The First Mission

SOS

“How come?” the desperate voice came from the communication radio in the AMA (Associated Mission Aviation) office of Sentani, Papua.

“They said there were no doctor available now. They promised to send a medical team next week. Over,” Bosco Fernandez, the AMA manager replied.

“Next week! People are dying every day everywhere. . . .” the voice continued reporting bad situation out there.

“Who is he?” I asked Bosco.

“Father Kees, the parochial church priest of the Star Mountain Range.” I had no idea where it was, and hoped it was still on Earth. “It is not far from the border with the Papua New Guinea,” Bosco continued after seeing my puzzled expression.  “A lot of people have died there, and Father has asked for help from the Provincial Health Office every day.”

“When did the outbreak start?”

“About three months ago.” I was taken aback.

Our conversation was interrupted by the repeated calls voice of Kees. “Wait a moment, Pater. There is a doctor here. I will ask if he is willing to help you. Over.”

“Will you, Doctor?” The request did not astound me. I had been thinking of volunteering, but hesitated to do so because I had never seen any single patient of confirmed malaria in my life—there was no malaria in Java, or at least in the area where I did internship. At medical school, I only knew malaria by textbooks and specimens under a microscope lens. I was a very fresh graduate of a medical school, just five weeks of being an MD.

A year before, I had worked as a volunteer in Kelimutu, Flores, and treated some patients with anti malarial drugs, but their malaria had never been confirmed by any laboratory test, and their signs and symtomps had not been specific of malaria. Handling malaria outbreak in the interior of Papua by myself? The Star Mountain Range sounded a huge and wild area. People are dying everywhere! What should I do if I had a dying patient in the bush?

With cautious voice, I said, “I will.” The sympathy for the suffering people and my adventurous instinct overcame my anxiety of being incompetent. Bosco looked very pleased and grabbed the radio speaker quickly.

“Father, he is willing. Over.”

“Great! Send him . . . A male or a female doctor? Over.” He and she are both dia in Indonesian.

“Male. He is going to Asmat to see the Hospital of Bayun. He is interested in working for the Mission. Over”

“It sounds he is the right doctor for the outbreak. Over.” Kees’ tone was completely different now, full of excitement. “Send him here with Brother Allo tomorrow morning. Ask him to see Doctor Budi to get permission and drug supply today.” Even in emergency situation we had to remember the bureaucracy; Budi was a high officer at the Provincial Health Office. I needed his permission because I was not registered in the Province. Neglecting this process might produce trouble for everybody in the future.

Human Planned Weather Decided

I had just felt sleeping a few minutes when somebody knocked my bedroom door. It was 3:30 a.m., the time I asked my landlady to wake me up last night. I could not sleep at all; my mind was full with what I would see and do the next day. The Star Mountain Range. The malaria outbreak. They made me anxious. As it was very early, I asked my landlady not to prepare breakfast. I just had a glass of hot tea. I had not finished it when the car from the Mission arrived.

I stayed with Fred Suebu family, the elder brother of the Governor Barnabas Suebu, in Sentani; it was not far the airport, only 5-minute drive from the AMA hangar. The family was kind; although their house was small and simple, they let me use one bedroom, their children’s bedroom.

There was someone on the seat next to the driver. He introduced himself. Brother Allo Dafroma was a paramedic of the Mission. Big, tall, and bald; he looked daunting. But, after hearing a few sentences, I recognized his accent, Florenese accent, and my negative impression disappeared. His parents were from Adonara Island, a small island at the east of Flores Island.

The AMA staff weighed everything we brought, including our bodies. And, we had to solve our first problem: the total weight was above the loading capacity of the Cessna, a single engine aircraft. Its maximum capacity was 300 kg; my body weight was 57, but Bro’s 87; and our luggage was more 200 kg. Thus, we had to leave some of our stuff to the next flight. The main problem was the next flight was scheduled five days later. We left behind most of our foodstuff, including some rice. The most important food for us was instant noodle; we carried them all.

All luggage had been loaded into the Cessna, and the sun had left the horizon more than an hour ago, but there was no sign for us to board. “We have to wait a moment. The weather in the Star Mountain is not good yet,” Kris, the pilot, told us.

I did not feel good at all. The lack of the sleeping, I thought. There was no comfortable place for lying down in the hangar. Moreover, I was too anxious with thoughts about how to handle the outbreak. To reduce this anxiety, I moved around between the side of the airfield and the waiting room, looking at the southern sky. It looked bright, but the radio operator in the Star Mountain did not report so. “The mountains are covered by thick clouds” is the most unwanted weather report; “the peak of the mountains of the ‘gate’ is clear” is the best heard of; “there is a blue hole at the ‘gate’” is between them. Of course, there was no gate in the sky.  It was a narrow gap between two mountains where the Cessna can enter and leave the valleys of airstrips.

I looked at Bro Allo covetously. He was sitting comfortably on the bench: legs straight, head back-rested against the wall, and eyes closed. He did not worry that the flight might be postponed. According to Bosco, Bro was an experienced paramedic. This information soothed me. I am not ashamed to learn from a paramedic because I realize that in the field, experience is often more important that theory.

“Oklip, Sentani,” Marcel, the Office Head of AMA, called the radio operator in Oklip.

“Sentani, Oklip,” a man answered.

“How is the weather? Over”

“Blue sky. Mountains can be seen clearly. There a thin layer of fog at the end of the airstrip. Over”

“Thank you. Over and out. Abmisibil, Sentani.”

“Sentani, Abmisibil.”

“How is the weather? Over”

“Fog covers the end of the strip, but the mountains are seen. Over” I was relieved but not completely.

“Sentani, Oksibil,” the Oksibil station interrupted. It was Kees’ voice. A Dutchman who spoke fluent Indonesian; his foreign accent was hardly detected.

“Oksibil, Sentani.”

“Marcel, Oksibil is still covered by white cloud, but the end of the airstrip is opening. Over”

The pilot asked us to board the plane. Finally we were going to fly.

“Don’t be too excited,” Bro said. He was right. In Papua, being up in the air does not guarantee we will land on the destination airstrip. After flying for hours and then landing on the same airstrip is not an unsual event in the interior of Papua.

“The heavier sit in front,” the pilot said. Bad luck for me. The best seat for enjoying the landscape from the air was taken by Bro, the only benefit of being over-weight in Papua. Obesity in Papua is not only bad to the health of the person him- or herself, but to other people who travel with them or to the interior people whose cargo has to be reduced because of the limited capacity of the small airplanes.

DeRainforestation

Sentani airport lies between the Sentani Lake—the largest lake in Papua: about 12 kilometer wide and 45 kilometer long—and the Cyclops Mountain. After passing above a large grove of sago trees, we were flying over the Lake; I could see the islands of the Lake better than from the lake side. Thatched houses of the local people lined the islands coasts. They are supported by wooden high poles, where the people tie their canoes. To stabilize the canoes, they tie an outrigger, but only at one side. Surely, single outrigger is not stable enough for the canoe to sail on the open sea.

All islands had a thinned-roof concrete building with a large cross at the top; the church is always at the center of islands and very easy to spot because there are not many big trees on the islands. The people do not do cultivation on the islands; the soil is infertile. Moreover, for thousands of years they have survived on sago starch, fish, and shellfish, plus some wild plants and fruit. Planting food plants are too time-consuming.

The Lake is surrounded by grassy hills forming twisted line. When the Cessna climbed over and passed the hills, the landscape was totally different: scrubs replaced grasses. However, within a few minutes, the lowland rainforest took over the view.

