Hansen's disease very different from Scriptures' 'divine punishment' .
By JUDY SIEGEL-ITZKOVICHwexler 248.88(photo credit: Courtesy)
One could have lived in Jerusalem for decades and never set foot in the mysterious yet majestic 122-year-old building opposite the Jerusalem Theater, two staircases down from 9 Rehov Marcus. Most of those who have heard of it call it the "Lepers' Hospital," but the name preferred by those who have worked there is Hansen Government Hospital.
With arched windows on the ground floor surrounding a large rectangular courtyard, a second-floor balcony and more rooms on the third floor, the hospital also has expansive if rather neglected gardens that are being restored by volunteers. Solid walls and gates add to the drama, as if it were still incarcerating lepers with disfigured faces and limbs.
Over the many decades since 1887, it has housed and treated around 600 victims of Hansen's disease, named for Norwegian researcher Dr. Gerhard Henrik Armeur Hansen after he discovered in 1883 that leprosy is caused by a bacterium called Mycobacterium leprae. This pathogen is closely related to the rod-shaped bacillus that causes tuberculosis but is much less infectious. In fact, Hansen attempted to infect himself with it but failed.
But the hospital premises were vacated nine years ago, with some of its rooms used for the Israel Hansen Disease Center and others for diagnosis and outpatient treatment of children with psychological problems. Now, Mayor Nir Barkat has announced that Prime Minister Binyamin Netanyahu has acceded to his request that the government make the "protected" edifice a gift to Jerusalem to mark the capital's 42nd anniversary of reunification. Barkat says it will be turned into a lively music and arts center for the whole country, and donors will be sought to finance renovations. The task of treating inpatients with the disease has been shifted to the Hadassah Medical Organization, which has opened a Hansen's clinic in its Rehov Straus building.
A few weeks ago, a special historical exhibition opened at the hospital showing rooms as they used to be in the late 19th and early 20th centuries, and allowing former employees, curious neighbors and other guests to see it. Between 700 and 1,000 people attended. It is due to remain on display even when the building becomes a cultural center.
THE LEPROSY (tzara'at in Hebrew) mentioned 55 times in the Bible that has terrified humanity since ancient times gave Hansen's disease a bad rap. Dermatologists say the condition that struck Miriam for speaking against her brother Moses (for marrying a Cushite woman), Naaman (in Kings II) and King Uziah (in Chronicles II) was a disease that turned their skin (and even hair) white; this symptom is connected to vitiligo - an autoimmune condition in which skin pigments are destroyed. In the Bible, this illness was regarded as divine punishment for "evil talk" and other sins. It is also described as afflicting the walls of buildings, leather garments and other clothing.
But the great Jewish sage and physician Maimonides presciently wrote during the Middle Ages that there was no connection between the biblical disease and what later became known as Hansen's. The word "leper" is a metaphor, a symbol of stigma. For many centuries, "leprosy" was considered a curse of God, often associated with sin. It did not kill, but neither did it seem to end. Instead, it lingered for years, causing the tissues to degenerate and deforming the body. Most people don't believe it still exists. Leprosy is unfortunately the name still used in India for the bacterial disease, and the disease is still a major health problem in many parts of Africa, Asia, and Latin America.
But Hansen's does not turn the skin white. To blame for the confusion - which condemned endless victims of Hansen's to abandonment by their families and confinement in institutions so as not to "spread" it, was the Third Century BCE Greek Septuagint mistranslation of the Hebrew text. For the word tzara'at, the translators erroneously used the word leprosum, the adjectival form of the Greek word lepra, according to Ruth Wexler, a religious nurse who has been working with Hansen's patients at the Rehov Marcus hospital since 1988.
Wexler, whose parents came on aliya from England in 1952, graduated from Shaare Zedek Medical Center's nursing school in 1970 (she has a daughter currently studying nursing at Hadassah). Married to the editor of the Cathedra Land of Israel historical journal and a mother of six, she lives in the Katamon quarter near Hansen Government Hospital. "A nurse at Shaare Zedek and the old Misgav Ladach maternity hospital suggested I work in Misgav Ladach's neonatology department. When it moved to its current building, I was chief nurse, but I left after three years due to family obligations," she recalls in an interview.
"The Health Ministry suggested that I go to Hansen Hospital. I had no knowledge about it, and my fellow nurses thought it was a bad idea . Even though they were medical professionals, they had the wrong idea about the disease and believed there was no way to help patients." Nevertheless, she made one visit that aroused her interest. At the Jerusalem hospital when she first visited it, there were between 20 and 25 patients, most of them Jews. All were immigrants from the 1950s, most of them Sephardim and a few Ashkenazim.
THE TALBIEH quarter hospital was not the first in Jerusalem. One was opened by the Turkish sultan in the Silwan area, but housed only patients who did not receive treatment. The leprosy hospital was opened in the Mamilla quarter outside the Old City walls, but it proved too small, so it moved to the one near the road that became Rehov Marcus and was the first of its kind in the Middle East.
