Leprosy was called “Ma Feng,” “Lai disease,” or “Hansen’s disease (different Chinese characters used than today)” in Chinese in the early days. The earliest record of caring for patients with Hansen’s disease can be traced back to the Qing dynasty in 1736 when the Qianlong Emperor began the first year of his rule.
The monument situated by a shelter set up by chief Qin Shih-wang of Changhua County were inscribed with words: “This county facility takes in people with leprosy and disabilities, but cannot provide for the elderly.” Also, general records of Changhua County written by local resident Zhou Xi states that “a care center was established by Qin Shih-wang in the first year of Qianglong’s rule, and it took in people with leprosy or disabilities.” However, these records cannot prove whether the care center was meant to take in only patients who suffered from Hansen’s disease, or whether the center provided any treatment.
It was not until the Japanese colonial era did Taiwan develop treatments and care for patients with Hansen’s disease under advice given by foreign missionaries and doctors.
In the beginning of the 20th century, Hansen’s disease in Asia began to gain attention. At that time, the main prevention method adopted by countries around the world was to place people suffering from the disease in quarantine.Lepers were sent to an isolated location to stop patients from having close contact with healthy people, therefore stopping the spread of the bacteria that causes the infection.
The Culion Leper Colony of Philippines, for example, was established on the isolated CulionIsland in the PalawanProvince. It is the world’s largest sanatorium for Hansen’s disease patients today. There are still settlements of leprosy patients remaining today in leper colonies around the world, including the Kalaupapa Leprosy Settlement and National Historical Park in Kalaupapa of Hawaii, Nagashima Aiseien Sanatorium in Japan, Sorok Island in South Korea, and Sungai Buloa Leprosarium in Malaysia.
Japanese scholarTaiyû Aokiwas the first person that called for building a sanatorium for Hansen’s disease in Taiwan in 1901. The word “isolation” began to appear in the law on leprosy prevention passed by the Japanese government in 1907. Japanese Governor-General Mitsunoshin Kamiyama took the advice of Dr. George Gushue-Taylor in 1927, and decided to establish the “Lo-Sheng Sanatorium under the Office of the Taiwan Governor-General” with a budget of 330,000 Japanese yen at Pojiao (today’s Huilong), which is at the border between the administrative areas of today’s Xinzhuang District and Guishan District. The sanatorium was completed three years later in 1930 and was commonly known as “Lo-Sheng Yuan,” the predecessor of Lo-Sheng Sanatorium. It was the first and only public institution established to prevent and treat Hansen’s disease in Taiwan.
The Lo-Sheng Sanatorium occupies about 30 hectares. In the beginning of its establishment, it adopted globally recognized methods to manage the sanatorium, and applied the measure which was believed to be the most effective at that time – placing all patients in an isolated institution that combines the functions of a hospital, shelter, and community; allowing patients with Hansen’s disease to have a place to stay without being judged by others; and being able to enjoy and respect life with dignity. This is how the name “Lo-Sheng,” which means “happy life” in Chinese, comes from.
When the sanatorium was first opened on December 12, 1930, it took in only four male and two female patients. Following the launch of a promotion campaign and the release of pamphlets about the sanatorium and leprosy aiming to improve the public’s understanding of the sanatorium and treatment of Hansen’s disease, as well as the mandatory reporting system imposed on hospitals, police house searches for patients, and compulsory treatment ordered by local governments, the number of patients increased dramatically. In April 1931, the number of patients at Lo-Sheng reached its limit of 100 patients.
With the assistance of the Taiwan Leprosy Prevention Association and civic groups, projects with five-year and 10-year terms were carried out to expand the sanatorium and increase its maximum capacity to 700 patients. In 1944, the sanatorium took in patients from the Happy Mount Colony in Bali, New Taipei and saw its number rise to 442 in the following year.
The Taiwanese provincial chief executive office under the Nationalist government took over the sanatorium in 1945 after Japan was defeated in World War II, and renamed it as “Lo-Sheng Sanatorium of Taiwan Province.” Taiwanese doctor Lai Shang-he was named the acting superintendent before Dr. Wu Wen-lung succeeded him in the following year.