I loosened my seat belt so that I could see through the window of the other side. I was busy to look out all directions. I could not see the soil because it was covered by trees, hundreds of kinds with different heights. The tallest ones looked like umbrellas. Although green was the dominant color, the color was a spectrum, from the very light to the darkest green. Yellow, orange and red tinted the green landscape, the color of shedding leaves. Some trees were tinted white, but these white things scattered when we approaching. Birds. My favorite view when I fly with Cessna or helicopter. They fly low so that I could even see the beaks of the birds individually. The white birds are either egrets or cockatoos. The colorful birds are usually parrots; they like flying in a flock noisily and could be hundreds in one flock. Sometimes, I could see hornbills, the largest flying birds in Papua—the non-flying ones, the cassowary, are much bigger.

The unbroken view of forest is interrupted by flowing rivers. Their paths are irregular and twisted, branching and merging at various spots randomly. When fly over them, we could not always see the water; the trees from both banks often connected one to the other covering the water. However, rivers are not the only breakers of the green landscape. Some long straight lines intruded the forest. Their grey and brown color spoiled the beauty of the landscape. The logging roads. At various points, a narrow brown path split leading to blocks of cleared forests. I saw stumps separated by black or brown logs; it was a mess.

“What village is it?” I asked Bro Allo pointing down to large squares that were full of tinned-roof houses.

“Arso,” Bro replied, “transmigration area.” I cursed. I had read a lot about the government resettlement program. The goal is to reduce the population density of Java, Bali and Lombok islands by relocating poor people to less populated islands. Each household was granted two hectares of land and food supply for one year.

In Papua, the lands are cleared tropical rainforests. The government had relocated hundreds thousands of households to Papua. This resettlement cost the disappearance of millions hectares of rainforest because the contractors always cleared the forest more they were supposed to. They made money more from the timbers than from the payment of the contracts. The news of the missing contractors of unfinished transmigration projects was not interesting in Papua. They left, not kidnapped.

The First Drop

The vegetation changes gradually when had passed Arso. The trees were smaller and shorter; stratification was easier sighted because the Cessna often flew between two mountains. The distance between the plane and ground shows the level of skill and confidence of the pilot; the shorter the distance the more skillful and confident, often ‘crazier,’ the pilot is. The craziest one dares to turn off the engine while flying down following a river—I love flying with this kind of pilot.

Kris the pilot was skillful and confident, but he was not crazy. He was a married man; being crazy was not clever for him. But sometimes he did dangerous maneuver, for instance, flying low until a few meters in front of the mountain wall before rising up suddenly to pass the mountain 10 to 15 meters above the canopies. He only did this when the sky was clear, but the clear sky did not last long in the interior of Papua, especially in the highland: one to two hours between 7 and 10 o’clock in the morning. For this reason, the montane forest is often called cloud forest.

The magnificent air view of the highland is the waterfalls. During the highest rainfall, we can see hundreds of them, from a few meters to one hundred meters high. However, most of them are only a few meters wide. We flew over some villages of the indigenous people. The thatched roofs are doomed-like. A village consisted of 5 to 12 houses; one of them was usually tinned-roof, the church. If there was a second one, it was usually the school.

“Oklip airstrip,” Kris’ voice interrupted my reverie. I followed the direction he pointed.

“Which one?” I asked.

“There,” Allo who answered my question, pointing to the mountain at our right side. Now I could see the airstrip: the inclined grass field. The top end was about 20 meters higher than the other end, I estimated. The length was about 300 meter—shorter than minimum requirement.

Kris maneuvered the Cessna three spirals down then I lost the airstrip—it was behind the lower hill the Cessna was circling. The tip of the left wing was only about five meters from the hill. A few second later I saw the airstrip in front of us, but it was now above us. We crossed a stream and were lining up with mountain slope. I could feel the adrenalin rush in my body. The inclination makes the speed down faster, the reason why the airstrip shorter than the minimum standard length. Landing is the most fun time flying with Cessna; my eyes are open wider; and my fingers are busy pushing down the camera and video shutters. The Cessna touched down at the lower end and then was running up the slope. It stopped about three meters before the top end of the strip

A big throng surrounded the plane. Two persons were running to us with a big block of wood in their hands. They stooped under the Cessna and stood up again. The blocks were under the wheels now; they prevented the Cessna from running down by itself in case the brake failure.

Except four people, all men wore penis gourds; the women put on grass skirts; and children were naked. The men with ‘normal’ clothes were the AMA employee and local teachers of the primary school. The AMA employee is usually the local preacher.

The arrival of Cessna was always an attraction to local people. They wanted to know who came and what were brought. The less often the place is visited by Cessna, the more people come to the airstrip. Some people do not mind to walk for hours to the strip just for watching the passengers. “Doctor, doctor.” I heard this word came out of many mouths. They looked at me as people looking at animals in the zoo. Later I knew why I looked like an exotic species in Oklip. It had only been visited once by the first doctor in Oksibil, the center of the Star Mountain Range.

The AMA staff unloaded Bro’s luggage. The plan was he and I would meet at one village between Oklip and Oksibil. He would stay at the local chapel today and walk to Oksibil in the following days. It takes two-hour walk from the airstrip to the chapel. Normally, the chapel is just a few meters from airstrip. They could not find a suitable area for the airstrip near the chapel.

I sat by the pilot when it took off again. Taking off was no less dangerous than the landing. It ran down first, and no sooner had the wheels left the land than the pilot turned the steer left and lifted up the Cessna maximally. Delayed 2 – 3 minutes and inadequate turning left and rising up would send us into the wall of the hill in front. Kris did not have a problem taking off this time.

The Mission of the Star Mountain Range

Kris pointed down through the window and hollered to me. I could not hear it well but I caught the word ‘Oksibil.’ I saw nothing below but white clouds. The Cessna was circling down slowly. One circle, we were still in the cloud; the second, the cloud became less white, some black shadows were vaguely seen; only at the third circle I could see the reflection of the tin roofs.

In 1989 no Cessna used GPS, the standard navigator for all kinds of vehicles. In a very cloudy area as we were then, the pilots relied on their memory of the areas and the precision they maneuvered their aircraft: blind flying. They had no idea how low precisely the cloud was.

Most pilots of government-owned airline will fly back to the origin after making two circles, but some missionary pilots are ‘crazy,’ flying very low (30 – 50 meters above the ground) blindly. The craziest are the pilots who land Cessna on the foggy airstrip. The rational and dedicated pilots usually find the closest airstrip after 3 – 4 circles, and wait there listening to the weather radio from the destination post. If the weather is not better, they fly back to the departure airstrip. This is the time the people at the destination post becoming more religious, especially if they are waiting their loved ones coming home.

Sometimes they fly down too late and would land the Cessna in the middle of the strip if they continue. In this case, they have to lift the Cessna nose sharply and quickly—In the meantime, the crowd at the airstrip will scream loudly. Failing to do so in time, the Cessna will end up in the river or gorge, or crashed into the mountain across.

This morning the clouds were rather low in Oksibil. Kris was a dedicated pilot; he tried hard to land the Cessna. Pater Kees guided him from the radio, “Fly south, there is a blue hole at the end of the airstrip.” I was nervous listening to the conversation between Kris and Kees. Kris followed the direction; we found the ‘blue hole’ but it was over the river, too late for landing. Kris lifted the Cessna and circled one more time before landing.

The Cessna was running back from the end of the strip. A big crowd had been waiting at the other end. I had never met Father Kees before, but I was sure the man who looked like a giant was him. The second tallest person in the crowd was a little higher than his waist.

“Yepmum,” the giant said. It was a greeting word of the local language, which also could be used for saying ‘thank you.’ “Kees,” he introduced himself. And I said my name in return.

“Your arrival is my best birthday present.” It was Kees’ birthday, August 18. He was born in Netherland and moved to Indonesia after graduated from a college. He finished his theology study at a seminary in Yogyakarta, joined the Franciscan order, and decided to stay forever in Indonesia by becoming an Indonesian citizen. His Indonesian was better than most Indonesians themselves—he could read Indonesian newspaper and write Indonesian letters and papers, the ability that was mastered by less than 100 live westerners in the world.

