Cuban Health Statistics Continue to Embarrass West

Cuban authorities mocked American health care providers today after the PAHO, the Pan American Health Organization, unveiled its report on health care at Madison Square Garden.

"In your face." jeered Juan Batista, Senior Health Advisor to Fidel Castro, after the report once again documented that on many of the most critical criteria - life expectancy, infant mortality, doctors as percent of population, and national health expenditure as percent of GNP, the Cuban dictatorship equaled or beat America.

Reached in the locker room not long afterwards, former US Surgeon General Everett Koop wiped away a tear. "We'll get them next year. Remember, we still have liposuction techniques that those reds can't touch."

The fallout after this embarrassing debacle, in which a poor third world country trounced the richest and most technologically advanced nation in the world, reached as far as the IMF and World Bank as economic leaders converge in Washington. A shamefaced Stanley Fischer remarked: "How can we defend our system of open economies and free market capitalism when these lawn jockies kick our butts on infant mortality?"

Fischer will have a particularly hard sell when he journeys to Jakarta next week to renegotiate a debt relief program. Indonesia, like many third world nations aligned to Washington during the cold war, relied heavily on coaching staff from the WHO, The World Bank, and the IMF. In terms of basic health care, however, they have little to show for their loyalty. Infant mortality in Indonesia is 43 per 1000, and life expectancy is 65 years. Cuba's rates are 7 per 1000 and 76 years, respectively, and have actually improved since the loss of Soviet economic support in 1989.

At a post-game press conference, the CEO's of Merck and Pfizer reacted with disappointment at the Cuba win and vowed to reallocate their resources with a goal of beating Cuba in 2001. "That means no money for marketing high profit 'lifestyle' drugs such as Viagra, Prozac and Ritalin. From now we're in the business of saving and prolonging lives as effectively as possible." said Pfizer's CEO.

The Americans were heartened by other statistics that indicated that the wealthiest 20 per cent of Americans had access to far better health care than the average Cuban. President Clinton stated: "Now we all know that we've got to be patient as we wait for those benefits with trickle down to the rest of us. But I understand the concern many Americans feel that it seems to be taking far too long."

President Clinton added that "There is reason for hope that America will pull ahead, as we still have the ability to prosecute corporations and individuals who violate the blockade and sell medicines to the Communist dictatorship." He pointed to the Torricelli Act and the Helms-Burton act as examples of how bi-partisan efforts can put pressure on the Castro regime. "The Cubans, for example, can't buy the only effective treatment for pediatric leukemia."

The health care conference was the highest rated pay-per-view event since the Tyson-Holyfield fight. The crushing loss was devastating to US fans, who had packed into sports bars across the country. In the final minutes of PAHO's presentation, as the results were read, Fidel Castro further enraged Americans by making the "choke" gesture at President Clinton.

Modern medicine for traditional people, traditional medicine for modern people

In Bali, there are two ways of responding to health problems: traditional Balinese medicine or allopathic "Western" medicine. Both systems co-exist in Bali, and local people will commonly go back and forth between doctors and healers - called Balian or Dukun - in their search for a cure.

Traditional medicine refers to a wide range of techniques and modalities which are described in palm leaf manuscripts called lontar. There is a remarkable array of lontar on a variety of subjects. Some are quite specific and demonstrate a strong understanding of human anatomy - describing, for example, the weight and length of a human intestine. But central to the traditional approach to health is the Balinese belief in a spiritual reason for health disorders. One never simply "gets sick", there is always a niskala, or "unseen" reason behind an illness or accident. Often the "prescription" is mantras and offerings. Even when medicinal herbs are prescribed, the herbs themselves are not considered the cure, but merely a means through which counter-active white magic can enter the body.

Since the arrival of Dutch colonialists, there has been allopathic medicine in Bali. It was not until the early 1900's that Indonesians medical doctors were minted, but the number of Indonesian doctors remains to this day woefully low - only 1 per 120,000. This makes allopathic medicine something of a luxury in Indonesia, and out of reach for many rural and urban Indonesians. The empirical or mechanistic foundations of allopathic medicine run counter to the Balinese propensity to see the body as a spiritual vessel held in balance by complementary forces. What kind of problems arise when a Balinese patient's belief system contrasts so markedly with the scientific approach of allopathic medicine? And what happens when western people, grounded in western empirical thinking, look for a cure from healers whose conception of disease is spiritual in nature?

The Body in Bali.
In the Balinese world view, the human is surrounded on all sides, as well as above and below, by forces held in balance by the cosmic order. To the north, kaja, is Gunung Agung, the sacred mountain. This region is considered positive. The east, kangin is also considered favorably. The South, kelod, and the west, kauh are generally regarded in a negative light. The Gods reside in heaven and the buta kala, "demons", reside under the earth. This basic order repeats itself over and over in Balinese culture - the head is good, the feet are dirty, the right hand is clean, the left is not. A Balinese home is likened to a human body as well, with the head as the family temple, the stomach as the kitchen, the anus as the toilet, and so on. The body is balanced in the center of all these forces, and should one side get too strong, health can break down.

