The Trace of Bird Flu from Kubu Simbelang (Jejak Flu Burung dari Kubu Simbelang)

By Khairul Ikhwan D

Generally, the condition of Kubu Simbelang is the same as other villages in the subdistrict of Tiga Panah, the district of Karo, North Sumatra. The farmland’s soil is fertile, the community values the tradition, and the harmony is maintained. However, people here really do not like talking about bird flu. It is not a taboo thing, it is just that they do not want to recall the trauma in the past.

“What is the use of talking about bird flu. It has passed, it is in the past. It is better to talk about other things,” said Caranta Perangin-angin (39), one of the people living in Kubu Simbelang, early December.

Avian flu was once an enormous problem for the people. The name Kubu Simbelang was prominent when the avian flu stroke greatly in mid 2006. Seven people in the village, who were relatives, passed away. Six of them were positively infected by avian influenza. This case was stated as the biggest cluster of avian influenza infection in Indonesia, and as one of the biggest in the world.

The title as the biggest cluster changed the atmosphere of the village. Simbelang which is located about 88 kilometers from Medan, the capital city of North Sumatra, was thrown into a tumult in all of a sudden. Lines of vehicles passed through the village’s road that had not been covered by asphalt. People from all kinds of circles came, World Health Organization (WHO), officials of the Agriculture Ministry, Health Ministry, provincial government officials, as well as groups of journalists. This case became headlines in mass media.

Caranta complained, “ This was actually a minor case but people exaggerated it. Most people in our community still think that it was deliberately driven to obtain projects from foreign countries.”

The Death Toll

The case, which Caranta thought was exaggerated, started when a 45-year-old woman named Puji Ginting passed away on May 4th 2006. Puji’s cause of death was not clear but what certain was the fact that two of her chickens died a couple of days before. Soon after that, Puji got sick and eventually passed away. It was strongly believed that she died because she was infected by the avian influenza, despite the fact that her blood sample had never been examined.

Learning abou this sad news, all family members made a visit of condolence and during that visit they ate chicken in the house. The following day, the late Puji’s next of kins started to get sick and treated at Kabanjahe General Hospital, in Kabanjahe the capital city of Karo. The medical examination revealed that the patients had pneumonia, cough, muscle pain, and low number of white blood cells. This condition led to the initial sympthom of avian influenza.

The patients were immediately sent to Adam Malik Central Hospital on Bungalow Street Medan as the central reference hospital for avian influenza patients. They were placed in an isolation room. Blood samples were taken and sent to Health Research and Development Office of the Health Ministry in Jakarta.

Before the results of the samples were revealed, the son of the late Puji, Roy Karo-karo (19), passed away on May 9th, one day after being treated in Medan. On May 10th, the late Puji’s sister Anta Ginting (29) also passed away. The next one was Boni Karo-karo (18), Roy’s little brother, who passed away on May 12th.

On May 13th, Rafel Ginting (8) also passed away. He was the son of Dowes Ginting (38), the late Puji’s brother. On may 14th, Anta Ginting’s daughter Breinata Tarigan who was only 1.5 years old passed away at the hospital. The last casualty was Dowes Ginting who passed away on May 22nd. Dowes had not been treated at the hospital but the result of his blood sample test showed that he was positively infected by avian influenza. The only survival from the cluster was Jonnes Ginting (27), the late Puji’s brother.

The number of the death tolls was high but the source of the disease still remained unknown. It was only assumed that victims were infected by the same source but what it was, was still a mistery. People’s fowls were indeed inspected and examined. The specimen of chicken’s cloaca and faeces were taken. Manure was also investigated, especially around the victims’ houses.

“At that time, the result did not show any sample that was positively infected by avian inluenza,” said Indah Setiowati, The Head of Animal and Fish Health Section of Karo Animal Husbandry Service.

Nevertheless, a fowl demolition was conducted in Simbelang in order to prevent the viruses from spreading.  Furthermore, the district of Karo tightened the control of cattle traffics, fowl products and manure. Two checking posts were all set. The first post was located in Doulu village, Berastagi to check vehicles carrying fowls coming from Medan. The other post was located in Merek, to check vehicles coming from Dairi District and Aceh.

