The laboratory, by Mr. Rainho
Mr. Jorge Rainho Costa has worked in the Laboratory of the former Hospital Colónia Rovisco Pais (HCRP) since 1968 and told how this service worked. He confided that: “I was the last one to leave, and whoever closed the door!” And so, since his retirement, in 2000, that closed laboratory perpetuated, in those who visited him, the feeling that time had just been suspended and that at any time that space could come to life and work again.
The year 2020 marked the end of that hope or hope by running the clock. The old hospital building that “fulfilled its mission” started a new care journey. The works, now underway, will transform the spaces where memories of a long time ago were just around another epidemic and the motto of its existence – Hansen’s disease.
Mr. Rainho, did not return to the hospital in time to see the laboratory one last time. The Covid 19 pandemic delayed the meeting. When he returned to the hospital, I saw him being renovated. Accessing our invitation, he came to share his memories. He found spaces and people that touched him and enriched the intangible heritage that will be intrinsic to them.
From the laboratory he reviewed the stuffing – a unique collection in the country consisting of equipment, files and samples that will give shape to one of the nuclei of the museum exhibition in the future. In the middle of this reunion, the analyst was recognizing and helping to identify pieces. There were many questions, and Mr. Rainho, in the midst of his enthusiasm, was unraveling essential memories to complete the puzzle of this story – his and his professional world.
He told us that he is the son of farmers and worked on his parents’ lands, but at some point he found, in the newspaper “Voz da Figueira”, a recruitment advertisement for cleanings at Figueira da Foz Hospital, and decided to change the direction of his life, competed. He didn’t like the job very much, so he tried to apply for the nursing course, given at the Hospitals of the University of Coimbra (HUC), but ended up taking the technical course in clinical analysis at HUC and went on to intern for six months at HCRP, where they even paid him as an eventual. He was close to home and as they liked their work he had “the hope of staying”.
But “the contest at the Tocha took a long time and that’s why I ran for the Curry Cabral Hospital in Lisbon. This hospital was specialized in infectious diseases and was where the first patients admitted to the HCRP came from. I was selected and although I tried to give up the place, I ended up being called and had to perform in Lisbon. There were few competitors for the places and the resuscitation service was going to open, which would have its own laboratory … ”When, almost two years later, he opened the contest at the Tocha, Mr. Rainho ran, with experience, and ended up stay. The head of the laboratory was Dr. Seabra Santos and later, Dr. Fausta Gaspar Nogueira succeeded him, who assumed the leadership of the laboratory until he retired.
Initially “we were four and I worked more with the microscope, but then we were reducing it until the laboratory stopped working. When Dr. Fausta retired, in the 90s, the service was not so much, as luckily the leprosy had reduced, the hospital and the pavilions were becoming empty, and so there was no justification to hire a new superior technician. The harvests continued to be made at the hospital, but the analyzes were carried out at the Faculty of Medicine in Coimbra and I accompanied them in transport. I only had a blood test or blood glucose if it was an emergency, ”said Mr. Rainho.
But when the Colónia Rovisco Pais Hospital was in full operation “it was the only leprosy hospital in the country and the second in Europe. It was the only laboratory that diagnosed leprosy. And, leprosy screening tests were performed every day. We received requests for analyzes from all over the country, samples from other hospitals and doctors, to confirm suspicions. If the result was positive, the patient would be followed by the HCRP ”. At the same time, “they collected samples from the laboratory that were collected during the brigades that traveled the country, by zones, once or twice a year”.
Mr. Rainho joined these brigades and confessed that he was the external service he most liked. “It was an intense day, the service was very tiring, we were out for several days, and we slept in pensions but I remember the atmosphere of camaraderie between colleagues and how I got to know the country from corner to corner. In this service, I felt that there was a mission and we were very satisfied when we identified a new case! ”
In the brigades “there was a script and we had the patients scheduled. We went through the hamlets, where there were more sick, many miserable. We went to visit the sick because they had no transport, some had no means, others lived in poor villages where we had to go on foot. My role was to help make the patient process with the history, analyzes and identification of the type of leprosy … In these brigades we accompanied the patient, who had to do analyzes once a year, as well as those who were communicating or family members and performed tests that determined their resistance to the disease – Lepromine”.