Consistent with this geomancy is the placement of four guardian spirits which guard over your health if you are Balinese. These spirits are called the kanda empat ("Four Brothers" or "Four Sisters"), and they watch over you from the spirit world from the moment of your birth. These spirits have a physical manifestation as well. At birth, they are associated with the placenta, amniotic fluid, blood, and vernix caseosa that are expelled during labor. The placenta, or ari-ari has an important function in helping a Balinese maintain their own health. The ari-ari is buried in the family compound and offerings are made to it. A lamp is burned on that spot for the next 40 days to guard it. A new mother might sprinkle breast milk on the soil near her child's ari-ari to feed the Kanda empat - and the Balinese say it has an added effect of stopping the baby from crying. Throughout life, whenever there is a health issue, offerings will be made to the kanda empat, whose names change over the passage of time. When a Balinese travels abroad he or she may take some soil from the area of the ari-ari with him to maintain that spiritual connection.

The Kanda Empat are associated with parts of the body on a physical level and the greater universe on a macro level. At birth, the Kanda Empat have the names Babu Sugian, Babu Lembaba, Babu Abra and Babu Kekere. They are associated with the amniotic fluid, the blood, the placenta, the umbilical cord, and the directions of north, south, west and east . Later in life the names of the Kanda Empat change, and they are associated with different parts of the body, the heart, the liver, the gall bladder and the kidneys, respectively. When a sick Balinese visits a Balian, the healer will call upon the Kanda Empat, invoking these spirits to aid the patient.

Balian
There are many types of healers in Bali. Balian Usada are learned healers who treat patients using mantras written in the lontar. Balian Pijat or "tukan pijat" are "massage workers" who manipulate muscles and energy with their hands. Balian Taksu go in to trance and, with little prompting, tell a patient what their problem is and how it can be cured.

What happens when a westerner visits a Balian? There are no Kanda Empat, and so there are no spirits to invoke. Bruce Carpenter notes that a comedy of errors may be the result: "If a westerner goes for a healing, and if he doesn't have ancestors in Bali, then any rituals that are performed are basically meaningless as far as the Balinese are concerned. But they are very polite people so when a Westerner comes and smiles and participates they are happy to sprinkle him with holy water. They don't really mind. But they probably think that you are a nut. They don’t really know what he is doing there."

This kind of spiritual tourism presents the danger of turning deeply held religious beliefs into tourist commodities, but few of the healers I spoke to considered it to be a serious problem. As a group they believed that Western people can benefit from traditional healing, even if they were not born into the Balinese cultural context and don't fully understand the esoteric mechanisms behind a healer's practice. They also believe that traditional medicine may be the only answer when a westerner falls victim to black magic, which they insist is not uncommon. Ketut Arsana, a healer in Ubud, recalls a time when tourist was brought to him in the middle of the night, rigid and trembling and covered with a red rash. Arsana recognized immediately that he had been victim of the occult equivalent of a hit and run accident. A spell has been sent by a leyak to hurt someone else and the tourist had been at the wrong place at the wrong time. The desti, or spell, had entered him. Recognizing the symptoms, it was relatively easy for Arsana to release the spell through massage, and the tourist recovered in a matter of hours.

The Medium is the Massage
Most westerners get their first experience of traditional medicine in the form of a Balinese massage. I am not referring to the massages offered on Kuta beach, which have nothing to do with traditional medicine, and rarely deserve to be called massage - but the types of massages offered by healers versed in what is originally an Indian import - the aurivedic tradition. This tradition describes energy channels called nadis. When you are healthy, your nadis are open and prana, or life-force, is allowed to flow. Problems arise when the nadis become blocked. due to imbalance in panca maka buta, the five elements earth, wind, fire, ether, and water, that according to Balinese philosophy, is the stuff from which all things are made. The deep tissue massage that is traditionally performed in Bali is used to break open the blocks one develop in the nadis.

Ketut Arsana opened Bali's first spa, The Bodywork Center, 25 years ago, starting a trend that now seems completely out of control. He is one of the few healers who can articulate his methodology - which he does with great reluctance, because many of his western patients are already too "pandai", or clever, for their own good already. "They are so clever, they are stupid." he laughs. Westerners spend far too much time engaged in intellectual and critical activities that they lose touch with the physical and spiritual aspects of their lives - and the physical health always seems related to spiritual well-being in the Balinese worldview.

According to Ketut Arsana, Westerners experiencing traditional medicine are either very open and accepting - thus easy to treat, or extremely "kaku" - "stiff" both intellectually and physically. I got the sense that he did not want to open the subject of the spiritual dimension of illness to western clients because the amount of explication involved was endless and incomprehensible to someone not born into the Balinese worldview. A common problem with westerners is slipped discs. Arsana says this is a fairly easy condition to treat. Does the patient really need to know that the cure involves releasing blockage in a small nadi connecting the stomach to the lower back, or is it better just to solve the problem? In Arsana's experience it is better to heal the patient: explanations can get in the way.