Kees took me around the Mission complex. We entered the wooden church—big enough for 500 hundreds people—that faced the valley of Oksibil. On its right side was his house, two storeys; the first floor was the living and dining rooms; the second floor was his bedroom, two guest rooms, and the chapel. Connected to the house was a row of rooms: Sister Agustina’s office, radio room, storage, and two guest rooms. He let me use one of the guest rooms at the second floor, the room with a beautiful view of the mountains around the valley.

“Let’s meet the Sisters,” Kees said. “It is almost lunch time.”

When entered the convent next to the presbytery, the lunch was ready. Kees introduced me to the Sisters. All four nuns were from Batak land, North Sumatera. The Batak are famous for speaking loudly with a lot of ‘bah’ at end of the sentence. The muder, the head nun, was Sister Agustina Simamora, who used to be the head of the order of Bennenbroek in Indonesia. She is one of a few nuns I really admire and respect. Friendly, funny, kind, smart, dedicated, honest, and pretty—even in the forty—she were my Miss Right. Unfortunately, Jesus likes this kind of woman too. And, I cannot compete with him in this case.

Having back in his house, Kees showed me some holes on the wall. “A soldier shot the wall,” Kees told me.

“Why did he do so?” He told me a long story about the hole.

The Interior of Papua was often like the Wild West: gun or rifle was the law. The soldier wanted something free from Kees, but he rejected the demand. The stress from living in the interior—many of soldiers were badly paid and left their family in the urban area—made soldiers or policemen tend to pull triggers lightly.

Oksibil is one of three sub districts of Star Mountain Range. The airstrip and Mission station were in Mabilabol. Although it was under the then Regency of Jayawijaya with the capital in Wamena, people more often to fly to Jayapura, the capital of the Province, for shopping or schooling. It takes more than two hours to fly to Wamena; it is ‘only’ one and a half hour to Jayapura. Moreover, there was only one flight, if the weather was good, per week from and to Wamena, while 3 to 4 from and to Jayapura. Often there was no flight for the whole month from Wamena.

The survival of non-indigenous people in the interior depends much on the Missionary, unless they do not mind to eat the staple food of the indigenous people all the time. Taro, sweet potato, and sago are fine for a short time, and then they would miss rice, noodle, and cigarettes. These daily needs and other essentials come from Jayapura or Wamena. The government-owned airline, Merpati, had Twin Otter aero planes that could carry 18 passengers and more 1000 kg luggage—5 times capacity of the Cessna—but the pilots easily turned around when the weather was a little bad, wasting the expensive fuel. The weather was often bad when they arrive over the destination village because they took off late. The missionary pilots took off for the first flight between 5 and 6 am, the government pilots after 8 o’clock. After 10 o’clock, most airstrips were covered by fog or cloud.

Kees briefed me in on the situation that made him ask for help in the radio every day. For the last six months, almost every day he received reports of death from villages in his area. People abandoned their villages because they believed evil spirits were angry at them and had killed their family and relatives. They lived in the jungles for months and suffered from the starvation because of the limited food source there. Their reaction to mass death might be right to save the whole community—there is something wrong in the village, we have to run away—but the explanation is not right, of course.

I explored Mabilabol by myself, talking to the nuns, missionary staff, teachers, government clerks, police and army. From them, in addition to the outbreak information, I also knew what the people think about Kees. People liked him because he made the flights from Jayapura came more often: more food and other daily needs available in the mission shop; mails arrived sooner; and they could go to Jayapura easier because more seats available. People disliked him because there was nothing free from him and he was disciplined and expected the others were so, which was incompatible with the easy going nature of the Indonesians and Papuans.

Kees was an idealist. He defended the oppressed and the poor—the Papuans and women were on the top of his list. All the AMA staff in Oksibil were women, which was unusual. Of course, there was a strong reason, besides equality issue, why Kees recruited these women. Women in Papua, maybe in all over the world, are much diligent than men, and they cause less trouble and are more trusted.

Kees’ idealism was often radically practiced. During the independence ceremony a day before my arrival, he refused to sit under the tent with the government officials and other VIPs of Oksibil. Instead, he stood among the Ngalum people under the rain. In Java, he told me, he chose land transport instead of airplane even if the airfare was paid by the Franciscan order.

His idealism and directness had often caused him in conflict with the army, police, government officials, and even the other clergies. The conflict was unavoidable if he worked with the same type of personality, ironically. For instance, Leony was a dedicated nurse Sister who was liked the local the people, but she did not survive long in Oksibil. For an unclear reason, she left Oksibil because of the conflict with Kees. She even refused to meet Kees years after.

In 1992, ‘the Bishop of the Star Mountain Range,’ his popular name among the missionaries, was pulled out by the Bishop of Jayapura (real bishop, of course). The Bishop was under pressure by the government to do so because the ruling party Golkar was concerned that it might lose the election in Oksibil if Kees was there during the election day. Kees was too influential and obviously disliked the government. Kees had often ignored the instructions or orders from the Bishop, the reason people called him ‘the Bishop of the Star Mountain range,’ but this time he must follow the order. He never went back to Oksibil since then and moved to Java working among the poor in Jakarta. He is a good man to me and taught me that defending the oppressed and the poor, and being an idealist is a suffering, but also happiness at the same time.

No Money No Service

With the aim of improving access to health service for the poor, the Government has built puskesmas (primary health center) in every district in Indonesia. People receive free service, or pay a little, in this puskesmas.

Puskesmas Oksibil was about 75 meters by the airstrip. It was a complex of wooden buildings standing on high poles. The front building was for outpatient; the back one inpatient; and the side, smallest but duplex, was the doctor and paramedic houses. Otto, the senior paramedic, showed me around; the doctor, as in Ilaga, was not available. The building condition was relatively good. The medical supply was adequate. However, there was no patient in the ward. The outbreak and dying people were reported but there was no patient in the only medical facility in the area!

One year before, a doctor had been assigned to the Oksibil puskesmas. He was the first doctor in the Star Mountain Range. But he only stayed for one month and was called back to Wamena, the district capital. This is not unusual in Papua; doctors officially work in the interior, but practically work the district capital.

The ratio of doctor to patients in Indonesia was about 1:12,000 then (1989), but in Papua it is about 1:40,000. The distribution of doctors is much skewed: more than 75% of them work in Java, and most of them work in urban or city areas. To solve this unequal distribution, the government did two important actions. Firstly, a puskesmas was built in every district or for every 30,000 people in one area. Secondly, the districts were classified into three categories: non-isolated, isolated and very isolated. And, all new doctors were obliged to work for the government and choose the area they wanted to work before receiving a private practice license or studying a medical specialization. They had to work for three years in puskesmas in non-isolated area, two years in isolated, and one year in very isolated. The salary in very isolated was about three times of in non-isolated. It seemed a very good regulation.

Most of freshly graduated doctors still preferred working in non-isolated area with lower salary because they could have patients at their private practice in the afternoon; live in town or not far from town; and send their children to good schools. Anyway, the difference of the salaries was not much either; the doctors in very isolated areas received only extra $100 per month. Because they had to pay more for the food, and other daily needs, these doctors actually received no more than the doctors in urban areas.

While the doctor of Oksibil was away, Otto was in charge. He is a Ngalum, and according to the WHO (World Health Organization) he would serve his people better than the outsiders because he understood the local language and culture well. Unfortunately, he did not.

Otto might not be as powerful as the heads of the Ngalum tribe, but he was certainly richer than any of them. He lived in a big and nice house built for the doctor. The house had solar cell panels, supposed for powering the vaccine refrigerator but instead powering his sound systems—both the panels and sound systems were millions of rupiah worth. Next to the house, he kept his fat pigs; more than twenty, I counted. One big pig was about three million rupiah; at least the pigs valued 50 million rupiah in total.

