Cysticercosis and Indonesian Counter-Insurgency in a Continuing Fourth World War
A devastatingly pathological infection known as cysticercosis, which has been running rampant in West Papua (or over 15 years, has now entered Papua New Guinea. In humans, cysticercosis comes from the pig tapeworm. Although Melanesians have kept pigs for thousands of years, the disease has never previously been known anywhere on the island of New Guinea. This is the story of how the Indonesian military introduced parasitic-infected pigs from Bali to the Melanesian peoples around the Paniai Lakes in the highlands of West Papua
The Pig-Human Tapeworm Cycle
The pig tapeworm, Taenia solium, is a parasitic invertebrate without a mouth, body cavity, digestive tract or anal opening. As a gutless flatworm it must absorb food directly through its body covering. Each mature segment contains male and female sexual organs and an excretory pore, A completed 7m tapeworm is a segmented chain with a communal lateral nerve cord. The sexually immature head segment, known as a scolex, has specialized suckers for attaching to the human intestinal wall; the middle segments are sexually functional and the terminal segments are mere egg sacks. Eggs are either released in the human bowel or egg sacks are excreted whole.
Pigs start the intermediate host cycle when they swallow Taenia tapeworm eggs. An 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 the bloodstream until it lodges in the pig's muscle and develops into its bladder-like form known as the cysticercus. These cysts eventually become the scolex, but develop no further until a human eats the cysticerci-infected pork. The scolex pops out, attaches to the human intestine and grows its full 7m of communal segments. Humans are the only host for sexually mature pig tapeworms.
Cysticercosis: A Zoonotic Infection of Humans and Pigs
Unfortunately, humans can act as intermediate hosts as well. When eggs of the pig tapeworm are eaten, bladder-like cysticerci can develop from the embryos in humans as well as in pigs, causing the disease of cysticercosis, which is the cyst invasion of Cysticercus cellulosae, the larval stage of T. solium, into human subcutaneous tissue, brain, eye, muscles, heart, liver and lung. Humans harboring 7m pig tapeworms rarely experience discomfort, but when they harbor cysticerci it is horribly pathogenic. Cysticerci of the eye most often occurs in the vitreous body and the sub retinal. Cerebral cysticercosis is even more severe, resulting in symptoms ranging from general malaise to epilepsy to death. Inflammatory reaction to the cysts in the brain is a veritable two- to five-year time bomb leading to epilepsy, psychosis and, often, death.
The First Epidemic of Cysticercosis in West Papua
Before this 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 the feces of 170 Ekari people admitted to Enarotali hospital located in the Paniai Lakes highlands of West Papua and discovered that 9 percent of them contained eggs of T. solium. Between 1973 and 1976, 157 patients with severe burns were admitted to the hospital . Three-quarters of the patients were classified as having third and fourth degree burns and 17 underwent amputations. Epileptic seizures before or during hospitalization were present in 64 males and 27 females. Nearly half of the patients displayed palpable or visible cysticerci.
Besides the subcutaneous tissues and muscles, cysts most often lodge in the brain. Autopsies confirmed that cysticerci located in the cortical layer of the brain caused the epileptic fits. The horrendous pathological outcome of the cysticercosis epidemic is illustrated in Fig. 5 and in the following case studies report of one
35-year-old male...admitted to the hospital for severe burns on his left foot. He had a past history of fits of four months' duration. One night while sleeping in front of an open fire, a child saw that the patient's foot was on the fire and pulled it away. The patient was unconscious and had no memory of the accident on waking up a few hours later.
An operation had to be performed, but the man died 18 hours after the operation. An autopsy was performed, showing that there were multiple and scattered cystic nodules involving all lobes of both cerebral hemispheres of the brain. More than 20 cysticerci were found throughout the brain, the majority in the cortical layer.
Subianto et al report that: A boy, 7 years old, was admitted with fainting spells and convulsions for three months. The convulsions started from the right hand spreading over the whole body. After a convulsion he fell unconscious. One night his father witnessed his son lying with part of his head and upper arm in the hot ashes of the fire. The boy was still unconscious when the father pulled him out of the fire.
Upon examination the face and the upper right arm were covered with third-degree burns. On the second day of hospitalization, the boy expelled segments of a tapeworm. Two complete adult tapeworms were removed from the stool after a treatment with Atabrine. The worms were identified as Taenia solium. Palpable or visible cysts were not detected.