Some aspects of the healers art are closely held secrets that might cause problems if they were widely known. Many lontar contain the warning "Do Not Disseminate" written on them, making it clear that information in the wrong hands can be dangerous, particularly when it pertains to the world of black magic. A healer is supposed to study diligently under proper supervision so that the syllables of healing mantras eventually enter his body and actually inscribe to regions of the healer's anatomy. These sacred syllables, called Modre, can be invoked and made to vibrate or speak to the equivalent area of a patient's stricken body, which has the effect of releasing the illness. This type of knowledge is a very closely guarded secret among literate usada healers.

Ketut Arsana believes that a healer should immediately know the problem without the patient saying a word. And the patient should not question the reasoning behind a particular treatment because it is disrespectful and counterproductive to the healer and the process. In traditional medicine, a policy of "Don't ask, don't tell" is the norm - quite the opposite of the western ideal of "informed consent".

This cultural norm of "don't ask, don't tell" can confound the application of allopathic medicine in Bali. Many Balinese visit doctors with the same ingrained expectations they used to bring on visits to Balian. A Balinese will never explain to a Balian Taksu why they have come. The Balian is supposed to know the reason intuitively without a word spoken. The unfortunate reality is that some bad Indonesian doctors - doctors who don't question their patients, doctors who make a cursory examination, a quick diagnosis and prescribe a shot of B-12 - may impress a Balinese due to cultural conditioning rather than a good doctor who exhaustively questions a patient. The latter might be regarded at lacking "sakti" for not knowing, intuitively the nature of the illness. A doctor who prides himself on his willingness to spend time with patients, ask them thorough questions on their symptoms, and empower them with vital information, might go unappreciated here.

Dr. Denny Thong is a doctor who is fascinated by the ability of certain balian to diagnose illnesses, particularly mental illnesses such as depression. Thong is intimately involved in the two worlds of health care in Bali. Trained as a psychiatrist, he ran the mental hospital in Bangli for many years. With co-author Bruce Carpenter, Dr. Thong wrote about his experiences in the highly readable book "A Psychiatrist in Paradise". Upon arrival in his new job, he soon learned that standard therapies used in western mental hospitals were wholly inappropriate in the Bali. The simple act of separating a patient from his family and confining him in a cell would have a devastating effect on both the patient and the family. Relatively few patients who were admitted into the hospital ever left - not only because of the stigma attached to mental disease but because of the high cost of the ceremonies that would have to be performed before the patient could be re-admitted into the family compound.

Thong also learned that patients were much happier with the treatment they got in the hands of Balian and there was evidence suggesting that had a far better record in "curing" mental illness that Psychiatrists. One healer in particular, Nyoman Jiwa, seemed to be adept in restoring patients to a more functional state. He did this by simply laying his hands on the patient. If the patient was a victim of black magic, they would feel a strong sensation not unlike an electric current. In acute cases, the pain was almost intolerable, and patient could only stand a few seconds of what appeared to be a gentle touch. After a series of treatments in this manner, the pain would disappear and mental health would be restored.

Intrigued by Jiwa's success, Thong asked him to help at the Bangli mental hospital. Thong created a "Family Clinic" on the hospital grounds. Patients and their families would visit the family clinic before being admitted to the mental hospital. If Jiwa diagnosed a case of black magic, the patient would not enter the hospital itself, and receive treatment in the family clinic in a series of out-patient treatments. By avoiding admitting patients except in extreme cases, the patient remained ritually clean and unstigmatized.

This new system seemed to work far better than the original system. Unfortunately, it attracted attention from the medical establishment in Jakarta. Dr. Thong was accused of promoting backward thinking and unscientific methods. For reasons which were never clear, Thong was transferred to Sulawesi to supervise a mental hospital there. The family clinic was demolished and the old, failed methods were reintroduced to the mental hospital in Bangli by the new director.

The moral of the Bangli experiment is that is that it is only western arrogance to imagine that allopathic medicine is universally appropriate regardless of cultural context. It underscores the necessity for the Balinese to judge for themselves which Western modalities it should import, adopt and embrace, be it Sigmund Freud, fast food, or MTV. The Bangli experiment does not create an optimistic picture. It demonstrates that a particular orthodoxy, when backed by Western power and dominance, can prevail despite evidence that it causes more harm than good. As far as psychiatry in Bali is concerned, Dr. Thong is skeptical but retains his sense of humor. The experience changed his perspective on his own discipline - "I no longer believe in Psychiatry!" he says with a laugh.

