14 matches out of all 3,298, 1 to 14 displayed.
| 1908 | McKean Leprosy Hospital Dr James McKean founded the Chiangmai Leper Asylum in 1908. It was the first leprosy center in Thailand, at a time when leprosy sufferers were usually rejected from home and community. Many had wandered until they came to beg in Chiangmai town in order to live, and found shelter and some community together living under the bridge. They went regularly to the mission clinic where they received compassion, food and wound care. Although there was no effective treatment for the disease, Dr. McKean asked the local ruler for land downriver to set up a leprosy centre where those rejected by society were given somewhere to live, and die, with dignity and love. Hostels, small cottages in village groupings, a clinic, a water tower and a church were built. Orderliness and benevolence were keynotes of the centre and the example and teaching of the missionaries led many patients into a vital Christian life of faith. Patients started as recipients but gradually became participants in activities of the center. In keeping with the strict moral views of those days, the women were housed in a separate "village" at the northern end of the property, and the men were at the other end of the property in the men’s village. Both villages were in a community with provisions for basic necessities, plus spiritual and medical help. Hospital wards, a school and more cottages were built gradually over the next 20 years to house the stream of patients making their way to McKean from all parts of Thailand, and even from neighbouring countries. Responsible patients were put into teams (to take of maintenance and as guards and nurses) to help run the center. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1924 | McKean Leprosy HospitalLépreux et léproseries au Siam - Chieng-Mai'. From Progès Med., 28-6-1924 (26) 415. Source: Keffer, L, Índice Bibliográfico da Lepra:1.500-1.944, Vol II, I-P. Biblioteca do Departamento da Lepra do São Paulo, Brasil, 1946. [Leprosarium] [Siam] |
| 1927 | McKean Leprosy Hospital"Our Christian leper people in the Chiengmai Asylum - we are all Christians save one man - have heard - through the October number of Without The Camp of the burning of the Yenping leper village in Fukien, China. These dear people are much moved ... They have asked me, therefore, to pass on to you at once their Christmas offering for the Yenping people. I am enclosing herewith the equivalent of fifty-seven ticals, all but five of which were given out of the loving poverty of these leper Christians." Dr. J. W. McKean, Chiengmai, Siam. "The Samaritan among the lepers", The Leper Quarterly, 3 (1927): 23. [Leprosarium] [Siam] |
| 1929 | McKean Leprosy HospitalCom os leprosos de Sião.-Tradução de L N Keysel'. Bol. Soc. Ass. Laz. Def. c. Lep., 1929:1 (5) 9. Source: Keffer, L, Índice Bibliográfico da Lepra:1.500-1.944, Vol II, I-P. Biblioteca do Departamento da Lepra do São Paulo, Brasil, 1946. [Leprosarium] [Siam] |
| 1930 | McKean Leprosy Hospital During the depression years, with financial support from America, Dr McKean and his son, Hugh, who succeeded him as director, encouraged patients to resettle into communities or leprosy villages scattered throughout the north of Thailand. The Center could no longer afford to provide free food and care for the numbers that had sought refuge there, and some patients wanted to return to family life. Trusted patients, often trained in the McKean Bible school, were trained in medical care and were sent out to areas of north Thailand where there were known concentrations of leprosy patients to work in clinics on land bought by McKean. These workers provided treatment, shared their faith, and acted as a liaison with McKean, whose staff visited periodically, enabling transfer of patients to the hospital if necessary. Patients moved out to live around the clinics, which were also becoming churches. With new arrivals, McKean bought more land. Some 25 such villages were formed, ranging from 10 to 120 patients. Social intercourse with other villages occurred warily at first, but gradually increased aided by medical, agricultural and educational development support provided from the Centre. McKean workers helped as advocates, when necessary, in villages to access local services as they came into existence. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1941 | McKean Leprosy HospitalFleming, R B. 'Um raio de luz para os leprosos.-Tradução de H Cunha. Uma esperança para o leproso.- Tradução de A W.' Arq. Min. Lep., 1941:1 (3) 253; and Rev. Comb. Lepra, 1941:6 (Março) [March] 25. Source: Keffer, L, Índice Bibliográfico da Lepra:1.500-1.944, Vol II, I-P. Biblioteca do Departamento da Lepra do São Paulo, Brasil, 1946. [Leprosarium] [Siam] |
| 1950 | McKean Leprosy Hospital Segregated patient care had been the policy thus far, and was provided at the Centre, and in the resettlement villages. But with the advent of DDS, the possibility of treatment and cure from the disease became a reality, even though therapy was advocated as needing to be lifelong. Patients still at the Centre (now named McKean Leprosy Hospital since 1949) began to improve and some were able to go home. However, stigma and fear prevailed in the attitudes of many and the number of residents at the Hospital steadily increased, reaching a peak of just over 1000 by 1969. Some more resettlement villages were formed during these years, mainly brought on by a policy dispute amongst some of the leaders of the work.There was improvement in the quality of life for the patients, with spiritual nurture and useful employment being provided. Various vocational activities helped. Many patients became very skillful in handcrafts and agricultural projects. Other more disabled workers lived and worked at McKean in various types of sheltered workshops, producing woodcarvings, lacquerware, sewing and embroidery items, or involved in a McKean vocational training centre for furniture making and printing. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1967 | McKean Leprosy Hospital Starting in 1967, the first of a series of skin clinics was established throughout the north of Thailand, with the purpose of detecting early cases of leprosy, and providing a more convenient and non-stigmatizing place for patients to obtain treatment closer to their homes. In 1972, it became the official Thai Government policy to integrate leprosy into their public health stations and hospitals, and the government officially took over the leprosy control work. This meant that McKean’s outpost clinics were no longer so necessary in all areas. (However, two of these clinics are still functioning as leprosy patients are still being detected at them, and they are seeing so many other dermatological cases that they help to subsidize the income for the main Centre). Reconstructive surgery had commenced at the Hospital in 1967, and outpatient supervision of care became popular as many people were no longer being forced to a life of isolation and rejection. At these clinics, many surgical needs were also being encountered (especially thyroid goitres), and as the waiting list at the main government teaching hospital was so long, many patients consented to having surgery at McKean. The reputation for reconstructive surgery (burns contractures, congenital deformities, cleft lips and palates) also attracted clients, and a steady stream of non-leprosy surgery provided a challenge for the rehabilitation staff. This had real benefits for the leprosy program, as patients who had earlier felt much self-pity now realised that others were worse off than they were. This was even more evident when the first genuine rehabilitation spinal injury patients were admitted in 1987. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1969 | McKean Leprosy Hospital Active rehabilitation: Another name change occurred in 1969, the Center now being called the McKean Rehabilitation Institute for Leprosy Patients, and rehabilitation became the official policy, though not yet effectively practiced. Surveys of the resident population revealed that a large number of them were able-bodied, or could be dramatically helped by physiotherapy and surgery, and could lead a normal productive life back in the community. However, most were reluctant to leave the security of the McKean community, some because of stigma or rejection by their families, but some because they were enjoying the free care and benefits of institutional life. The announcement of a plan to charge one baht per day rent for those living in McKean cottages without medical or social reasons for remaining in the Hospital led many patients to rethink their future. Those who completed therapy or rejected medical advice regarding physiotherapy or surgery were considered to be ready for discharge. This policy led to two results: many patients began to leave: some to resettlement villages, but many went home to their own families, surprisingly well accepted, because they were now economically self-sufficient. It was evident that the alleged stigma was often due to the fact that formerly they had been regarded as an economic burden, an extra mouth to feed, and not helping with the family income because of their disabilities or reluctance to participate in society. The other result was that a small group of patients kept trying to find accepted reasons to stay - requests for more and more surgery, or further vocational training courses, even Bible training. Two more resettlement villages were formed to encourage more of these able-bodied people to live independently outside, and modern techniques of agriculture were taught - soil and water conservation, organic farming, etc. Teams from the Institute made regular visits, providing treatment, examining contacts, teaching ulcer care and prevention of disability and acting as advocates for patients with the local authorities. This mobile team also followed up defaulters and other patients living in the area, in addition, conducting school surveys and giving health education about leprosy in schools and temples. An intense anti-stigma campaign was conducted using TV and radio time, newspaper and magazine articles, poster displays at public festivals, car stickers and T-shirts with slogans, etc. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1978 | McKean Leprosy Hospital A significant contribution began in 1978 when the Institute employed a trained social worker with psychology and counselling skills to head up the Social Welfare Department. He took over the assessments of the patients, and began visiting or contacting their families to evaluate the reality of, and causes of, the stigma. Many more people were empowered to go home and were assisted in their re-entry into society. By 1980, the only long-term residents at the Institute were the "unrehabilitatable" - physically disabled, or so socially removed from their former life that return was impossible. Confusion was now occurring in McKean when new "short-term" rehab patients were admitted, and mingled with some of these longtimers. The newcomers were getting the wrong message that McKean was a place where they could stay forever in a happy pleasant atmosphere - the colony mentality was still alive and well. A separation of types of ministry was needed, relocating all of those needing residential care to the "women’s village", a kilometer away, renamed Buraphaniwet Village for the Elderly Disabled, and leaving only the rehabilitation candidates in the former "men’s section" near the hospital. Buraphaniwet Village has a capacity for 100 people with a waiting list of potential members (ex-residents becoming too old to cope with life in the resettlement villages. (In the future, it will eventually become a retirement village, especially for the disabled. By 2003, there are already 11 non leprosy people there because of cerebrovascular accidents or "strokes", for whom adequate care at home is not possible). Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1980 | McKean Leprosy Hospital The Annual case detection rate began to decline in 1977 - this was true for the whole country, and is probably the result of many factors. BCG vaccination given at birth, improved health, hygiene and sanitation, which boosted the immune status as it combatted hookworm and other parasite infestations, and raised the nutritional status of the ordinary person. The Government leprosy control programand their integrated policy undoubtedly was a major factor, with better case control and follow-up of patients, and a better understanding of therapeutic principles and the nature of leprosy reactions (ENL and Reversal reactions were formerly blamed on "drug allergies" and the medication was stopped or drastically reduced, resulting in very irregular therapy, low dosages, and basically DDS monotherapy). The decline in leprosy numbers, and the reduction in surgical needs as the backlog of patients suitable for surgery was dealt with, meant a reduction in leprosy workload, and the threat of insufficient work to challenge future physiotherapists and occupational therapists. With the advent of MDT in 1982, the case-load was further reduced. McKean medical leadership recognized the need for strategic planning for the future, and was asked by the Board to review options. They surveyed the needs and existing service provisions in north Thailand. Options for a change were considered (general hospital, combined TB/leprosy program, AIDS, specialist eye/ear hospital). Extended rehabilitation for the physically disabled was an untouched area where much more could be done with our expertise and staff skills. McKean could thus maintain expertise for future generations of leprosy patients, and at the same time treat physical problems like spinal cord injuries, cerebral problems (strokes, head injuries, encephalitis, etc), and polio, congenital deformities or limb injuries, where our experience with leprosy would be relevant to helping these other conditions. Dr John Bender, a rehabilitation expert from Ogden, Utah, visited and conducted a seminar on basic rehab methods, and gave advice on the type of facilities we needed to have to run a successful rehab center, and the name was again adjusted in 1988 to McKean Rehabilitation Center, omitting all reference to leprosy, but fully intending to integrate leprosy patients with other patients, as leprosy was still our "first love" and main reason for existence. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1992 | McKean Leprosy Hospital A new facility was built to replace the obsolete buildings that had evolved gradually over the previous 80 years. The rehab specialist advised us to get all the therapy workers under the same roof, and to develop the team concept, with weekly team meetings to discuss goals and progress of each patient. Team meetings commenced in 1987, and the new building (wards, PT, OT rooms, shoe and prosthetics department, etc) was commenced in 1992. The old dormitory style wards were unsuitable for modern Thailand, where new peripheral hospitals were newly built as more modern structures. Severe flooding in 1987, 1994 and 1995 made these old buildings a liability. The new wards have a maximum of 6 beds in each room, with some private rooms available for patients who need isolation, and the spacious therapy rooms are the envy of all who visit. It is a vast improvement on the former setup where all departments were scattered over a wide area in crowded and inadequate facilities. The improved hospital conditions have attracted more interest from potential staff members, and referrals are gradually increasing from other hospitals as they become aware of such a rehabilitation unit in Chiangmai. By 1999, the ratio of leprosy to nonleprosy admissions had almost reached 1:1. Our goals for rehab patients included mobility and independence, but self-propelled wheelchairs were not procurable locally. Imported ones from the West were too expensive and too big. A visiting UK engineer was asked to pioneer wheelchair production and a wheelchair factory was started making custom-made self-propelled wheelchairs. This was done in 1988 with almost immediate orders from all over the country for such chairs and other walking aids and equipment. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 1993 | McKean Leprosy Hospital In 1993, the Thai Government offered special funds for selected community health projects, and McKean’s project proposal of Community-Based Rehabilitation (CBR), was accepted by them. McKean’s long and cordial relations with district health offices in leprosy work was developed further with the CBR project for the physically disabled. Surveys have now been conducted in 4 different districts of Chiangmai province, and 640 disabled identified and assisted in various ways. Trainees from each district received instruction in CBR, and techniques to help patients become more mobile and more functional, and the patients, families and communities are actively involved in planning CBR activities, encouraging them to use local materials to modify houses, and provide aids for daily living. McKean acts as a resource center, and occasionally some of the CBR people are admitted for surgery or intensive therapy. In some of the former leprosy villages referred to earlier, the leprosy farmers have been regarded as "demonstration farmers", teaching techniques that leprosy patients have been carrying out for many years, thanks to the teaching of agricultural experts working from McKean, sharing their practices in soil and water conservation and organic farming. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |
| 2003 | McKean Leprosy Hospital The present situation : The challenges for a leprosy specialist center are diverse. Ironically, the original situation of unwanted leprosy patients gathering under the Chiangmai bridge by night, and begging by day has re-appeared. The present group are Burmese refugees, illegally in Thailand, in order to beg in affluent areas. This group has learned that treatment is available in McKean, and they are coming. Their illegal status means they avoid any official treatment with the integrated health services for registered Thai nationals. With the deployment of former experienced government leprosy control workers, the task of diagnosis and treatment falls on district hospital workers, who may have minimal leprosy understanding. McKean’s role has returned to one of training in cooperation with public health leadership. McKean is now part of the government "Health for all" programme - providing total care for the local district population as a general hospital, and referring on to the university hospital those for whom we cannot provide expert services needed. The local people are now coming to McKean for general outpatient and inpatient care, and emergency treatment. This has led to further integration, and has involved us in more public health activities - health promotion, vaccinations, and screening of the population for preventable diseases. Dr Trevor Smith (McKean Rehab Center, Chiangmai, Nth Thailand) [Leprosarium] [Siam] |