Otto’s salary was about 200,000 rupiah. It was enough for buying daily basic needs, but not for his fancy sound systems and big pigs. Most of his income came from the fee he charged to the patients, who were supposedly to pay nothing. If the patients had no money, they had to pay with anything—the most often were chicken and sweet potatoes or taro, the staple food. If Otto cannot sell the taro and sweet potato anymore, he would record the charge as debt and collect them later in the form of pig. The patients had no choice if they wanted to receive medicine. Of course, Otto’s boss in Wamena knew about this corruption, but could do nothing. He could not fire him because the procedure was long and complicated involving the Minister of Health in Jakarta.

I asked Otto to open the drug storage. It was full of medicine; some of them were already either expired or damaged. I took medicine as much as I could and left the puskesmas with some bags of full of medicine. I felt like a Robinhood and was ready to give away the wealth from the rich, cruel, noblemen to the sick and poor people out there.

The Relativity of the Beauty

The most difficult thing in the interior for the non-Papuans is to live with the loneliness, especially for single person. Days are long; life is the same from day to day for most people; they do not go beyond two kilometer from the place where they stay; the exception is the soldiers who must patrol the area and the doctor who is supposed to visit villages outside the district capital. If they have no friend to talk to, or no interesting topic to talk about, they listened to the transistor radio. The transmission is usually poor and the entertaining stations are not many either.

Single woman is rare. For every 100 single men, there is only one single woman, I think. Thus, no matter how they look, single woman never stays single long in the interior. Bonita (not her real name), the younger sister of Sister Horas (ibid.), would not be considered beautiful in normal society, but in Oksibil all men, including “local” bachelors—married but single locally—stared at her anytime she was passing by, specifically on her upper front and lower back parts. She initially stayed in the school staff complex, but Sister Horas relocated her soon too her convent. Bonita’s house was never quiet in the evening.

The preventive measure was not effective. She was the most beautiful single woman in Oksibil; her sister could not watch her 24h per day. Within a few months, the only single woman relocated herself to the house of a farming educator from Bali, and they moved to Wamena later on. Oksibil had no pretty single woman anymore; days were felt long again for Oksibil single men. They were back sitting on the hot tin.

The Ghost Villages

The supernatural causation of diseases might be a history in the western worlds, but it is still a cogent explanation for many illnesses in eastern worlds, including Indonesia. In Papua, angry evil spirits might be the only explanation for sudden mass deaths. In fact, the reaction to this believe has saved some Ngalum communities from being wiped off by communicable diseases.

Evenings were cold and dark except in the Mission complex. Pater or Suster turned on the generator at 6 and off around 10. Pater extended the cable to the police complex in front of his office, a symbol of friendship, which was appreciated much by them. With the light, they could play cards and turn on their radios or cassette players.

We dined at the convent; tt was a special dinner for two celebrations: Kees’ birthday and my arrival. The food was delicious and plentiful, but I could not eat two special dishes. The first one was the ketchup pork; anytime I eat pork, I vomit. I think it is a psychological trauma from my childhood; my grandmother always forced me to finish the pork. The second dish was dog’s meat, which is the favorite dish for the Bataknese. I love dogs but the alive ones.

After dinner, some of us played cards, the skill we need to survive in the interior. Pater and Susters asked me a lot of questions. I told them about my Ilaga trip and my experience in Flores. They also informed me about the people in Oksibil and about the Ngalum tribe. The Sisters just came a year ago taking over the Dutch nuns. They had to learn life skills quickly because the Dutch nuns left soon; they were very old; some of them had lived in Papua more than 40 years.

It was foggy and cold when I left the convent. A few minutes later the generator noise stopped, but I had already turned on the fluorescent light on the wall at the head of the bed. The light was powered by solar cells, and we were not supposed to turn it on long. I soon fell asleep.

I woke up early in the morning by the urge to defecate; I had had dinner too much. I fumbled the side of the mattress looking for my torch—one of survival skills living in the interior: keep the torch all the time at the same place. It was bloody cold outside the bed. The toilet was downstairs, one of the rooms in the row outside. It was bloodier cold when the door opened, a gush of cold air rushed through and hit my face. Dense fogs blanketed the yard. I carefully entered the toilet room. The toilet was a modern type, a sitting one, minus toilet tissue. I had no problem with that, but I did with the water in the bucket. It was bloodiest cold, especially when it touched my buttocks after the evacuation of my bowel.

The voice of prayer woke me up. I looked through the glass window; it was still dark outside. I got up and joined the nuns and Father in the chapel next to my bedroom. The morning prayer was not long; I loved it; long prayers were boring and I believe that God must prefer the short ones too. Too many human beings—assuming no other life forms do the same—pray at the same time, and I believe, most of these prayers are requests, proposal, or demands.

The breakfast was very good: fresh-baked bread with chocolate spread and cheese—a combination that many of my western friends raised their brows. It was the best cheese I had ever had. Kees brought it from Netherland. The coffee was rather strong too me; I was not a coffee drinker yet. In Yogyakarta my breakfast had been rice and soup, or gudeg, the famous food from Yogya.

As a warming up, Kees asked me to visit the twin villages of Dabolding and Serapding. I could see these villages from my bedroom. They were separated by a narrow gully. A lot of people died there, Kees told me. He ordered some Ngalum people to accompany me.

We headed the airstrip and followed along its right margin. The weather was beautiful; the green mountains behind the twin villages were clear. After crossing the airstrip at its end, we went down a grassy path and stopped at a hanging bridge over Ok (Ngalum language for river) Sibil. A short bridge, but it was swinging hard when somebody passed it; it could had been fun if the floor and side rails had been ‘normal.’ Less than a half of the wooden planks were still on the floor; but, most of the existent ones were not intact either. Hold the side rail all the time, the advice. However, the rotten rattan rails were not reliable either. No doubt that we would end up in the river with broken leg or arm, at least, if we missed the planks; the river was full of big rocks. My escort might have laughed at me when they saw me crossing the bridge; they only needed one minute, but it took me about five minutes to cross it.

The path was up after the bridge and we arrived at the west end of Serapding. The village was not a traditional one; it had been built by the government. Two rows of houses were separated by a narrow, slippery, and muddy path. The house walls and floors were made of wooden planks and the roofs were of tin. The windows were very small; the walls and floors were holed between the planks—the planks must have still been wet during the construction. I saw no ceilings so that I could see the sky through the holes on some parts of the roofs. All houses, about 100, had the same design: one tiny  living room and two small bedrooms—one bed in one of them leaving space at one side only.

The kitchen was a separated unit at the back of the house. It was a traditional hut with a domed thatch roof and a fireplace in the center, a honai dapur (kitchen hut, the combination of Ngalum and Indonesian language). The government named the house rumah sehat means ‘healthy house,’ but I did not think people would be healthy living in dark and small houses with no bathroom and toilet.

The center of the family activity was not the house, but the kitchen. The house was only used for storing things. They chatted, ate and slept in the kitchen, surrounding the fireplace. “Too cold and too many mosquitoes inside the house,” they answered when I asked why they did not sleep in the house.

Some of them had made a fireplace inside the house, but had abandoned the trial. The fire burned the wooden floor and it heated the tin roof made the house felt like an oven. Thus, the Government spent billions of rupiah for building useless houses. I did not think the officials cared about it. Most of the money ran into their and the businessmen’s pockets from marking up the projects’ cost.

Some years later, a malaria control program was carried out in Dabolding and Serapding. People were given permethrine-impregnated bed nets. They were very happy with the gifts, especially when most cockroaches and ants in the houses killed after being in contact with the bed nets. But, the population of mosquitoes did not decline, and therefore, the malaria rate did not decrease either. The explanation was simple: the anopheline mosquitoes bite in the evening only and people slept in the kitchen, not under the bed nets in the bedrooms.

Back in the villages. Kees already had sent a message to the villagers the day before, but when I arrived, Serapding was still quiet. I found people at two houses only. “They are still in the jungle,” one of my escorts told me. “They are coming.”

