Ghost Month in Penang: an island haunted by the spectre of dengue fever

Behind a short wall, a shirtless man watched as a shroud of smoke settled on the street across from his house. It was not uncommon to see smoke in early September, as the neighbourhood would often burn paper and incense for Ghost Month — when the deceased would visit the human realm before returning to hell, and people burned offerings for dead relatives and friends.

But there wasn’t any sight of flames or the smell of burning paper. This smoke was heavy. It did not rise above the treeline and leave a faint grey trail as usual; instead, the thick white mist seemed to collapse on itself, expanding rapidly as neighbours rushed indoors. One woman promptly collected the clothes she’d left on her porch to dry before scampering back indoors with a hand on her mouth. Another boy, walking by a paved sidewalk, ran frantically away from the vicinity of the smoke as his dog followed.

The man watched his neighbours scramble inside before heading into the safety of his home.

On the island of Penang, Malaysia, the month of September means many things. The monsoon season brings cooler nights, fewer tourists, and the looming threat of dengue fever.

‘Water poison,’ as it was fittingly named by the Chinese in 992 CE, was first recorded in Malaysia at the start of the twentieth century on the island of Penang itself. Records say that the disease was carried into Penang by an outsider — a Singaporean — although sources vary on this claim.

Outsider or not, ‘mosquito-mania’ did not hit until more than seven decades later, when the 1973 dengue fever epidemic saw a record-breaking 969 cases and 54 deaths by the end of the year. However, this was not the last time that Malaysia would cross paths with dengue. Most recently, the disease broke out in 2019 with 80,000 cases and 113 deaths. For the government, this was a national disaster; for the people of Penang, it was just another year.

Evidently, dengue’s presence has seeped into the island’s culture across the span of half a century, to the point where the disease has gained an almost mythical status among locals. The black and white stripes of the dengue mosquito have come to symbolize the frail and vulnerable.

To keep the young ones inside after dark and away from the forests, parents often tell tales of friends or relatives who had contracted the virus. The elderly wear long-sleeved shirts to prevent getting bitten. Parents hang mosquito nets on the beds of infants and young children. There is an unspoken rule to never walk outside alone at dusk, as the mosquitoes are said to target those without company.

In Penang, dengue is less of a disease than a metaphor for the culture of fear that pervades the community during the warmer months when the virus can survive.

~

Among those caught up in the seasonal craze of dengue fever is Tan Lan-Hwa, who has had her own brush with the disease. The 80 year old resides on the foothills of a heavily forested region — awkwardly named Pepper Estate — that used to be an orchard. In the dense tropical rainforest directly behind her house, there remains a small mud road.

One can follow this road on a 15-minute trek through the jungle to reach a dilapidated reservoir that had fallen into disuse for as long as anyone in Pepper Estate could remember. Tan vehemently insists that this reservoir is the root of her troubles.

“Where there is water, there are mosquitoes,” I remember her telling me, speaking hoarse Mandarin with Malayness, a linguistic trait of people from this region. “And where else is there water around here?”

She went on about how they should have drained the reservoir years ago and how children who went skinny-dipping had all contracted the disease. But by then, she had nearly lost my attention. Perhaps the constant squeaking of the antiquated ceiling fan inside her house got the better of me, but I honestly couldn’t have cared less.

Tragic as it was, these narratives were all too common among locals; growing up on the island, I listened to these stories repeatedly, and like most things your parents tell you in your childhood, you eventually hear so much of it that you almost tire of it completely. In Tan’s house, my focus shifted instead to the replay of The Dark Knight airing on the television in front of us.

She told me that she and both of her daughters-in-law had contracted the disease in the same year and were hospitalized for half a month in the same hospital. They had fevers of over 39 degrees Celsius, sweated profusely, and received mandatory intravenous therapy.

She didn’t need to describe the rest; from my experience, even the youngest child from around here knew dengue fever’s symptoms in and out.

First, and probably the most distinct, is the infamous rash. It’s such a common feature that the locals have a standard name for it. The second symptom is the persistent sensation of itching, which comes with a constant urge to scratch large areas of skin. And if that wasn’t your cue to seek medical help, the ensuing nausea and body pains would make any person find a doctor.

When I asked her how it felt, Tan struggled to string together words. “It hurts,” I remember her uttering. “The head hurts.”

I was slightly put off by the hesitance of the responses; they sounded more like an amateur doctor trying to explain the symptoms of an unknown disease. So I kept asking. How did you feel being alone in the hospital? Did you feel lonely? How do you think your daughters-in-law felt? But she would always look me in the eye and give the same vaguely hesitant response, over and over. “It hurts, it hurts, it hurts.”

The sizzling of a frying pan from the kitchen seemed to merge with the smouldering Malaysian heat. Tan had gone to take an afternoon nap, but I was restless. Apart from the intense stuffiness of the un-air-conditioned house, her response made me think. It hurts, I thought to myself again and again. It hurts. As the credits of The Dark Knight began to roll, I felt a slight itch on my left knee. There was a penny-sized red bump, with a visible hole in the middle.

It was already five o’clock.

~

Tan wouldn’t let me walk to the taxi stand in the middle of dengue season, so her son in-law, Ah Kam, drove me home. As the sun set, we drove about 15 minutes down Tanjung Tokong, which was lined with food stalls and gift shops in preparation for the weekly night market. There were old ladies selling cheap jewellery and hawkers dishing out street food on the sidewalks, but not a single child.

