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EARLY HISTORY
At the beginning of the twentieth century missionaries working in a medical clinic in Chiang Mai were concerned for the plight of leprosy sufferers, rejected form their homes and villages by the fear and stigma that has surrounded this disease in many parts of the world over the centuries. In Chiang Mai town many of these needy folk were living under the bridge and coming to the clinic for help.
In 1907, Dr. James McKean, and American Presbyterian missionary, petitioned the benevolent ruler of Chiang Mai, Chao Inthwarorot Suriyawong, and was granted the use of Koh Klang, an island surrounded by river and canal, to found a leprosy colony. This land had formerly been the rulers elephant corral, and local people believed t was haunted by the spirit of a wild white elephant.
Small bamboo cottages were built, and the wooden ones, as Dr. McKean invited leprosy sufferers to come to live in the newly founded Chiang Mai Leper Asylum in 1908. Word spread and needy sufferers found their way to this rapidly growing settlement, some having walked form China or Laos or Burma.
Dr. James McKean
THE LEPROSY COLONY ERA
Over the next thirty years the area was developed into five attractive neat villages of individual wooden and stucco cottages. Hostels and clinics and wards were built, a water tower added the recreation hall erected, and the first bamboo church eventually replaced by the beautiful building with flying buttresses still used today.
The opening in 1922 of the Mary Stoner village for patients was graced by Chao Dara Rassami, daughter of former Chiang Mai ruler Chao Inthawitchayanon and consort to King Chulalongkorn, who was elevated to the title of Queen in 1908. In 1927 Thailands King Rama VII and his Queen visited McKean and paid for the making of Koh Klang access road to McKean. The McKean museum contains pictures of celebrations when different new buildings and villages were officially opened. Dr. McKean is said to have owned the first car in Chiang Mai, and it seems to have been a prized treasure as it is often featured in the pictures of formal event of the era.
Before World War Two here was no known cure for leprosy, but in McKean the patients were assured of compassionate care and adequate food, a place of acceptance in a growing and well-organized community, with oversight and regulations for community living based on the Christian principles of the founders. Many leprosy sufferers appreciated the practical evidence of Gods love that had changed their lives, and chose to become
Christian believers. A small Bible school built in McKean Gave many patients the opportunity to study more deeply about this faith.
Patients were assigned to a home and to teams to help in community life; cleaning, sweeping, caring for chickens, and planting vegetables and orchards. Some were formed into work teams and old photos show them forging knives and oxcart wheels. Others donned uniforms and joined the islands police force(pictures show them resplendent in uniforms with hats but no shoes!), while others were trained to act as nurses and therapy aides. A vocational center was opened to provide training and work in printing and in furniture making. Crafts workshops were developed and patients were trained in wood-carving, traditional lacquer-ware making, sewing and embroidery, silk spinning and weaving.
Child patients came to live in the hostels for boys and for girls. Receiving treatment of therapy from the hospital each afternoon, they were encouraged to commence or resume basic education each morning in Suepsangtham, the Sick Childrens School inside the center, by then known as McKean Leprosy Hospital. Many patients had children in need of support while the parent received treatment, so a school and dormitories for well children were commenced outside the entrance bridge to this model colony.
In the early years patients were treated with chaulmoogra oil, extracted from the hard fruit on the many trees still growing around McKean. After World War Two the new sulphone drugs were known to be effective against leprosy. For the first time there was hope of a cure for this disease. All patients were given this Dapsone treatment. McKean museum displays the chaulmoogra tree fruit, and the hollow bamboo which as beaten by a stick as the signal to patients twice a week to line up and receive their Dapsone tablets and a drink of water, and their pocket money. How ever stigma remained a big issue, and even the coins used by patients were specially marked, (see examples in McKean museum), for fear that non-patients might use the same money and be contaminated.
LEPROSY VILLAGE SETTLEMENTS
Many patients showed great improvement in health, and some were keen to return to faming life out in the community. Some were chosen and trained to be responsible for McKean medicine posts set up around the countryside on land purchased by the center, where sufferers could go for medication and assistance instead of making the long trek to McKean. Some chose to make simple homes near these clinics. McKean purchased more land for them to farm, and small leprosy communities of subsistence farmers began to form, and churches grew up round the clinics. During the Depression years the missionaries had found it hard to maintain the funding needed to care for so many in the center, and they had encouraged willing and healthy patients to move out to these emerging resettlement communities or leprosy villages.
