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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

COLUMN: Contagionism Rules

Reflections on Portugal's Hospital-Colony Rovisco Pais

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The main building of Rovisco Pais, as it looked in 1947
In 1947, Portugal began the compulsory internment of people with Hansen's disease in a newly-built hospital colony called Rovisco Pais. The political context was the Estado Novo, or New State, the authoritarian regime that ruled Portugal from 1933 to 1974.

The hospital colony was established in the same decade that Promin was discovered.* Yet the internment policy continued until 1974, when a revolution ended Portugal's decades of dictatorship. That the policy didn't end sooner was largely due to political reasons.

Internees continuously subverted the frontiers restricting their freedom.

Until the 1930s, Portugal had no prophylactic or therapeutic strategy for Hansen's disease. The lack of one had been denounced by the medical profession since the late 19th century as a national embarrassment that reinforced Portugal's subordinate position in Europe.

When the regime decided to bestow funding for the construction of a modern leprosarium, its reasons were due less to the relative incidence of the disease in Portugal, and more to do with the political representation of it as a disease that "stained" the image of a country that saw itself as a modern nation and as an imperial power.

Between 2006 and 2008, I carried out ethnographical and documentary research at Rovisco Pais as part of an interdisciplinary project of the University of Coimbra's Department of Anthropology. By then, the hospital colony had been converted into a physical rehabilitation center; however, it retained a Hansen's disease service where 26 former internees still live.

The New State's strategy was based on a centralized program and on contagionist legislation that severely restricted the civil rights of people with Hansen's disease. Compulsory internment (assisted by the police) added a juridical aspect that criminalized the medical diagnosis, while the insistence on separating the infected from the non-infected created stigma. As Eurico, one of the former internees, said of the strategy, "They said it was to end leprosy in Portugal... But instead of ending leprosy, they ended up with lepers!"

Rovisco Pais shared many features with other modern leprosaria. These included: segregation from the outside world; segregation between the sexes, except in family areas; self-sufficiency; a prison; and recreations such as a cinema and a newspaper.

But it also propagated a paradigm of moral regeneration that reflected the paternalistic ideology of the Estado Novo regime. Internees learned trades such as masonry and shoemaking, were taught literacy and hygienic habits, and the hospital colony extolled the values of family, religion and work.

Notwithstanding the strictness of the colony's

regulations, internees continuously subverted the frontiers that restricted their freedom, including rules governing gambling, alcohol and relations between the sexes. In so doing, they showed how even the most oppressed people always resist power, and retain their own identity and goals.

Political Struggle

In the 1990s, when Rovisco Pais was turned into a rehabilitation center, its original residents were faced with eviction. As Cândida, one of the residents, put it: "When I wanted to leave, they wouldn't let me, and now they wanted to force me to go!"

In response, they engaged in a political struggle for the right to stay and to receive lifelong medical and social care. They argued they were owed as much by the Portuguese state, given its assault on their civil rights in the past. They secured these rights by legislation enacted in 1996.

It is fair to say that most people today are not aware of this history. But "public forgetting" is never a politically neutral process. Many times, past social conflicts have been erased from the public memory in the construction of official versions of national or collective histories. The policy of compulsory internment of people with Hansen's disease is one such instance.

Studying the oral memory of people who were affected by the compulsory internment policy is

thus important. It helps in understanding the history of that policy more deeply, by shedding light on the social and personal experience of it. But equally, it prevents anachronistic, authoritarian medical practices that tend to be enacted upon peripheral social groups from being imported to the present.

AUTHOR: Alice Cruz

Alice Cruz is a medical anthropologist and PhD candidate at the Center for Social Studies/Faculty of Economics of the University of Coimbra.

Footnote

*Promin was first used as a treatment for Hansen's disease in 1941 by Dr. Guy Faget at the National Leprosarium in Carville, Louisiana. It was later replaced by Dapsone, before the introduction of multidrug therapy in the early 1980s.