South Sea Gold: Chapter Twenty-three

The message from the Owego Mine arrived at South Sea Gold's Port Moresby office next morning. As it happened, Jeremy Blake was the first to see it.

"Mr. Li, I don't know what they've got down there, but it could be serious. Even at best, I believe we should approve transport of these children to Alotau Hospital. Sending the company plane for them would be a positive move in our public relations situation."

Li Kao Hsai rubbed his chin as he studied the fax. "Not many helpful details here, but yes, Jeremy, I agree we could use some favorable publicity, and sending the plane would help. Fax the mine, tell them we will provide transport for the three children and one parent apiece to Alotau. Tell them to be ready this afternoon."

"Yes sir. Would it help if we could seize the initiative with a press release for tomorrow's editions?"

"Do it. I'll square it with headquarters in Hong Kong." But he thought, I'm not sure how.

Blake's news release arrived on Sophia's desk at 3 pm, well before deadline. She conferred with Jon Sinto. "This is an important change on South Sea's attitude. Tom and Matt are on the scene; how can we get in touch with them? "

"With luck, I can raise Matt on his mobile, but the conversation usually breaks up. The children are already on their way to the Alotau Hospital as we speak. The best way to reach Tom and Matt is to call that helicopter man Tom knows, and just have him go to Owego and bring our people to Alotau. They can go on covering the case from there. I think the service is listed as Island Heli, or some such." She checked her computer. "Island Heliport. That's it." She looked up at Jon. "What'll I tell him?"

"Tom's been there a week or more. He should have covered the local scene thoroughly by now. Kim and Morrie will need a little time to pack. If the pilot goes to Owego early tomorrow morning, or better yet, tonight, he can get them back to Alotau tomorrow noon. Matt could either go with them, come back here, or stay on Owego; it's up to him and his boss at The Chronicle."

"I'll suggest Matt come back here," Sophia said decisively.

Sinto looked at her, saw her blush, but said nothing.

Tom, Kim, Morrie, and Matt loaded aboard the waiting helicopter next morning. Kim was very apologetic to Beverli and two of her pupils and their mothers who had come to see her off. "I hope I can come back soon, but it depends on my husband; his boss sends him wherever there's news. Anyway, I'll see the children at the Alotau hospital and let you know how they are." Morrie waved bye-bye to his friends as the helicopter rose and arced to the southwest. Kim stayed with Morrie at the Alotau guest house, while the two men went to the hospital. "Tell the kids Morrie and I will come see them tomorrow."

Tom and Matt asked the attendant at the hospital emergency room if they might speak with the doctor attending the three children from Owego. Presently, a young woman in a white coat appeared. "I'm Doctor Silanta. And you are...?"

They produced their respective reporter ID cards. "We've been following the children's condition for the past four days at Owego. "What can you tell us?"

"First, I need to speak to the parents," the doctor said. "Please wait here a moment." After a five-minute wait she returned, satisfied that the parents did indeed know these two men. "They can talk with you now. I'd like to verify a few details of their story with you too, if I may."

Tom talked with the children and parents in Tok Pisin then switched to English with the doctor so that Matt could follow it. "They say that they feel less pain now, but want to know when they can walk again. What do you think happened to them, Doctor? The attendant at the mine clinic said they had a virus."

"From what I've observed so far, they have no fever, and their minds are alert. I understand they all got this the same day?"

Tom nodded. "Within about a 36-hour period. Palli missed school first; Lisa missed the next day, and Timothy got ill later that same day."

"Sometimes we see a kind of hysteria among school children; one gets sick and then others imagine they have it too," Dr. Silanta said. "It's definitely not polio, with their legs so stiff. No signs of encephalitis or brain fever. I've not seen anyone like this before."

"About the hysteria," said Tom, "I saw Timothy the first day he became ill, and I found his muscles stiff, as you say. And he was the last to get sick. I don't think it was a "me too" reaction. It was real."

"I'm going to talk about these kids with the other doctors at our staff meeting tomorrow morning. There's always a reason for what's happening. We just have to find it." She excused herself to see another patient who had arrived in the Emergency Room.

"What did she say?" demanded Timothy's mother, an aggressive large woman.

"She was just discussing what diseases resemble the children's behavior. She is honest about it; says she hasn't seen anyone like this before, and will talk with the other doctors at their meeting tomorrow morning."

Timothy's mother snorted. "There's not much to decide!" she declared. "Either a witch is to blame, or the foreigners who came to dig in the ground and kill the fish." She spat betel juice out the window as Tom and Matt left.

"So, what do you think?" Matt asked as the two men walked back to the guest house.

"Something wrong in that village, something that's not happened before. Nobody in West Owego is sick, and the ER doctor here hasn't seen anything else like it in Milne Bay. Must be something involving the mine, but what? And why these three children and not others?"

A half-dozen doctors gathered in the children's ward the next morning to go over the known facts. They talked with the parents, examined the children, reviewed the symptoms. They considered diet, known parasites and infections in Owego's home district, as well as on the mainland around Alotau.

