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The strong point of this slim volume lies in the author Loh Kah Seng’s choice to ground his work in oral history, specifically some 20 interviews with former leprosy sufferers having been forcibly interned at the Singapore Leprosy Relief Association (Silra) Home or in the ‘Valley of Hope’ (Sungai Buloh, Kuala Lumpur). Given that such isolation facilities are currently being transformed into homes, and that the inmates are theoretically being reintegrated into mainstream society, this volume helpfully sheds light on many unknown aspects in the modern history of leprosy, especially in Southeast Asia. Loh’s book also nourishes our historical memory, and the research was suggested and financed by the International Leprosy Association’s Global Project for the History of Medicine. This project, funded by the Nippon Foundation and based at the Wellcome Unit for the History of Medicine at the University of Oxford, is currently developing a database of leprosy archives around the world; the project also aims to ensure that the voices of people affected by leprosy are heard (http://www.leprosyhistory.org/english/englishhome.htm).

Laurence Monnais
Université de Montréal
Social History of Medicine, 24 (1), Apr 2011
Link to full article: http://shm.oxfordjournals.org/content/24/1/174.extract

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Review in s-pores

Liew Kai Khiun

Loh Kah Seng. Making and Unmaking the Asylum: Leprosy and Modernity in Singapore and Malaya. Malaysia: Strategic Information, Research and Development Centre, 2009. 152 pages.


The impression of a leprosy asylum is one of isolation of seemingly contagious patients with repulsive skin lesions away from main population centres. Practically cast away from society, it would be assumed that these inmates would also be abandoned by the forces of history. A former inmate in Singapore’s leprosy asylum at the Trafalgar Home in Buangkok recalled one night during the Japanese military occupation of the island between 1942-45, Japanese soldiers raided the place after a tip off about the existence of a gambling den. A hapless suspect was promptly interrogated on the spot and determined to be guilty.

Ever since they captured the city from the British, the Japanese authorities had in both a demonstration of their presence and efforts to contain disorder from the war, had swiftly beheaded criminal suspects. The same fate was about to happen to the victim, when suddenly the officer realised that his sword would be tarnished by the blood of the leper. He ordered the jaga (local reference to mainly security guard) to get him a tongkat (truncheon). Realising this would also be fatal, the latter provided the Japanese officer with a branch from a tree instead. The branch was use mercilessly on the victim, but he survived (p. 52). This anecdotal episode not only highlights the harsh exposure and the responses of the most stigmatised peoples the forces of history. More importantly, in contemporary Singapore where the word “Buangkok” is associated with that of a subway station, historian Loh Kah Seng intends to give a voice and a history to the former residents of the asylum. In an age of emerging and re-emerging infectious diseases, Loh feels the experiences of these subjects should serve to sensitise societies and governments to be “mindful of how ordinary people are treated, and mistreated, in the campaign against disease and infection” (p. 118).

The recent decades have seen a proliferation of scholarly works on the historiography of leprosy and historians like Edmond Rod have drawn a critical relationship between the framing of the disease and the process of colonialisation in his works on Leprosy and Empire: A Medical and Cultural History (Cambridge University Press, 2006). In this respect, scholars have increasingly recognised leprosy as not just a clinical problem, but one inflected with complex socio-cultural meanings and legacies. As such, it deserves not only to have its own history, but it should be an integral part of every society’s past. This historiographical consciousness also explains the driving force behind Loh’s research.

More than just a clinical description, Loh illustrates the intimate relationship between leprosy, developments in modern notions of diseases and contagion and the operations of British colonialism. While leprosy had been familiar to the non-Western world for centuries, it was the modern notions of bacteriology that the disease was classified as a contagious pathogen by the 19th century. Although stigmas did exists in pre-colonial societies, it was under Western colonial governance that witnessed more systematic and institutionalised efforts in identifying, segregating, quarantining and treating people with the disease, leading to the birth of the modern leprosy asylums.

