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Eve Rifkah, Outcasts: The Penikese Island Leper Hospital, Little Pear Press, 2010. Reviewed by Harvey Fenigsohn (September 2011).

Location: Humanities in Medicine Collection
Call Number: PS 3568 I4645 O87 2010

Eve Rifkah's remarkable collection of poems, Outcasts, was inspired by the patients of the Penikese Island Leper Hospital, founded in 1905 and closed in 1921. During that period, the Commonwealth of Massachusetts cast out of society thirty-six men and women suffering from Hansen's disease, more commonly known as leprosy. The patients lived and died on a small, lonely island in Buzzards Bay, forever bereft of friends and loved ones.

Through the power of her imagination, Rifkah resurrects these long forgotten souls, granting them a voice—the voice of a poet. For almost all of her ninety-nine poems speak to us from the viewpoint of the patients—living as pariahs—reviled and feared. A microcosm of humanity, the patients represents all those who suffer the pain of rejection and exile. In dedicating her book, "to outcasts everywhere," Rifkah suggests that the plight of the Penikese outcasts sounded a universal resonance.

Intrigued by Ken Harnett's public television documentary, "The Lepers of Buzzards Bay" (1994), Rifkah vowed to learn more about the leprosarium and its patients. She found valuable sources in the official and unofficial records, newspaper articles, letters, journals, and assorted memorabilia hidden away at Harvard Medical School's Countway Library. Rifkah discovered the inhabitants of Penikese were both patients and prisoners, their hospital a penitentiary where they served a life sentence for the crime of leprosy.

At that time, a false belief harkening back to biblical times held that leprosy was a highly contagious disease, a danger to anyone in contact with the leper. Onlookers were terrified by the "mitten hands" and flattened noses distorting the victims' bodies. Today we know that only five percent of the world's population harbors a genetic defect making them vulnerable to a disease now controlled by medication. Patients needlessly condemned suffered a shameful, unjust punishment.

Describing her work as a "docu-drama in verse," Rifkah structures her work in four acts framed by a prologue and an epilogue. Following the poems, she provides a helpful "Author's Note," and brief biographies of each patient. In the prologue, the poet alludes to her role in telling the Penikese story and in Act 1, she describes the island's geological formation by an Ice Age glacier, "in a time colder than cold." She also honors the legends of an ancient culture, impersonating a Wampanoag Indian chanting his tribe's legend of how the island was formed (23). We hear, too, the shrill objections of twentieth century mainlanders to the establishment of a leprosarium so close to them:

The good citizens of Marion, Mattapoisett raged and stamped
petitions flew with nor'easter force (23).

Artfully using figurative language and precise details, the poet evokes a keen sense of place and mood. For example, she employs the poetic device of personification in which non-human things are presented as having human characteristics or emotions, as when she describes birds who appear "dressed in sadness/gulls, pipers, plovers, terns, cormorants, gray white, black..." (61). With her attention to detail, Rifkah names the exact species of the sea birds, and through personification, she pictures them as "dressed" in human clothes and expressing sadness, a human emotion. The poet also makes effective use of the poetic device of alliteration, the repetition of the same sounds or of the same kinds of sounds at the beginning of words or in stressed syllables:

Clackers and bell in medieval time announced the leper
Sonorous sounds screamed the coming of lepers (24)

Act 2 sets the stage, envisioning land and seascapes as the patients saw them. We sense how clearly the poet imagined the haunted setting of the hospital- a treeless crop of rock-strewn terrain and mist-shrouded beaches. However, visiting Penikese only in her imagination proved insufficient for Rifkah. Compelled to travel there, she walked the island, viewing grave stones of the fourteen who died on the island.

At the Countway, Rifkah learned the patients spoke Russian, Hebrew, Portuguese, Japanese, Chinese and Turkish - reflecting a plethora of national, ethnic, religious, and cultural backgrounds. Rifkah commented, "This speck of glacial moraine became a tiny United Nations of outcasts" (94). The poet noted, too, that despite their great diversity, the patients lived together harmoniously.

Nevertheless, while all of the thirty characters were united in sharing the same illness, each suffered his or her own private agony. Two patients devolved into insanity, unwilling to acknowledge their illness. A young girl, first described as "pretty and well formed," was later depicted as having "suffocated by growths in her throat." (100). In perhaps the book's saddest poem, we hear the anguish of Morris Goldblatt, a 41 year old Russian Jewish emigrant, inconsolable at being torn from a wife and five children who visited once, but became hysterical and never communicated again:

Why is it you don't write? This disease is not curse enough, you curse
me with silence (39).

In Acts 3 and 4, details from the Countway sources lend verisimilitude to poems of patients describing their daily lives-expressing their pain but also savoring their limited pleasures. For the patients could take comfort in freely roaming the island, enjoying the fresh air. Some grew gardens; some kept birds; others fished and worked at paying jobs. They enjoyed listening to a talented patient's guitar music and delighted in singing. As one says:

We clean each other with song
wash gray skies blue (27).

Above all, the patients found solace in the compassionate treatment of Dr. Frank Parker and his wife, who dedicated themselves to the welfare of the islanders, determined to ease their pain. For fifteen years, the couple remained at Penikese, maintaining their loving care until the hospital closed. In "Marion Parker Tells Her Story," we hear the voice of the doctor's wife:

I told Frank we could do good work, live a simple life, and bring some
pleasure to those cruelly afflicted
our friends feared for our safety (47).

With only thirteen patients remaining, the state finally disbanded the Penikese Leprosarium in 1921, sending the Parkers to the mainland, where ironically, they, too, became outcasts. Having infuriated Governor Channing Cox because he so strongly resisted the closing of the hospital, Dr. Parker was denied his pension. The last poem in the Epilogue reveals that the doctor, vilified in the press for his "bad treatment" (91) of the patients, must flee to faraway Montana to resume his career. We learn, too, the fate of the remaining patients—expelled to an even more remote and less humane leprosarium in Carville, Louisiana.

We can only marvel at Rifkah's achievement of masterfully bringing ostracized, marooned ghosts to life. One finds little to criticize given the impressive quality of Rifkah's poetry. A minor cavil: had she named each of the four chapters in addition to numbering them, we could better know the particular subject of each, understanding how each coheres in the whole of the drama. A minor cavil indeed—considering how the depth of Rifkah's research, the power of her language, and the empathy of her heart all combine to create a lasting work of art.

The views and opinions expressed in this review are strictly those of the author. Comments and suggestions may be sent to Harvey Fenigsohn. See past book reviews by Harvey Fenigsohn.