They took me to the community center, located between the villages. The elementary school, the largest building in the villages, was on its left. Two teacher’s houses stood next to the school. The classrooms were typical: holed wall and roof, but there was no hole on the floor, thanks to the contractor who did not install the planks. Win-win solution: they pocketed extra money from not buying planks and poles, and the students and teachers suffered less likely from falling onto the ground.

While waiting for the people coming, I looked around. The soil was white clay, reflecting sunlight strongly. It was slippery because of the rain water. Puddles here and there, and I found mosquito larvae in them and in the drainage around the villages; they were also numerous in the barrels for collecting rain water.

One by one people were showing up. I examined and treated them, mostly for wounds and common cold. Some of them had enlarged spleen, and they usually looked paler than the normal ones—I had to check their inner eyelids to confirm the paleness because of their dark skin. Each of them received chloroquine, the malaria drug, for three days.

Kees had told me that we had to watch them taking medicine; if we gave the medicine for taking home, the most likely they would just keep the medicine any place in the house. However, as I would not able to come again, I distributed a 2-day paper pack of medicine after they took the first dose in front of me.

Thinking that no more people would come, I checked all houses one by one. Most of them were locked except the kitchens. The people were afraid of coming home because they believed evil spirits who had killed their family were still in the house. In Oksibil, it was normal that houses were deserted for months after one or more of their residents died. At present, it meant almost all houses had dead residents in the last one year. To confirm it, I checked the list of residents Kees gave me; I crossed about 40% of the names.

They were ‘ghost villages,’ but I still found some people in some houses. They were not the people who had come to see me—all back disappeared to the jungle after receiving the medicine—but the people who were too sick to come to the community center and to hide in the jungle. One of them was the tribal head.

“What is his sickness?” I asked his wife because he was not very conscious.

“Sick on whole body and hosa,” She answered with ‘fragmented’ Indonesian. She was not too bad; most old women did not speak Indonesian at all. I understood the words, but I did not know what she meant with ‘sick whole body.’ And, hosa was not an Indonesian word.

My escort explained that hosa was shortness of breath, and he tried to help me get specific symptom but he did not succeed. I only knew that he had headache because the wife nodded her head when I pointed the head of his husband’s. ‘Sick whole body’ was probably pain on multiple joints and muscles.

I rarely got clear answers when I asked my patients “which part of your body hurts?” It seems their concept of sickness is the opposite of the one of western medicine. In western medicine doctors always try to look for a specific organ or system in trouble, which make the western medicine very fragmented. For example, ENT (ear, nose, and throat) specialists see ENT only; ophthalmologists see eyes only; neurologists see nerve system only. If they found no abnormality, they would tell the patients ‘you are OK’ even if the patients have a serious problem with the heart or lungs. Unlikely would they spend time to check the heart and lungs of the patients because they have forgotten how to detect abnormalities in these two organs. They will just send the patients to cardiologists, pulmonologists, or other specialists if the patients complain about shortness of breath.

Fragmented medicine is surely unwanted, but holistic concept of medicine is not helpful for me in the interior; I needed to know which main system was in disorder. In the beginning I tried to have detailed history of illness, but in the end I started doing physical examination soon after ‘whole body is sick.’ The language barrier—my translator’s Indonesian was not good either—made it impossible to get a reliable history of illness. Later in his house, Kees helped me with the translation. ‘whole body is sick’ was usually malaria; hosa was shortness of breath with cough and chest pain, most likely pneumonia; and ‘leaked’ was diarrhea.

Along the way home to Mabilabol, I pondered on the life of those people and over their irrational believe of illness causation. But, that irrational believe might have saved them from the “extinction.” In the jungle, there might not been any anopheline mosquitoes, therefore, the malaria transmission was cut off. However, I realized that the strategy was not enough to fight against malaria. They needed help from Bill Gates and other billionaires who are concerned about ATM (Aids, Tuberculosis, Malaria).

School in the Interior

School system started 2000 to 3000 years ago in ancient Greece, China, India, and Mesopotamia; in the interior of Papua, it started 25 to 40 years ago. It is an evolution process in those countries, but a revolution in Papua. And It has resulted in entirely different, even the opposite, impacts.

Kees had made an itinerary for me. Serapding and Dabolding was an ‘appetizer,’ only half an hour from Mabilabol. Today I would walk for two hours, the estimation from Kees. Not too bad because I had done longer walks before in Ilaga. Moreover, I would carry nothing but a small backpack because Kees assigned five men to help me. They carried medicine in aluminum boxes with their noken, the traditional net bags.

Losing the sight of tin roofs made me feel good. The mountains close to us were green; the faraway ones bluish. Having passed a stream, the path became narrow and rocky. The first half an hour was really fun, but afterward the struggle started.

Even with sandals—others barefoot—and no heavy bag, I was still the slowest walker. The path was very slippery, to me. When I first slipped and tumbled, I laughed and they laughed; at the fifth times, I cursed and they were mute. Swallowing my pride, I accepted a stick from them after the belt of one of my sandals was broken off.

The sharp rocks were stabbing my soles at every step. My calves were aching from walking up and down steep paths. And I felt cold; my T-shirt was wet from the mixture of sweat, rain water, and mud. When my feet were stuck in the mud, I was thinking of the hookworms. I had some wounds on my legs and the larvae of the worms could easily enter my blood vessels. Let them be, I had medicine for worm at the presbytery.

Having walked hard for two hours, the voice of children was melodious. Finally my misery would end soon. My legs that had been very heavy became light. “We rest here,” I said to my team when we reached the elementary school, the origin of the children’s voice. I stretched my legs and lay down on the building floor. Heaven!

“What is the name of the harbor in Aceh?” The question came from the classroom behind the wall. No answer. “Sabang.” It was not the voice of children, but a man’s, the voice of the person who asked the question. He continued asking many questions on the names of harbors and airports in Indonesia and answered those questions by himself. I suspected he just read the names from a book in front of him.

“Who is the name of the president of America?” Quiet. “Who is the president of Indonesia?”

“Soeharto.” A girl’s voice. Girls are smarter in most elementary schools.

I was very sure that none of those children had seen a harbor, and most of them might never see one in their whole life. I was sure too that not all of them knew what a harbor was. They might ask what a ship was when the teacher explained what a harbor was. They knew a dugout, and it does not need a special place to go ashore: the largest canoe was about six meters, the longest log they could get from the jungle. And only the teachers’ children who had seen cars and motorbikes.

Aceh? Sumatera? America? Where are they? They heard Wamena, Sentani and Jayapura, the places they often heard from the communication radio at the presbytery. Wamena was two hours away by Cessna; and Sentani was about one and a half hour.

President? Was he like a the tribal chief? How many wives did he have?

Imagine how frustrated the teachers are in teaching the national curriculum at the interior schools—well, they might have been not; the most important is finishing the syllabus and receiving the salary every month. For students, memorizing those names and words is crucial; they are the answers of the final examination of grade 6, the first step to become a civil servant. The next step was to receive a certificate, the absolute pre-condition of the application. Failing to do so, they would be a farmer for life.

How many of those students would be civil servants? For the boys, not more than 5%, I believe; girls 1%. However, most of them would receive certificates—even the ones could hardly read—because their parents or themselves had paid the teachers. These ‘graduates’ usually refuse to work in the garden or gather food in the forest. They would hang around in Mabilabol for a while, jump onto the Cessna, and end up as jobless migrants in the regency or provincial capitals.

I agree that these people need education to prepare them facing the unavoidable modernization, but the curriculum should be adjusted to the needs of the majority—farming technology for better food; hygiene and sanitation for healthy life, simple reading and writing for local jobs. Sadly, until 2013, the school system is still the same as in 1989: memorizing names and words.