Aside from the Trafalgar Home in Singapore, the legacy of leprosy in British Malaya can perhaps be located in the asylums established in Sungei Buloh near Kuala Lumpur and Palau Jerejek, an island off the coast of Penang. Physically fenced off by barbed wire installations and armed guards, the layouts and regimentations of these leprosariums were little different from prison camps. In spite of being seen as negatively dissimilar to the wider mainstream public, it is interesting to note that not only the demographic composition. With schools, temples and recreational facilities, the religious and cultural practices of these inmates closely paralleled that of the world which had systematically shunned them.

What distinguished Loh’s work has been his ability to vividly reconstruct the social conditions of the leprosariums as well as the experiences of actual former residents through his oral interviews. Those doing historical research on disease in the colonial context would find that this is a difficult undertaking, particularly for illnesses that carries a deeper social stigma. To begin with, the collective memories of these marginalised peoples as dignified and autonomous subjects are often given scant recognition by institutions that would often regard them as medical statistics. Added to this, locating and gaining the trust of these survivors at the social peripheries would also be daunting for prospective researchers. The graphic and voluminous accounts collected by Loh here reflects in turn the confidence and trust that his subjects had for him, feelings that must have involved substantial efforts on the part of the author. Part of his emphasis on reaching to the subjects personally comes from his inclinations to go beyond official records that have tended to reduce their subjects into faceless statistics and pitiful sufferers. From these accounts, he has pieced together more vibrant narratives of the painful memories of separation and dislocation from families, active and passive resistance of the medical regime, as well as the continued battle against the lingering social stigmas even leprosy is no longer seen as a dangerously contagious disease.

Another outstanding aspect of Loh’s study has been his refusal to fall into the ideological claims of both modern science and the progressivistic claims of the contemporary nation-states of Malaysia and Singapore. From his findings, both supposedly “rational” Western biomedical sciences are as guilty as well as “superstitious” vernacular folk healers were guilty of misdiagnosing and mistreating patients suspected with leprosy. On a broader macro scale, attempts by the postcolonial officialdom to spread the fruits of development in rehabilitating former inmates to new modern concrete buildings became another form of arbitrary and traumatic displacement from one set of walls to another.

In sum, for both academia and the general public, Loh’s historical study becomes a critical reminder of the necessity in looking at the past from not just sultans, colonial administrators and prime ministers, but those from the very margins of society.

Liew Kai Khiun obtained his B.A (Hons) and M.A. from the National University of Singapore, and was awarded his doctorate by the Wellcome Trust Centre for the History of Medicine at University College London. Among his main research interest has been that of medical history in British Malaya. He has just edited a book on Liberalising, Feminizing and Popularising Health Communications in Asia (London: Ashgate 2010). He is currently at the Wee Kim Wee School of Communications and Information at the Nanyang Technology University.

WHO Goodwill Ambassador’s Newsletter
No. 41 December 2009: 5
http://www.nippon-foundation.or.jp/eng/2jcahj000005bps8-att/8f0j6k000006tuct.pdf

How a “high modernist” approach to leprosy control was subtly subverted.

Alongside modern diseases such as AIDS and SARS or the H1N1 strain of influenza that is currently in the headlines, leprosy does not attract as much attention or the same level of research. Often, too, the voices of those affected by leprosy have been neglected or simply ignored.

Providing a corrective is Making and Unmaking the Asylum. At the center of Dr. Loh Kah Seng’s study are men, women and children from different ethnic groupings in Singapore and Malaysia who, as a result of being diagnosed with leprosy, ended up in sanatoriums such as Singapore’s Silra Home and the Sungai Buloh leprosarium north of Kuala Lumpur.

The book examines how a “high modernist” development ethos impacted on the history of leprosy in colonial and postcolonial Singapore and Malaysia. As defined by social scientist James Scott, cited by the author, this is “a self confidence about scientific and technological progress.”

