The Fatal Strain (5 page)

As soon as they arrived, it was clear they desperately did not want to be there. “They didn’t accept that it was avian influenza,” recounted
Dr. Nur Rasyid Lubis, the hospital’s deputy director and head of its outbreak response team. “They tried to refuse all treatment. We could treat them only because their condition made it impossible for them to resist. But if they had been healthy enough to walk, they all would have run away.”

The family members balked at giving blood for testing. Several initially refused to go to the isolation ward set up for suspected bird flu cases. “None of us believed it was bird flu,” Puji’s sister-in-law later recounted. “We thought it was black magic. Everyone in the family was getting sick and no one else was. Someone had put a spell on our family.”

That account was offered to me by the wife of Puji’s younger brother Jones. I must have given her an inquisitive look because she added, “Black magic is very common in our place.”

True to local practice, relatives and in-laws had streamed out of the mountains to keep vigil at the hospital. They crowded into the large room where their kin were lined up in two facing rows of metal cots and scoffed at the insistent advice of hospital staff that they put on masks and gloves to protect themselves.

Puji’s oldest son died just one day after being admitted to the hospital. One of Puji’s sisters succumbed next.

As Jones watched his kin perish in the beds around him, he confided to his wife, “If I stay here, I’ll be dead.” Jones’s fever had topped 102 degrees and showed no sign of breaking. Fresh X-rays revealed that his left lung had entirely clouded over and his right lung was nearly as bad. He told his wife it was time to leave.

“I was losing hope,” Jones later recounted in a raspy voice, almost a whisper. His stare was blank beneath thick eyebrows, and his cheeks were sunken. He had been a young tough. Now his arms and legs, covered with elaborate swirling tattoos of red and green, had grown emaciated. He had dropped twenty pounds during his struggle for survival, and his tank top hung off his shrunken frame. “I was afraid of the hospital,” he continued. “I thought I was going to die. I can’t remember much, but I remember running away.”

At that moment in the retelling, Jones fell silent. His wife, a chatty twenty-three-year-old with long hair parted in the middle and tied in
the back, picked up the thread. “We were watching our family die one by one,” she recalled. “We thought the hospital could not cure him.”

Jones had slipped out of the hospital with his wife and two young sons and hailed a taxi on the street. They told the driver to take them to a congested, working-class quarter of Medan jammed against the edge of the city airport. The houses were jumbled together along narrow alleys. Young men lingered on cramped front porches. Drainage ditches ran past the doorsteps and chickens pecked in the fetid black water. Every few minutes, an airplane would pass overhead with a tremendous roar. A year earlier, an Indonesian jetliner had crashed into the neighborhood moments after taking off, killing at least 149 people, including dozens on the ground, yet the incident was soon all but forgotten outside the quarter. This was the kind of place where Jones could disappear.

Jones also had relatives there to take him in. One, a distant relation, was a doctor with a practice on the main boulevard. Jones went to see him. The doctor examined Jones, prescribed some medicine, and offered an unwelcome diagnosis. “You have bird flu,” the doctor said, urging the feverish fugitive to return to Adam Malik Hospital. Jones balked.

If Jones could not find the answer in the city, he reasoned, he should go home to the mountains. He and his family hired another taxi and fled Medan. They drove deeper and deeper into the jungle, following the steep winding road and treacherous switchbacks up and up and up to the highlands of Karo, where cool breezes offered relief and promise of a cure.

 

 

By the time health officials in Sumatra realized they had a problem, it had already been two weeks since the eldest Ginting sister, Puji, fell sick, and six others were already desperately ill.

District health and veterinary officials drove to Kubu Sembilang and summoned the villagers. “Bird flu is here, now, among you,” an animal-health officer told the hundreds of people who gathered at the village hall. “To break the chain of infection, we have to depopulate your livestock.”

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 had 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.