Pregnant Men

If our body has something grossly abnormal, we always try to fix it. We will do ‘doctor shopping’ and spend so much money; we might even borrow money in doing so. This abnormality will affect our mood negatively and influence our social relationship undesirably. This chain of reactions does not happen to the Papuans in the interior.

Okpoldib was also a government resettlement for local tribes, but it was much larger than Dabolding and Serapding. The houses were precisely the same type—wooden walls and tin roofs plus a kitchen hut at the back—but they were in four rows; the total number was 120 houses. A trench about 10 centimeter deep and 20 centimeter wide ran in front of each row of houses. The water was brown, in contrast to the color of the white soil, but I could still see the mosquitoes larvae wriggling in it.

Having dropped our luggage in the community center, I explored the bush at the back of the housing complex and visited the closest houses before finding a small can. I filled it with some water and went back to the bush. I found the right spot behind the bush for draining my bowels. I had had a stomach ache for the last one hour.

Of course, what I had done was not a good example for the villagers. Both they and I did the same thing for the same reason: no toilet in the village. I was sure that there had been a toilet picture on the sketch of the house the contractor had submitted to the government during the bidding. I was sure too that the officials knew about the invisible toilets before he signed the document stating the project completed. The money split between businessmen and officials did ‘magic’ in all projects in Papua. And, the victims were always the local people: staying in ‘the healthy house’ without toilet.

The community center was packed with people when I came back from the bush. It was a big building, about 10 times 10 meters, standing on high wooden poles. Its walls were low so that I could see the people inside. The floor clattered when I stepped in. “Watch out, Doctor!” people shouted. I would have ended up under the building if they had not warned me. The plank I would step on was loose; we had to step on its center to pass it.

I glanced around the building. The women and children were sitting at the right wing of the entry. The men were standing at the other wing; the sitting ones were the old men and sickly looked ones. About 100 persons, I estimated; half an hour ago, there had been none. The messenger Kees had sent worked well this time.

As there was no furniture in the center, we borrowed desks and chairs from the school. Four desks became one examination table. I ordered the chairs and the other desks put at one corner. The patients would be registered and called by one assistant from Kees; two other assistants would give medicine to the patients I had examined; the translator was the local teacher.

Almost all people wore traditional clothes: men with penis gourds (koteka), women with grass skirts (sahli). Comparing with the Dani in the Grand Valley of Baliem and in Ilaga, the Ngalum people are short: men are around 150 cm, women 140 cm; only the Yali people are shorter than them; the Dani are about 170 cm or taller. They shared the same genetic source from the same ancestors coming from the Asia thousands years ago. They are the evidence of the evolutionary process: short stature is more advantageous for moving long and fast in the rugged mountainous regions.

Geographic isolation—mostly caused by tribal wars and rugged landscape—could be one of the main differential factors on physical morphology, also on linguistics diversity. However, this geographic isolation theory cannot explain the physical difference between the Ngalum and the Dani in the west area of the Baliem Valley. Both the Star Mountain and West Dani area are very mountainous and rugged. I suspect the protein is the main differential factor. There was more animal protein (large crayfish) in the rivers in West Dani than in the Star Mountain range. This nutritional effect is very obvious between the coastal people or small island people and the Ngalum people.

The most striking feature is their bellies: they were huge except for young muscular men. I noticed too that the pot belly people were rather pale comparing with the not-so-big belly ones. In other areas of Indonesia, I would suspect either heavy burden of intestinal worms or too much alcohol consumption is the cause. Worms mainly among the children, alcohol the Christians.

I asked the assistant to start the registration. It was the men who first came to the table. “The very sick and women with babies come first,” I told the people. I moved among them doing triage.

‘Limpa’ was the word from almost everybody when I asked their complaint. They pointed their upper left belly while saying so. I examined them and found the limpa patients have really enlarged spleen. Limpa is the spleen in Indonesian. An Indonesian doctor must have told them the name of the lump in their belly.

Normally the spleen is not palpable. Some diseases, one of them is malaria, cause the spleen enlarged because it is part of the immune system in fighting the invasion of the germs. However, the spleen of some people here were enlarged so gross that I could see it from a distance. When I palpated their belly and measured their spleen enlargement, I had a difficulty in the beginning: I could not feel the lower edge of the spleen. Later, I knew my mistake: I started the palpation in the wrong location.

At medical school, I learned that the spleen enlarged from upper left to lower right of abdominal cavity and quantify it with Schuffner Scale 1 to 8. Here, the enlargement was not that direction, but from upper left to lower left. The spleen could have filled the left half of the abdomen, but the Schuffner scale was still no more than 4. I learned later that I had to use the Hackett Scale instead of the Schuffner one.

These people’s spleen was so grossly enlarged that it filled the hip cavity, below the abdominal cavity. Its lower margin was in contact with the hip bone and made me difficult to detect it. If they were men and walking, they walked like pregnant women because the enlarged spleen was very heavy and it forced them to bend their back bone in the abnormal curvature.

Spleen is a fragile organ, the reason why it is well protected by the rib. When it enlarges, it exposes to the danger of being ruptured by abdominal trauma. Some of these people had spleen bigger than a football and they still played football. If their spleen was hit by either the foot of other player or the ball, the possibility of death was high due to the massive internal bleeding.

The women do not play football, but it did not mean the enlarged spleen less risky to them. Domestic violence was common and some husbands might be ‘confused’ and kicked the ball inside their wife’s belly. The other danger was when they were pregnant: there was not enough space for the fetus to grow. If they reach the maturity, it would be a miracle if they could come out of the womb alive. But, the miracle happened sometimes.

Malaria was the most likely of the cause of the limpa. Normally the spleen will shrink to normal size when malaria is cured, but these people seemed having malaria all year. There are drugs for malaria prevention, but they are not safe for long term use and the people are not used to taking medicine regularly—irregular medication with inadequate dosage will produce drug resistant, the most challenging factor in malaria eradication program.

As mosquito control is almost impossible in the interior, the only option available is leaving the endemic area. They did it by staying in the jungle, but they had to come back to the village after the wild fruit and animals were not enough for everybody. In the end they just accepted the malaria as the part of their life and the enlarged spleen became normality. They would reach an endemic equilibrium state, if they are lucky, the state indicated with the population stability or zero population growth: the number of dead people equals the number of survived babies to adulthood.

Providing Medical Service

Besides her husband, doctor is the only man that woman lets stare and stroke her body. The Ngalum women let me do it too, but I needed some people to make these women lying on their backs.

My first patient was an old man with a penis gourd; he did not understand Indonesian at all. I put the back of my left palm on my right cheek, bend my neck to the right, and closed my eyes. He understood and lay on the floor. But, there was a problem: he lay on his side. I asked my translator to ask him lie on his back but the patient refused to do so. “He is ashamed,” my translator said. I got it, and I asked him to move to the corner of the room. This time he did not mind to lie on his back because nobody could see his testicles. People could still see his testicles swaying under his groin when he was walking but he was not ashamed. Why?

To examine the abdomen of a man with a penis gourd, I needed help from someone to hold it down. The gourd lay on the wall of the abdomen preventing me from palpating the liver and spleen correctly. Pulling it out was not an option; no man would let me do it in public. Examining a woman was more arduous; I needed help from two women, at least. The women were shy and almost all of them had never been examined by a doctor or male nurse before. The corner was not private enough; finding and installing a curtain would take a considerable time. I had to compromise: examining them with their position on the side. Not perfect, but it worked.

Doing an obstetric examination is always a struggle; I could not do it in the compromised position. I absolutely need two persons to hold the patient’s legs to the sides. Otherwise, I would play ‘peek a boo’ with the patient: I move the top leg to the side, she moves the other leg on it, and we keep doing it until some people restrained both of her legs.

“Why are they laughing?” I asked one of the teachers.