The future of traditional medicine
It seems unlikely that traditional medicine as currently practiced in Bali will survive many more generations. The effectiveness of allopathic medicine against what were once fearsome diseases has undermined - rightfully - the value of certain traditional treatments. Many lontar were written for diseases that are no longer a threat - The Usada Kacacar consists of mantras, local pharmacology, and diagnostic tips pertaining to the treatment of smallpox. Smallpox was wiped out by vaccines introduced in the 1920's. Similarly, it doesn't make much sense to consult the Usada Mala for treatment of goiter when modern medicine offers an effective treatment. Leprosy is a condition that, years ago, was the most fearsome disease ever to plague Bali. The Usada Ila (sometimes called Usada Cukil Daki) treats the disease as the worst form of black magic, and requires that those stricken move as far as possible from home. In these cases, the superiority of allopathic medicine over traditional medicine is obvious.

If traditional medicine is destined to die off, one can only hope that allopathic medicine will develop greater sensitivity to the cultural context of Bali and be open to incorporating new (old) ideas. There may be reason for hope in the regard, as recent Western research has actually proven via double blind studies that prayer - both by and for a particular patient - can significantly improve a patient's chances of recovery. In cases where a technique is effective without making empirical sense, the burden should be on modern medicine to study and incorporate it into acceptable practice.

Unfortunately, in politics as well as in the politics of medicine the economically dominant system will survive. Medicine is big business, and there is every indication that the huge gap in health care quality that separates the rich and poor in Indonesia will grow more acute. The problem is not in lack of resources - public health policy in a country like Cuba has been wildly successful, and Cubans now enjoy lower infant mortality rates and live longer than Americans - but it is unlikely that an equitable system of medicine will appear in Indonesia any time soon. The economics of an unequal system, that primarily serves to benefit Western-based pharmaceutical industry, seems to be firmly entrenched. Paradoxically, the high cost of allopathic medicine in Bali may help to keep Balian busy in the short term, since Bali's poor have no other recourse.

Western visitors to Bali, armed with up-to-date information, economic power, critical yet open minds on traditional medicine, and a grounding in empirical science are able to make informed decisions on their health-care options. The Balinese majority, however, are not so lucky. Accurate information is hard to come by, and 32 years of military rule did not generally support the development of critical thinking skills. Pharmaceutical companies take advantage of this and foist the equivalent of snake oil on the general population. The Balinese have little in the way of health care options, and indeed may get the worst of the two worlds.

The Strange Case of Mangku Pogog

For the past four years, Mangku Made Pogog has been confined to bed in his home in Mengwi, Bali. Paralyzed by a stroke affecting the left side of his body, he is unable to walk more than a few steps. A bucket is kept nearby in case he needs to urinate, and Pogog spends his days watching television, smoking and watching after his grandchildren.

He is a different man than the one I met six years ago. At that time he was a reknowned Balian (Healer). Articles on him were published in the magazine "Shaman's Drum" and the Bali Post. Two film crews from abroad had visited his home, and producers were negotiating for the rights to tell his story. He had been flown to Jakarta, Italy and Malaysia, and was treating the Sultan of Surakarta for lung cancer. At age 59 he had the body of an athlete half his age. And he was growing rich as wealthy tourists from abroad came to see him, paying increasingly high sums for his unique combination of massage, yoga, and mantra.

I was one of the westerners who visited Pak Mangku in those days. I had read the article in Shaman's Drum, which described a bizarre healer who could make the blind see, cure leprosy, and treat infertility. His treatments often involved him licking a patient's wound or area of infection - a dangerous practice to say the least. But the author of the article - and many of Pogog's patients - testified to miraculous results. But I didn't come for a healing. I came because Pogog was charismatic and photogenic, and as a documentary cameraman, I thought he would make an ideal subject for a film. I sent a letter to Robin Lim, the woman who wrote the article, and she gave me the e-mail address of an American named Jerry, who was studying with Pogog at the time. Jerry confirmed that I could shoot for the purpose of a documentary.

When I arrived, Pogog was 25 meters up in the air in the palms of a swaying coconut tree, dropping the heavy fruits to the ground. He quickly shimmied down and I introduced myself. Pogog cut quite a figure, even at age 59. His heavily muscled body was flexible and strong from many years of yoga. When he learned that I practiced yoga as well, he was pleased - this common ground helped to break the ice. He was curious about my video camera and wanted to know how much it cost. I explained to him my idea for a documentary and he agreed to let me videotape. My plan was to find out if he was the miracle worker that he was proported to be. I didn't tell him that my hope was to document a "miracle" healing. If Pogog turned out to be a charismatic charlatan, I would make a film about that. Either way, I was doing my job as a journalist - or so I thought at the time.

Fred Eisenmann's book "Sekala and Niskala" was my original reference point. Eisenmann describes the different kinds of Balian - Balian Taksu, who go into trance and communicate with the spirit world, Balian Usada, literate healers who specialize in mantras and prayers read from lontar scripts, and Dukun beranak - who are often both abortionists and midwives. Not all Balian are healers. Some specialize in Balinese numerology or kosalah kosaleh - geomancy. Others, like Juru Nerang, who are called to prevent rain if you are planning a wedding.

