On a flat green peninsula beneath a towering range of sea cliffs in the middle of the Pacific Ocean, there is a hidden community of people who are isolated many times over.
The first layer of their separation is the geographic divide of living on an archipelago with more than 2,000 miles of salt water extending in all directions. Then there is the fact of living on Molokai, a sleepy island of red clay and black lava rock and tart flowers, where there are no traffic lights and there is no movie theater. And then, zooming in once more, there is the isolation of Kalaupapa, a peninsula on the north shore of the island, thousands of feet below the rest of Molokai, that stretches out toward the Pacific.
Kalaupapa was established in 1865 as a settlement for the exile of people who had Hansen's disease, then called leprosy. More than 8,000 people died at the colony, which served as a quarantine prison until 1969. (One of the best known stories in modern Hawaii history is that of "Koolau the leper," a man who allegedly killed the policeman and three soldiers who tried to force him to leave his family and relocate to Kalaupapa.) Survivors who remain at Kalaupapa today—some forced to move there as recently as the 1940s—do so by choice.
"I had a sense that quarantine was a practice that was going away," said Geoff Manaugh, a writer who has focused on the spatial and socio-architectural aspects of quarantine. "But as diseases become more resistant and people travel much further much faster, quarantine is becoming much more in vogue. It's not a last gasp at all, this fairly archaic approach to disease management."
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The practice of isolating sick people stretches back to the days of the Old Testament. By the 14th century, during the outbreak of the plague in Europe, governments began establishing formal quarantine protocols, according to a short history of the quarantine by PBS. During the smallpox epidemic of the 1730s, New York City residents were banished to Bedloe's Island, where the Statue of Liberty would be erected a century and a half later. When astronauts first returned from the moon in 1969, they spent three weeks quarantined in a trailer, awaiting lab results as scientists tested their blood for moon germs. (No lunar diseases were found, though it's still kind of a bummer we didn't find life up there.)
Today, as West African nations combat the worst Ebola virus outbreak in decades, modern quarantine practices are in full effect. There are specially designed suits, masks, ventilation systems, ambulance docking stations, and jets.
Sickness-related isolation may carry the same stigmas and raise the same questions about civil liberties as it always did, and yet quarantine locations—the isolation spaces themselves—are far more integrated with the rest of society than they once were. Quarantining someone today still means cutting them off from society, but it no longer requires sending them to an actual island.
During the early Kalaupapa era, given the technological limitations of the time and the nascence of germ theory, any hope of an effective quarantine required physical distance. (Robert Louis Stevenson called Kalaupapa a "prison fortified by nature.") That explains why government officials banished sick people to islands. It was across the East River from Manhattan, on North Brother Island, that "Typhoid Mary" Mallon was forced to live for 24 years. Mallon was the notorious cook blamed for infecting dozens of people—three of whom died—with typhoid in the early 20th century.
The United States now has 20 quarantine stations—in major cities like Boston, Philadelphia, New York, Chicago, Atlanta, and Los Angeles—where the Centers for Disease Control and Prevention has federal authority to detain anyone they believe may have an infectious disease. (The agency makes a distinction between "isolation," which it defines as the separation of ill people to stop the spread of disease, and "quarantine, "which involves restricting the movements of well people to see if they become sick.)