Alan Sipress - The Fatal Strain

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.

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!