On January 6, 1866, the first group of nine men and three women leprosy patients were dropped off at the mouth of Waikolu Valley, the closest accessible point to Kalawao on the southeast side of the peninsula. By October, 101 men and 41 women had been left in an isolation settlement surrounded by controversy and concern from the beginning. At first, the Board of Health thought patients would be self-supporting. After all, Hawaiian people had lived on the peninsula for hundreds of years, sustaining themselves and raising sweet potatoes for export, and the very first patients moved into houses left behind by Hawaiians who had lived in the area.

But this belief proved to be wrong. It soon became apparent that most patients were too ill or demoralized to be self-sufficient. Reports filed by the resident superintendent; by the Board of Health agent Rudolph W. Meyer, who lived on top the pali overlooking the settlement; and complaints by patients and their families all spoke of the insufficient supplies and housing. With no hope or will to live, some patients fell into vice and immorality. As stories spread of the deplorable conditions, many Hawaiian people hid their afflicted relatives and friends, hoping to prevent their discovery and a one-way trip to certain death. Others chose to go into isolation with their loved ones as a kokua, a helper.