Monday, January 06, 2003

42. THIRD WORLD

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I made another summer journey to the United Kingdom to see my parents. As proof that they were fit and well, my mum and dad took me on long walks in hilly Cumbria and showed me holiday videos of their treks in the Austrian Alps.

Prior to flying back to Indonesia, I spent a few days exploring London and there were two images of the metropolis that stuck in my memory. In St John’s Wood, I saw what looked like a fat-cat millionaire step from his million pound house into a big black Mercedes paid for no doubt with a more than adequate salary; and in the East End I saw a deathly pale anorexic little woman totter past a boarded-up shop with a child whose little face looked pinched and deeply lined with worry. The British newspapers were full of stories of drugs and drug-related crime but had surprisingly little comment about US inactivity in preventing mass genocide in Rwanda or US activity in keeping an eye on Zaire’s mineral wealth.

On the evening I returned to Jakarta, I hurried to see Min, whose Teluk Gong home was minutes from the airport. He was now almost as tall as his big brother, Wardi.

"How’s Min?" I asked Wati, as I stood near the door of their hot little front room. I could see that Min looked as if he had been through a rough couple of weeks. His eyes suggested bad dreams.

"He didn’t speak some of the time you were away," said Wati, with a slight grin.

I wished Indonesians could avoid smiling when delivering bad news. "Has his friend Mustapha been taking him for walks?" I asked.

"Sometimes," said Wati, avoiding looking at me.

"I’ve paid Mustapha in advance, so he should be," I pointed out.

"Mr Kent," said Wardi, sounding very concerned, "there’s a little boy called Nur who’s sick in hospital. Something to do with his brain."

"Which hospital?" I asked.

"The Dipo. A government hospital," said Wardi.

"How long has he been in?"

"Months, Mr Kent."

"Months! You should have told me before I went on holiday." I was feeling jet-lagged and not in the best of humours.

"I didn’t know until recently that Nur was ill," said Wardi, sounding indignant.

"Where does his family live?" I asked.

"Near our house, just down the road."

"And you didn’t know he was ill?" I was sceptical. There are few secrets in a small community where everyone is in and out of each others’ houses.

"They only just told us," said Wardi.

"Let’s go to the Dipo Hospital straight away. We’ll take Min." In Jakarta it was evening, but my body clock was working on British time, so I was not yet ready for sleep.

The third class ward for children was a dark, high-ceilinged, pre-Florence-Nightingale place, full of pale, emaciated little children. It looked as if no money had been spent on decoration or improvement for a hundred years. It was like a workhouse after the funds had been cut off. It made me think of cemeteries and gulags. We were not far from the luxury mansions of the politicians, the diplomats, the timber and oil barons, the generals and the administrators. No doubt top officials of United Nations institutions were dining in nearby five star hotels.

Nur, aged about ten or twelve, was lying naked on a bare bed. He was seriously malnourished and unwashed. He was not attached to a drip. Strangely, his plump mother, who sat by his bedside, had a smile on her face. Perhaps it was a smile of welcome, or embarrassment, or submission. Min was very subdued.

"Is there a nurse?" I asked.

Nur’s mother shook her head.

I glanced over at the next bed, where a small girl was having difficulty breathing. "What’s wrong with your little girl?" I asked the child’s sad-faced father, who was seated by the bedside.

"TB," said the thin ragged man.

"Is she getting any treatment?"

"We have no money."

"Doesn’t this hospital give free treatment to very poor people?" I asked.

The man smiled. The girl was struggling for breath. I hurried down the ward to try to find a doctor and in a side room found a small elderly nurse reading a comic. I asked her to come quickly to the ward. Making a sour face she got up and came to have a look.

"Her lungs are permanently damaged," said the nurse.

"Can’t you do something?" I asked.

"Nothing we can do," said the nurse. The girl was in fact now breathing more easily.

"What about Nur? What’s wrong with him?" I asked the nurse.

"It’s an abscess on the brain," she said.

She went on to explain that Nur had been in hospital for four months, that he urgently needed an operation, but that the mother could not possibly afford to pay for such a thing.