Donations for the building came from the German baroness Augusta, who was shocked by the conditions of lepers in the holy city. The first medical team was comprised of German Protestants, The Herrenhut Brotherhood, then the British branch took over and English churchmen became involved. Most of the patients then were Muslims and Christian Arabs, with only a few Jews. In 1948, the new government took over the building, and the facility became the responsibility of the Health Ministry. The chief of dermatology at the then-Hadassah Hospital was in control, and there was a "house doctor" who headed a staff that included nurses and maintenance and administrative workers. "Most of the Arabs fled Israel, and the new wave of patients were largely Jews who arrived in the waves of immigration," Wexler continued. When the Health Ministry decided to stop hospitalization in 2000, the remaining patients were discharged to geriatric institutions.
TODAY, WEXLER continues, Hansen's disease still exists, mostly in India, Brazil, Central Africa, Nepal and some in every country, even in Europe and the US. People move from place to place, but as transference of the disease requires significant exposure to the bacteria, it takes a long time for the disease to develop and symptoms to appear." Infection results by droplets from the upper respiratory tract, such as nasal secretions that are transmitted from person to person.
But the Hansen's disease nurse notes that "it's very hard to get infected, despite the myths. About 95 percent of the people who are exposed to the bacterium remain healthy, as their immune system attacks and destroys it. Some of those who do get infected may have something genetic that prevents them from making antibodies to attack it," she explains. "But the TB bacillus, which is similar to Mycobacterium leprae, is deadly. Hansen's disease disfigures and can have serious neurological effects if not treated in time with a drug 'cocktail' of antibiotics." However, the first mono-antibiotic treatment was given in 1941.
"I have taken care of people of all ages. Many look like healthy people, as they were treated in time. But some of those who contracted Hansen's decades ago and did not receive the necessary antibiotics are disfigured. Others have disfigured hands and feet or even paralysis due to effects on the peripheral nerves," Wexler continues.
She says that nervous system complications of poorly treated diabetes such as neuropathy are similar to those in untreated Hansen's disease; when their sense of feeling is numbed, patients can't feel heat, cold, pressure or pain, and their limbs are damaged. In fact, diabetologists learned from Hansen's patients about how to treat diabetes complication of the feet.
"They don't know to take their arm or foot away. They can unintentionally hurt their extremities. They can get infections of the wounds, which untreated might penetrate to the bones. This damage is not inherent to the disease and can be prevented. We nurses teach them to use their eyes to check hands and feet, keep them clean, use skin creams and perform exercises to stop contractions." Patients with complications may suffer paralysis of the eyelids; they can have no feeling in the corneas and fail to remove dust or dirt without scratching and traumatizing the corneas.
Wexler recalls during her early days at the hospital a 60-year-old man who had been been an inpatient since he was nine. "He had some relatives, but they didn't want to be in touch with him. Yet such a case was quite unusual. When I arrived, there were people who had nowhere to go; they were there more for social than medical reasons. Usually there were two patients to a room. After the first dose of antibiotics, a patient is not infectious, as the drugs wipe out the bacteria. How fast depends on at what stage they were diagnosed. If they were treated early, some nerve function can even be restored, as patients usually went for care when it was too late."
Dr. Leon Gilad, a senior dermatologist and chief of wound care at the Hadassah University Medical Center in Jerusalem's Ein Kerem, is today in charge of some 200 Hansen's patients at the Rehov Straus outpatient clinic, where Wexler works and sometimes conducts research with colleagues. For example, she and an occupational therapist discovered that there is less feeling on the top of the hand than in the palm in patients with complications. There are some five to 10 new patients every year, among them foreign workers and immigrants.
She continues to visit the old hospital and the permanent exhibition. "We want to put out a book - and not just in Hebrew but in English too so the word will get out." She discloses that there are several Hansen's disease museums around the globe, the best known being in Carville, Louisiana. "There is also a Global History Project centered at Oxford University and a Web site devoted to the disease. Many Hansen's disease hospitals are being closed because people are treated and cured or followed up if they suffer chronic problems. We intend to put up a Web site about Jerusalem's hospital."
The nurse is pleased that the hospital building will not be turned into real estate reserved for the wealthy. "It should be enjoyed by everybody, and an arts and music center is a wonderful idea. When parts of the building were renovated for the exhibition, the flooring was ripped out to expose the wonderful old stone tiles underneath. The site would be perfect for studios, galleries, a performance hall and a restaurant." Quite a change for a once-lonely building that rarely saw guests.
The hospital exhibition is open on Wednesdays from 11 a.m. to 1 p.m. and 4 p.m to 6 p.m It will be open also on Friday, June 19, July 24, August 7, August 21 from 9 to 11 a.m. Admission is free, but tax-free donations will be welcome to Friends of Eitanim for Hansen's Hospital. For more information, e-mail ruth.wexler@gmail.com. If volunteers become available, the exhibition will also be open at least two afternoons per week.
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