Irene. Involution and conversion of the Hospital

Irene Louro graduated from the School of Nursing of the Franciscan Missionaries of Our Lady in Porto. Before working at Hospital Rovisco Pais, he had worked at Hospital de Aveiro, Hospital de Cantanhede and at School of Nursing of Guarda. For personal reasons, she opted for the hospital career and went as head nurse for the Tocha on 10/17/93. She retired on 12/31/2014.


When it was placed there, Nurse Irene recalls that the institution was “in a transition phase, there was talk of several hypotheses for the conversion of the institution, and sometime later the Hospital became the Center for Rehabilitation Medicine in the Centro Region – Rovisco Pais.”


At the time, there would be about three dozen Hansen users or ex-patients without active disease. As time went by, some passed away and when Nurse Irene retired, there were only 12 users. “It was a Hospital without movement, that is, there were no patients coming in”. Of the users she met there, Nurse Irene recalls that “there were some independents, but there were dependent patients and, some many dependents. They were followed by Dr. Maria de Lurdes, a dermatologist and Dr. Pagaimo, a doctor of internal medicine. For other specialty consultations, they were taken to the University of Coimbra Hospitals. And dependent users had medical and nursing assistance 24 hours a day”.


Nurse Irene recalls that “some of these patients still occasionally showed positive results in the tests for Hansen’s disease screening, but they were not in the contagion phase. In general, the users left there were noticeable the marks left by the disease: either by the facies – with the shape of the mouth, nose, eyebrows characteristic of these patients, or at the level of the limbs with wounds and perforators, amputations due to injury or absence of the extremities of the hands or feet as a result of bone degeneration resulting from the disease process”. Another striking aspect that she noticed early on was that “(…) there was still segregation, not on the part of the health professionals and the people who worked there but on the part of the users themselves. They still felt the stigma of the disease. They had that instilled in them and so they avoided contact, for example a simple kiss… ”.

The ex-patients who remained in the institution did not return to their families for several reasons: due to their own choice, the lack of a family background, essentially due to the disintegration and severance of connections, others because they were social cases. While they were in the hospital, “they enjoyed all the health care inherent in a normal hospital stay” says Nurse Irene. All this assistance was free, so they managed their assets and pensions without this charge. Most of them “were not visited by families and remained until the last days. We were their family! The permanent and very in-person contact over the years ended up fostering friendship and creating affective bonds, so they saw us as their family! ”


From the history of that hospital, Nurse Irene recalls that she was “very surprised by the organization that the hospital had” and that she became aware of, either because of the stories she was told, or because of the evidence still visible in the heritage that survived the institutional vicissitudes and time. In this sense, Nurse Irene, shares some knowledge about the history of the institution she was obtaining and that motivated even, together with Nurse Mário Bexiga, to gather various materials and equipment from the old hospital in the building known as locutório, next to the concierge, with a view to creating a museum.


The old Hospital, as Nurse Irene says, “was a small self-sufficient village and had its own radio, open-air cinema, post office, dairy and pigsty … even a prison. (…) The chapel, with a unique type of construction, worked as follows: the priest stood on the altar, in the center of the chapel, and saw everyone, the staff were in front of the priest, then in a wing were the men and on the other, on the other side, women. But regardless of gender separation, boys were born… Aseptic births took place and immediately after birth they went to the Preventory… Parents later visited us through the windows, but did not touch them, in the so-called Locutório. (…) When the girls grew up, they took up residence in the Asylum (where they are now continuing care). There lived with them an ex-patient, who was a cultured lady and taught them to be and to be, to embroider, etc. As men could not “touch” the girls, they called that place Tarrafal “.

The former hospital’s self-sufficiency also covered sectors such as the pharmacy or even the laboratory. Nurse Irene recalls the explanation that Mr. Ângelo, who was a pharmacy technician, gave him about the various machines for making pills and ointments. “The Pharmacy made medication and bandages like Edoli’s, manipulated, ointments, compound balm, vitamin A, DDS pills…”


Regarding the history of that hospital, Nurse Irene also mentioned: “those who know the works of Professor Bissaya Barreto know that they wanted the best for the sick… At Hospital Rovisco Pais they had dishes from Vista Alegre and French pyrex. And in terms of equipment too. The patients, as they suffered from bone problems, received treatments in a room on the ground floor of the hospital where there was equipment for physiotherapy – paraffin and mud tubes and Hubbart tank, parallel bars, among others. There was a former head nurse who had specialized in rehabilitation nursing and was doing these treatments but when he retired he stopped doing it. When the Rehabilitation Center started, the Hubbart tank was later taken to the General Rehabilitation building for hydrotherapy, and later, when the outpatient service was created, it went to the new pavilion, where the pool is located today”.


By specifying the symptoms and manifestations of Hansen’s disease and existing structures in the old hospital, their own techniques were still evident, which have been developed over time.


There were rooted routines that were difficult to change by professionals who had been at the hospital for a long time. Nurse Irene recalls that “when I got there I had a dynamic and different perspective that allowed for the implementation of new rules and modes of organization, right from the dressing room and in therapy. Thus, together with Nurse Mário Bexiga, it was possible to innovate and break some routines. And then, we started training… ”


Nurse Irene followed the process of converting the Hospital into a Rehabilitation Center and about this phase and the beginning of her new activity recalled: “I was in the project. It was a very complicated phase. Not in relation to users, as they have always been safeguarded. They feared, they were afraid, but they were always protected! ”


The Center for Rehabilitation Medicine in the Centro-Rovisco Pais Region was created by Decree-Law No. 203/96, of 23 October, as an entity within the National Health Service. In that decree it was stated that the continuity of care for all patients who were hospitalized.

Nurse Irene considers that “the main driver of this decree and of the effective conversion of the hospital into a Rehabilitation Center was Dr. Santana Maia, an influential physician who served as a president of the Order of Physicians and knew the work of Bissaya Barreto”. She explains that almost five years had passed between the publication of the creation decree and the beginning of the conversion works. As “the construction works never advanced, the Board of Directors, of which Dr. Santana Maia, Dr. Arenga and Enf.º Bexiga were part, managed to make funds available for the works and also obtained the return by part of the Social Services of the Ministry of Health of one of the pavilions that was in the best conditions to install the General Rehabilitation Service still in place ”. There were several vicissitudes in this process, even so that the pavilion could be vacated in time. Nurse Irene shares that “we all had to get together on a Thursday because the work started on Monday”. It also recalls the challenges they faced, namely in the need to create back-up services, but above all, how important it was to hire two female physiatrists – Dr.ª Margarida and Dr.ª Arminda to start the Rehabilitation Service. 


The first patients were received in 2002 and Nurse Irene recalls that “the first patient was taken over by Dr. Margarida Sizenando. It was a big responsibility. But the option followed by the Board of Directors to achieve this result was strategic and vital for the process to move forward. The fact that it started in that pavilion made the Rehabilitation Center an irreversible process, and originated the Center today.


(Text based on oral testimony, in 2020, validated by the interviewee. Interview and writing by Cristina Nogueira – CulturAge)