We set out to find the oceanfront leprosy hospital late one morning. Walking as far as the Quy Nhon beach would take us, we then turned up a narrow road into the hills.
The walk was steep and hot. We were flanked by palm trees and roadside cafes. Every so often, we’d find a pile of clamshells in the bushes.
At the top of the hill, laborers with heavy metal haircuts were using rods to break up the road. They stared at Michele, giving her shy smiles when she waved.
From the top, we could see the tips of pagodas tucked into the deep green forests blanketing the hills. A sign for the Quy Hoa National Dermatological Leprosy Hospital pointed downwards. We followed, relieved that the uphill walk was over.
There were a few empty cafes on the way down. Most kept roosters under wicker or metal baskets; I wondered if there was a cockfighting circuit. It was mid-day by now and nobody seemed to be around.
We reached the entrance to the hospital grounds. Next to the guard booth was a giant bust of G.A. Hansen, the Norwegian doctor who discovered the bacterium that causes leprosy. His giant bald dome shone against the light blue sky. We paid the small fee and entered the grounds.
I had read about the hospital in Lonely Planet. “Leprosy may not conjure up images of fun in the sun, but this really is a lovely spot…Treated patients live together with their families in small, well-kept houses. Depending on their abilities, the patients work in the rice fields, in fishing, and in repair oriented businesses or small craft shops – one supported by Handicap International produces prosthetic limbs.”
We were visiting because I was curious about the hospital as a social enterprise. On paper, it reminded me of Jaipur Foot, an Indian charity that produces custom-made prosthetics at no cost to the recipient.
I visited Jaipur Foot with Journeys for Change; most of the workshop staff there wore prosthetics themselves. One of the employees had even run a sprint alongside a Journey participant, beating her soundly.
Though Jaipur Foot generates a bit of revenue through selling its technical expertise, the charity is almost exclusively funded by donations. I wondered how Quy Hoa Hospital funded itself — the description in the book made it sound almost like a self-contained economy. The fact that it was on a beautiful beach made it all the more intriguing.
As we walked up the stairs to the clean, white hospital building, a doctor came out to the veranda and looked us over. “Information center?” I asked. He nodded and deposited us in a small office. There was a woman behind the desk. She spoke no English but motioned for us to wait.
After a few minutes, a young woman entered, greeted us, and asked why we had come to the hospital. I explained that we were interested in seeing the businesses run by the patients. She seemed confused. “You want souvenirs? There’s a shop on the beach,” she told us. “Why don’t you go there?”
I mentioned what the guidebook had said about the on-site prosthetic workshop. Could we visit that?
She asked to see the book. When I pointed out the passage, she said, “Oh, I understand. But you can’t see the workshop. It’s private. You’re just tourists.” I felt a surge of embarrassment at the fact that I was wearing a swimsuit (coupled with relief that I was wearing a shirt).
I countered by explaining that I’m a journalist who writes about social enterprise. It was the first time I’d ever described myself this way, but it felt natural. I wanted to see how the hospital used business to make the lives of the patients better.
“Ah! Ok, I understand. You’re a journalist,” she replied. She might be able to show us the workshop, but first she’d have to check with the director, who was on break. Could we come back in two hours?
Michele and I took the path behind the hospital and arrived in the Garden of Celebrities, which is filled with unsmiling busts of famous doctors and scientists. The statues of Europeans (I knew only Pavlov, Marie Curie, and the hero of Nha Trang, Alexander Yersin) were written in Vietnamese and French.
The path led us down to an empty boardwalk, where fallen pine needles had been swept into tidy patterns. Beyond the boardwalk was a deserted white-sand beach. We walked down to the water. It was stunning.
At either end of the beach, the waves crashed into rocky cliffs. We walked the length of it, past palm and pine trees and clutches of cactus. When we had reached the rocks, we turned inland, following a path leading to a large building that looked like a college library. It was empty; the only noise came from a group of laborers having lunch outside. We said hello and walked by.
Eventually, we wandered into a village. It was quiet and peaceful. We surveyed the houses – big, well maintained, many with gazebos that jutted out over small ponds – looking for a place to have lunch.
We walked a while before finding a patio stacked with boxes of snack food. There was no sign, so we hesitated before entering. A man was sitting at a small table; when he saw us, he ushered us through the gate. After seating us, he called to someone inside the house.
In the room attached to the patio, I could see a few prostrate bodies in front a TV showing an old Tom and Jerry cartoon. A friendly teenaged girl came out to meet us. In halting English, she asked if we’d like some instant noodles with egg. We nodded with enthusiasm and she went in to cook for us.
I grabbed a bag of Pockets, a snack food we hadn’t encountered before. They were good – Cap’n Crunch filled with coconut. As we ate them, a middle aged woman cycled up to the house. She seemed surprised and amused to find us on the patio. Grinning and speaking loudly in Vietnamese, she pulled down another bag of coconut snacks and handed it to us. Then she pressed a beer into my hands, which I declined.
