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Indra* had a hangover. He’d been drinking bootleg whisky until the early hours of the morning and now felt decidedly unwell. Rolling over on the thin mattress in his shared room in Medan, North Sumatra, he opened his eyes and looked for his roommate Roby. Peering through a thick fog, he rubbed his eyes and noticed his vision was blurry. “I could barely lift my head off the mattress. It felt like I had a brick lodged in the back of my skull. The pain was excruciating, not like a normal headache at all,” he says.
As he tried to get up, Indra heard coughing. Even though his eyes couldn’t focus properly, he was able to make out Roby slumped in the doorway. His friend was covered in blood; Indra initially thought he’d been stabbed. When Robby started coughing again, Indra saw that he was vomiting blood which had soaked through his white vest. Neither man knew it at the time, but they were both in the grips of methanol poisoning.
A silent killer
From March to April 2018, Indonesia experienced its worst ever spate of methanol poisoning incidents in West Java, Jakarta, and Papua, leaving more than 100 people dead and over 160 in hospital after drinking bootleg alcohol containing fatal amounts of methanol. It’s caused a renewed wave of interest in methanol poisoning, but this has been a silent killer in Indonesia for years. It’s difficult to get serious figures on the number of people who die of methanol poisoning every year, largely because it’s often misdiagnosed or attributed to something else, such as bleeding in the brain. A report by the Centre for Indonesian Policy Studies (CIPS) provides an indication: “Nationwide, 487 people died from illegal alcohol poisoning between 2013 and 2016—a 226% increase over figures from 2008 to 2012.”
From March to April 2018, Indonesia experienced its worst ever spate of methanol poisoning incidents… leaving more than 100 people dead and over 160 in hospital
Methanol, which is colourless and odourless, is a by-product produced during the fermentation process of making alcohol. Just 30 ml of methanol—about a shot glass’ worth—can kill you. It’s meant to burn off naturally when alcohol is being distilled, but a mistake made during this process may leave it present in the final product. Looking to cut costs and speed up production targets, Indonesian home breweries and black market alcohol factories sometimes fail to sufficiently heat the alcohol—or eschew the heating process completely—leaving the deadly methanol behind.
Reports of methanol being deliberately added to poison consumers are extremely rare, if they happen at all; it’s far more likely to be a case of human error. To make things worse, some illegal brewers deliberately mix spirits with rubbing alcohol and other products like mosquito repellent, rat poison or shoe polish to make the alcohol stronger and give it hallucinogenic properties. This in turn confuses the issue of straight methanol poisoning versus those who have been poisoned by other illicit substances.
When humans ingest methanol, it metabolises into formaldehyde. “It’s like your body is being embalmed from the inside out,” Lanang Suartana Putra, a doctor at Sanglah Hospital in Bali, told the press in 2016.
Methanol poisoning is not a widely understood issue, so many drinkers don’t know they’ve been poisoned until it’s too late. Because it can’t be detected in drinks through taste or smell, many people think they’re just suffering from a hangover. The initial symptoms do closely resemble a night of heavy drinking: headaches, stomach cramps, nausea, loss of appetite and sensitivity to light. One key sign of methanol poisoning is blurred vision as the methanol attacks the central nervous system. Methanol poisoning also happens fast: within 12–24 hours of consuming tainted alcohol, many drinkers may be asleep, hungover or still drunk when they start to feel unwell. It’s essential that consumers get medical treatment as soon as possible, but methanol poisoning is often misdiagnosed—with dire consequences.
Misdiagnosis
There are various reasons for misdiagnosis. Indonesia is the most populous Muslim nation on earth and has always had a contentious relationship with alcohol. Although alcoholic drinks are available legally across most of the archipelago, alcohol is prohibited in Islam, so poisoning victims who visit hospitals in Indonesia may be judged, refused treatment or misdiagnosed by medical staff unfamiliar with methanol poisoning. In rural areas in Indonesia, deaths are sometimes blamed on demons or as righteous punishment for drinking alcohol in the first place.
When Indra saw his friend vomiting blood, he managed to get up off the floor, put him in a pedicab and take him to a local hospital. Once there, however, the hospital staff diagnosed Roby with alcohol poisoning—a common misdiagnosis—and hooked him up to an intravenous drip. Indra says that when it started to take effect, Roby began screaming and tried to rip the needle out of his hand. “It was as if the medication was reacting with the methanol in his bloodstream,” says Indra. “He said his veins were on fire.”