"We think it's a condition in the nervous system." Dr. Silanta explained to Tom and Kim, following the doctors' conference, but we have no neurologist on our staff. We'd like them to see someone at Port Moresby General Hospital or the Medical School who is more specialized than we are."

"Is there a neurologist up there?" asked Tom.

"There are neurosurgeons. And perhaps someone in pediatrics who has done special study on the nervous system since the time I trained there. We frankly don't know what else to do. But if this affected three children, it can affect more, and we need to find out what is happening."

"South Sea Gold has paid for this up to this point," said Tom. "But what about further transport and expenses?"

"Our hospital business office can figure the cost by air or by sea ambulance. It's cheaper to treat three children now than to treat a possible epidemic later. We'll work it out."

The neurosurgeon at Port Moresby's General Hospital spoke with an air of authority. "It's some acquired general defect in the central nervous system," he pronounced, after examining the three children the next day.

"What does that mean exactly, Doctor?" asked Tom. He often thought his whole job as a news reporter could be described as breaking down experts' big words into language the average reader could understand.

"It means there is nothing I can operate on," said the surgeon. "No brain tumor, no epilepsy, no physical injury. But we have a pediatric specialist from India visiting this week, and I'd like to consult him."

Dr. Sandur Rao, MBBS, visiting lecturer from Mumbai, India, was a physician in his fifties, with graying hair and a quiet manner. He made hospital rounds with three UPNG medical students who had expressed interest in childhood neurological diseases, and he found the three children from Owego very interesting. "We have here," he said, "three children with an obvious defect in nerve transmission, who all suddenly became ill within a day or two, without any preceding warning. They complain of pain in the legs, and falling over when they try to walk."

He lifted one of Timothy's thighs with his hand and gently tapped the tendon below the kneecap. Timothy's knee jerked involuntarily. The doctor then supported the calf of Timothy's leg, and with his other hand underneath the foot, briskly bent the ankle upward; the foot jerked back and forth several times before resting. "As you can see, his reflexes are active. Over-active, in fact. Who can tell me the nerve pathway from the leg to the brain?"

The students hesitated, not wanting to make a wrong answer. "The lower nerve goes from leg to spinal cord, where it connects with the upper nerve that goes to the brain?"

"Just so," Dr. Rao smiled. "And in polio, which segment is damaged?"

"The lower one."

"And therefore, what happens in the leg muscles?"

"There's no functioning nerve, so the leg just lies there, limp. It's paralyzed."

"So this is not polio, correct?" All three students nodded. Dr. Rao continued, "But if the upper nerve in the pathway from the brain is damaged, the spinal cord can still tell the muscle to contract, but the brain controls it poorly, if at all.

"We then have, not limp paralysis, but 'spastic paresis'―tense weakness. So these children have developed, all together, and suddenly, an upper motor neuron defect."

The students waited expectantly, their faces blank.

"There are several obscure conditions which cause such a problem to appear slowly," said Dr. Rao, "but only one that I know of that appears suddenly in children, and sometimes in women after childbirth, called konzo. It occurs in Africa where children often have to survive on a diet of cassava. Would one of you ask these mothers what they usually feed their children?"

A student translated the question into Tok Pisin. "She says manioc." The doctor motioned to ask the other two. "Manioc", they both replied. "But that's another word for cassava." the student added.

The specialist spoke quietly, with no trace of self-importance. "Now being a good doctor sometimes requires you to be a good detective. It does little good merely to make a diagnosis. You must find out the 'why' and correct it if you want to make your patient well. In my medical work in Mumbai I see an occasional laborer or his children who have moved there from East Africa, where many of the poorest people live on manioc. Who can tell me the problem with that?"

A student volunteered, "It tastes blah unless you add sugar."

Dr. Rao encouraged her with a faint smile. "And by 'blah' you mean...?"

"Not much taste, or even bitter. But it fills you up," she added.

"And why is it bitter?"

Apparently, none of the three students had ever thought about that.

"There is a trace of cyanide in the manioc pulp," said the doctor. "Not enough to kill you, but not wise to take every day, unless you are careful how you prepare it. Ask these mothers how they do it."

The girl student translated the question. Timothy's mother answered, her mouth full of betel, "Mash it and cook it."

"Does she soak it?" asked the doctor.

The student moved the spittoon on the floor closer to Timothy's mother, who ejected a mouthful of blood-red betel juice, tucked her cud into her cheek, and exhibited her blackened teeth. "If I have time." Her manner made it obvious she considered these questions a waste of that time, too.

"So now we may have a diagnosis, but we don't yet know why three children from different families reached the crisis point of sudden nerve damage at the same time. We'll see these children again tomorrow, and meanwhile, you three young doctor-detectives explore what these three children have in common apart from the others in their village."

"What's the cure for konzo?" asked one student.

"There isn't any." The specialist's face was sober. "Once it happens, it's a life-long disability. The best we can do is physiotherapy, to teach them how to walk in spite of it."