Social Intimidation

It had not been ensured where the source of the avian influenza came from. Yet this case had made the people in Simbelang suffer. The news in the mass media gave negative implication because the case had made North Sumatra be considered as avian influenza extra ordinary occurrence area. People were afraid to come to Simbelang because they were scared of getting infected. Most of public transportation also refused to transport people to the village. Even worse, almost all of Simbelang’s agricultural and livestock products were rejected at the markets.

Simbelang was started to be banished. Only people who were still relatives or had the same family name wanted to visit the village.

Actually, several days after the avian influenza case occured, the Head of Karo District, DD Sinulingga, was invited to the village to eat chicken and it was proved that he was just fine and healthy. However, this activity could not erase the stigma that the village was the source of avian influenza. The banishment kept going on.

This condition caused the people of Simbelang to reject the media, journalists and all outsiders who came to the village for avian influenza issues. They even gave an ultimatum to the health researchers to leave Simbelang. Demonstrations were carried out in Karo, Medan and Jakarta. The demonstrators even took the action of drinking chicken blood brought from Karo in order to show that fowls in Karo were not contaminated by the virus.

This effort did not bring an immediate result. Owners of chicken farms carried the heaviest burden. The price of chicken which was Rp. 15.000/kg did not attract people to buy it. Various activities of eating chicen together did not boost the sales. Most of the owners of restaurants in Karo no longer provided meals with chicken.

Tarigan, one of the livestock sellers in Kabanjahe said, “It is hard to calculate the lost. But for sure it’s a lot.”

Endless Cases

The cases of avian influenza in Karo seemed endless. After Simbelang, some fowls were found dead in other areas in Karo. It even spread to some neighboring districts such as Deli Serdang, Dairi and Simalungun. Different from Simbelang, this time research found that some fowls were positively infected by avian influenza.

Stamping out of fowls were conducted in various areas, including Sumbul, Sumber Mufakat Village, Kabanjahe, which was located about 20 kilometers from Simbelang. Some Sumbul residents were sent to Adam Malik Central Hospital because they were suspected to have been infected. Eventually the results were announced to be negative.

The stamping out did not run smoothly. Some people thought that their fowls were not infected and rejected to have their fowls culled, despite the compensation of Rp. 12.500 per bird. They finally agreed to comply because of the Law No. 4/1984 about epidemic and how to overcome the pandemic. The law determined that whoever obstructs the goverment’s effort to overcome the pandemic will be imprisoned for maximum of 1 year and or will be fined maximum of Rp. 1.000.000.

The absence of improvement in Karo had made Aburizal Bakrie (Minister of People’s Welfare), Siti Fadhilah Supari (Minister of Health) and Anton Apriantono (Minister of Agriculture) went to visit Karo and Sumber Mufakat Village. At that time, all ministers and the officials wore personal protective equipment, a protective suit which was called robot suit by the local people.

Some people were offended due to the fact that their village was considered as an infected place, and they fought against it. They asked the ministers to take off their protective equipments if they wanted to enter the village. There was a debate before the robot suit was finally taken off and the discussion with the people could be conducted in the village hall.

Three Years After

Avian influenza was actually not a new thing for North Sumatra. The first case occured in May 2005 in Huta Padang Sub District, Simalungun District and was stated to be positive. The Head of Reporting and Information of the Avian Influenza Disease Control Management Unit of the Agriculture Ministry, Tjahjani Widiastuti stated that although there was no human infected, the spreading was very rapid.

“Up to December 2005, the virus had infected 14 sub districts and municipalities in North Sumatra,” said Tjahjani in the Inception Workshop, Media Partnership Program: The Human Face of Avian Influenza, a joint program between the Agriculture Ministry and The Food & Agriculture Organization (FAO) in Jakarta.

Unfortunately, this first case was not made as a lesson. When the case of avian influenza occured in Karo a year later, the local government did not seem ready. According to Caranta, the weakness of dealing with avian influenza in Simbelang was the slow response. A few of days after the first victim died, there was no significant action taken such as poultry disinfection nor medical prevention for the people. It led to a high number of death tolls.

Furthermore, existing information was confusing. For example, the Health Minister stated that the source came from manure. Later on, this was annuled with an uncertain statement. People did not obtain adequate information about the disease.

