The Fatal Strain

by Alan Sipress

  The cooperative spirit lasted precisely one day. Trouble began when provincial veterinary officials drove up from Medan, pulled rank on their local counterparts, and announced that all the samples taken from local poultry were negative for bird flu and the mass cull, though prudent, had been unnecessary. The villagers were livid.

  Kubu Sembilang was in revolt by the time a team of disease investigators from the provincial government arrived in the highlands later that week. Local officials pleaded with them to go home. “We’re frightened something might happen to you,” one local health officer warned them. “You might be attacked.” The investigators retreated.

  A day later, the provincial team returned reinforced by disease specialists who had flown in from the national health ministry in Jakarta. This time they managed to enter Kubu Sembilang. But the villagers refused to answer any questions: What was the possible source of the infection? How did the victims catch it? Was anyone else in the village sick? After several frustrating days, the team from the national health ministry withdrew to Jakarta and never came back. They were too scared. Villagers had threatened to stab them.

  “We chased them away,” Puji’s brother-in-law admitted to me when I met him a few weeks later. The man had a hard face and bitter eyes. His tone grew more menacing the longer I peppered him with questions. “There is no such thing as bird flu. It’s bullshit,” he continued. “This is all simply black magic.”

  That last line was recited to me over and over as I explored Kubu Sembilang. There were no sick chickens in the village and only one sick family. What else could it be but an evil spell?

  A neighbor laid it all out for me. “This is something supernatural,” began Tempu Sembiring, a fifty-year-old orange grower with a balding pate and salt-and-pepper mustache. An unlit cigarette bobbed between his lips as he recounted the tale. “Their father used to be the chief gangster in this area. He took his power from a spirit called Begu Ganjang at a holy place in Simalungun. This is revenge for worshipping at that place.”

  According to Batak lore, Begu Ganjang can be conjured by offering him the liver, heart, and gizzard of a red rooster wrapped in four banana leaves along with seven pieces of chili pepper and chunks of banana. These are to be placed around the perimeter of a late-night ceremony, at the four points of the compass. The rooster’s blood is drained into a coconut husk at the center and then the spirit summoned. He is believed strongest at a mystical site in the district of Simalungun on the shores of Lake Toba, in the heart of the Bataks’ highland domain. Once called, Begu Ganjang will do his master’s bidding, delivering wealth and protection. But the spirit will remain faithful only as long as periodic oblations are offered, and unpaid debts to Begu Ganjang can be collected from kin in blood.

  “Ponten was quite powerful,” Sembiring continued, lowering his voice to a whisper as he mentioned the patriarch’s name. “When he died five years ago, his friends came all the way from Jakarta. The condolence flowers stretched all along the road. They stretched from there,” he said, pointing at the Ginting homes in the distance, “all the way to here.” He scanned his finger past the soccer field, the village church, and the dirt track leading up into the orchards. “The family had to be sacrificed. It is a payback for what happened in the past.”

  The village of Kubu Sembilang was in full rebellion as the investigation moved into its second week. WHO had received final lab confirmation that the outbreak was caused by bird flu. But Karo district residents objected that their poultry were not to blame, and, in mid-May, half a dozen farmers beheaded a chicken and drank its blood to demonstrate that their birds were healthy. A week later, with Indonesian officials designating Karo a bird flu-infected area, scores of poultry traders furious over the potential loss of revenue descended on the provincial capital, Medan, again slaughtering chickens and drinking their blood in protest.

  The WHO team’s initial effort to visit the village was “significantly delayed” by security concerns, according to an internal agency report. “It was later learned by WHO that quite strong hostility was expressed by some villagers, including a threat to bodily harm of laboratory staff,” the report said.

  When the WHO investigators, accompanied by Indonesian health officials, finally entered the village nearly three weeks after Puji fell sick, they recruited twenty local volunteers to monitor fellow residents for fever and set up a temporary health post on the soccer field, offering free medical care. The investigators bravely pieced together the chronology of the outbreak. They tried to collect samples from family members to see how widely the infection had spread. But, the WHO team reported, “Such requests were universally refused.” The investigators traced those who had contact with the victims, providing them Tamiflu for protection. But many of those who were closest to the Gintings refused to take it.