Epileptic seizures were observed during hospitalization, especially when the usual dose of phenobarbital (50 mg t.d.d.) was decreased. One year after discharge he was readmitted with burns on both feet.
Of 2,000 Ekari people near the Enarotali hospital surveyed by Subianto and Tumada in 1973, 87 (4.2 percent) had developed cysticercosis and 8 percent had developed intestinal taeniasis infection. Between 1975 and 1977 cysticercosis and taeniasis increased and spread, with intestinal infection rates up to 20 percent. However, faecal specimens demonstrate a low sensitivity for the parasite. In one African study only 6 percent of the stools showed taeniasis, but autopsies indicated over 60 percent of the population was infected. By 1978 serological tests confirmed that at least 25 percent of adults and children were infected with cysticercosis; undoubtedly, the majority of the Ekari people are now infected.
Who are the people the Indonesian physicians and the international parasitological 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. Anthropologists and southern neighbors of the Me people call them the Kapauku; linguists and their northeastern neighbors call them the Ekari. The Me people, who number around 65,000, speak a Papuan language of the Trans-New Guinea phylum. Their homeland is the Paniai Lakes region that forms a large highland basin 1,500m above sea level. Paniai Lakes is the westernmost of four densely settled highland basins, also in West Papua is the Baliem Valley; the Wahgi and Asaro valleys are in Papua New Guinea.
Me are labeled by Indonesians, physicians, consultants and even anthropologists as primitives from the Stone Age. This label has been invoked by many to dismiss the health epidemic by which they are now besieged. A reply from the Javanese governor to the consultant Desowitz that "You know, they are not like you and me. They are very primitive, and it is extremely difficult to change their customs even for their better health", typifies the disdainful regard the Indonesian state has for the Me and how it justifies its aggressively "advancing civilization" and eradicating "superstitions" and "primitiveness" from Me life. The Indonesian physicians think the "primitive huts" of the Me are partly responsible for the rampant epidemic seizures and infection with cysticercosis. Gajdusek, the first international consultant to visit the Me, called them "Stone Age Highland Melanesians" with a pig-breeding culture. Desowitz, the second international consultant to visit the Me, somehow found enough humor in Ekari "Stone Age toilet habits" to title his book New Guinea Tapeworms and Jewish Grandmothers in commemoration of the devastating epidemic and to disparage the culinary practices.
Unfortunately, the traditional Ekari barbeque doesn't allow for thorough cooking. The Ekari throw the dead pig on the fire just long enough to warm it up. One reason for this haste is that, except at the big feasts, an Ekari wants the pig he slaughters to be all his. Neighbors are not customarily invited to dinner. The Ekari kills his pig secretly - or as secretly as a pig can be butchered - in the dead of night, following the kill with a quick turn on the fire. A fast-food meal takes place in stealth and gloom. (This and other customs have not endeared the Ekari to anthropologists, who have described them as greedy and avaricious, and as "primitive capitalists.")
Pospisil admits his only interest in the Me was in their primitive law and isolation. He sought "an untouched Stone-Age Papuan society to study primitive political institutions in action." Pospisil's exhaustive analysis of pigs in Me economic and ritual life does not support Desowitz's accounts that they secretly binge on undercooked pork. Successful pig breeding is the most important source of a man's wealth and prestige. Pig trading in juwo, the pig feast, tapa, the pig fund-raising ceremony and dedomai, the pig market, is necessary to achieve the political leader status of a "big man". The Me display their wealth through the channels of conspicuous generosity; stingy, greedy big men have been known to be executed.
Putu duwai naago, the birth ceremony, maligned by Desowitz, is actually an occasion of conspicuous generosity and distribution of free food. It is given by the father in honor of his newborn child. Everyone who comes is treated to pork prepared in a dopo cooking mound steamed together with fern leaves, vegetables and sweet potatoes. Desowitz throws up his hands in dismay at the abysmal cultural gap between civilization and the Me when a big man says, you tell us not to eat the infected pig, to be careful, to cook it long. How can this be done? If a child is born at night we must sacrifice a pig immediately; there is no time to look and see if it has seeds. The pig must be killed and eaten at once.
Pigs have been in New Guinea for at least 5,000 years. In the highland basins, intensive agriculture has supported competitive big man-pig exchange systems, as among the Me, for more than 2,000 years. Pigs are an ancient, integral part of Melanesian culture and identity.
