Saturday, November 19, 2005

Iwan


It was January 1994 and Min's house in South Jakarta, the one next to his former school at Wisma Utara, was still empty. It was time to find out if Iwan, the boy with leprosy, was ready to move out of the leprosy hospital and into Min's former home.

On a sunny Saturday morning I motored to the hospital in Bekasi to see Iwan and his granny. I have to admit that I might have misjudged the place. Now, as I arrived, I was noticing the hospital's flowering bushes, the neat patches of vegetables, and the training workshops. Iwan was seated beside his granny on a bench outside his ward.

"Iwan! How are you?" I asked. I could see he was now chunky, almost fat.

"Good, Mr Kent. We want to go home." Iwan wore a wistful, pleading expression.

"Let's go and see the doctor," I said, hoping I would not meet the middle-aged doctor with whom I had once quarrelled. "He may want you to stay."

Dr Agus was a friendly young man with intelligent eyes. There were a few damp patches on the ceiling in his surgery; the metal chairs were uncomfortable; but the doctor's white coat was spotless.

"Iwan would be better staying here, for physiotherapy," said the doctor, smiling warmly, "but he can treat himself at home as long as he calls in here once a month for any surgical work required on ulcers. He still has to get his medicine. There's some resistance to the drugs but they're still effective for most people and they are working for Iwan. You know it can take years to cure leprosy."

"Is he a risk to anyone?"

"Not as long as he's getting his medicine. It's like TB."

"What causes the leprosy?" I asked.

"Bacillus mycobacterium leprae is the bug. This kind is related to the TB bacteria but it grows much more slowly. We think you get leprosy by long term, close contact with an infected person. It's not easy to catch and most people seem to have immunity."

"So Iwan probably caught it from someone in his village in Karawang? Wouldn't he have kept a distance from someone with their flesh eaten away?"

"At first, people show no signs of the illness," said the doctor, "but they may still be infectious. And in some homes you may get a dozen people sleeping in one small room. You know we're still getting a lot of new cases."

"So what does leprosy do to you?"

"Skin sores and ulcers develop. There's numbness. Flesh and nerves get destroyed. The ends of toes and fingers may disappear."

"So Iwan will always be limping around?"

"I'm afraid so. Ideally we'd go into patient's homes and villages and wipe this disease out."

"Why's that not happening?"

"In Indonesia we don't spend enough on health. Much less than Malaysia. And some of the money is misused. Another problem is training. There's no minimum standard for doctors and nurses."

"How is money misused?"

"Let's just say that some administrators lead very comfortable lives. When you pay a bill, always get a receipt. Otherwise the money could go into someone's pocket."

"Does that happen here?"

"Not here." The doctor was looking at his broken filing cabinet.

"You mentioned nurses?" I said.

"It's a problem in this country. My mother was in Hospital. The doctors were good but some of the nurses would never have passed nursing exams in Singapore or elsewhere. One nurse was trying to attach a drip and managed to get blood all over the floor. No rubber gloves."

Iwan was looking unhappy.

"So," I said, turning to Iwan, "The doctor would prefer you to stay here."

"Mr Kent, I want to go home," he said, looking tearful.

"Will you remember to take the pills?" I asked.

"Yes, Mr Kent."

"OK. Do you want to live in Min's former house in Cipete?"

"OK, Mr Kent." Iwan smiled shyly and his granny gave a big toothless grin.
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