  Before I’d set off myself for Kubu Sembilang, I had worried I’d also get a hostile reception. A relative of the Gintings in Medan had given me the name of an uncle in case I needed help. When I got to the village, the man was away. But an aunt and cousin politely greeted me and invited me into the spartan eatery they ran, offering roasted pig and blackened dog. Then they served me up an earful.

  “The doctors gave us Tamiflu but we didn’t take it,” recounted the aunt, Mamajus Boru Karo. She was thirty-eight years old with long filthy hair, parted in the middle. Her face scrunched up as she retrieved the unpleasant memory. “Why should we take it? We don’t have bird flu.”

  “The doctors said we should take it as a precaution,” offered Sanita Ginting, the twenty-nine-year-old cousin, her brown eyes opening wide.

  “We’re healthy,” Mamajus retorted. “If we took it, we could die.”

  Sanita nodded in agreement and acknowledged she, too, had thrown aside the medicine. Seated at a scuffed table by the window, her gaze drifted toward the semipaved street outside. A few goats, chickens, and dogs scavenged among the potholes for discarded morsels of food. A highland breeze chased scraps of litter down the road. Sanita’s attention returned to the cramped, concrete room with its chipped green paint. She, too, was getting agitated.

  “We were scared of the health officials and of the WHO,” Sanita admitted. The doctors had given her relatives medicine and shots, and yet they got worse and worse until they died. “It’s possible they murdered them with injections.”

  “Why would they do that?” I asked.

  “To keep them from infecting anybody else,” she answered.

  I looked at Mamajus. She was seated cross-legged on a wooden chair in the doorway. She concurred.

  “Of course we’re suspicious,” Mamajus said. “They told us it was bird flu even before they had any lab results. They were just making it up.”

  “They think we are stupid people, uneducated,” Sanita interjected. “We didn’t go to advanced schools like them so they think they can say anything. But if no poultry are sick, how can it be bird flu? It’s irrational. We can think even if we’re stupid. Where’s the proof?” Then came the refrain: “It was black magic.”

  When I had spoken earlier with provincial health officials, they told me they had tried to take blood samples from everyone who had contact with the victims.

  “I didn’t give a sample,” Sanita responded.

  “I didn’t give a sample,” Mamajus echoed. “I don’t know anyone in my neighborhood who gave blood samples.” She paused, glancing at Sanita for confirmation, and then continued, “We got angry. We said, ‘Why do you want to take our blood? That’s only for sick people.’ ”

  Without specimens from the villagers, the world’s picture of this unprecedented outbreak was, at best, incomplete. I decided to ask the health officials from Karo district itself. They were the ones closest to the scene and fluent in the local dialect. I finally caught up one evening with Dr. Diana Ginting, the health department director, for a talk literally in the shadows. She was still on duty despite the late hour, her jacket pulled tight against the chill, because a new bird flu outbreak in poultry ha
d been confirmed hours earlier. As we sat on the dimly lit steps of the government building in Kabanjahe, the once-sleepy parking lot in front of us had been transformed into a war zone. The district was mobilizing for a mass cull, marshalling scores of uniformed security forces and civilian officials to carry out the late-night operation.

  As Dr. Ginting distributed surgical masks to the gathering forces, she recalled what had earlier transpired in Kubu Sembilang. The doctors had tried to calm the people and coax them into giving blood. “It wasn’t easy,” Dr. Ginting said. “They kept wanting to know why.” When the medical staff had put on masks in preparation for drawing blood, many villagers took offense. Nearly everyone refused. Across the province, health officers were eventually able to collect thirty-two blood specimens, including many from doctors and nurses who had treated the victims. But in Kubu Sembilang itself, investigators ultimately took just two samples, from a neighbor and the local midwife. “The people here are very difficult,” Dr. Ginting said. “Maybe we weren’t good enough at convincing them.”

