cases, the disease had tended to die out. When infection in a patient had been reduced to a low bacterial index, , the possibility of infecting others was almost negligible. “All in all, leprosy is a mildly infectious disease, and nothing to be frightened of with reasonable precautions taken,” says the patient. “Of course, there is always the odd susceptible person who contracts diseases without any apparent reason. However, health policies are supposed to be formulated to suit general conditions, not odd cases.” The claim made by the Fiji Medical Department that Fiji was unique in its leprosy problem could be viewed in the light of the systems in practice in countries whose local conditions were

as diverse as it was possible to find, according to the patient. He gives the following details of treatment methods in various countries, most quotations being from medical literature: Trinidad: “Patients are not forced into strict Isolation. Only bacteriologically positive cases are admitted to a leprosarium, but where adequacy of home conditions and other circumstances permit, patients are allowed to have treatment at an out-patient clinic.” Brazil: “Compulsory segregation has been eliminated . . . the old methods of combat, based on theleprosarium, are being superseded by measures more efficient and more economic." French Africa: “Domiciliary treatment by sulphane.” Indonesia: “Infectious patients are compelled to stay in their villages and have separate rooms or huts . . . only admitted to leprosarium when unable to provide isolation.” Japan: “There has been no compulsory enforcement in recent years.” United States: “The only leprosarium is at Carville, Louisiana. Here it is usually only the lepromatosis cases that are treated but in cases where the medical authorities approve, the patient may have home treatment. Patients under treatment at Carville have 30 days' leave every six months to go home, and are given week-end passes. There are out-patient clinics in other States.”

Australia: “The Peel Island Lazaret, Queensland, was closed in August, 1959, in accordance with the recommendation of the International Congress of Leprology in November, 1953, and the patients are now treated at home, with the exception of four hospitalised patients.” Western Samoa: “According to a visitor who arrived two days ago from Apia, there appears to be no restriction on the movements of leprosy patients, except to take their medicine regularly, and to eat and sleep in their special part of the hospital." “The Director of Medical Services in Fiji predicted two years ago that it was more than possible that in 15 years' time, Makogai could be closed, as there would be no further use for it,” the patient says. “As the Fiji Medical Department says, there are still about 40 patients admitted every year. This trqnd does not support its optimistic view of the leprosy problem in Fiji. “Rather does it prove what every other country has found, that compulsory segregation drives the disease underground, which is borne out by the fact that almost every new patient arriving at Makogai is advanced in the disease.

“That hundreds of persons at Makogai should eat their hearts out, day after day, as their present and future lives are being slowly but surely ruined, while those responsible indifferently and leisurely go into abstract and irrelevant aspects of a problem that exists largely ip their own minds, is something beyond the realms of logic,” the patient says. “The iron curtain of Makogai isolation that has hidden the tragic farce for so many years still exists, but is wearing thin. Let us hope that modem knowledge and economic necessity will somehow bring about the final destruction of a system which has no place in the civilised world,” says the patient.