I looked at Nur’s tiny unclad skeletal body. "Why isn’t he on a drip?" I asked.

"The mother already has a large bill to pay. She has no money left," said the nurse.

"Can we move Nur to first class?"

"There’s a private wing," said the nurse, without enthusiasm. "You can pay for him to move there. But the doctors and nurses in the private wing are just the same as here."

I turned to Nur’s mother. "Would you like to move Nur to the Teluk Gong Hospital? They did a good job with a patient called John." I was aware that the Teluk Gong Hospital was run by Christians and that Nur was a Moslem.

"No," said Nur’s mother, quietly but firmly. "I prefer the Dipo Hospital."

"What about the private wing here?"

"Yes," she said.


Next morning I dashed to see Wisnu, at the expensive Jeruk Clinic. The boy was still being kept in a small side room and still looked too heavily doped.

"Is Abi here? Has Abi been taking Wisnu for walks?" I asked the nurse.

"Abi’s not here."

"Has he been taking Wisnu for walks?"

"I’m only here certain times in the day. You’ll need to ask Abi?"

"Do you think it’s likely he’s been taking Wisnu for walks?"

"Ask Abi."

At that moment, the affable and ever charming Dr Joseph arrived to pay a visit to his patients. I explained to the doctor that I wasn’t happy with Wisnu being tied up and heavily drugged. I wasn’t happy either with the high cost of the clinic.

"Wisnu has these movements of the head. He does need medication," said the doctor, looking concerned.

"Very expensive medicine?" I asked.

"You know there are cheaper medicines in Jakarta, but many of them are fake."

"Fake?"

"When you buy cheap antibiotics, be careful," said the doctor, putting on his serious face. "Many drugstores don’t have the proper licenses. Sometimes the medicine is bogus and could even kill you."

"Where do the cheap medicines come from?"

"Officials. Crooked hospital staff may sell hospital medicine to sidewalk vendors or drugstores. Then there are factories making fake pills."

"Who’d do that?" I asked. Was I about to learn yet more about the awfulness of the elite?

"Maybe very powerful people. Very high ranking."

"Who can you trust?"

"Government ministers go to Australia or Germany when they get sick," said Dr Joseph, winking. "But you’re OK at a good private hospital here." He emphasised the word private.

"What about Wisnu?" I said, feeling that the conversation was getting a little off track "What are we going to do with him?"

"I have another clinic, the Taman Clinic," said Dr Joseph. "I run it with several partners. It’s not near here but it’s cheaper. Wisnu can move about more there."

It was beginning to sink in that Dr Joseph must be doing quite well financially; he worked at the Dipo Hospital and at Dr Bahari’s clinic, and he had a financial interest in two clinics, the Jeruk and the Taman. "How far away is the Taman Clinic?" I asked.

"Half an hour’s journey from the centre of the city. Shall we have a look?"

"Let’s go."

The clinic was in a sizeable bungalow with big light rooms which were crammed full of beds and doped young adults, all fairly smartly dressed. Some patients were lying down, some were seated watching a big colour TV, and some were wandering about. Nobody was in a straight-jacket. There was a large garden for recreation. It was better than the Jeruk Clinic and I decided that Wisnu should move in.

"Please don’t give Wisnu too much medicine," I said. "He doesn’t need to be doped."

"He does need some medication to help control his head movements," said Dr Joseph, smiling sweetly.

"How’s his behaviour?"

"He needs an eye kept on him with eating and going to the toilet."

I took Wisnu for a pleasant and peaceful walk in a nearby kampung comprising red-roofed bungalows, a mosque that was big and prosperous, a market garden full of healthy Chinese kale and Bombay shallots, and a football pitch where happy young boys in faded jeans were kicking around a plastic ball; and then I dashed to the Dipo Hospital.

I found Nur had been transferred to the Dipo’s private wing. He was still unwashed and still not on a drip but the ward was clean, well equipped, and full of light and colour. There were lots of nurses, although most had the same tough expressions on their faces as elsewhere in the hospital. There was even a doctor: a man with an expensive suit, a balding head, and a round face that seemed brim full of upper-middle-class self-confidence.