  Tortured by the diagnoses of big-city doctors, Jones, the youngest of the Ginting siblings, had bolted the hospital, fled the suffocating back alleys of Medan, and absconded for the highlands of his ancestors. But he arrived shadowed by death and local officials.

  He initially sought out a witch doctor who lived in a hamlet amid the cornfields about ten miles from his home. This healer poured some water into a cup and recited an incantation. Then he gave it to Jones to drink. Next, applying the standard treatment for a fever, the medicine man prepared a paste of beras kencur from crushed rice and galangal (a root similar to ginger) and rubbed it on his patient’s face and body. The remedy did not work. Jones was on fire.

  His neighbors were not happy to see Jones when he returned to his home in the district capital, Kabanjahe. They were terrified of the curse. They had also heard that Jones had become the target of a major manhunt. The provincial health department, alarmed that a contagious patient was on the loose, had asked local officials to track him down and ship him back to the hospital in Medan. The word on the street was that police had also joined the hunt for Jones and his family.

  “They’ll arrest us if we don’t go back,” Jones’s aunt warned him.

  Jones objected, “If I go back there, I’ll die for sure.”

  Jones and his wife debated what to do. The family told Jones they would defer to his wishes. But with his condition deteriorating, he was no longer in any shape to keep running.

  After three days on the lam, Jones was readmitted to Adam Malik Hospital, a sprawling urban medical complex of white buildings with red tile roofs that, like many public hospitals in Indonesia, was in need of a little convalescence of its own. The corridors were clean, but their tile floors were chipped and the air was sour. Many of the fluorescent lights were out. While groundskeepers kept busy raking the lawns, the grass was perpetually overgrown, and many of the bushes were draped with drying laundry. The hospital was named for a former Indonesian vice president. But a letter had fallen off the sign over the main entrance so that it now read ADA MALIK, which is Indonesian for THERE’S MALIK!

  Though Jones had surrendered to health authorities, he was not done fighting. He refused to take Tamiflu or accept intravenous medication and injections of antibiotics. As hard as it was to breathe, he would rip the oxygen mask off his face. The nurses were terrified of him. When they came close, he would wrestle them away, flexing his tattooed biceps, or lunge at them with a fork.

  The doctors treating him in the special “red zone” set up for bird flu patients looked around and found a young resident physician whose family was from Karo district. He could speak to Jones in his local dialect. Soon the resident won a measure of cooperation. But only a measure. Jones began taking his medicine but still resisted giving the blood samples required to monitor his progress. “He thought it would make him weaker. For people like him, one drop of blood is worth a plate of rice,” one doctor told me.

  The red zone was demarcated with a red line painted on the hallway floor outside the two rooms where the most infectious patients were segregated. Hospital staff donned masks, helmets, rubber gloves, gowns, and boots before crossing the line. But as Jones slipped in and out of consciousness, now hooked up to a ventilator, more than a dozen unprotected family members pitched camp on the outdoor terrace just beside his room. They filtered in and out of the ward all day long, wearing neither masks nor gloves despite the timid protests of the medical staff. “We weren’t afraid of catching the disease,” his wife explained. “If we have to die, we’ll die. No one else would look after him. Even the nurses were reluctant to look after him.”

  Dr. Luhur Soeroso, the silver-haired chief of the pulmonary department, took a deep interest in Jones. “This is a very rare case,” he told me as he thumbed through the patient’s file. When I met Soeroso, he had an air of composure and comportment that seemed out of place amid the bedlam beyond his office door. He wore a pink shirt with a pair of Mont Blanc pens in his breast pocket and a red tie fastened with a gold clip. On each hand he wore a gold ring, one inlaid with small diamonds, the other with a large black stone. He had just completed writing an article about Jones that he was hoping to publish in the New England Journal of Medicine. While all the other family members who caught bird flu had died within twelve days of falling sick, Soeroso noted that Jones was still alive and battling the virus six weeks later.

  Jones was also unusual because he had developed brain abscesses after three weeks in the hospital and was suffering from severe headaches, mental distraction, and crippling muscle pain. Soeroso attributed this to a secondary infection caused by parasites that Jones had long ago picked up in his village. The intense battery of antibiotics and other medication had depressed his immunity, allowing the parasites to attack the central nervous system. He had tested positive for a parasitic infection called toxoplasmosis. A CT scan had revealed multiple pockets of pus in his brain.