I later visited Eisenmenn in his home in Jimbaran and he went into more detail. "Balian are people who specialize in black magic, in relieving people of ailments thought tobe caused by spells cast by jealous neighbors or family members. " he told me. In the past, before the arrival of allopathic medicine, Balian performed a variety of non-supernatural duties, such as setting bones, preparing medicinal plants and poultices, and offering what would now be called psychological counseling. But since the arrival of western medicine, they have surrendered most of those duties to doctors. "But when doctors fail, it will quickly become mysterious and a Balinese will suspect black magic as the cause. Then they will go to a Balian."

Spend any time in Bali and you will hear stories of miraculous healers who receive a "wayhu", a boon from God, which gives them the power to heal people of diseases that doctors consider incurable. Assuming that real healings do occur, the first question from the sceptical empiracist is how? What is the mechanism? And why does a Balian succeed when doctors fail?

Ask a Balian and he will tell you, with typical Balinese modesty, that they themselves do not heal - God heals sick people through them. But that explanation is unsatisfying to Westerners. Fred Eisenmann, who is chemical engineer by training, thinks that the healer's closest ally is the patient's own immune system.

"Given time, many sick people will get well on their own accord, with or without doctors or healers. And both doctors and healers take advantage of this. But Balian almost always spend far more time with a patient than a doctor. A balian will commonly spend more than an hour with a patient asking a variety of concerned questions. This has to help the patient's attitude, and recent research has concluded that the patient's attitude towards his sickness can have profound therapudic value."

The time a Balian spends with a patient very often reveals social, physical, environmental and psycological conditions that prevent the body's own immune system from fighting the disease. A healer may succeed when a doctor fails because the healer has a wholistic rather than a symptomatic approach.

Balinese rarely go alone to a healer - often they bring their entire family. I would sit in Pogog's balé for hours on end watching him joke, interview, and entertain a patient's family. At first I thought this a terrific waste of time. But after a while I came to realize that Pogog was trying to understand the family's complex dynamics - who had the power, where the allegiances were, and how they impacted the patient's health.

One day an elderly man and his sullen, tattooed, teen-age son came to visit Pogog. After tea and conversation, Pogog began to massage the older man, who complained of migranes, back pain and high blood pressure. As Pogog worked, the son sat nearby and watched, smoking. Usually the patient's family members watch from a nearby platform, but this young man sat close by and interupted the massage by interjecting comments like "There's a mangku in Gianyar who does that." and "Why are you massaging his arms? He's got headaches."

Without warning, Pogog, who was seated in full lotus position, lifted himself up on his arms and shot his legs backward, kicking the young man in the chest and knocking him off the balé. The young man was more stunned than hurt, but everyone froze. Pogog launched into a diatribe against the youth. "You want to know why your father is sick? You are the reason he is sick! You! Get out! You want to report me to the police, go report me. I didn't invite you into my home."

The young man backed down immediately and quickly left Pogog's compound after muttering apologies. Pogog finished the massage, prayed, said a mantra, sprinkled the old man with holy water and told him he should come back in a few weeks for another treatment - without the son.

That was a unique case and atypical of the majority of patients who came to see Pogog, but it dramatically illustrated how and why a Balian might have an advantage over a doctor, who would have simply looked at the old man, taken his blood pressure, given him a shot of B12 and some aspirin. Pogog's diagnosis - to my eyes - seemed accurate. And though it wasn't ethical from a medical standpoint to kick the son off the balé, most of the people visiting Pogog were were in fact drawn to him because of his fearsome reputation. By entering his home were tacitly agreeing to experimental, unproven, and shock therapies.

Balian are unusual people, but Pogog was unusual even for a Balian. He did not fit the textbook definition. His practice was a synthesis of different forms. He was an excellent masseuse on an island known for its tradition of therapeutic massage. He was versed in the ayurevedic system of healing that stresses energy channels called nadis, which can be opened via yoga and deep tissue massage. He was literate and knew many mantras. He owned books on Yoga and anatomy. And he was always learning, though I was chagrined to see that he had met enough "New Age" westerners to incorporate healing crystals into his practice. More important, his treatments seemed to work. I looked up one of the patients mentioned in the Shaman's Drum article, a fellow with a terrible skin condition that Robin Lim thought to be leprosy. It turns out that the man was suffering from a crippling case of psoriasis. This man told me that he had been symptom-free for a year after the healing Lim witnessed - and he believed it was Pogog who healed him.

