How The West Was Won

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Cysticercosis and Indonesian counter-insurgency in the continuing “Fourth World” war against the OPM.

A controversial analysis by Dr David Hyndman

ADEVASTATINGLY pathological

infection known as cysticercosis, which has been running rampant in Irian Jaya for more than 15 years, has now entered Papua New Guinea. In humans cysticercosis comes from the pig tapeworm, but though Melanesians have kept pigs for thousands of years the dis ease has never previously been known anywhere on the island of New Guinea.

This, then, is the story of how the In donesian military introduced infected pigs from Bali to Melanesian peoples around the Paniai Lakes in the highlands of East ern Irian Jaya.

The pig tapeworm Taenia solium is a parasitic invertebrate without a mouth, body cavity, digestive tract or anal open ing; it absorbs food directly through its body covering. Each mature segment con tains male and female sexual organs and an excretory pore. A completed 7 metre long tapeworm is a segmented chain; the sexually immature head segment, known as a scolex, has specialised suckers for at taching to the human intestinal wall; the middle segments are sexually functional and the terminal segments are mere egg sacs. Eggs are released in the human bowel or egg sacs are excreted whole.

Pigs start the intermediate host cycle when they swallow Taenia tapeworm eggs.

The adult tapeworm does not develop in the pig: instead, the hatched egg works its way through the intestinal wall and enters a vein. The embryo then travels along the pig’s bloodstream until it lodges in muscle and develops into a bladder-like form known as the cysticercus. These cysts eventually become the scolex, but develop no further until a human eats infected pork. The scolex pops out, attaches to the human intestine and grows to its full seven metres of communal segments.

Humans are the only host for sexually mature pig tapeworms, but unfortunately can act as intermediate hosts as well. When eggs are eaten, cysticerci can develop from the tapeworm embryos in humans as well as in pigs, causing the disease of cysticer cosis: the cyst invasion of Cysticercus cel lulosae, the larval stage of T solium , into human tissue, brain, eye, muscles, heart, liver and lung.

Humans are the only host for sexually mature pig tapeworms, but unfortunately can act as intermediate hosts as well. When eggs are eaten, cysticerci can develop from

the tapeworm embryos in humans as well as in pigs, causing the disease of cysticer cosis: the cyst invasion of Cysticercus cel lulosae, the larval .stage of f. solium , into human tissue, brain, eye, muscles, heart, liver and lung.

Humans harbouring pig tapeworms

rarely experience discomfort, but when they harbour cysticerci it is horribly pathogenic: cysticerci of the eye most often occurs in the vitreous humour (the fluid within the eyeball) and the subretina.

Cerebral cysticercosis, where cysts lodge in the brain, is even more se vere: inflammatory reaction to the cysts in the brain is a veritable two-

to five-year time bomb leading to epi lepsy, psychosis and often death.

Before the current epidemic there had been no reports of human taeniasis or of cysticercosis in humans or pigs anywhere on the island of New Guinea. In 1972 two Indonesian physicians examined faecal samples from 170 Ekari people admitted to Enarotali hospital, in the Paniai Lakes area of Irian Jaya, and discovered that 9 per cent contained eggs of T solium.

Between 1973 and 1976, 157 patients with severe burns were admitted to the

same hospital. Three quarters of the patients were classified as having third and fourth degree burns and 17 underwent amputations. Epileptic seizures before or during hospitalisation were present in 64 males and 27 females. Almost half of the patients displayed palpable or visible cys ticerci under the skin, frequently on the arms or legs; besides subcutaneous tissues and muscle, cysts most often lodge in the brain and autopsies confirmed that cys ticerci located in the cortical layer of the brain caused the epileptic fits.

Of 2000 Ekari people near the Enaro tali hospital surveyed in 1973, 87 (4.2 per cent) had developed cysticercosis and 8 per cent had developed intestinal taeniasis in fection. Between 1975 and 1977, cysticer cosis and taeniasis increased and spread, with intestinal infection rates up to 20 per cent. By 1978, serological tests confirmed that at least 24 per cent of adults and chil dren were infected with cysticercosis; un doubtedly, the majority of the Ekari people are now infected.

Above: The brain of a cysticercosis infected Me woman contained more than 2000 cysts. Left: Burns are common consequences of infestation.

Who are the people these Indonesian physicians and international parasito logical consultants call the Ekari? Why were they the first to suffer the ravages of cysticercosis and how did they become infected?