Indonesian Introduction of Biological Warfare into West Papua
According to the World Health Organization (WHO), taeniasis-cysticercosis is increasing in many countries due to intensification of animal production, development of meat industries in several developing countries, and increase in world meat and live animal trade, large-scale inter-country migration of agricultural and other workers, the "camping explosion" in some countries with an increase of promiscuous defecation, other breakdowns of sanitary conditions, [and] sewerage farming…
In "live animal trade" and "large-scale intercountry migration" the WHO foreshadows the purposeful movement of live pigs and large-scale transmigration taking place from Indonesia into West Papua. I believe the WHO should add biological warfare to its list of transmission conditions.
Years after the outbreak of the cysticercosis epidemic among the Me, Indonesian physicians working in the Enarotali hospital assert in the internationally circulated Tropical and Geographical Medicine journal that the cause of the increasing number of taeniasis solium and cysticercosis 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 disregard an earlier statement in the more obscure Bulletin of Health Studies in Indonesia that:
Some of the village headmen blamed the newcomers from outside as the ones who brought the disease to the Paniai area. Others suspected that the disease was introduced through pigs brought in from the other island. Another opinion was that the disease has been introduced as a punishment for the death of several soldiers in the 1969 uprising.
Bending and Catford state categorically that transmission to the Me was restricted to a single importation of one batch of infected pigs from Bali in 1971.
As Gajdusek notes, 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 the 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 stated to Desowitz that "we are not blind. We can see the seeds that give us illness in the pig flesh."
Desowitz's reconstruction of historical events indicates that the tapeworm rode the "anticolonial wave; the vehicles of transport were men and pigs." The anticolonial wave, Indonesian expansion into the Fourth World nations of West Papua, started in 1963 when the Dutch reluctantly pulled out, leaving West Papuan self-determination to be decided in a 1969 "Act of Free Choice." Until 1969, Indonesia had outlawed any social movements for autonomy in West Papua. The UN peace-keeping force withdrew in 1963. At that time, more than 15,000 Indonesian troops were stationed in West Papua. Land disputes immediately took place; Indonesian military officers seized indigenous peoples' land and resources for themselves and for transmigrants from Java. Politicized intellectuals and indigenous peoples linked to form the Organisasi Papua Merdeka (OPM), the Free Papua Movement. Founders of the OPM were Afak people and many had been trained by the Dutch for the Papuan Volunteer Corps. They fought the first OPM armed resistance movement in 1965 and sustained the struggle for two years.
In 1969, 1,025 indigenous community leaders were chosen by the Indonesians to represent some one million West Papuans in the "Act of Free Choice." President Suharto declared that any West Papuan who opposed integration in the Indonesian state would be guilty of treason. The first major OPM armed struggle against the "Act of Free Choice" took place at Enarotali and was launched by the defection of 85 well-armed Papuan policemen to the OPM. Encouraged by such action from within Indonesian ranks, local villagers laid seige to the Enarotali airstrip and four others, digging holes in the runways to prevent landings. On April 29, shots were fired at an aircraft carrying Irian's military chief, Sarwo Edhie, wounding a police inspector who was with the general. Local morale was boosted by raising the Morning Star flag and declaring the area liberated from Indonesian rule. Then Papuans seized a Catholic mission radio and broadcast an appeal to army headquarters at Nabire asking Indonesia to withdraw its troops and allow the people to choose their own future. According to a press statement by the Irian governor, Franz Kaisiepo, the revolt had the support of all the leaders of the 30,000 people in the region. The statement said, forthrightly, that tribes that had been enemies for years were united in their hostility to the Indonesians.
The Indonesian army responded to OPM armed resistance by firing machine guns from aircrafts and flying in paratroopers, forcing more than 14,000 Me from their villages and into the bush as refugees. A few months later in July another major confrontation took place in the Paniai Lakes region. Thousands of additional Me people abandoned their villages; women made food gardens in the remote portions of their mountain homeland and the men attacked Indonesian patrols on many fronts. The sham election finished by August 1969, and Indonesia officially announced West Papua as the province of Irian within Indonesia. In Australia, Labor MP Charles Jones, later a minister in the Whitlam government, complained that "nobody seems concerned that there should be independence for coloured people from other coloured people".