Is what Pogog does magic? I looked up the word "magic" in the dictionary and discovered that one of the definitions was "The art or science of getting results." Results, then, are the key - whether you get them via art or science, intuition or injections. I believe that Pogog and other Balian intuitively know that many physical ailments are the result of mental pathologies, and that the way to cure the physical is to confront the learned behavior that cripples the body's own immune system. Obviously, a Balian's methods would never stand up to the scrutiny of a peer review board, but this is because Pogog's strength as a healer came from an intuitive understanding of the Art of medicine.


A typical session with Pogog began with a lengthy discussion / consultation. You would then accompany Pogog to the balé and Pogog would "listen" to your feet - breaking a Balinese taboo against having the lower part of the body touch the higher part. Pogog would then begin the treatment. He used a number of "props" including two large round rocks and a hardwood log. He would place the rocks in various parts of your body - the soles of the feet and palms of the hands, the armpits and in the groin area, and hit them with rock. Hard. This didn't hurt you - the dense stone absorbed the kinetic energy - but it was loud and the effect was dramatic and startling. Pogog be telling jokes and laughing the entire time.

If you had a specific or obvious problem - a persistant rash, broken bone that would not heal properly, or even an open wound with advanced necrosis, Pogog would apply his betel-stained saliva or even lick the affected area. He would then continue to place you in a variety of yoga poses, manipulating the muscles and tendons, and then invite you to sit on his shoulders as he walked around the compound, laughing, singing and dancing all the while. Then he would sprinkle you with holy water and send you to the temple to pray.

Pogog's use of his mouth and saliva during his treatments was probably the most contraversial aspect of his methods. From my perspective, this was at best highly unsanitary and at worse compounded the risk of spreading infectious disease. I tried, along with many others, to impress this upon Pogog and he would invariably laugh and say that he wasn't like a doctor who needed a mask and rubber gloves because he had his own way of protecting himself against disease. After much prodding, he eventually explained why he thought he was immune from common contagion.

The Shaman's Drum article did not report that Pogog believed his healing power came from an animal spirit. In 1963 he was extremely poor, and was having difficulty feeding his new-born children. He went out to the flooded rice fields at night to search for fish and to pray for a better situation. One night, he told me, a giant leech appeared, enveloped him and entered his mouth. He went unconcious, but woke before dawn as if from a dream. He went back to work and immediately caught three large catfish. His good fortune as a fisherman continued for a long time after that - but even more important he discovered that his saliva had the power to heal. By literally "licking" the problem, he could heal a variety of conditions that only decorum prevents me from describing.

He told me that before treating anyone he asked help and permission from this spirit, who even had a name. The spirit, in exchange for "using" Pogog's body, would protect him from sickness.

Pogog and Pogog's family clearly believed in this spirit, and had even built a shrine to it. When I asked Pogog if I could photograph this leach, he laughed. "The leach is like the wind. You can't see the wind itself, but you can see how it moves the trees." Obviously, it was difficult for me to accept the reality of a supernatural leach, and no doubt Pogog would have had difficulty accepting the spiritual beliefs that inform my family, who purportedly eat the body and blood of Christ on Sunday. What these two belief systems or epistomologies have in common is a strong central image and metephor that is, by definition, a mystery. The metephor of a leach, which injects a venom and simultaneously removes sickness or "bad" blood, is a primal and resonant visualization tool that was once popular even in Western medival medicine. The metephor no doubt goes even deeper, and may be linked to pre-Hindu, animist beliefs that still inform the world-view of Balinese villagers.

All of these aspects of Pogog's Art: the metephors, the imagery, the massage work, seemed aimed at breaking down - almost literally - a patient's body and their attitude toward their body. He would disarm you with humor, poke you, twist you, bang on you, pick you up, lick you, sing and dance with you until every boundary you ever erected, every rule you ever knew, the edifice of your personality had been broken, inverted, complimented, mocked, lifted, dropped and shattered. The physical, kinesthetic process of the "massage" mirrored a psycological process that asked you to look again at the vessel you call your body, take inventory, and reevaluate the nature of your "sakit" - your sickness - and your relationship to it.

And after breaking you down, what were you left with? The sakit was still there, but a patient's relationship to the sakit had been transformed. Given that patients were usually accompanied by their families, the relationship of the family to the patient and his sakit - distinguished by pity, disgust, guilt, fear, schadenfreude and enabling patterns - had been altered. And since a large audience of strangers in the waiting area had witnessed this treatment as well, the patient's relationship to the outside world had also been reconstructed and redefined. These cathartic transformations did, in many cases, lay the foundation for physical, biochemical change.

But to concentrate on the "Art" aspect of Pogog's "magic" is to draw an incomplete picture. Pogog was a skilled masseuse with a deep understanding of the "science" of anatomy. In my own work as a student and teacher of yoga I have traveled to India and all over South-East Asia and met with a number of people with a deep understanding of the body on both a gross and metaphysical level. Pogog was definitely one of the best in this regard. His own yoga practice was phenomenal. He also had the ability to put or assist his patients into advanced yoga positions that were theretofore physically impossible for them. He also knew, like an osteopath or doctor of chiropractic, how to help people with real - not psychosomatic - physical injuries or damage. An example:

Often boys are born with one or both testicles undescended. Usually, the testicles drop into the scrotum before the child is 12 months old. When the testicles do not descend, the only option doctors have to offer is to operate. As with all surgical procedures done under general anesthetic, there is always the chance of complications - hemorrhage, infection, and even death.