“What happened was that the government spoke more through mass media. People needed a massive handling and not massive publications which led to bad perception about Simbelang as the source of avian influenza. However, it has not been proven until now,” said Caranta.

This was evaluated as an irony. The case was enormous with a high number of victims, yet the source of the disease remained unknown. The people had already suffered when the government eventually stated that there were no fowls in Simbelang infected by avian influenza.

Cured Because of Shamanism

The people of Simbelang had been banished at least for almost three months. Things got better along with the spreading of avian influenza in North Sumatra. Within the year of 2006, the disease stroke 26 villages in 17 sub districts and 11 districts and municipalities that led to the stamping out of nearly 100.000 birds. For the people of Simbelang, the spreading corrected the assumption that Simbelang was the source of the viruses.

When Jonnes Ginting recovered from avian influenza, it became a tremendous hope in the effort to overcome the banishment. He was the only survival from the case of avian influenza cluster in Simbelang. Jonnes was a proof that avian influenza did not always end up with death. However, what brought this man to recovery was unclear. All of Jonnes’ relatives who were also treated at Adam Malik Hospital were also given tamiflu and high dose of antibiotic. Yet, only Jonnes survived.

“Until now, we do not know the reason why. It can actually be analyzed medically to find out the cause but the cost is too high and there is a strong possibility that the test must be carried out abroad,” said Professor Luhur Soeroso, the Head of Avian Influenza Team in Adam Malik Central Hospital, the place where Jonnes was taken care of for about 2,5 months.

Jonnes also had a similar question. He was still wondering about what actually cured him.

“I don’t exactly know what cured me. Probably it was the medicine given by the doctors, chinese herbal that I drank, or perhaps because I drank traditional wine when I stayed at the hospital,” said Jonnes last December.

Jonnes was treated at Adam Malik Central Hospital since May 8th 2006. During the treatment in the hospital, his family also tried alternative healings. Len Ginting, Jonnes’ uncle said that some shamans also tried to heal Jonnes remotely. The result was not satisfying so that they kept hoping and relying on the medical effort.

According to Jonnes, the period of treatment was quite torturing with continuous blood sample taking and the ingestion of various medicines. He even tried to escape after the first couple of days at the hospital.

Jonnes said, “I went to a relative’s house on Jl. Pasar II, Medan.”

Four days later, Jonnes’ relatives brought him back to the hospital because his condition worsened. To prevent him from escaping, the police guarded his room in the isolation room Rindu A.

Under a very strict monitoring, Jonnes had to comply to undergo the treatment. However he could not get away from his addiction for “tuak”, an aromatic traditional beverage made of “aren” tree. The relatives quietly gave him the drink when the doctors were not around. It could be done because the control in the isolation room was not too tight. The relatives could come and go without having to wear any masks or other protective equipments. Excpetion was only during high rank officials visits, where standard isolation procedures were conducted as written in the guide book.

Medicines From China.

While Jonnes was being treated at the hospital, someone came to his relative’s house in Kabanjahe, bringing 2 plastic bags of dried grass herbal medicines.

“That man came from Hongkong, China. He mentioned his name through his translator but I do not remember it anymore. He asked whether that was the house of Jonnes who had been infected by avian influenza as reported in mass media. When I confirmed, he directly gave the two plastic bags. He said that it was the medicine for avian influenza and he guaranteed that Jonnes would recover. After that, I delivered the medicine,” said Len Ginting.

On that day, Len Ginting had just actually came back from the hospital. He could not bear the grief since he was sure that Jonnes would not make it just like his other relatives. However after learning about the alternative medicine, he went back to Medan on that same day to give the medicine to Jonnes.

“When you pour boiling water, the grass turn the water color to solid black. Soon after drinking it, Jonnes vomitted some kind of mucus a couple of times,” said Len Ginting.

Jonnes got better after ingesting one pack of the herbal medicine. He stopped taking the herbal medicine and the remaining pack was kept. However, Len was not sure where the pack is now.

Jonnes actually left the hospital on July 20th 2008 and he had an obligation to come to Adam Malik Central Hospital once a week for check-up. Recently, a team of doctors came every six months to Jonnes’ house on Jl. Veteran, Gang Sempakata, Kabanjahe.