Before Chen Chung-ying was named head of the sanatorium in 1953, very few people were willing to work at the sanatorium because of the public’s longstanding fear and rejection of lepers by the Taiwanese society. Moreover, the sanatorium saw chaotic situations during the war because of conflicts between the growing number of military patients and Taiwanese patients. Poor management also caused some patients to escape, leading to the number of patients dropping to a record low at 240 in 1947.
When Chen took office in December 1953, he re-organized managerial affairs, promotedpatient autonomy, and improved the living conditions in the sanatorium. He also tapped into public resources to improve society’s understanding of Hansen’s disease. In addition, Chen introduced the concept of occupational therapy and encouraged patients to take part in physical work and skill training workshops. An occupational therapy unit was also created to teach patients how to cook, make crafts, take care of animals, and tend gardens. As a result, the number of patients gradually increased again to a record high of 1,074 in 1963.
To follow the global trend in treating Hansen’s disease, new drugs were introduced and isolation measures were modified. Following the amendment of the Leprosy Prevention Law in 1962, the launch of a 10-year plan on leprosy prevention in 1965, and a subsequent 10-year plan in 1976, Lo-Sheng Sanatorium began a trial of Diamino-Diphenyl Sulphone (DDS) introduced by the Joint Commission on Rural Reconstruction in 1952, marking a great step in treating leprosy and pursuing the possibility of complete cure. However, limited quantity of the drug forced the sanatorium to decide which patients could take the drug through a raffle, and this led to hoarding and drug abuse.
In addition, a strong side effect known as “leprosy reaction” may occur in some patients, leading to aggravation of leprosy symptoms, an acute surge of the disease bacteria, and serious discomfort and lesions all over the body. Thus, some patients refused to take the drug while others overdosed in the hope of recovering sooner or ending their lives completely.
Religious activities have been thriving at Lo-Sheng during and after World War II,And several houses for religious gatherings or buildings sponsored by churches were built on the sanatorium grounds. For instance, a Christian church began fundraising for building a chapel in the sanatorium, while the Buddhist Jikei group started planning a temple in the same year.
In terms of caregiving, some patients had to pay for their own food and clothes due to the lack of resources after the retrocession of Taiwan. At that time, leprosy containment policy still followed the isolation measures used during the Japanese colonial era, such as compulsory admission and the use of barbed-wire fences to prevent patients from escaping. Also, a sanitation ditch filled with disinfection liquid was kept to separate the patients’ area away from the administration region in the sanatorium. Moreover, newborns were taken away immediately from their parents and raised by the church’s orphanage. They were allowed to return to their parents only after reaching legal age.
Laws concerning leprosy and regulations such as “Law on Leprosy Prevention,” “Enforcement Rules for Leprosy Prevention,” and “Enforcement Rules for Leprosy Prevention of Taiwan” under the Japanese authorities were all abolished. However, “Enforcement Rules for Leprosy Prevention of Taiwan Province” was taken from the old rules and amended in 1949, and the same applied to the “Regulations for Managing Patients in Lo-Sheng Sanatorium of Taiwan Province,” which was amended in 1951. Both regulations maintained discriminating measures such as sanitization and forced sterilization, and upheld a nationwide emergency notification system. Also, the rules forbad patients or those suspectedof infection from working. For patients who were taken to the sanatorium by force and unable to support their families, county and city governments offered stipends to their families, while the medical and living expenses of those inducted patients were paid by the provincial government.
Lo-Sheng offered a clinic service, but would ask those already diagnosed with leprosy to stay atthe sanatorium for treatment. As the country’s only public leprosy sanatorium, it had been assigned by the Provincial Bureau of Health and Welfare to check for prospects and accommodate all identified patients. Therefore, the number of patients rose every year. The cost of aforementioned services was high and public facilities and living conditions all required desperate improvements. However, the government was unable to offer more funds due to the large expenditure of war. Thus, the sanatorium was forced to seek outside help.
Assistance from church groups and the United States made up the majority of outside aid received by Lo-Sheng. For example, most foreign medical personnel working in the sanatorium, such as Sister Alma from Germany, Marjorie Bly from the United States, and Norwegian doctors Bjarne Gislefoss and Olav Bjorgass, were sent to Lo-Sheng through church networks. German doctor Scheel, Mrs. Lillian R. Dickson, Rev. Bob Harmond, Mrs. Nelson, U.S. Ambassador Karl L. Rankin, and wife of American military doctor Lyneo also made significant financial contributions and material aid to renovate and expand the sanatorium. Mrs. Dickson, in particular, was the first one to bring much-needed material aid to Lo-Sheng, and was widely respected by the patients.