The Ekari are a “Fourth World” people who call themselves the Me. Anthropolo gists and southern neighbours of the Me people call them the Kapaukau; liguists and their northeastern neighbours call them the Ekari. The Me people, who num ber around 65,000, speak a Papuan lan guage: their homeland is the Paniai Lakes region that forms a large highland basin 1500 metres above sea level. Paniai Lakes is the westernmost of four densely settled Highlands basins; also in Irian Jaya is the Baliem Valley, while the Wahgi and Asaro valleys are in Papua New Guinea.

Me are labelled by physicians, consult ants and even anthropologists as primi tives from the Stone Age. This label has been invoked by many to dismiss the health epidemic by which they are now be sieged. A reply from the Javanese gover nor to one consultant that, “You know, they are not like you and me. They are very pri mitive, and it is extremely difficult to change their customs even for their better health”, typifies the disdain the Indone sian state has for the Me and how it justi fies its aggressively “advancing civilisation” eradicating “supersititons” and “primitiveness” from Me life.

Indonesian physicians have written that the “primitive huts” of the Me are partly responsible for the rampant epi demic seizures and infection with cysti cercosis. The first international consultant to visit the Me called them “Stone Age Highland Melanesians” with a pig-breed ing culture, while their second interna tional consultant visitor somehow found enough humour in Ekari “Stone Age toilet habits” to title his book New Guinea Tapeworms and Jewish Grandmothers in commemoration of the epidemic.

But pigs have been in New Guinea for

at least 5000 years: in the Highland basin intensive agriculture has supported com petitive big man-pig exchange system, as among the Me, for more than 2000 years.

Pigs are an ancient, integral part of Me lanesian culture and identity ... so how did cysticercosis arrive? And with whom?

Years after the onset of the cysticer cosis epidemic among the Me, Indonesian physicians working in the Enarotali hos pital asserted in the internationally cir culated journal Tropical and Geographical Medicine that the “cause of the increasing number of taeniasis solium and cysticer cosis in the area could not be established.

The origin of the pigs in the Paniai district could not be traced since pigs have been in the area for a long time.”

In so doing, they disregarded an earlier statement in the more obscure Bulletin of Health Studies in Indonesia that: “Some of the village headmen blamed newcom ers from outside as the ones who brought the disease to the Paniai area. Others sus pectd the disease was introduced through pigs brought in . . .”

Doctors Bending and Catford, writing in the British medical journal The Lancet in 1983, stated categorically that trans mission to the Me was restricted to a sin gle importation of one batch of infected pigs from Bali in 1971. As another re searcher has noted, it was the Me “who first noted the appearance in the pig flesh of strange cysts, which they had never seen before, and brought this to the attention of doctors, missionaries and administrators.

“They themselves had associated this infection with the introduction of new pigs, a gift from the Indonesian government in Java, since they had first seen the cysts in the flesh of new pigs and such cysts had appeared later in their own pigs.”

A Me big man said in 1984 that “we are not blind. We can see the seeds that give us illness in the pig flesh.”

The tapeworm may well have ridden the “anticolonial wave”; Indonesian ex pansion into West Papua, which began in

1963 when the Dutch pulled out and al lowed West Papuan self-determination to be decided in a 1969 “Act of Free Choice”.

When the United Nations peacekeeping force withdrew in 1963, more than 15,000 Indonesian troops were stationed in West Papua or Dutch New Guinea.

Land disputes began to occur imme diately. Indonesian military officers seized indigenous peoples’ land and resources for themselves and for transmigrants from Java, inspiring the creation of the Organ isasi Papua Merdeka (OPM); the Free Papua Movement. Founders of the OPM were Afak people, many of whom had been

trained by the Dutch for the Papuan Vol unteer Corps. They fought the first OPM armed resistance movement in 1965 and sustained the struggle for two years.

In 1969, 1025 indigenous community leaders were chosen by the Indonesians to represent some one million West Papuans in the “Act of Free Choice”. President Su harto declared that any West Papuan who opposed integration in the Indonesian state would be guilty of treason, but the first major OPM armed struggle against the Act took place at Enarotali and was launched by the defection of 85 well-armed Papuan policemen to the OPM. Encour aged by such action from within Indone sian ranks, local villagers laid seige to the Enarotali airstrip and dug holes in the runways to prevent landings.

On April 29, shots were fired at an air craft carrying West Irian’s military chief.

General Sarwo Edhie, wounding a police inspector. Papuans seized a mission radio and broadcast an appeal to army head quarters at Nabire to withdraw its troops and allow the people to choose their own future.

According to a press statement by the West Irian governor, Franz Kaisiepo, the revolt had the support of all the leaders of the 30,000 people in the region. ►

Pigs, central to Highlands tradition, are now a source of disease and death.

