Wednesday, September 21, 2005

Dede and Chandra

Near Bogor’s Jalan Pledeng, I called in at the simple red-roofed home of elfin schoolboy Dede, brother of gypsy-faced Rama.

"How are you and how is your sister?" I asked Dede who was sprawled out on the settee. I noted that his hair had grown long and that he was wearing dark glasses, an earring, a heavy-metal T-shirt, and ripped jeans. There was no sign of Rama or granny.

"Fine, mister," said Dede. "But I’ve had dysentery."

Now, what did I know about dysentery? There is bacillary dysentery caused by bacteria. There is amoebic dysentery caused by a tiny amoeba. And sometimes dysentery can be caused by parasitic worms. One study done on a sample of several hundred apparently healthy Indonesian schoolchildren showed that over 70% of them had some type of parasitic infection.

In some areas, 80% of Indonesians have had bacillary dysentery by the time they’re aged five. With bacillary dysentery, the disease strikes suddenly. At its worst there is abdominal pain, stools may become watery, there may be fever, nausea and vomiting, and there may be muscular pains, chills, backache and headache. After one or two days there can be pain in the rectum and lower abdomen and frequent small stools which may or may not contain mucus and blood. In severe cases there may be rapid weight loss and dehydration; the bug invades the lining of the large bowel and multiplies there, killing cells. Occasionally the bug invades the bowel beyond the surface lining. One form of bacillary dysentery produces a toxin, which causes additional tissue damage, and may lead to kidney failure. A doctor will prescribe antibiotics. Some strains of the bug are becoming resistant.

Amoebic Dysentery is common in Indonesia. In some regions over half the population are carriers of amoebic cysts. This is partly because human excrement is used as fertiliser. The cyst is the inactive stage. When cysts enter the body with contaminated food or water they are changed inside the intestine into active amoebas and may cause dysentery. The symptoms usually begin gradually. Some people who have the amoeba show no symptoms. But if the amoeba gets through the intestinal wall, ulceration takes place and there is diarrhoea which may be mild or which may involve high fever and frequent watery stools with blood and mucus.

With chronic amoebic dysentery, the patient gets diarrhoea, lasting for 1 to 2 weeks, several times a year. This can be dangerous if the amoebae spread to the liver or brain, and form abscesses there. Destruction of liver tissue is the most frequent complication of amoebic dysentery. Infection by amoebas, whether of the intestine alone or of other parts of the body, is called amebiasis. To diagnose dysentery a hospital should take several fresh stool samples over a number of days. This is because some of the stool samples of infected people will show no signs of amoeba. The disease may be treated with a ten day course of a drug like metronidazole to remove the amoeba from the intestines, with a drug such as iodoquinol to make sure the bug is completely killed off, with an antibiotic to deal with any bacterial infection, and finally with a drug to deal with any infection of the liver.

"What kind of dysentery have you had?" I asked Dede.

"Don’t know," said Dede.

"Did the doctor do any tests? Did he take a sample of any diarrhoea?"

"No," said Dede, with an amused look on his face.

"What medicine did he give you?"

Dede showed me a small cheap plastic envelope which failed to list the name of the medicine it had once contained.

"The doctor told me to keep my finger nails clean," said Dede, holding up nails that looked cleaner than those of your average Indonesian.

"Are you better now?" I asked. I had noted that Dede showed no obvious signs of weight loss.

"I’m better now," said Dede.

I politely declined the offer of tea and cakes.

After lunch of cola and biscuits at the Internusa shopping centre, I went for a stroll. Outside a brightly painted Moslem school, a brick structure that appeared to consist of perhaps only one or two classrooms, a skinny young boy with skinny bare legs was selling cakes from a tray. Around the boy, tropical sunlight created Matisse-like blocks of brilliant colour: the blue of the school door, the green of the wall, the pink of the boy’s shirt. The boy’s eyes sparkled with joy and his smile was wide and almost saucy. I took a photo and gave the child a few coins. He told me his name was Chandra.

I continued my walk, ascending steep stone paths and following winding lanes. It was Bogor at its best: a jumble of house walls and flowering shrubs with different shapes and textures and smells, a host of happy children, and the sort of air of gaiety you might expect on a sunny day on Italy’s Amalfi coast.

After half an hour I found myself back near the Moslem school and sighted Chandra with a group of small friends.

"Give me some money," said Chandra, holding out his hand and not smiling.

"I’ve already given you some," I explained.

"I need money," said Chandra, scowling.

"I’m not giving you any more."

Chandra’s eyes looked moist. He turned his back on me and stomped off.

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