It is not difficult to see why the Me people were singled out for the transcultural transfer of T. solium-infected pigs. By West Papuan 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. Desowitz is decisive about tapeworm trafficking when he writes that the Me were uncertain, to say the least, about the change in regime, and during the plebiscite, or shortly thereafter, the Indonesians sent troops to Enarotali. Some of the soldiers came from Bali. Indonesia's President Suharto softened the military action by sending a gift of pigs. The pigs, too, came from Bali, the area in which pig rearing is largely concentrated, since Bali is Hindu and the rest of Indonesia is mostly Muslim. Whatever the political and social advantages of the gift, the medical result was an unforeseen tragedy.
The Indonesian military is certainly not admitting that it introduced cysticercosis as a diabolical form of biological warfare, but I cannot accept that the cysticercosis epidemic is no more than a tragically unforeseen consequence of a beneficent military gift. One small batch of infected pigs proved to be an insidiously simple counterinsurgency tactic to decimate and demoralize the enemy. The extent of the demoralization 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.
The Indonesian military does not accept responsibility for the infected pigs. Yet, from the counterinsurgency training Indonesian officers receive from the American military and the ferocity with which Indonesia pursues the Fourth World War in West Papua, there seems little doubt they are capable of using cysticercosis as biological warfare. The Indonesian military continues to suppress Me resistance to invasion. In 1981, a major operation code-named "Clean Sweep" by the Indonesian army was aimed at decimating sustained OPM resistance across West Papua. The campaign was particularly aimed at the Me people: a TV team from the Dutch KKRO network filmed hundreds of men and women training. Most of them carried traditional weapons and they shouted anti-Indonesian slogans. By August this area was being bombed, and villagers alleged the use of napalm and chemical weapons. The highlands death toll was put at between 2,500 and 13,000. The Dutch TV people, having received news from the area, suggested the upper estimate. The PNG government favoured the lower, or even less, while Indonesia did not comment at all.
The Spread of Cysticercosis
In less than five years from its introduction, cysticercosis was present in all the communities shown in Fig. 5, indicating how rapidly the epidemic spread among the peoples of the West Papuan highlands. Desowitz states there is "clear evidence that the infection has now spread to other parts of Irian Jaya." Gajdusek and Mitton indicate that by 1973 taeniasis and cysticercosis had already spread to the Western Dani people living in the Baliem Valley. By 1975 these zoonotic diseases had spread to the Mountain Ok people around Ok Sibil through introduction of infected pigs brought from the Paniai Lakes area. Cysts spread among the local pigs and, according to Gajdusek, "all of the surrounding pigs were killed and burned, and it is hoped that the new focus has been eradicated." The severity of the epidemic is attested to by Bending and Catford, who led the last medical research expedition to the Paniai Lakes in 1977. They are concerned 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 border. 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 subcutaneous nodules, calcified muscular nodules on X-ray, or Jacksonian epilepsy...and examinations of 52 stool specimens disclosed neither eggs nor terminal ripe segments of Taenia solium.
The long continuing West Papuan Fourth World War escalated in 1984. Indonesian counterinsurgency reprisals and road building on the border forced more than 1,800 refugees to seek asylum in Kamokpin camp and more than 400 more to Niogomban camp among Yonggam people. Papua New Guinea referred to the refugees as "border crossers." Conditions were so dreadful in the refugee camps that by August 1984, 52 percent of the children from one to five years of age had severe malnutrition with signs of kwashiorkor (Ulijaszek and Welsby 1985). 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. While on a return visit among the Wopkaimin in late 1985, Ian Fraser-Stuart, a Department of Primary Industries scientist, informed me that there were 12 confirmed cases of cysticercosis in the Kamokpin and Niogomban refugee camps. It appears that cysticercosis had not been eradicated around Ok Sibil and it is now on both sides of the border.
Combating Cysticercosis
The OPM should inaugurate a massive education program among the indigenous West Papuan peoples. Public health measures undertaken by missionaries and Indonesian officialdom have been unsuccessful because of distrust and other cultural reasons. Papuan people should be encouraged to dispose of feces in pit latrines and to thoroughly cook pork. These realistic preventative measures can and should be taken. Intestinal taeniasis is treatable with drugs like mebendazole. Newborn pigs can be immunized, but the expense of these drugs forecloses their use in West Papua. Massive pig killing to break the parasite life cycle is also unrealistic, given the enduring cultural importance attached to the pig. Finally, the OPM could also disseminate the cysticercosis story through its network of international supporters.
Article copyright Cultural Survival, Inc.