A total of 22 resettlement villages were founded in the north of Thailand. Initially McKean appointed one member to be responsible for residents health and keep medicine supplies and to bring patients back to McKean if necessary. Settlers were concerned that their children should have educational opportune and wanted them to remain in Suepnatheetham School, the well childrens school with its three large dormitories. McKean set up schools for elementary school children in the village settlements, and sought sponsorship for children in the villages, and for high school students in the hostels and school near McKean. By the late 1960s there were over 2,000 children in this childrens education sponsorship program in leprosy settlements around the country.
INTEGRATION AND REHABILITATION
By 1970 it was being recognized by world health organizations that it would be wise to promote strategies to counter the stigmatizing of leprosy sufferers and the resultant practice of separating and isolating them. With treatment widely available the aim was to encourage the policies of integration and rehabilitation but could it be done? The McKean team actively set out to prove this is possible and in the process became a forerunner worldwide in comprehensive rehabilitation initiatives and integration practices.
The new name of McKean Rehabilitation Center was adopted. The medical team opened general integrated Out-Patient Clinic venues in five different areas of Chiang Mai province. Doctors would visit regularly to provide treatment for patients coming to these clinics, including leprosy patients, who were thereby encouraged to remain in their own homes rather than relocate to the center. McKean medical team redoubled their public education efforts, particularly emphasizing leprosy education to reduce the stigma and misunderstandings about leprosy in the general community, and to encourage people to recognize early signs of the disease and come for treatment and prevent disability. McKean mobile team visited schools everywhere, teaching about leprosy and examining school children and visiting adults referred to them by the school children and teachers.
Later, as the Thai government developed an effective leprosy control program country-wide, and began more active case-finding of leprosy patients in the community, McKean worked closely with them serving as the leprosy referral center in the North. McKean doctors served as clinicians for various leprosy research projects.
The idea of rehabilitating leprosy patients was at first regarded with suspicion by patients and communities alike. Old prejudices were hard to change; old hurts and fears were deep. By the early 1970s more than 5,000 patients had been treated in McKean and nearly 1,000 were still living there. Many presumed they would never be able to integrate into society again and some were fearful to even try. They needed comprehensive rehabilitation assistance in order to have the confidence to return to the names and community that had rejected them. Some needed cosmetic or reconstructive surgery, in order to reduce telltale signs, and to have better mobility and function. For others, vocational training or income generation assistance was a vital pre-requisite so they would not be a burden to families and could support themselves. Many needed much spiritual and psychological encouragement and the assurance they could still return to McKean for any treatment needed in the future.
McKean staff efforts to fight stigma were greatly enhanced when their Majesties the King and Queen of Thailand visited the center in 1978, and spent time with patients and staff. The King had earlier sent his personal physician to help those in need of eye surgery, and he specifically talked with many disabled patients who were beneficiaries, giving them the thrill of a lifetime!
The King donated fund to help renovate the hostel for the elderly, and Crown Prince Vajiralongkorn visited McKean for the opening of the renovated building.
Social worker and health educators visited the patient's families and communities and helped pave the way for their acceptance and successful return Ex-patients working significant roles in McKean were fully recognized as staff employees, alongside the increasing number of Thai qualified professionals now willing to join the team, an McKean offered loan to help former patients establish independent homes for their families to live outside the center.
McKean mobile teams regularly visited leprosy village settlements and patients in outlying communities to give health care support, and to encourage eco-friendly agricultural development. They included local farmers in training opportunities.
McKean coordinated extensive childrens education and family development project for decades, starting with children in leprosy villages and the locality of McKean itself. The Leprosy Mission sponsored teacher and school in villages where children had no other access to education until government school were built in these areas. TLM supported kindergartens in five villages, and provided scholarships for patients and family members to receive advanced education and vocational training. Many of these later joined McKeans professional staff. McKeans Christian Childrens Fund project supported childrens schooling in some other villages, and integrated leprosy families and other poor local families near McKean in all activities while enabling their children to have educational opportunities together. Thousands of children received education though these project.
Some patients had already been dislocated from home and family for several decades when rehabilitation policy was implemented. They were too old and disabled to be rehabilitated into the general community, and were accepted as permanent residents into the north village on McKean property. The most in firm elderly a disabled are cared for in two hostels, and other more mobile residents look after their own needs in the small cottages. All receive meals on wheels three times a day from the McKean kitchens.