The ideology and practices that grew from this have had, according to Dr. Loh, paradoxical outcomes upon the management of leprosy in the two countries. On the one hand, the high modernist state’s will to clean up social ‘messiness’ — combined with the coercive powers to do so — led to the segregation of people affected by leprosy and near-total control over them by the state, which sought to protect society from an imagined social danger.

On the other hand, the author documents how the high modernist logic was subverted, or at least resisted, by the very people it sought to dominate. The majority for whom the asylums became their permanent home devised strategies to salvage their ‘bad’ lives. They formed friendships, married, practiced their religion and put on cultural performances. Some joined secret societies, gambled, smoked opium, trafficked in contraband items, and partook in riots and strikes. In so doing, they sought to contest and remake the terms of their confinement.

What this thoughtful and discerning study underscores is the need to be mindful of how people are treated, or mistreated, in the campaign against infection. Leprosy may be an old disease compared with modern pandemics, but the lessons it teaches are no less relevant for it.

Making and Unmaking the Asylum: Leprosy and Modernity in Singapore and Malaysia by Loh Kah Seng (SIRD, Petaling Jaya, Malaysia, 2009).

AUTHOR: Syed Muhd Khairudin Aljunied is a lecturer in the Malay Studies Department of the National University of Singapore.

31 October 2009
Straits Times
Review – Others

Living with stigma of leprosy
Cheong Suk-Wai, Senior Writer
899 words
(c) 2009 Singapore Press Holdings Limited

LOCATED on the eponymous isle that flanks Penang Bridge, the Jerejak Rainforest and Spa is an idyllic retreat hugged by thick Malaysian jungle.

The visitor is greeted by glossy darkwood floors, intricate wood carvings adorn its walls and the linen is spotless white-and-blue. But for those old enough to remember, from 1871 till World War II, this was a fearsome no-go area that served to isolate leprosy patients

It was, in fact, colonial Malaya’s first such colony, to be followed much later in 1930 by the Sungai Buloh leprosarium set up in Selangor.

In Singapore, from where the British governed the rest of Malaya, there were holding areas for leprosy sufferers only in Kandang Kerbau Hospital and then McNair Road. Eventually, such patients were sent to Pulau Jerejak for good.

What a world away Jerejak’s Balinese body scrubs, steam baths and jacuzzis seem from the frightful 4,000-year-old disease whose name comes from the Greek word lepis for scale.

Since 1873, leprosy has also come to be known as Hansen’s Disease, after Norwegian scientist G.H. Armauer Hansen, who first discovered that it was caused by the bacterium Mycobacterium leprae.

Up till the early 20th century, leprosy was thought to be incurable, but a cocktail of drugs proved to be effective in stamping out this badly disfiguring and nerve- deadening disease that often results in the loss of sight and limbs.

Unfortunately, it was often confused with syphilis and thus erroneously thought to be highly contagious when, actually, scientists have since found that 95 per cent of people are immune to leprosy.

All this makes the disease’s tortuous and sometimes callous course in Malaya all the more tragic.

It was only in 1949, after three British nuns from the Catholic order of the Franciscan Missionaries of the Divine Motherhood settled down here and agreed to nurse leprosy and tuberculosis (TB) patients, that the British authorities were willing to set up a leprosarium proper, the Trafalgar Home in Woodbridge.

Such things are all but forgotten these days, but local historian Loh Kah Seng has just launched his book, Making And Unmaking The Asylum: Leprosy And Modernity In Singapore And Malaysia.

The book tracks how the British authorities were bent on compulsory segregation of all sufferers, which in effect rendered anyone stricken by leprosy effectively a walking corpse.

It was from late 2004 that Dr Loh had been researching the history of leprosy in Malaya for the International Leprosy Association’s Global Project. His core finding is that, in banning leprosy sufferers from mingling with the rest of society as a means of minimising the risk of contagion, Singapore’s early governments prioritised the control of society for economic progress and modernisation above the needs of individuals.