As we stopped at a red light, I picked up a familiar scent. The air-conditioning had broken down in his antiquated Honda Civic, so I had wound down the backseat window. Before I could recognize the distinct smell of chlorinated ammonia gas, Ah instructed me, with a tone of urgency, to wind up my window. But it was too late: thick smoke invaded the car.

“Dammit, those idiots never use insect repellent,” I remember Ah cursing as we both erupted in a series of coughs. “Now the whole neighbourhood is going to get smoked again.”

“Do they always spray this when someone gets it?” I asked. The smell of chlorine started to sting, and a single tear rolled down my cheek. As our coughing came to a halt, Ah returned to his senses, sitting upright and firmly adjusting his hands on the steering wheel.

“Yeah,” he mumbled. “Government policy.”

The heavy white smog covered the entire street. We could still smell it from inside our car. As the smog dissipated, three men came into view, each carrying a gas machine the size of a gatling gun. They were wearing green fleeces and bright red caps, with ragged scarf masks that covered most of their faces. Despite their distinct apparel, I could tell they weren’t locals. Whether it was their darker skin, long curled hair, or perhaps even their avoidance of eye contact, their presence stood out within the rowdy atmosphere of the night market.

As they walked past us, Ah shot me a quick glance. “I’ll say, you better stay away from the Bengalis,” I remember him saying, nodding his head in their direction. “I heard a whole flat of them nearby got dengue the other day.”

I knew for a fact that dengue wasn’t contagious and was also fairly certain there weren’t any designated flats for immigrants around the area, but I decided to keep my mouth shut to avoid sparking an awkward debate. “There’s plenty of diseases where they’re from anyways,” he continued as the red light turned green.

As we drove in silence for what was left of the short journey, the image of three men walking in the midst of thick, chlorinated smoke began to sink in. These men, likely migrant workers, were part of the nearly two million foreign workers in Malaysia — not to mention the thousands more working here on less than legal terms. Most came to Malaysia with dreams of a metropolitan hub that welcomed Muslims but instead were greeted with disdain and racism.

However, this certainly is not a recent trend, and most Malaysians would agree. As early as the late nineteenth century, Chinese and Indian immigrants who came to mine tin on the shores of the country were met with communal violence, leading to the infamous Racial Riots of 1969.

Although racial tensions have eased since the 1950s, general attitudes can be hard to change, which certainly remains true in Penang itself. Perhaps this was best illustrated when the state recently announced a ban on teaching foreign workers local culinary skills in an attempt to “safeguard Penang’s food heritage,” with a resounding 80 per cent of people voicing their support of the ban.

While we are no longer killing immigrants on the streets or passing belligerently racist laws in Parliament, subtleties like this alienate certain members of this xenophobic society. Considering these circumstances, it almost felt wrong to write about dengue without talking to at least one of these people.

When I stepped out of the car, the first thing I heard was the harmony of chirping crickets in the distance. The sun had already faded to a dark orange as the street lights started to light up one by one. Watching the car drive into the night, I knew what I was going to do next. This time, I would be waiting for the smoke.

~

As I drew my curtains in the morning, I was once again greeted by a wall of white smoke. It had been two weeks since I last spoke with Tan, and within that span of time, I recall that the entire neighbourhood had already thrice been visited by the mosquito control department — once for every person hospitalized.

From my quarters above, I had a view of the desolate street below. There were no joggers, dog-walkers, or couples in sight — only a lone masked man wearing a green fleece jacket and a bright red cap.

Earlier that week, during the first instance of aerial spraying in the neighbourhood, I had attempted to speak to one of the men. I didn’t need to catch a glimpse of the hefty gas machine he was carrying on his back to recognize that he was a member of the dengue control squad, as there are few people who would wear a thick fleece jacket and mask in the 35 degree Celsius afternoon heat.

However, before I could get a word in, he began to wave at me. This was no friendly greeting; he waved frantically, shaking his head left and right while muttering something I could not make out from under his thick mask.

The minute I left, I heard the familiar buzzing of a gas machine, so it was apparent that he did not want to talk — at least to me. Perhaps I should have persisted, or at least inquired as to why he refused to speak, but that day, I left with more questions and no answers.

I watched the lone man walk up the street with a stream of smoke trailing the gas machine. Combined with the noise of construction and the buzzing sound of the gas machine, the image looked almost too apocalyptic for a cloudless day on a tropical island. All the gas, the deaths, the cases of hospitalization, the horrific tales of survivors — these were the profound effects of dengue fever on Penang. Or were they?

Strangely, I realized that all I knew was from stories I had heard. Indeed, dengue had killed hundreds, perhaps thousands of people in the past, but these modern-day stories were so engrossing that I’d never considered the true impact of dengue on this island right now.

Common sense would dictate that our advances in the medical field should have made an impact on the numbers — it would be asinine to think otherwise. So I sat down and pulled out my laptop. Presumably, a good place to start would be the number of deaths in 2020.

One.

As I clicked on site after site, scrolling past article after article, trying to convince myself there had to be more, the smoke slowly began to settle. The lone man was nowhere in sight. A lady poked her head out of her house. Then an old man, followed by a group of children. One by one, people emerged from their houses. As if nothing had happened, the neighbourhood came back to life.

Cover visual: FIONA TUNG/THE VARSITY