Doctors without Protection
Native doctors and orderlies were heroes when the pestilence outbreak hit Malang in the 1910s. Doctor Cipto Mangunkusumo became an icon and a voice in the media.
AN orphaned baby girl was found inside a hut in Kepanjen, Malang, East Java, in 1912. Her parents are dead because of the plague that also killed most of the people in the regency. Luckily, doctor Cipto Mangunkusumo found her during a visit to treat villagers. He took the baby and adopted her, giving her the name, Pesjati, which was taken after ‘Pes’ the Indonesian name of the plague. Her name is forever bound to the plague caused by the bacteria Yersinia pestis, which killed millions of people in the East Indies from 1911-1934.
Cipto was a savior not only to Pesjati. He was also on the frontline during the prevention of the pestilence in Malang. Hans Pols, a historian from the University of Sydney, Australia, wrote the book Nurturing Indonesia: Medicine and Decolonization in the Dutch East Indies, in which he said that it was Cipto who, in 1912, signed up to be posted near Malang so he could directly help patients. Before that, he opened up a private practice in Solo, Central Java.
Cipto was knighted the Order of Orange Nassau from the Kingdom of Netherlands for his efforts in combating the plague. “The clarity of his political views and his devotion to fighting the plague earned him a stellar reputation among the indigenous population,” Pols wrote.
But Cipto was an eccentric, and he declined the knighthood. A historian from the University of Indonesia, Syefri Luwis, said that after finishing his term in Malang in 1912, Cipto was busy with political affairs together with associates Douwes Dekker and Soewardi Soerjaningrat. In 1915, Cipto returned to Solo, planning to help fight the plague there. But his sour relationship with the government and his constant rebellion against Dutch Indies officials prevented that from happening. “Cipto then put the knighthood medal on his buttocks. He rebelled against and mocked the government,” Syefri said on April 6.
Dr. Cipto Mangunkusumo, 1913./KITLV
That was not the only time Cipto expressed his dislike to the colonial government’s unfair treatment. Cipto, the eldest son of an aristocratic family in Semarang, Central Java, graduated from the School tot Opleiding van Indische Artsen (STOVIA), formerly Sekolah Dokter Djawa or Javanese Doctors’ School. While most STOVIA graduates wore Dutch-style doctor apparels, which symbolize a higher social class, Cipto identified himself as a commoner—wearing modest Javanese clothes, smoking clove cigarettes.
Cipto also often created controversy due to his uncompromising characteristics. He even opted to break up with Boedi Oetomo after the organization’s first congress, thinking it was too elitist and conservative. When in Malang, Cipto’s coming to the region was also how he showed resistance against the Dutch Indies.
According to Martina Safitry, a lecturer of history at the Surakarta State Islamic Institute who studied the roles of native paramedics and doctors during the plague outbreak in Malang, most Dutch doctors did not want to deal with patients directly. Apart from being discriminatory—only willing to help fellow Europeans—they were afraid of contracting the disease from patients who are mostly farmers.
Cipto’s initiatives became important because at that time the plague was so widespread. He treated patients without proper protective equipment, which were rare at the time. Dealing with commoners who were dying from the plague on a daily basis, Cipto said that how the colonial treated his kin amid the epidemic caused more people to die. Martina said that Javanese doctors were paid far lower than their European peers. “It was these unfair treatments that pushed Cipto to talk to newspapers, igniting the spirit of nationalism,” said Martina, whose thesis was about the doctors and orderlies of the plague in the Dutch Indies.
Being on the field every day made doctors more sensitive to social economic issues. Morover, the doctors—including Cipto—were consistently faced with human suffering in all social classes and ethnicities. They realized that patients are not only suffering from illnesses, but also stricken by poverty, cruelty, and poor working conditions. Cipto wrote his sharp criticism in a number of newspapers, including De Express. He also charged no fees when treating the poor, the same thing that doctor Soetomo did.
In his book, Hans Pols wrote that the medical school STOVIA was the birthplace of a new awareness in politics, inspiring graduates to participate in the nationalist movement. Boedi Oetomo, which advocated access to modern education, was pioneered by medical students like Wahidin Soedirohoesodo dan Soetomo. It was their commitment to medical science that inspired several of these young men to imagine a new, independent and healthy nation. It was what motivated them to, firstly, criticize the implementation of healthcare in the colonial era.
The doctors were also the first indigenous group able to enter the European social sphere. On the other end of the spectrum, European physicians held strong, open hostilities towards native doctors, stemming from their frustrations over their own social status. At the beginning of the 20th century, indigenous physicians became active in the East Indies Doctors Association (Vereeniging van Indische Artsen), such as W.K. Tehupeiory, Jeremias Kaijadoe, and Abdul Rasjid. There was also Abdul Rivai, a doctor who was also an active writer and journalist, one of the first graduates of the Javanese Doctors’ School. He founded a biweekly magazine called Bintang Hindia.
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MARTINA Safitry said there were a total of 14 Javanese doctors, including Cipto Mangunkusumo, who served in Malang when the outbreak occurred. They participated as there was a shortage of medical personnel, forcing the colonial government to ask STOVIA medical students in their final semester to continue their studies in direct practice—battling the epidemic. In return, they no longer need to do final projects as a requirement to graduate. Doctors from the European Continent had initially offered to help, but was denied by the Dutch East Indies government.
The plague actually subsided after the government implemented a one-year regional quarantine in Malang in 1912. Martina said that residents who lived in huts were relocated to barracks, to minimize transmission from mice.
Houses that were made from bamboos were recommended to be replaced with brick walls. However, not all residents could afford renovation. Thus, the government burned down people’s houses, making the situation even more tense.
Unfortunately, the government decided to lift the Malang lockdown after only a year. The pestilence had not disappeared completely, and it returned—threatening people’s lives again. “The condition worsened,” Martina said. As a result, in 1914, an agenda was established to increase the number of medical staff assigned to tackle the plague. Because medical studies in STOVIA took too long—up to 10 years—an orderly school was established for the indigenous population, with a shorter curriculum. This school, Martina said, was incidental, and the materials given were adjusted to what was needed at the time. “The graduates were addressed to as their respective fields of expertise, for example the plague orderly.”
Abdul Rivai, doctor and editor of Bintang Hindia, 1902./KITLV
The existence of native elderlies helped change the health system in Java. Before there were doctors and orderlies specializing in the plague, villagers went to the dukun (shaman). However, the government banned the practice, creating stigmatization against dukun and the narrative that they were unable to treat the disease. In 1930, the government even campaigned against dukun through a documentary directed by Willy Mullens. The film showed how shamans work in illogical ways—as seen through the eyes of Europeans. After that, most medical treatments shifted to manufactured chemicals from factories. The medical technology was then brought by doctors and orderlies to villages.
In 1935, a special school for orderlies was established in Purworejo, Central Java. The school received operational assistance from the famous United States-based Rockefeller Foundation. Later, the school expanded its specializations—not only for plague orderlies, but also smallpox and latrines. “Before there was an orderly school, all tasks were carried out by STOVIA doctors, assisted by the plague orderlies, who were natives,” Martina said.
According to Martina, the presence of medical orderlies at the time did not speed up the handling of the epidemic, because medical and communication technology was far from sophisticated. The lengthy process of communication—from the central government to the regions—contributed to the slow resolution of the outbreak. “If the handling of Covid-19 is also slow, it means we are experiencing a setback,” she said.