Apart from supplying food and clothes, Mrs. Dickson also raised funds to set up nurseries for patients’ children, such as Mercy Home and Peace Home. She also established a chapel in 1952, an occupational therapy room in 1954, the Sacred Light Ward for young male patients and the King’s Daughter Ward for young female patients, halfway homes for the cured but unemployed patients in 1958, and a ward for the blind in 1966. Interestingly, Japan began to offer more assistance starting in 1971. For instance, Japanese doctor Kazuo Saikawa of the World Health Organization, who served as a surgeon in the Nagashima Aiseien Sanatorium, was sent to Taiwan for inspection work in 1957 and had provided his service several times at Lo-Sheng. He also visited patients in southern Taiwan. Meanwhile, OsakaDentalUniversity also conducted free clinics for patients in Lo-Sheng. Japanese businessman Ryoichi Sasakawa started donating equipment such as electrotherapy machines in 1968, and subsidized health officials and doctors to carry out field surveys and learn about how lepers were treated and cared for across the nation. He further donated US$100,000 to establish a training facility for leprosy caretakers and medical personnel, which was later named the Sasakawa Memorial Hall.
In 1956, Lo-Sheng Sanatorium began sending medical teams to offer clinic services around Taiwan. It later founded the Taiwan Provincial Commission of Leprosy Prevention in 1959 with the help of the provincial health bureau, and took part in the amendment of the Law on Leprosy Prevention in 1962 and the implementation of two 10-year plans on leprosy prevention (first in 1965 and second in 1976).
The sanatorium also introduced a series of new policies to change the society’s view on leprosy, such as the removal of wired fences and the sanitation ditches in 1954. It also allowed cured patients to leave the sanatorium for the first time in November that year. In 1955, the sanatorium opened its door to the public for visits, and encouraged cured patients and those who are not infectious to leave the sanatorium, return home, and search for jobs. It also repealed the rule that required patients to undergo involuntary sterilization before marriage.
On May 20, 1956, leprosy patients voted for the first time in a New Taipei City election. Though it was not easy for to patients to return to their homes and old communities, the sanatorium set up an occupational therapy room in 1959 to train patients to do various jobs, encompassing gardening, raising livestock, sewing, engineering, hairstyling, cooking, playing instruments, laundering, and caregiving.The sanatorium also helped to sell products made by patients.
The advancement and breakthrough in ways of treating the Hansen’s disease have led to discussions of the future needs and functions of Lo-Sheng Sanatorium. Therefore, in the 10-year plan mapped out by the Taiwan Provincial Government in 1976, one of the long-term goals was to close the facility within 25 to 30 years by transferring the remaining patients to regular hospitals. The subsequent 10-year plan on leprosy prevention published in 1986 reaffirmed that the goal was not to simply cure patients, but to ensure that the disease is completely eradicated. This goal meantthat the main function of the sanatorium would be transformed from a treatment provider to the role of monitoring the spread of the disease. The 1986 plan also addressed the issue on living arrangements of elderly patients at Lo-Sheng for the first time, and decided that those who were discharged by the sanatorium will be taken in by charity groups.
In 1991, the Taiwan Provincial Government proposed relocating the sanatorium to Yuli Township in Hualien County or Bali District in Tamsui. However, the relocation plan was opposed by local residents and related organizations in those areas. Thus, the provincial government planned to renovate the sanatorium as a public health center in the following year, but had to abandon this plan as well because the Taipei City Department of Rapid Transit Systems had already selected the Lo-Sheng site for building the Xinzhuang Depot. During the two years of debate and uncertainty, residents in communities around the sanatorium had also proposed the compromising solution of turning the facility into a multifunctional hospital.