◄ The Indonesian army responded to OPM armed resistance by firing machine guns from aircraft and flying in para troopers, forcing more than 14,000 Me people from their villages and into the bush as refugees.

A few months later, another major con frontation took place in the Paniai Lakes region. Thousands of Me abandoned their villages; women established food gardens in the remote portions of their mountain homeland and the men attacked Indone sian patrols.

The “election” was completed by August 1969, and Indonesia officially an nounced West Papua as the province of West Irian within Indonesia Irian Jaya.

It is not difficult to see why the Me people were singled out for the transcul lural transfer of infected pigs. By Irian Jayan standards they were densely settled around the Paniai Lakes; thousands had taken up continuing armed resistance against incorporation into Indonesia, and their homeland was a prime locality for Javanese transmigrants.

Indonesia’s President Suharto soft ened the military action in the Me home land by sending a gift of pigs. The pigs came from Bali, the area in which pig rear ing in Indonesia is largely concentrated, since Bali is Hindu and the rest of the country is mostly Muslim.

Whatever the political and social ad vantages of the gift, the medical result was an unmitigated tragedy.

The Indonesian military is certainly not admitting that it introduced cysticer cosis as a diabolical form of biological warfare, but I cannot accept that the cys ticercosis epidemic is no more than a trag ically unforeseen consequence of a beneficent military gift.

One small batch of infected pigs proved to be an insidiously simple counter-insur gency tactic to decimate and demoralise the enemy. The extent of that demoralis ation is testified to by a Me big man who said: “No one lives forever, and if we must die, then we must die. Life is not longer a pleasure. We are only half men. The Indonesians will not let us make warfare that gave us manhood.

“I no longer care if I eat corrupt pig flesh . . . When the missionaries brought us the coughing sickness [a whooping cough epidemic in 1956], we rose in anger; this time we have no heart to do so.”

In fewer than five years after its intro duction cysticercosis was present in doz ens of communities near the PNG/Irian Jaya border communities, indicating how rapidly the epidemic spread among the people of the Irian Jayan highlands. There is evidence that the infection has now spread to other parts of Irian Jaya: by 1973, taeniasis and cysticercosis had already spread to the Western Dani people living in the Baliem Valley, and by 1975 the dis ease had spread to the Mountain Ok people around Ok Sibil.

The severity of the epidemic is attested

to by Drs Bending and Catford, who led the last medical research expedition to the Paniai Lakes in 1977. They were con cerned that cysticercosis threatens the continued existence of the Me people, and that “it ranks as one of the major causes of mortality in the adult population.”

The Mountain Ok people live on both sides of the contemporary political bor der. In 1978, a WHO medical research team reported that the Wopkaimin Mountain Ok in nearby Papua New' Guinea showed no signs of cysticercosis “either as sbucutaneous nodules, calcified muscular nodules on X-ray, or epilepsy”, but the continuing West Papuan war escalated in 1984, when Indonesian coun terinsurgency actions and road building on the border forced more than 1800 refugees to seek asylum in Kamokpin camp and more than 400 more to Niogomban camp among the Yonggam people. The Papua New Guinea Government referred to the refugees as “border crossers”.

Conditions were so dreadful in the ref ugee camps that by August 1984, 52 per cent of the children from one to five years of age had severe malnutrition with signs of kwashiorkor; conditions at home were perceived as worse, so more than 10,000 refugees remained in these and other camps along the border of the Western and West Sepik Provinces.

What can be done to combat the spread of cysticercosis? The most efficient method would be for the OPM to inau gurate a massive education program among indigenous West Papuan peoples; public health measures undertaken by missionaries and Indonesian officialdom have been unsuccessful because of dis trust and other cultural reasons.

Papuan people should also be encour aged to dispose of body wastes in pit la trines and to thoroughly cook pork. These realistic preventative measures can and should be taken.

Intestinal taeniasis is treatable with drugs such as mebendazole, and newborn pigs can be immunised, but the expense of these drugs forecloses their use. A disad vantage of immunisation is that Highlan ders encourage their domestic stock to breed with feral pigs an efficient way of ensuring the gene pool is as broad as pos sible in which tapeworms are endemic.

If domestic pigs could be freed of tape worm infestation, other measures would still be needed to control parasite infest tation in wild pigs.

Massive pig killing to break the para site life cycle is also unrealistic, given the enduring cultural importance attached to the pig throughout Irian Jaya and Papua New Guinea. n

Dr David Hyndman is a senior lecturer in the Department of Anthropology and So ciology at the University of Queensland.

He has 14 years’ research experience in PNG, with a focus on the political ecology of indigenous peoples.