The soup came out and the woman continued to talk to us. The girl who had greeted us laughed as she tried to translate. There was a family vibe between them and it made for a pleasant lunch. When we asked for the bill, the woman told us that it had come to 60,000 VND. The girl laughed and gave us the real price, which was closer to 40,000 VND.
Wandering around the village after lunch, we came across teenage boys shooting pool in an open-air billiards hall, people catching fish in a murky stream with their bare hands, rice paddies, and an industrial chicken coop.
Back at the hospital, we sat in the same office as before. Within minutes, the young woman had returned. The director had agreed to let us see the on-site workshop. We were thrilled.
The woman, Ho Thu Linh, led us across the grounds and explained that she worked for the hospital’s International Cooperation Department. I asked if she gave tours to many international charities; she said yes.
Linh’s English was good. She told us that there are 4,000 people with leprosy living in the Central Highlands of Vietnam, the majority of whom come from ethnic minority populations. The Quy Hoa hospital is the biggest of several in the region, each of which provides free treatment, room, and board to anyone with leprosy.
As we walked across the grounds, we learned that, though the stigma persists, leprosy is easily treated and cured. Ninety-five percent of the world’s population is naturally immune to it. After just two weeks of treatment, those who contract it are no longer contagious. The course of medication lasts between six and twelve months.
We arrived at the prosthetics workshop and entered into a sunny room filled with shoes and plaster casts of feet. Several men looked up from their workbenches and smiled. Some of the shoes were clearly meant for feet without toes.
In the next room was a batch of prosthetic legs. Through Linh, one of the workers told us that the workshop produced 2,000 shoes and 132 prosthetic limbs this year. It costs them 100,000 VND (US$5) to make a standard shoe, 200,000 VND (US$10) to make a custom shoe, and 940,000 VND (US$48) to make a custom prosthetic.
Because so many people with leprosy live in remote areas without access to medical care, the staff at Quy Hoa regularly travel to villages throughout the region. On these visits, hospital staff will conduct medical examinations and fit people for shoes and limbs.
The custom molds are then brought back to the workshop. When a shoe or prosthetic is ready, it is delivered to the recipient, who pays nothing.
I asked Linh how the hospital finances all of this work. The blurb in Lonely Planet had led me to believe that Quy Hoa at least partially funded itself through revenue generation.
Linh explained that the entire budget comes from donations. The government provides a subsidy, but the biggest donor is the Netherlands Leprosy Relief Foundation. The scope of Quy Hoa’s work is contingent upon donor funding – when the pot is big, they treat more patients. This year, though, they had to scale down outreach due to budget constraints.
Linh also told us that a Japanese foundation, Sasakawa Memorial Health Foundation, builds two houses every year in the nearby village. Apparently, the stigma associated with the disease is so strong that many patients choose to relocate their entire families to the area around the hospital – not just during treatment, but for the rest of their lives. In fact, this is how the village came into existence. Ever since the hospital was founded by a French priest in 1929, families effected by leprosy have been settling down here.
“Where is this village?” I asked Linh. When she gestured toward the area just beyond the workshop, it dawned on me that Michele and I had spent the afternoon wandering through “leprosy village” without even realizing it. The people who served us lunch, the fishermen, and the boys playing pool – they all lived there because of a direct connection to leprosy.
“The men who make artificial limbs in the workshop are children of leprosy people,” said Linh. “They come from the village, too.”
In that moment, I realized I had approached this site visit with misguided expectations. This wasn’t a social enterprise; it was a mini-society.
The people in the village live and work without fear of stigma – something they can’t do anywhere else in the country. After treatment, ex-patients and their families provide for themselves; they fish, farm, and run their own businesses. Even if the hospital isn’t generating its own income, the beneficiaries are.
Most social enterprises aim to empower a group of marginalized people. And this is what’s intriguing – here, the residents empower themselves. There’s no social enterprise strategy in place; the village is simply a space to live and raise a family. The residents can create their own livelihood opportunities if they want to. Nobody tells them what to do.
Could the village model be scaled or replicated? It’s hard to say. There are certainly conditions unique to Quy Hoa – access to farmland and fishing, undeveloped real estate, proximity to an up-and-coming tourism destination – that enable it to thrive. If you were to build another village, you’d need to find a site with similar assets.
But the point is not to squeeze Quy Hoa into the constricting language of social enterprise. The village is an externality. The hospital did not create it; the leprosy patients did. They are the ones who made it flourish.
For social entrepreneurs, here’s the lesson: your beneficiaries know what they need better than you do. Give them space and support and they’ll provide for themselves.
Qui Hoa National Leprosy Hospital
http://en.quyhoandh.org.vn/qhen/trang-chu | firstname.lastname@example.org