"We need to operate on Nur tomorrow," said the doctor, after being introduced.

"Why has he had to wait all these months without treatment?" I asked.

"The mother has a low income." The doctor sounded irritated by my un-Indonesian bluntness.

"He looks very weak, very thin," I said. "He’s not been on a drip and looks dehydrated. Shouldn’t we wait until he’s stronger before giving an operation?"

"He needs to have the operation urgently. The mother agrees," said the doctor.

"Why is he not on a drip?" I said.

"Ask the nurse." He swept off.

"Nur looks very weak," I said to his mum. "Are you sure you want the operation tomorrow? Wouldn’t it be better to wait?"

"No. Tomorrow for the operation."

I turned to a nurse. "Why is Nur still not on a drip?" I asked.

"He doesn’t need to be on one all the time," she said.

"Was he on a drip earlier on?"

"I’ve just arrived. I don’t know." Off she went.


Next evening, when I returned to the Dipo Hospital, Nur was no longer in the private ward.

"Where’s Nur?" I asked his mum, who was standing next the nurses’ desk.

"They’ve moved him," she said, for once not smiling.

I turned to one of the nurses. "Is he still in the private wing?"

"No. He’s back in the other part of the hospital," she said, looking up, then returning to her paperwork.

"But I’ve paid for him to be in the private wing," I pointed out.

"He’s in intensive care," said the nurse. "The private wing doesn’t have a separate intensive care unit."

"Has he had his operation?" I asked.

"He was taken to the operating theatre this morning," said the nurse.

"Did they operate?"

"He had his anaesthetic," said Nur’s mum. In her plastic flip-flops she was looking very out of place.

"What happened then?"

"He was moved to intensive care," said the nurse.

"Did they operate?"

"You’ll need to ask in intensive care," said the nurse, head down, busy writing.

Nur’s mum and I set off along gloomy corridors and up endless cobwebbed stairs until we reached the intensive care ward. We were back to the colourless, dimly lit part of the hospital. Water dripped from a damp patch on the ceiling. There were what looked like blood stains on a wall. A TV was showing a violent American movie and the sound was turned up full volume.

"Where’s Nur?" I asked a nurse seated at a table.

"The bed in the middle." She pointed to a shaven-headed body attached to various tubes. The little boy looked lifeless.

"How is he?" I said.

"Very serious," said the nurse, being unusually frank.

"Has he had the operation?"

"I don’t know. I think so."

"Can I see a doctor?"

"He’s praying."

"I’ll wait."

I looked around at the various patients, none of them moving. I listened to the screams and bad language coming from the TV. We waited and waited.

Eventually a boyish-faced doctor emerged from a side room.

"Sorry to keep you," he said, grinning widely. "I was having a sleep."

"How is Nur?"

"It’s not good," he said. "His brain is, how do you say, damaged."

"Did he have the operation?"

"He had the anaesthetic and became very ill," said the doctor.

"So he didn’t have the operation?"

"Maybe not. You’ll need to ask the surgeon."

"Can I speak to the surgeon?"

"He’s not at the hospital."

"Tomorrow?"

"Maybe next week. I don’t know. He works at many hospitals."

"So what happens now to Nur?"

"We’ll have to consult the neurologist."

"And then?"

"Nur is brain dead," said the doctor, speaking very quietly.

The words did not quite sink in. I hoped I had misheard. "What do you mean?"

"We’ll wait for further checks and then maybe have to switch off the life-support."

Anger shot through my system. "I’m going to see the director of the hospital," I stuttered.

I strode out of the ward, down the cobwebbed stairs, along several corridors, and then up more stairs to the area where the senior manager had his office. The wood panelled walls and the comfortable chairs reminded me of the plushest of five star hotels.

"Can I speak to the director?" I asked a secretary seated at a large desk.

"He’s not here," she said.

"The deputy director? Somebody in charge?"

"Not here."

"Will they be here tomorrow?"

"No."

"When will they be here?"

"Don’t know."

"Where are they?"

"Gone off on the Haj pilgrimage."



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