“They have never seen people examined by a doctor,” he answered. I then remembered that the first doctor only stayed for one month and had not have time move around. The nurses, including the non-papuan ones, never do physical examination. They only ask ‘what is your sickness’ and give the medicine. And, most doctors do the same thing, unfortunately. They suffer from post-graduate amnesia by forgetting the rule number 1 of internship: ‘no history of illness, no physical examination, no diagnosis’.

They were amused; I was frustrated. For malaria, I had no problem; I took enough chloroquine from the puskesmas. But they had many other diseases. I heard non-stop coughing from various spots in the room. Most children had one or more the following diseases: respiratory tract infection, diarrhea, severely infected wound, scabies, and skin fungal infection. Kees had informed me about these diseases, but he did not give me enough medicine for the treatment. Since everybody asked me to treat their skin problems, I gave a small tube of ointment, supposed for one person only, for 3 – 4 people—squeezed the content into some plastic bags. I did the same thing to a bottle of syrup medicine.

All patients took the medicine on the spot. My assistants gave the pills and water to the adults and I spooned the syrup into the mouth of the children. I also asked the assistants to give instruction how to take the medicine at home to everybody. We could not write it down because all of them, except the teachers, were illiterate. For the wounds, I had to do the dressing by myself because none of the assistants were paramedic.

“Do not take it at once,” I said it for more than 30 times. “Each time one spoon.” I was not sure they would or could do it. Many of them did not have a spoon at home. I hoped that none of them would be smart enough to think ‘it is easier to take one bottle at once than to take it spoon by spoon every day.’ If there was, it would be a disaster: drug overdose and a dead child.

To minimize the possibility of drug overdose, I gave them takeaway medicine in plastic bags. For instance, chloroquine was taken over three days—I shortened one day for practical reason—3 pills on the first day, taken on the spot, 2 pills every day on the next two days. That was easy for adult, but not so for the children. I had to grind the pills and fill the powder into a small plastic bag. This process was time consuming and the dose was inaccurate because I only brought one pestle and one mortar.

For the medicine taken more than once per day, more work and time were needed. I drew on the plastic bag a half of ring for the sunrise, a full one for noon, and another half under the ‘horizon’ for the sunset. Each bag contained the pills or the mixed powder they had to take at one time. One patient could have nine small plastic bags for three day medication; more than nine would be confusing.

Some children had pneumonia. Penicillin injection was the drug of choice, and I had it with me. The problem was the penicillin injection needs to be given more than once per a day and over 5 to 7 days. The maximum I could do was to give injection once, and left some antibiotics pills to the parents for taking home. The effect of oral antibiotics on the severe diseases such as pneumonia is not reliable. However, it was better than nothing.

I had treated many patients, but the people did not seem fewer. Most of the treated patients and their families stayed. They watched me working, talked to each other, and giggled. They looked happy. Some of them were eating boneng, the sweet potato, their staple food. I was hungry and looked at my watch, ten minutes past one.

Rain was falling and the center was wet from the rain water splashing through the open wall and dripping from the roof. We had to move the desks and chairs to the dry area. I was freezing but keep working. At two o’clock, there was no sign of lunch coming yet. I was starving, my belly hurt. I had finished all snack I brought from Mabilabol. The only thing I could swallow was drinking water.

“No boneng or taro?” I asked the local teachers with some irritation. They looked at each other, silent, and one of them told a boy to go the teacher house. One hour later the boneng and taro came. Baking them was a long time for a starving person.

The rain had stopped when I finished treating the patients, but then the center was surrounded by fog. I hastily packed my things; I did not want to be caught by either the rain or darkness. The return trip was supposed to be easy because we went down, but it turn out to be harder than the coming one. The rain made the path muddy and very slippery, and forced me to ‘walk’ on my butt often. The walking stick did not help me much; some people held both my arms when we passed some difficult paths. I was staggering because my right big toe was throbbing painfully after tripping up on the rocks a couple times.

We arrived at a small bridge. It was not really a bridge, but two rotten logs crossing a gully. People in front of me passed it easily. When my turn came, I stared at the bridge, thinking. No rail I could hold. “Doctor, go down. The bridge is too slippery.” It was too slippery for me, but not for them. They ran crossing the bridge so easily, reminding me the martial art masters in the movies.

Some went down ahead. Ignoring my pride, I went down into the gully. Two persons held my hands from the top, another two held my butts below; slowly they released my hands. At the other end of the gully, two persons pulled me up while the other two pushed my butt up. I felt so hopeless.

Medical Miracle

Medical miracle happens rarely; it happens when patients with mala (poor) or pessima (very bad) prognosis survive. It seems this miracle occurs more often in the areas lack of western medical system.

They were watching me at the door, then talking and laughing. I ignored them, busy with the malaria slides and microscope on the table. It was a small room by the convent; the Oksibil nuns had let us—the US NAMRU team—use it as our laboratory and clinic.

“Doctor, do you remember him?” the speaker pointed to his friend. I look at the pointed boy, a Ngalum about 13.

“No,” I replied.

“You saw him three years ago.” He mentioned the village and it lead my mind to the past.

Traditional villages spread out across the interior of Papua; the population is between 40 and 500 each. The most populated village is usually the center of the district administration or the mission station; it usually has an airstrip. In a cluster of hamlets—small villages—the closest neighboring hamlet could be one day walk. And, this was the hamlet Father Kees suggested to visit. “The people say there are a lot of people died in Bulangkop. The cause was unclear because those people have not come here often. I myself have not visited it for quite a long time,” he said.

Kees gave me six travel companions; one of them was Allo, a seminary student from Ilaga, the area I had just visited a week before. Two years later he became the first priest from the West Dani tribe, an achievement for him and his tribe. Studying seven year in a seminary was a struggle for a papuan because there had not been a formal and written education system in their society. And, celibacy had been unknown in their culture. And, recently I heard he took off his robe and got married. The chemistry in his brain is stronger than the calling from Jesus Christ, I think.

We passed Okpoldib quickly and easily because I took one day break before. The landscape was pristine but the path then became steeply up and down; gradually the path faded from not being used for some weeks even months. I walked with a stoop and was often out of breath at long climbing. Climbing was not so torturing comparing with walking down—my buttocks hurt and wet from ‘kissing’ the soil when I slipped.

I always expected a flat path at the peak or the bend in front during the climbing. Flat paths were heaven, but mostly fleeting. The sliding following the climbing path was the pattern. My knees hurt badly when I tried to stop the sliding on the steep slopes. To pass a very narrow bend, I had to lean my body to the wall, put my feet on the protuberance of roots, looked for anything to grab—usually tree branches or roots—and move sideways. I might look like Spiderman. If there was nothing to grab, two persons grabbed me from both sides; they kept me moving and alive.

Having walked for nine hours—fell into gorges twice—we finally arrived in Bulangkop. There was only one ‘healthy’ house: the local teacher’s; he also taught catechism or Catholic religion to the people who wanted to be baptized. I entered the house and lay down on the bench in the front room. My legs throbbing painfully and I started to feel cold and hungry—colder than during the trip—then I changed into dry clothes.

I gave rice, noodle, and tinned food to Lucas, the landlord. I did not expect food from the villagers anymore. There was an unwritten rule in the interior: the straight hair should feed the frizzy hair. If they come to our house, we feed them; if we come to their house, we feed them too. I considered the food was the payment for the bed, a small one without mattress in the front room—it was also my clinic.

There were a few people came on the first day; some of them from another village two hours walk. Most people were in the jungle looking for food; some children stayed for schooling. After half an hour without visitor, I went to a honai, traditional hut, in which the people said there had been a very ill person. We opened the door, it was dark. Sunlight penetrated through the door and the gaps on the log wall, but it was not bright enough for me to examine the person lying down. I could see his ribs because he was naked and very thin. He lay down still, but I knew he was alive from his heavy and noisy breath. He had pneumonia, I was pretty sure.