Dr Loh, who has also studied the effects of the Great Depression in 1930s Malaya, points out that even so, the British were selective in how they regarded leprosy sufferers in their colonies. For example, he argues, because Singapore was important to them economically, they made it illegal not to confine institutionally anyone with leprosy. In India, under its 1898 Lepers Act, by contrast, only paupers had to be segregated.

While the colonial government pursued compulsory segregation on the grounds that leprosy was highly infectious, Dr Loh points out that they backslid badly when they were short on funds. In 1937, when the Great Depression squeezed budgets and housing people became a great cost, the British government in Malaya admitted that leprosy was only ‘very slightly infectious’ and that compulsory segregation was ‘unnecessary and costly’.

His book abounds with examples of the British taking a sledgehammer to flies in dealing with the hundreds of leprosy sufferers, especially considering that TB was vastly more contagious but patients were allowed to roam freely.

Dr Loh records former leprosy sufferer Kuang Wee Kee as saying that, of the most-feared diseases in mid-20th century Singapore, ‘leprosy, TB and mental illness were the three brothers. Mental illness was…the little brother. Second brother was TB. Leprosy was the big brother. These were the three big clans’.

Once segregated, however, the leprosy sufferers were well fed and encouraged to be active in the open air as much as possible. They even grew vegetables and tended livestock, albeit within the confines of their delineated compounds.

Many gave up the struggle against the hopelessness to which society had consigned them. Many thus became incorrigible gamblers, instigating fights and killing themselves.

Yet many other leprosy sufferers ‘unmade the asylum’, as Dr Loh puts it, by founding musical troupes, writing and performing plays, and publishing inmates’ stories in magazines for sale.

Unfortunately, the push of progress continues to belittle their efforts to live with self-respect. In September 2005, residents of the Singapore Leprosy Relief Association had to move from their leafy premises with generous spaces to a flatted factory-like building. There, even for married couples, privacy is no priority. Finding their own digs is often a pipe dream given the stigma that still sticks to the disease.

Noting how contagious diseases are rearing their ugly heads these days, Dr Loh muses: ‘We have a social duty to be mindful of how ordinary people are treated, and mistreated, in the campaign against disease and infection.’

suk@sph.com.sg

Book Launch in KL

BOOK LAUNCH: Making and Unmaking the Asylum: Leprosy and Modernity in Singapore and Malaysia

SIRD, Save Valley of Hope Solidarity Group and the Kuala Lumpur & Selangor Chinese Assembly Hall Youth Section (KLSCAH-YOUTH) jointly invite you to the launching of Making and Unmaking the Asylum: Leprosy and Modernity in Singapore and Malaysia, a book by Loh Kah Seng.

The book will be launched by YB Elizabeth Wong Keat Ping, Selangor state Exco member for Tourism, Consumer Affairs and Environment.

Date: 15th August 2009 (Saturday)
Time: 2.00pm – 4.40pm
Venue: The KL & Selangor Chinese Assembly Hall, No. 1, Jalan Maharajalela, 50150 Kuala Lumpur, Malaysia.

This very special event also brings together representatives of the former residents of Valley of Hope in Sungai Buloh—the world’s second largest leprosy settlement that was partially demolished in 2008 despite calls to preserve it as a heritage site—to share their life testimonies and thoughts resulting from state and public stigma against leprosy. The audience will include social activists and friends/families members who shared solidarity with the Valley of Hope.

For further details please contact Ms Lee Siew Hwa at 03-7957 8342/8343 or 016-465 5107; or Mr Chong Ton Sin at 016-379 7231.

All are welcome. Please feel free to circulate this invitation.