The Taipei City Department of Rapid Transit Systems soon contacted the Ministry of Transportation and Communication to sought the Executive Yuan’s approval in June 1994 for its plan to appropriate the government-owned Lo-Sheng land for building the Xinzhuang Depot, while the southwest corner of the sanatorium by Zhongzheng Road would be used to build new wards and medical facilities before existing buildings were tobe torn down. The Executive Yuan approved the design of Xinzhuang Line and Luzhou Branch Line in the following month, which included building the Xinzhuang Depot on the site of Lo-Sheng.
To coordinate the construction of the Xinzhuang Depot, the provincial government’s health bureau agreed to move and rebuild the sanatorium to the mountain side behind the existing facility, and began the immediate coordination of Lo-Sheng’s renovation and relocation plans. While the Executive Yuan’s initial plan of establishing new hospital buildings in 1999 included building one-storey houses for current Lo-Sheng residents at Lo-Sheng, the plan did not address the facility’s future given the declining number of patients. Therefore the plan was modified in 2000 to build an eight-story building for general care and medical services. By this time, Lo-Sheng Sanatorium has begun its transformation into a community hospital in addition to its original responsibility of curing and caring for patients with leprosy.
Meanwhile, the sanatorium has changed the way it works from instructing and managing patients in a closed environment to offering guidance and assistance to patients who also enjoy autonomy. The evolution can be seen from the early principles of management, in which regulations still emphasized management of patients in all aspects during the 1990s.By the early 2000s, Lo-Sheng changed its rules of patient care, established rules for the creation of a self-ruling commission, and implemented schemes that help patients become reintegrated into regular communities.
In addition, the opening of the Huilong clinic in 2002 revived the generalmedical services of the sanatorium again. With the improvement of medical service and staff members, over 10 specialist medical areas have been added, which has paved the way for the sanatorium to become a community hospital. It also provides better services for elderly patients with multiple chronic diseases.
The new building, which was completed in April 2005, offers better medical services with new equipment. It has also improved the environment of clinics and medical spaces in the sanatorium. More importantly, the care offered to patients with Hansen’s disease was changed and tailored to meet their different conditions.
Before 2008, all the work concerning prevention of Hansen’s disease and care offered to patients were conducted under administrative orders and regulations without any law that would protect the rights of such patients. It was not until the relocation of the sanatorium and the controversy sparked around the building of a metro depot at Lo-Sheng did the human rights of the patients receive attention, prompting the passing of the Act of Human Rights Protection and Compensation for Hansen’s Disease Patients.
After the plan to relocate and rebuild Lo-Sheng was approved in 2000, the public started to develop different opinions on the site selection for the Xinzhuang Depot. When construction began in 2002, local residents in Xinzhuang organized a Saving Old Trees Group and launched a campaign to rescue old trees in the sanatorium. The campaign was different from the previous ones that focused on improving local facilities and prosperity.
Local campaigners also learned from the victory of Japanese patients with Hansen’s disease, who won a legal battle that deemed the leprosy prevention law was unconstitutional. The Japanese cabinet under then Prime Minister Junichiro Koizumi openly issued an apology to the surviving patients and passed a compensation law to remunerate these patients.
In 2004, former President Chen Shui-bian visited Lo-Sheng to mark the 50th anniversary of the World Leprosy Day, and issued a public apology to the patients on behalf of the government. Chen also presented Lo-Sheng residents with medallions that were inscribed with the phrase “Leprosy Warriors.” By this time, lawyers and civic groups also began to fight for patients’ human rights through demonstrations calling for the preservation of the sanatorium as a historical site, and filing a lawsuit in Japan for the 25 patients sent to the sanatorium by the Japanese government before World War II. On October 25, 2005, the 25 patients won the suit in Japan and each received 8 to 14 million Japanese yen in compensation. When the news spread to Taiwan, the Presidential Office responded to the legal victory by promising compensation to patients who had suffered from isolation measurements implemented by the Nationalist government, and that it will evoke the perspective of human rights and the protection of vulnerable groups in formulating compensation plans.
When the new building was completed, the Department of Health, concerned about the safety of patients who lived in the mountain area, began to help consenting patients at Lo-Sheng move into the new building.However, this led to criticism from the public who thought the patients were forced by the government to move in the new building, which was considered isolated from the outside world.