Trying to understand how everything was going on, Mr. Rainho explained to us how they did the collection for the analysis that would allow the diagnosis of leprosy to be confirmed, which consisted of the analysis of mucus and skin: “When collecting nasal mucus, the patient was asked to if he blew, and after the nasal cavities were cleaned, we would swab to the septum of the nose, gently rotating and subsequently making a 2 or 3mm smear in the center of a slide. Later, this slide followed the staining rights, being seen under a microscope.
When collecting the skin, we observed the patient in order to identify a spot, lepromas or lumps where the patient normally did not have the sensitivity to do a small biopsy there. We anesthetized a little, and with a proper instrument a little tissue was collected and then put in formalin. Before entering formaldehyde, a direct examination was performed. Then, for confirmation, a deeper biopsy was performed, in which the staining was the same. These slides were studied because if the initial result was negative, the staining would be repeated, to see if it spread some time later”.
Continuing the explanation, and regarding Hansen’s disease, Mr. Rainho mentioned that there were three types of leprosy – Lepromatous, tuberculoid, nervous. That “the lepromatous form was the most malignant and contagious, but that it was not hereditary”. Additionally, he stated that “when the lepromas were already visible, it meant that the person had the disease for a long time”.
About the Lepromina test, we learned from Mr. Rainho that it “was produced at HCRP. It was extracted from a tissue harvested from the lepromatous type, then boiled, crushed in a mortar, put in formaldehyde and then filtered and stored in bottles in the refrigerator”. The function of these tests was to determine bacillus resistance in uninfected people and to determine the type of leprosy when already infected. Thus, as he explained, “when the test was done to family members or communicators of the patients, and if there was a positive result, it meant that the person tested had some resistance / immunity to leprosy and therefore if he contracted, it would not be the most malignant form. When injected into the patient himself, it allowed to perceive the type of leprosy he had. For example, if after three weeks at the inoculation site there was no reactivity, keeping a small hard lump we were faced with a negative test and an indication that it was of the lepromatous type”.
Mr. Rainho says that in the initial period there were many cases of leprosy and that he verified the existence of some ignorance about the disease: “anything was leprosy and there were many cases in which they came and then we verified that it was not leprosy. Once a doctor came to accompany a lady from Madeira. He was very confident because he believed he had discovered a leprosy patient. But when he entered the harvest room, I told him: as an analyst I say that this is anything but leprosy, for me it is scabies! The doctor was offended that I doubted his diagnosis and said to me: Yes, I am the doctor and I know where I come from and what I am doing! He insisted on analyzing the leprosy. Then I went to put the case to my boss, on the 1st floor, and she went to see the patient and informed the doctor that they were going to do both tests. We took samples and in the analysis the mucus was negative and the fungi were positive. It was scabies, in fact!”
From everything we learned about the laboratory and the hospital, it is possible to perceive not only the very important role that the HCRP laboratory played in the diagnosis and investigation of the disease, but also in the process of granting discharge and leave to patients, since they depended on the results regularly performed analyzes. So we took the opportunity to find out more and Mr. Rainho recalled some of the rules in force for obtaining sick leave and discharge: “The patient was allowed to have a day’s leave when he had a negative mucus and skin test, or two negative to mucus and a little positive to the skin (weak). One-month licenses were only possible after twelve negative tests (mucus and skin)”.
In the case of discharge, he explained: “it was necessary to have several negative analyzes, to be clinically stable and to be able to do your life at home. Because if the patient was about to be discharged, Social Work went beforehand to see what the family environment was like, how the house was doing and only after that they could grant discharge ”. At the bottom of the HCRP there was dual assistance – medical and social, and as Mr. Rainho explained: “the social worker was very supportive of the patients who needed help. In addition to their health condition, they looked at their social conditions and were also given monetary support after discharge”.
In the initial phase, there was a lot of ignorance and the rules were tighter. But in the HCRP final, Mr. Rainho acknowledges that “the rules were not so strict anymore”. He worked to strengthen bonds of friendship that he was building with patients – “with a handshake, with the collection of blood without the use of gloves, as this meant that we were not afraid of leprosy and the patients were more comfortable and happy!”
Looking back, Mr. Rainho remembers everything with a twinkle in his eye and the certainties that distance from time, age and experience brought him, he also tells us: “if in the 1940s there were a significant number of patients and family members, there are currently almost no cases… Leprosy has been eliminated and the hospital has fulfilled its mission! Today there are other diseases and we know what the treatment is!”
(Texto baseado em testemunho oral, em 2020, validado pelo entrevistado. Entrevista e redação por Cristina Nogueira – CulturAge)