The villagers elect their own committees to run their community activities and are involved with gardening or activity projects in their village including elderly aerobics!
McKean social welfare program providers monthly financial help to enable other elderly disabled patients to remain in their own village home but be able to buy the necessities of life. Where possible the McKean team has encouraged local churches to be involved in ensuring the well-being of the elderly in their village community.
THE ELDERLY DISABLED
McKean social welfare program provides monthly financial help to enable other elderly disabled patients to remain in their own village home but be able to buy the necessities of life. Where possible the McKean team has encouraged local churches to be involved in ensuring the well-being of the elderly in their village community.
THE CHANGING SECEN
By the early 1980s McKean Center was no longer a leprosy colony, having gradually succeeded in rehabilitating all the residents of the former colony back into community life or establishing them in their own village for the elderly disabled.
Concerns had arisen in the 1970s that Dapsone resistance was a widespread problem, dashing hopes that this one drug alone could successfully be used to cure leprosy. By
1981 Multi-Drug Therapy was recommended for the treatment of leprosy and this is still in vogue today, with confidence that leprosy can now be cured. It is clear that, in Thailand, the numbers of new leprosy cases have been steadily decreasing and we are seeing success in tackling the leprosy problem in this country. There is a vital need to maintain competent leprosy services for the new cases still being diagnosed in Thailand. Patients experiencing complications and nerve damage continue to need the expert services of a referral center, and this is one of McKeans significant roles. McKeans Chiang Mai Christian Clinic in the town established a self-care clinic unit so that domiciliary patients would receive appropriate encouragement to look after wounds and prevent further disability.
EXTENDED GENERAL REHABILITATION
By the mid 1980s McKean leadership felt the calling to move towards developing this center into an extended rehabilitation center, integrating leprosy patients and disabled people in all its programs. Many disabled people were in need of the same comprehensive rehabilitation service that we were providing for leprosy patients. Some were already seeking McKean help. McKean had a strong professional team including doctor and therapists sent by the Leprosy Mission International, and staffs were becoming more involved in the cause of the disabled. But would it be possible for the old leprosy segregation ideas be overcome, and would other patients be willing to receive treatment here alongside leprosy patients?
McKean worked to change its public image and develop its capacity to serve other disabled people well. A new hospital building specifically designed as a rehabilitation center for disabled people was opened in 1993. Ramps were added to give wheelchair access to McKean public buildings and staffs were trained in disability issues.
Finding lack of suitable products on the Thai, McKean developed a wheelchair workshop, producing self-propelled wheelchairs, push-pull tricycles and other aids to mobility, custom-made for Thai patients and conditions. A group of stucco houses along the river was renovated and designated as a village community were disabled patients could learn a variety of vocational activities, seeking some that might be developed into their particular means of self-support at home in order to help their families to have sustainable livelihoods. Many have learned to manage their life situation more independently, t set goals and make project and business plans, work co-operatively, gain skill in natural farming, producing micro-organisms needed for making compost, growing mushrooms, for gardening and care of fish and chickens and ducks. They gained skills in banking, potting plants, making sweets form dried fruits, or making popular traditional food items.
McKean opened its gates and invited new groups to share its lovely setting. Large fish ponds were dug and developed and public Fishing Park Days were held. School groups were invited for educational tours and some began including McKean visits in their schools community service programs. Disabled groups were invited for fun day activities in McKean. Leprosy patients were able to be integrated more into these groups activities also.
COMMUNITY-BASED REHABILITATION
The experiences of McKeans teams, gained over many years of rehabilitation work in village communities with leprosy patients, were applied as McKean commenced community-based rehabilitation projects for physically disabled people in various districts. The team liaised closely with local health workers to discover and survey needs of disabled folk often hidden away in their home communities. The projects encourage families and communities to better understand the problems and the potential of disabled people in their midst, establish rehabilitation goals, and become actively involved in encouraging the disabled folk to achieve their maximum potential physically, socially and economically.
McKeans variously skilled team members are able to use their expertise to help encourage patients and their families to have sustainable livelihoods through eco-friendly agricultural development and income generation projects, craft making skills, or accessing educational or vocational training opportunities, It has been wonderful to see the positive changes coming into the lives of many physically disabled people and their families, and greater integration of the disabled in their communities.