When the treatment didn’t work the hospital finally—hours after he’d been poisoned—agreed to perform dialysis on Roby, the only treatment for advanced methanol poisoning. It ultimately saved his life. But the delay left Roby with severe side effects. When New Naratif spoke to him about the incident, he says he remembers little of that night other than waking up in hospital after the dialysis. He struggles with severe memory loss nowadays and can barely remember the questions he’s been asked, losing the thread halfway through his answers. Indra also says that Robby suffers from delusions; he keeps claiming that he’s getting married soon, even though he’s housebound and has been married for years.
Indonesia’s alcohol problems
Indonesia is not the only country in Southeast Asia that has a problem with methanol poisoning; Thailand and Vietnam have also had cases of people being poisoned by bootleg liquor. But Indonesia does have some unique alcohol-related issues that have led to the rise in methanol poisoning deaths across the country.
One such issue is an alcohol tax of 150%, meaning that imported spirits are prohibitively expensive for many Indonesians—the average starting salary of a university graduate is around IDR3 million (USD225) per month. But it’s not just about less affluent Indonesians; everyone, from students to holidaymakers, wants to buy alcohol as cheaply as possible. If a bar is going to sell a vodka and coke for IDR15,000 (USD1.80), something widely advertised outside drinking establishments in Bali, it needs to keep costs down by using locally brewed illicit alcohol rather than genuine imported spirits.
Even if you can afford it, there’s another problem with accessing legal alcohol in Indonesia. A law enacted in 2015 made the sale of alcohol illegal in mini-markets across Indonesia (with the exception of Bali), a policy introduced by then-trade minister Rachmat Gobel, who declared that alcohol was to blame for moral corruption engulfing Indonesian youths. All the new law has done, however, is make it more difficult to buy alcohol, a consequence highlighted by critics of the bill from the beginning. The bill was also opposed by former Jakarta Governor, Basuki “Ahok” Tjahaja Purnama, who said that “the ban could encourage the illegal sale of alcoholic beverages in the city”.
The rise of bottle shops
Purnama was right; many Indonesians, unable to purchase alcoholic drinks in mini-markets, have turned to unlicensed “bottle shops” which usually sell fake alcohol or moonshine like the whisky that Indra and Roby drank. The alcohol sold in these shops is not properly regulated and there’s no way of knowing what it contains. According to CIPS, the ban on prohibiting the sale of alcohol in mini-markets has had a negative impact and “[…] research in six Indonesian cities confirmed that, instead of curbing the desire for intoxication, prohibition facilitates the growth of black markets, a case especially evident in areas with partial prohibition that limits the distribution of alcohol to particular zones.” In other words, prohibition doesn’t work—it just drives the market underground, sometimes with lethal consequences for consumers.
When New Naratif interviewed Indra about the bottle shop where he purchased the whisky that almost killed him and Roby, he brought up an allegedly widespread practice that’s endangering the lives of drinkers. Indra identifies the bottle shop in Medan only as “Warung X”—the owner refused to speak on record, referring us instead to Indra, who self-identifies as a “loyal customer”, as his spokesperson.
Indra’s been buying bottles of liquor from Warung X since 2004 and explains how they buy and test their alcohol: “When a sales representative comes from one of the local factories, the shop asks loyal customers like me to act as testers.” It’s an amazing revelation. According to Indra, the bottle shop, and many others like it in Medan, uses “loyal customers”, in return for free drinks, to sample new batches of alcohol to see if they’re poisoned.
But what if a bottle of alcohol contains methanol? “If it has methanol in it then, yeah, you die,” replies Indra, laughing uproariously and slapping his thigh. “But look at me, I’m still alive.” He says he sometimes feels unwell when sampling new batches of alcohol in the shop; if that happens, he always stops drinking immediately. Still, such a method of using customers as tasters of unlicensed or home-brewed alcohol is highly risky.
When New Naratif approached five different bottle shops in Medan, none of the owners would speak on record about exactly where and how they obtain their alcohol or allow us to take photographs, despite claiming that they were selling alcohol legally from licensed local factories.
Lifesaving campaigns
Over the years, the Indonesian government response to the epidemic of methanol poisoning has been virtually non-existent. Banning the sale of alcohol in mini-markets has had the opposite effect when it comes to keeping consumers safe, and it’s been left to other groups to pick up the slack. One such group is LIAM—Lifesaving Initiatives About Methanol—Charitable Fund, an Australian charity founded by Lhani Davies following the death of her son Liam Davies at the age of just 19.