Pogog had a different technique which he commonly performed on boys and young men with this condition. He would perform deep tissue massage in the patient's lower abdomen and try to pop the testicle through the obstructing guberculum into the scrotum. If that didn't work, he would take the patient's scrotum into his mouth and - while continuing the abdominal massage with his free hands - create a vacuum with his mouth which would pop the testicle through the blockage and down in place.

I described this technique to a western doctor and, as might be expected, he shook his head and winced. No western doctor could perform such a technique without losing his medical license because of the impression of sexual impropriety. But after thinking about it for a moment, this doctor agreed that the technique did have merits. Unlike with surgery, there was no risk of infection or the side effects associated with general anesthesia. The procedure took about ten minutes, was inexpensive, and the patient could go home not days but minutes later.

Might not the patient suffer psychological scars following so shocking a procedure? Particularly in taboo-ridden Balinese culture? That is certainly a risk, but is by no means certain. And the benefits of the procedure to a boy or young male, i.e.. normal sexual and reproductive function - might overweigh any mental trauma associated with the technique.

So now we enter into the grey moral area where Balian and Dukun take up residence. Robin Lim witnessed these types of transgressive, highly theatrical techniques and later said "I couldn't figure out it he was the most deviant person I have ever met in my life or a person so deeply, in his heart, in love with his patients that he would do anything in order to heal them." It is easier to question Pogog's sanity than his motives, particularily after witnessing, on many occasions, Pogog risk his own health to heal a patient. I was with Pogog when he treated an American who was H.I.V. positive. While there was no exchange of body fluids, I felt quite uncomfortable with the process and tried to voice those fears to Pogog, who mocked and dismissed my concerns.

While I was concerned with Pogog picking up a bacterial infection or virus, Pogog's Balinese friends were more concerned with the spiritual danger of his work. In the Balinese world-view, if you rid someone of an illness that is karmic in origin, you run the risk of taking on that sickness and that karmic debt. And if a patient's illness was the work of a Leyak, by "eating" the sickness Pogog could incur the wrath of that sorcerer. Nyoman Jiwa, an articulate Balian from Bangli, said to me that the risks involved in becoming a healer were great - and far more dangerous than catching an infection from a patient. Pogog never tried to hide what he did, and everything was out in the open. He welcomed strangers, foriegners, police officers, and reporters to witness his work, proud of the fact he had nothing to hide.
Many of Pogog's patients were women and Pogog's wife or daughter-in-law was always there to providing assistance, which helped mitigate the impression of impropriety. It takes a great deal of courage for a woman to visit a male Balian. Bali is always swirling with rumors of "balian cabul" - "horny" or "porno balian" who tell women they can cure them of their problem in exchange for sex. Pogog was accused of this as well, which, based on my own observations, was unfair and inaccurate. Pogog did indeed perform acts like the one mentioned above that could be construed out of context as being of a base, sexual nature. The fact that Pogog, with men or with women, always enjoyed himself, didn't help his reputation. But more often than not women arrived with a male family member in toe, and were fully aware of what they were getting into.


Many women to Pogog who were having difficulty getting pregnant. Some testified to me that Pogog cured them of their problem, and pointed to healthy babies as evidence. I suspect that Pogog's shock treatments were particularly effective in breaking women out of cultural conditioning or learned behavior that manifested in infertility. His treatments were effective on western women as well. I know two women who were both "cured" by Pogog. The first had not had a period in six months. After one treatment, she had her period the next day. The other woman had a recurring bacterial infection that resulted in internal pain and an unpleasant discharge. Pogog's treatment of women involved the usual battery of invasive massage, mantra, and prayer, but he also - sometimes but not always, quickly blew air into their vaginas - usually in full view of their husbands or families. The women I talked to were uniformly bemused by this but did not feel victimized. And they were grateful to Pogog for being returning to health.

With all this, Pogog was doing well, rebuilding a house, and looked forward to a long career.