2.00pm Guests arrive
2.10pm Guests are seated
2.40pm Video screening: Valley of Hope
3.00pm Introduction to Making and Unmaking the Asylum & a tale of solidarity by a representative of the Save Valley of Hope Solidarity Group, Teoh Chee Keong
3.15pm Book launch by YB Elizabeth Wong, Selangor state Exco member for Tourism, Consumer Affairs and Environment. Discussion session with author, ,Loh Kah Seng and representative, ex-resident of Valley of Hope, Lee Chor Seng
3.50pm Discussion and Q&A
4.20pm Tea, chit-chat and book signing
4.40pm Ends

Loh Kah Seng. Making and Unmaking the Asylum: Leprosy and Modernity in Singapore and Malaysia. Petaling Jaya: SIRD, 2009. Pp. 189. ISBN: 9789833782765. Product ID: 434

‘An outstanding and timely contribution to the historiography of Malaysia and Singapore: well-written, comprehensive, compelling, and poignantly illustrated. The stories present a striking and moving narrative of life on the margins of society. Highly recommended reading on the social history of Malaysia and Singapore’. Dr Ernest Koh, Lecturer, School of Historical Studies, Monash University

‘This book awakens us to the final remaining agendum for people affected by leprosy: a challenge to society, and to each of us as members; how we chose to respond is a measure of our conscience and sense of justice’. Kay Yamaguchi, Sasakawa Memorial Health Foundation

Making and Unmaking the Asylum is a book which tells of two entangled stories – one of the misapplication of modern medicine – and the other of the resilience and resourcefulness of those who suffered from the disease and its terrible consequences.

It is a social history of leprosy and leprosy sufferers in Singapore and Malaysia. It is a story of what has been feared, hidden and nearly forgotten.

But it is also a book which demands that we examine the nature and consequences of our unceasing pursuit of modernity. It calls to attention the discomforting shape of our beliefs in modern science, disease and contagion.

The book started in 2004 with research into the official records on leprosy in Singapore and Malaysia. The documents unravel the operation of a powerful policy of compulsory segregation; those suffering from leprosy were seized by the authorities and detained indefinitely in leprosariums. There was no cure; instead, the inmates were to be socially engineered into ‘self-respecting’ members of ‘an organised community’. It was chiefly the low-income Chinese men which the policy targeted.

The asylum became a social experiment in ‘high modernism’ while society was to be kept safe from what was erroneously believed to be ‘a dangerous contagion’.

Life for many reluctant inmates was ‘living hell’. Some sought escape over the high walls and barbed wire of the leprosariums. Others simply rejected the dreary and alien regimen of institutional life by committing suicide. The treatment, ineffective until after the war, caused physical and emotional pain and trauma, and led many patients to reject it.

But the sufferers also contested the regime of high modernist segregation in dynamic and ingenious ways. This became clear to me when the vantage point of the government embedded in the official records was countered and balanced out by the experiences and voices of the sufferers themselves. I interviewed elderly former patients at Silra Home, in Singapore, and Sungei Buloh Hospital, the so-called ‘Valley of Hope’, in Kuala Lumpur.

Collectively, subtly and in the long run, the inmates became ‘residents’, where the asylums were ‘unmade’ and became ‘homes’. Sungei Buloh, Pulau Jerejak and Trafalgar, the three main leprosariums in Singapore and Malaysia, were all reimagined and recreated by the residents themselves. The asylums’ keepers were not unchallenged in projecting the power of high modernism and were unable to prevent the rise of semi-autonomous ways of life in the leprosariums.

The residents insisted on the importance of family, friends, popular culture, and religion in the institution, and on activities which were officially frowned upon, such as forming secret societies, gambling and moonshining. The residents, in short, possessed ‘the weapons of the weak’.

But, as the book emphasises, the public stigma against leprosy remains, the disease continues to be misunderstood, and many cured patients still experience family and social rejection. As they have faced various forms of physical and emotional relocation and dislocation in the past, they are now confronting the reality that their homes will soon be demolished or converted into new uses. The history of leprosy in Singapore and Malaysia is not yet at an end.

Loh Kah Seng
May 2009