Luhur Soeroso said, “It is only a routine check-up. Jonnes is no longer getting treatment and he does not take any medicine anymore. He is completely recovered. However, his health will probably be monitored forever.”

In connection with Black Magic

For Jonnes, the avian influenza virus has changed a lot of things in him. Prayers and spirit were the only things he had when he was treated in the hospital. Jonnes said, “When you are infected by avian influenza, spirit is the only thing that you have. Everything is very hard to do, but you can make it.”

Ever since he recovered, Jonnes no longer worked at Kabanjahe terminal, in Kabanjahe Sub District, Karo District, North Sumatra. With his wife Amesti Br. Tarigan (25) he works on his small orange plantation in Simbelang while taking care of his two children, Raymond Ginting (7) and Veldy Ginting (3).

“Now we go to the field to earn money for our family” said Jonnes.

After feeling completely well, agriculture was Jonnes’ choice. During his treatment at the hospital, he wanted to change many things, including leaving his life at the terminal. Among the mobsters at Kabanjahe terminal, the name of Jonnes Ginting was quite respected. Three months after being released from the hospital, the police caught him because he was involved in a murder case and was sentenced 4 months in prison.

Jonnes was indeed born in a family who ruled the street. His late father Ponten Ginting was quite respected in Karo. The Ginting family was known to have high magical power, and it was believed that Jonnes inherited it. It was proven that he could survive from a black magic attact, which was called avian influenza in the mass media.

When avian influenza became an epidemic in Simbelang, some of the people did not believe that it was a disease because it hit only one family. They were more convinced that it happened because of a practice of black magic, commonly called “teluh”. For the people of Simbelang, avian influenza was a new word and as a disease name, they thought of it as a quite strange name.

“At the time, people were afraid to go out of their houses. Not only because of avian influenza, but also because of black magic practice. If it were really because of a disease, then all the people in the village would be infected too. Besides that, a chicken farm in Kacinambun Village, which is located near Simbelang, was just fine. There is not such thing as avian influenza. It is already called bird flu, similar to bird news (rumor), it is not trustworthy,” said Karsima Sembiring (20), one of the people in Simbelang.

The Head of Public Health in Karo, Diana E. Sembiring admitted the fact that many people believed in avian influenza as a practice of black magic. Some people could not accept the fact that their village was infected by avian influenza.

“Change needs time, but we keep giving them explanation. Some people have already changed their opinion,” said Diana.

Apart from the different understanding, Diana said that people were still encouraged to live healthily and with good sanitation. They were suggested to locate the coops in the distance of minimum five meter off their house. Furthermore they were advised to go to the nearest clinic if sympthoms such as high fever, difficulty in breathing, flu, cough and pain were felt.

To anticipate the occuring possibility of avian influenza case, every public clinic in Karo was supplied with 200 tablets of Tamiflu. Meanwhile, one equipped isolation room and medicines were provided in Kabanjahe Hospital for avian influenza patients which costs Rp. 1.000.000.000. Therefore there is no need to take the patient to Adam Malik Central Hospital.

The isolation room for avian influenza patients was provided at Kabanjahe Hospital due to its status as the reference hospital for avian influenza treatment. In North Sumatra there are four more similar hospitals namely Pematang Siantar Hospital, Tarutung Hospital, Padang Sidempuan Hospital, and Santa Elisabeth Hospital in Medan.

Although the anticipation was well evaluated, one of Indonesia’s parliament member Nasril Bahar from North Sumatra said that avian influenza remained a serious threat. It is proven by the fact that unlike Maluku and Gorontalo, North Sumatra is still considered as susceptible to avian influenza and has not been freed yet.

“The cases of banishment that happened to the people of Kubu Simbelang should be seen as a valuable lesson for the government. A good handling module must be prepared. The banishment happened because people do not have adequate information and that is why socialization must be conducted continuously,” said Nasril.

Nasril added, “Of course the most important thing is to avoid casualties. Eight fatalities are enough for North Sumatra.”

The last human case fatality of the avian influenza was Nerpi Sitinjak (26), a resident of Percut Sei Tuan, Deli Serdang District. She passed away on May 12th 2007, 3 days after being treated in Adam Malik Central Hospital. (*)

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