  The family’s stubborn resistance to blood tests had made treatment difficult. But then the medical staff struck a deal with the family. If Jones would agree to give blood specimens, the family could invite a witch doctor to the hospital to see him.

  Agenda Purba was laboring in his rice paddy when the Mitsubishi van drove up. He looked over to see who it was. Several passengers were strangers, but he recognized at least one man from his village. The visitors said they had a sick relative in Medan and needed Purba’s help urgently.

  “Can’t you bring the patient to me? I have no way to get there,” Purba demurred.

  “He can’t leave the hospital,” one visitor responded. “We’ll take you to him.”

  Purba was in no mood to make the long trek to the coast. It was already late in the afternoon. “I’ll give you the right ingredients so you can do it yourself,” he said.

  “No, please, can’t you do it the first time?” the visitor pressed.

  Purba thought it over and agreed. “But on one condition,” he added. “Bring me all the way home again.”

  Along with Suherman Bangun, Purba was one of the most prominent witch doctors in the village of Jandi Meriah. He was a skinny fifty-six-year-old with disheveled, graying hair and an oddly elongated face, carved with deep creases. A few wispy white beard hairs sprouted from his chin. His manner was agitated, almost manic, and when he spoke, he would look into space and squint, his heavy lids settling over melancholy, light brown eyes.

  Even as a boy, Purba had realized he was special. He could always climb the tallest coconut trees in the village. But it was only when he turned twenty-one that he became a mystical healer. “I got the inheritance from my grandfather. He had this power. Before he died, he gave me the power by touching my left arm,” Purba told me, rolling up his sleeve, extending his arm and tapping it with his right knuckles to illustrate the bequest. “I can still communicate with him through dreams.”

  Within years he became famous for his specialty: curing hernias. “If someone’s colon i
s sticking out their anus, I chew up some betel nut and spit on his stomach,” Purba explained with the cool detachment of a doctor describing an upcoming outpatient procedure. “I don’t have to touch him. I just light a cigarette and hold it. When it burns down to my fingertips, that’s the moment the colon goes back inside the body. But I can make it happen whenever I want. If I say you’ll heal tomorrow, you’ll heal tomorrow. If I say ‘heal now,’ you’ll heal now.” Over the years, Purba claimed his reputation had attracted patients from as far as Medan and even Java island. “I can do hernias, snakebites, and scorpion bites,” he boasted. “But I don’t do broken bones.”

  Before Purba had driven off to Medan, he’d rushed home to slip on his one clean shirt and say good-bye to his wife. She’d insisted he promise to stop along the way and eat something, reminding him he’d been under the weather and needed to keep up his strength. He promised. “I didn’t want her to get angry at me,” he recalled.

  The van pulled out of Jandi Meriah about an hour before sunset and reached Adam Malik Hospital six hours later. It was midnight by the time Jones’s relatives had hoisted the ailing young man from his bed and carried him out to the terrace for the ceremony, setting him down in a chair. Purba began to prepare the ingredients. He laid out twenty-one betel pepper leaves, each about the size of his calloused palm, arranging them in rows. Then, into each, he deposited palm blossoms called mayang, some pasty white lime called kapur sirih, reddish brown chunks of an astringent called gambir produced from local vegetation, and bits of the orange-colored betel nut from an areca palm called buah pinang.

  Purba asked Jones his name. Jones told him, and the witch doctor began to chant over the leaves, praying for the young man’s recovery. Then Purba lifted the first of the stuffed leaves to his lips. He chewed it up, puckered, and softly spit it onto Jones’s forehead. Bending over the patient, he gently blew the slime over the flesh. The witch doctor lifted the second leaf, chewed it up, and spit it onto Jones’s chest, repeating the same procedure. He continued until he had finished all the leaves, slathering the torso, arms, legs, hands, and feet, alternating between left side and right, making particularly sure to cover all the joints.