As a part of McKeans longstanding encouragement for patients to have adequate means of living, the McKean agricultural team has been an integral part of the development of sustainable agriculture and organic farming networks in Thailand, and these activities have helped the integration of leprosy farmers in development projects.
THE PRESENT ERA
By the beginning of the 21st century Thailand was one of the leading countries in the world in tackling the leprosy problem and in integrating leprosy services into the general public health system, and McKean is one of the first examples of an integrated general rehabilitation center. Other countries were beginning to follow in the same direction, and McKean has had the privilege of helping train and share ideas with workers from many countries.
More than 500 new cases of leprosy were still diagnosed in Thailand in 2007, and there were about 300,000 new cases worldwide. Leprosy is still a problem that needs to be tackled consistently and it is vital to maintain center with specialized leprosy knowledge. There are still many thousands of former patients who are disabled and can still be disadvantaged and in danger of increasing disability.
In Thailand the challenge remains to maintain adequate expertise to diagnose and treat leprosy, and to deal with leprosy complications promptly and effectively to avoid lifelong disability for patients wherever possible. So McKean maintains an important role as leprosy referral center in north Thailand, and a center for expertise in leprosy. Many of the untreated leprosy patients are in marginalized communities without access to health services. McKean as a community-based project seeking to reach needy folk like these with leprosy treatment, prevention of disability support, and assistance for necessary surgery for marginalized disabled folk. There is still some public misunderstanding, and pocket of stigma continue to distress those diagnosed with leprosy. The elderly disabled patients, dislocated form homes in the former eras, still rely on McKean personnel to be their family. Leprosy patients and physically disabled people are still amongst the most needy and impoverished people in society and the social welfare work of McKean is vital in enabling these folk to access the help they need for healing and empowering to live productively. But the McKean focus is an integrated one, and form 2001-2008 McKean served as a local general hospital, deeply involved in the health promotion and disease prevention initiatives as well as treatment of general health problems for patients in the local area.
McKean rehabilitation Center is a service unit of the national Protestant Church, The Church of Christ in Thailand, which appoints the Board and the Director. The center raises approximately 70% of its own annual budget. The remaining financial support is received from generous supportive groups and individual donors. This support is vital for maintaining the on-going charity work that will continue to bring the hope of new life to needy leprosy patients and disabled people in northern Thailand today and tomorrow.
INTO THE FUTURE
The McKean story continues today and tomorrow to be one of meeting the needs of disadvantaged people in society. Even after a century of service McKean seeks to pioneer new dreams and visions in Thailand amongst the neediest groups.
Age-care has become an immediate concern in the local community, with its decreasing proportion of middle and younger generation, and the change from the settled extended family compound way of life. People are living longer, but needing support due to infirmity, strokes and debilitating conditions. McKean ministry is further expanding provision of quality age-care, to provide appropriate multi-tiered facilities for elderly persons shoes families are unable to give them the daily care they need at home. McKean opened nursing-home facilities within the hospital, and completed plans for the building of a new complex, comparable with facilities in western retirement centers. Dok Kaew Center includes wing of units for semi independent elderly, attached by a covered way to a central community area for dining and activities. There is also a secure wing for the elderly suffering form dementia. In the future McKean envisages the north village developing modernized independent living units. McKean is also seeking to encourage age-care activities in the community. How fortunate that the land granted to Dr. McKean is such an extensive and green environment, suited to the development of aged-care communities in the future.
McKean is also recognizing that a wider community needs the expertise developed here in vocational activity training to promote sustainable livelihoods. Around the country many former leprosy patients remain impoverished and without ideas and ability to develop self-support. McKean has also had long term involvement in development work and encouraging eco-friendly agriculture and sustainable livelihoods.
In 2007 McKean formally commenced offering more training courses and seminars for workers and for patients from other areas in vocational activities and natural farming. Leprosy patients and disabled person in McKean form part of the training team along with McKean staff in the mixed farming area behind Dream Weaver Village. Vegetables, fruit, flowers, fish, chickens, ducks, pigs, (please note no nasty smell!!) and natural compost pits can all be found here. McKean is also offering some international workshops to share its wide experience, and help encourage leprosy workers and patients in other countries in increased involvement in comprehensive rehabilitation and sustainable livelihood empowerment also. The project is producing healthy organic foods for sale and developing the Cream Weaver Village range of products including shampoo and detergents.
Providing seniors with a secure and caring community founded on Christian love and commitment.
DOK KAEW GARDENS
Senior Care Program
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