I was not the only person who read the article in Shaman's Drum. A large influx of foreign patients, waving the article, would appear at the market in Mengwi looking for a guide who could take them to "Mr. Pohoh". (Robin Lim had mispelled Pogog's name in the article, which cause no end of confusion, because "pohoh" means "mango" in Balinese.) Jerry, the American apprentice healer, was helping marketing efforts by creating color displays and distributing pamphlets in Ubud that were headlined "Meet a Balinese Shamanic Healer". With this type of publicity it is no wonder that Pogog began to attract some oddballs. There was Jerry, who thought himself a Balian and a pemangku in spite of the fact he could not speak Indonesian, let alone Balinese or Kawi, the Sanskrit -based language of Balinese lontar. There was a British man, clearly mentally ill, who in one particularily manic moment told me he was God. There were a couple of clever local tour guides who brought minibuses of retired couples on holidays for a massage, and French expatriate heroin addicts from Kuta trying to take the cure, and a couple from California looking to add spice to their love life with a "tantric massage experience". It gets worse. A woman from America led a tour of gay men from San Francisco - some H.I.V. positive - who wanted to be treated. A film crew from Germany arrived and spent a week with Pogog, paying a great deal of money to document his work. And there I was, ringside, with my handicam.

All of this affected Pogog's practice. I think he began to show preference to western or wealthy Indonesian patients over the local villagers. He talked a lot about a tour of America, which Jerry was trying to organize. I got the sense that Pogog's family was feeling the pressure as well. There is a cultural stereotype of Balinese people as being prone to jealousy, and I got the sense that all the attention Pogog was getting was not going unnoticed by his economically struggling neighbors. Moreover, Pogog himself was changing. He talked more and more about money, and even derided patients whose sesari (an offering that included money) was insufficient.

I was conflicted myself. Would the documentary I was making open the floodgates further? Was my presence helping or hurting this man, who I had come to call a friend. Journalists can hide behind the facade of "objectivity", but at a certain point a journalist can become a part of the story, and the excuse no longer holds. Having first come to Bali in 1984, I knew full well the effects of tourism and the West, which is intent on turning Bali into a theme park with no thought to the environmental, and spiritual cost.

I said good-bye Pogog and his family and wished them well. I had done what I set out to do, and hoped, not very optimistically, that I could edit the film in such a way as to do justice to Pogog and at least help spin the debate in a positive way. But I knew that the contradictions of the subject, and the complexity of Pogog as a "text" would make that difficult.

No doubt the debate on this man and on the issues surrounding traditional healers will be with us for some time. It hardly matters to Pak Pogog anymore. Pogog was stricken by a massive stroke in late 1997 that left his entire left side paralyzed. A CT scan revealed a complete non bleeding stroke, and the doctor who treated him doubts that Pogog will ever walk again.

Initially, some of Pogog's Western friends rallied to his side. Jerry flew back to Indonesia and performed his own brand of energy healing on Pogog, without apparent result. Another westerner put some queries out on the internet hoping to raise money for Pogog's physical therapy, with limited results. As the weeks and months past, and as Pogog showed limited signs of recovery and almost no personal initiative, visits by foreign guests became fewer and fewer. It has now been years since Pogog has heard from his student Jerry.

A good many people are relieved that Pogog is out of business. The image of an infection-licking, disease-sucking yogi is hardly one that appeals to the Balinese Tourist board. Some of Pogog's enemies were actually pleased with the turn of events. I met an expatriate couple - part time residents of Bali since the 70's - who considered Pogog to be a Leyak, or black magic practitioner. A woman with a history of depression whom they knew had visited Pogog at one point and weeks later committed suicide. They blamed Pogog for this. When I informed them that Pogog was now completely incapacitated, the response was "Serves him right". They later went on to say that as a healer, Pogog was basically an overrated abortionist.

I doubt Jay Goodman would agree with that assessment. Jay is the H.I.V. positive patient that Pogog treated back in August of 1997. At that time, Jay's long term companion had just died and Jay had just been diagnosed. Doctors informed him that his t-cell count was too low to put him on the then standard therapy of AZT. Jay avoided all traditional treatment and decided instead to take a vacation in Bali. He heard about Pogog and I witnessed and filmed his treatment.

Jay and I still talk on the phone and correspond by e-mail. He's still
completely asymptomatic, and doing just fine.

Pogog's response to the stroke followed archetypal pattern of shock, denial, bargaining, and depression. Resignation/acceptance, the final stage, still remains elusive. With the medical world offering him no hope, he turned to traditional healers and dukuns himself. At various time he has said to me that the cause of the stroke was black magic sent by other jealous healers. Another theory was that he was cursed by his ancestors for renovating his home with his new wealth before rebuilding the family temple. He also said the problem stemmed from the fact that he left Bali to perform healings - he had a dream that told he lost his healing gift because he committed the error of putting foreigners ahead of his own local community. "That is why I am in this prison." he told me.

A stroke is probably a worse fate than death for a intensely physical man like Pogog. Caught in this prison, Pogog seems now to be in a negative feedback loop of fear, guilt, recrimination, blame and anger. His enemies bask in schedenfreud and his allies are incapable of changing or altering the situation. The irony of the situation is that Pogog needs someone like his old self. He needs to be taken out of this spiritual and psychological double bind before there is any chance of a healing to occur. It is ironic and even tragic that he cannot apply his own intuitive healing genius to himself. Who, now, will heal the healer?

THE END