He did not respond to my calling, but opened his eyes for a short time when I pinched his belly. I put the bell of my stethoscope on his chest: abnormal sounds on almost the whole lung fields. With the medicine I had and limited visit time, he had hardly had a chance to survive. He could not eat at all, only drank water; he should have had an infusion, which I did not have with me. I gave him penicillin injection and chloroquine every day for three days. When I left Bulangkop, he was still alive, but no significant improvement. He would die soon, I thought. I was wrong. He is the boy in the beginning of this story.

Naming Mountains

Papua Island (both Indonesia and PNG) might be the island with the highest number of mountains, hundreds, in the world. As it also has the largest number of tribes (around 500)—with their distinct languages—the naming of mountains is complicated. Some of these mountains have strange names, such as Saw Mountain, Star Mountain, or even Boobs Mountain.

The next two days, I visited the neighboring hamlets. All were traditional; all were simple but beautiful. However, most of them had no people. The people were in the jungle, my travelling companions told me. Some came to me, received the treatment, and returned to the jungle. But, their reason was not running away from the angry evil spirits, but gathering food and hunting animals. The teacher said there had not been many people dead recently.

In one hamlet, the people told me there was a very sick person. They took me to his honai. It was empty. “Where is he?” I asked them.

“This morning he was here.” We searched him in the next hut. He was not there either.

“It is him, Doctor!” the boy was pointing at the bush behind a big hut. I saw a moving shadow and the children chased it. They called the name of the ‘sick’ man. He was too quick for the children.

“Let him go. He will not die today,” I told the children. Dying man could not run fast; refusing medical service was a human right.

Brother Allo arrived on my third day in Bulangkop. “I felt I was going to lose my legs. That Bald Mountain!” He pointed the high mountain in front of the teacher’s house. I was amused. I had not known that mountain’s name was Bald Mountain, but I noticed Allo’s head was bald.

The names of mountains in Papua—hundreds of them—are often weird. I had no idea, might nobody neither had, why people named where I was the Star Mountain range. I looked up in the maps of Papua. It has different name, a Dutch name. Most geographical bodies in Papua such as rivers, lakes, mountains, and valleys, are in either in Dutch or local languages on the maps.

Each tribe has a name for every mountain around them. The other tribes who live not far from that tribe have different name for the same mountain. Thus, one mountain could have 4 to 7 names. The names are often funny; one mountain was named Boobs Mountain, which is easily guessed the origin of the name.

The peak of the Bald Mountain, viewed from Bulangkop, had always been foggy or cloudy all day. Allo left Oklip two days ago and he had to cross the Mount Bald and some other lower mountains to come here. It would be very hard for the big man doing so, but he made it. He had lived in Papua more than ten years and got used to climbing mountains for days.

As the sign of my sympathy, I gave all my rice and instant noodle to Allo. These foods were luxurious here. One kilogram of rice was 2,600 rupiah while in Java was only 400 rupiah; one pack of instant noodle was 750 rupiah, in Java 100 rupiah. The airfare is the cause of these crazy differences. It cost 2,000 rupiah to carry one kilogram things from Jayapura to Oksibil. Making it complicated, the maximum capacity for one flight is only 300 kg (including passengers) and the flight had been irregular.

On the way back to Mabilabol in the following day, we dropped by at Anabang hamlet and provided a brief medical service. The people living in traditional hamlets were healthier than the ones in the resettlement complex; the honai is healthier than the rumah sehat, the healthy house. Finishing the service, we rushed out. We had missed good food and soft mattress and warm blanket.

Hell Village

Mosquito is well known for its annoying bites that could transmit deadly malaria and dengue hemorrhagic fever. In Papua, it also transmit another awful disease: elephantiasis. The scary thing about it is the elephantiasis is a silent illness. You will only find out you have it years later after getting the bites. It still haunts me, sometimes.

Kees gave me 2-day break before the next service. This time we flew because it would have taken us 3-day walk to Iwur. The rainforest became denser when we left Mabilabol. The mountains became hills after three minutes on the air. And, the winding rivers became wider and brownish, look liked gigantic snakes. The most beautiful view was the birds: numerous and very colorful, and big. Flocks of birds were either flying around below us or playing around on the canopies.

The Cessna flew low after five minutes on the air. I wished we had flown longer. “Iwur,” Kees, sitting next to the pilot, pointed a group of traditional houses below. However, the airstrip was not close to it, but across a river, the Digul River, the famous river in the Indonesian history. There is a place called Tanah Merah (means red land) down the river where two founding Fathers of Indonesia, Bung Hatta and Syahrir, were isolated by the Dutch colonial administration. In Tanah Merah, the River Digul was much wider so that big ships can sail it.

The landing was easy because the airstrip flat and open, but the river crossing on foot was not. A rattan bridge was hanging on the river, but it did not look like a bridge: two pieces of rattan on the floor and another two for the rail. The locals crossed the river through the bridge; we did it by a dugout. The river was around 15 meters wide and the current was strong; the canoe went ashore about 25 meters to the right of the departure point. Surely the people arrived at the other side much faster than we did. But I did not think I would cross that swinging rotten bridge. I did not swim well enough against the current.

The people took us to a little wooden house with tin roof. The roof and side window were covered by climbing plants. It was a presbytery. Kees opened the rusted padlock of the door. I smelt the moldy air inside the house. It had not opened for months. Kees asked the people to clean it up.

While they were cleaning the house, I went down to the river. I took off my clothes, except the underwear, and immersed my body in the water. It was good. Iwur was very hot because it was only 200 meters above sea level. As there were no people in the village, we had no service on the first day, and I could stay long the river and explored the surrounding.

I went back to the house at dusk. The air was not too hot anymore, but there was another problem. Hundreds of mosquitoes were hovering above my head and they bit my legs, arms, and neck. I applied insect repellent and then sat next to Kees. He was holding the name list of Iwur people. I often heard ‘dead’ word from the people when Kees read the names. He crossed about 100 names in the list, including the local paramedic. It meant 25% of the population had died within six months.

The survived ones did not look well either: pale and skinny. Their hair was straw-colored, one indication of malnutrition. Their bellies were huge. And the most peculiar was the ‘ball’ under the belly of some men’s—as big as a volley ball. I had not known what those were until Kees told me about the elephantiasis, the disease that I only read in medical textbooks. I noticed too many more people had swollen legs and arms, the other forms of elephantiasis.

The cause of elephantiasis is filaria, tiny worms living in the human blood and lymph systems. Like malaria, filariasis is also transmitted by mosquitoes; the difference is there more than one genus of mosquitoes can transmit the disease—only the genus anopheline in malaria. These tiny worms block the flow of the lymph system in some parts or organs of the human body. The accumulated fluid causes these body parts or organs swelling and hardened.

Most of the people were still in the jungle. As no messenger had been sent, I had to see them there. We walked south in the mud for half an hour before reaching the Digul River. This time there was neither bridge nor dugout. We had no choice but crossing the river on foot.

I took my shoes off before stepping into the river. The current was strong; I could have managed it if the bed of the river had not been very slippery. Just about two meters from the bank, the water surface was already on my waist. I could cross it by jumping from one rock to the other rock—like in the classic Mandarin martial art movies, which was done by some of my travel mates—but they were too slippery for me.

Two people were holding my hands, but it did not help me from being pushed by the current. I was wet to the head even before the half of the river width. And, I decided to cancel the trip after swallowing some river water when the current knocked me down.

My shoes were wet, but I put them on back anyway. I raised my trousers and saw some things falling down. Leeches! They were fat; the skinny ones were still hanging on my legs. I counted after removing them off: 15. My lower calves were itchy and painful. I could still see blood flowing out from the bite wounds.

We only stayed for two days in Iwur. Nothing much we could do. The jungle was too difficult for me to venture within a short time. When we were back in Mabilabol, the medical team from the Provincial Health Office, one doctor and three senior health officers, had arrived. Allo and I flew back to Sentani on the next day. My first mission was accomplished.