Liam drank vodka and lime mixes at Rudy’s Bar on Gili Trawangan in Lombok on New Year’s Eve, 2012. The drinks that he thought contained imported vodka were actually locally brewed arak, a kind of fermented liquor, which contained lethal amounts of methanol. Liam suffered a seizure on his way to hospital in Lombok, where he was misdiagnosed with a brain bleed before being flown back to Australia where it was tragically too late to save his life.
“It’s like a ticking time bomb and it doesn’t affect the rich…It’s always the people at the bottom who are going to be affected”
New Naratif spoke with Davies, who lives in Perth, to find out what the charity has been doing since it was set up in 2013 to warn people about the dangers of methanol poisoning. Davies explains that they’ve just finished a training session in the city of Yogyakarta, teaching doctors and local hospitals about the international standards and protocols of using ethanol as a blocker for methanol poisoning. For many in the medical field in Indonesia, this is one of the most difficult things to get to grips with, as the treatment for methanol poisoning is actually to introduce more alcohol, in the form of ethanol, to slow the process of methanol attacking the body and buy time for a patient to reach a hospital where dialysis can be performed.
LIAM Charitable Fund has now run training sessions across Indonesia in cities like Yogyakarta and Makassar as well as the island of Lombok. In Bali alone, the charity has trained 80 local hospitals and clinics on how to administer ethanol blockers to patients presenting with methanol poisoning symptoms. Davies says that Dinas Kesehatan, the Indonesian Health Authority, has been extremely supportive of the training sessions, but it still hasn’t all been plain sailing. In a recent training session, 16% of doctors said they would not treat patients using ethanol blockers and Davies has had reports of patients attending hospitals in Lombok only to be refused treatment for any symptoms related to alcohol—and by extension methanol poisoning—for religious reasons.
I ask Davies whether she’s surprised by the recent spate of deaths across Indonesia. “No. It’s like a ticking time bomb and it doesn’t affect the rich,” she says. “They can just get duty-free or pay for a cocktail using imported alcohol. It’s always the people at the bottom who are going to be affected.”
There is also resistance to campaigns against methanol poisoning both at home and abroad: “We get accused of ‘Bali bashing’ when we talk about methanol poisoning. But we’re not telling people not to go to Bali or not to drink when they’re there. All we want to do is give people information so that they can make informed choices” says Davies. This includes recommending that consumers in Indonesia stick to beer or drink duty-free spirits that they have brought with them.
Davies wishes there was more media coverage of both local and international cases. Methanol poisoning in Indonesia is usually only reported when a Western holidaymaker is involved and it’s deemed newsworthy. Although there have been tourist deaths in Bali, Lombok, and North Sumatra, the recent spate of poisonings this year—half of which are thought to have come from a single contaminated batch of alcohol—resulted in deaths across Java and Papua Province. Methanol poisoning isn’t just about backpackers partying cheaply; it’s a countrywide issue that affects everyone.
Methanol poisoning isn’t just about backpackers partying cheaply; it’s a countrywide issue that affects everyone
Davies also wishes more cases of “near misses” were in the news; she cites a recent case in Bali where a backpacker was successfully treated for methanol poisoning but didn’t want to speak out for fear they would be blamed for drinking cheap alcohol. But such reticence has the inadvertent effect of perpetuating a dangerous lack of awareness. “People believe it’s no longer an issue if it’s not in the media and that creates a false sense of security. It’s like wearing a seatbelt. We don’t hear of all the times a seatbelt saved someone’s life. But it’s still important to wear one,” she explains.
LIAM Charitable Fund has ambitious plans for combating methanol poisoning in Indonesia in the future: “We’re always going to push for a nationwide world standard procedure for methanol poisoning. It’s been accepted in Bali. But we need to get it into hospitals all over the country,” says Davies.
Indra had a mild case of methanol poisoning and made a full recovery. The reason why some people die and others survive, even if they have been drinking together, is that methanol is lighter than ethanol and floats to the surface of a bottle of bootleg alcohol. If the bottle is tainted, the person who takes the first drink is likely to get a glass of almost pure methanol and suffer the full consequences.
Until the healthcare practices developed by LIAM Charitable Fund are accepted nationwide, drinking bootleg liquor in Indonesia will always be a deadly game of chance.
* Name has been changed at the interviewee’s request.
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