At that time, the Taipei City Department of Rapid Transit Systems had suspended part of its construction due to the contentions. The Council of Cultural Affairs listed Lo-Sheng as a temporary historic site to stop the argument over the designation of the site after the amended regulations of the Cultural Heritage Preservation Act was announced and enacted. However, protests continued and remained in pursuit of a legislation that would legally protect thehuman rightsof Lo-Sheng patients and preserve the site in its entirety.
After the Executive Yuan sent the draft of Regulations of Compensation for Hansen’s Disease Patients to the Legislative Yuan for examination and approved the plan of keeping 41.6% of the sanatorium as proposed by the New Taipei City Government, the Public Construction Commission made a decision on the preservation of the sanatorium after going through rounds of communications and discussions. The decision made on May 30, 2007 was to keep 39 of the 55 existing buildings, relocate or rebuilt ten of them, and tear down six.
Some organizations were not satisfied with the decision, and the dispute became more and more serious, especially when the Taipei City Department of Rapid Transit Systems completed the handover of land on Sept. 12 that same year,triggering a large-scale and violent protest for the first time in the sanatorium. By the end of that year, the draft of Regulations of Compensation for Hansen’s Disease Patients was suspended because of the unresolvable differences between parties.
With the government’s insistence on caring for leprosy patients while continuing key infrastructure projects, the Act of Human Rights Protection and Compensation for Hansen’s Disease Patients was finally enacted on July 18, 2008.
Apart from formally replacing the term “leprosy” with “Hansen’s disease” and conducting measures of educating the public on the medical condition, the Act offered compensation to the 294 patients living in Lo-Sheng as well as 948 others who lived in care centers outside the sanatorium. As of December 31, 2010, they have received a total compensation exceeding NT$730 million (NT$730,626,662). In Cabinet meeting 3131 on February 12, 2009, former Premier Liu Chao-shiuan also consoled the patients by issuing a public apology for the way they were treated in the past.
In addition, the sanatorium drafted a regulation on the protection of Hansen’s disease patients’ right to medical care, which was approved by the Department of Health on Sept. 12, 2008.The regulation has helped the sanatorium in continuing to provide proper medical care to its patients, including the establishmentof a functional health resort and medical center, as well as using the subsidies exceeding NT$10 million granted by the Department of Health on the renovation of existing buildings in Lo-Sheng.The objective of the bill was to ensure that every patient could receive dignified and humane care, as well as live the rest of his/her life in a peaceful environment with respect. Leprosy patients who lived in places other than Lo-Sheng would also receive care with patience and kindness under the scope of the promulgated legislation.
Regarding the rights toadequate medical treatment and care of Hansen’s disease patients, the bill follows the Regulations of Human Rights of Hansen’s Disease Patients passed by the Department of Health under the Executive Yuan, which had set up a unit composing of three government officials, four nongovernment experts, and four representatives selected by Hansen’s disease patients to provide advice and suggestions. The unit held thirteen meetings and successfully helped raise the monthly allowance given to each patient by NT$1,000, ensured payments of pensions, and established an elevated pedestrian bridge to connect the old and new branches. The unit also assisted nearly 100 former patients and their families in applying for compensation.
Nevertheless, the forced relocation of residents on the area designated for the Xinzhuang Depot was protested on December 3, 2008 by some civil groups and patients.. The safety of the remaining buildings on the site and potential damage wrought by the depot construction was another issue of concern, but the remaining residents professed their desire to continue living at their Lo-Sheng quarters.
The cultural preservation of Lo-Sheng Sanatorium, which received a lot of public attention, started to develop in different direction after it was named a potential World Heritage Site candidate in August 2009 by the Council of Cultural Affairs. It was listed as a cultural landscape and historic monument by the New Taipei City Government in the following month.
The Department of Health also sent delegates and teams to visit the Kalaupapa Leprosy Settlement and National Historical Park in Hawaii and several leprosaria in Japan while seekingmore funding and manpower to better study the historic and cultural value of Lo-Sheng’s 80-year history. The tentative plan at the moment is to open a human rights forest park and a museum at the old site to display the medical history of Hansen’s disease in Taiwan.
On the other hand, the quality of life and privacy will remain as a top priority for patients in the relocated Lo-Sheng Sanatorium. In the near future, the new site will be transformed into a long-term care facility that would also offer community medical services.