Red Clots of Sihr

When I was a kid, I used to read Mastika magazines that my family bought every month. I remembered there was a huge collection of Mastika in our library, kept in a closed section and tucked away at the bottom of the shelves. I didn’t just read the main story but all the articles in it. The scariest ones are always about the tortured deceased from the graves, the horrifying mutilations that happened to the sinners, the ghosts that prey on poor villagers, and also mystique tales of the pilgrims doing Hajj in Mekah.

It was a thralling experience, absorbing those stories. I came to learn that there are such things as witchcraft or black magic being practiced here in Malaysia. From movies and books I know pretty much these things exist in every culture around the world. Like Malaysia, our neighbouring countries like Thailand and Indonesia also have numerous pockets of communities who dwells deep in witchcraft.

In Islam, witchcraft or black magic (really, is there such thing as white magic?) is called sihr. I learnt in primary religious school as early as 7 years old that sihr is forbidden to be learnt and practiced. Sihr is even mentioned in the Quran (al-Baqarah, verse 102-103), meaning that it does exist. It’s not made up. But it is a haraam thing and should be avoided.

As I grow up and become a doctor, I become very skeptical about vague symptoms that the patients used when describing their ailment. It’s always about “angin” (wind) that strikes me off. Angin from the stomach can easily be interpreted as gassy abdomen, but some people use angin to describe abdominal pain as well. Angin in the muscles could be musculosketal pain or soft tissue injury in origin, angin in the head could be from migraine to vertigo. I usually became more bewilded and exasperated when the patient told me their angin moves from stomach to the arms, then to the back of their neck and up to the head. However, there are more established uses of the word angin in prescribing medical condition such as angin pasang (hernia) and angin ahmar (stroke).

It goes up to the point that I do believe sihr exists, but I don’t believe its manifestations upon the human body. It’s always science, science, science to me. Anything that seems “unnatural” as claimed by people is just unexplained and undiscovered logical science behind it that we simply don’t have enough information yet. As the saying goes, “Magic is just undiscovered science”. I doubt these alternative treatments that the patients went to. “It’s bogus, it’s a sham!” I curse to myself often. I struggled to understand how these people forsake modern medicine and cling on to shamans and religious treatment centres to treat their symptoms that us doctors can interpret, sometimes, as very obvious like a broken femur, hyperthyroidism, bipolar disorders, or cancer - until I saw this patient who came to the health clinic with sudden bouts of blood clots from her throat. 

It’s not coughing up blood nor blood vomitus. She didn’t have any cough or abdominal pain. The sudden sensation in her throat made her to expel blood with clots non-stop. It happened quite alarming one night, without any prior warning, when she was getting ready for bed. Before this she was fit as a fiddle. There is no constitutional symptoms, no coffee-stained vomitus or blackish stool, no loss of weight or appetite, nothing. The next day she straight came to the clinic and I attend to her at the ILI counter outside the facility because we have to always rule out tuberculosis (TB) first.

I was in my makeshift room that afternoon, doing my managerial work (I seldom see patients nowadays, woe is me) when my MA knocked my door and asked me to see this blood-coughing lady. After donning the PPEs required (FACE SHIELD! MASK! GLOVES! APRON!), I went outside to see a 50+ years old lady, holding a plastic bag in her hands. Every half a minute or so she spitted out into the plastic bag crimson clots that later I determined to be blood. 

The first thing she asked me, as soon as she mentioned that she is spitting? coughing out blood? is whether she has witchcraft done upon her (santau, in her exact words). Not whether she got TB or lung cancer or anything, but witchcraft. And she asked me, a medical doctor in half full PPEs, in such a straightaway manner that I had to reciprocate in similar fashion. In my most polite tone of voice, I confess that I know absolutely nothing on how to give a diagnosis of witchcraft to my patients that I see. But, I promised her that we would do everything that we could to rule out other equally sinister and ominous medical conditions that can explain her spitting out blood clots.

Further history taking was done and examination of the throat and the lungs are normal. As we don’t have x-ray facility here, I consulted my FMS whether I can proceed with my plan to send the patient straight away to a tertiary chest clinic centre. We decided that it was the best course of action and after I spoken with the doctor in charge of the chest clinic, I explained to her that she must be transferred to Taiping for a thorough examination and investigation.

A week or so later, I asked her to come to the clinic for a medical review. She was warded there for 5 days where she had to complete a course of IV antibiotics as they thought it could be CAP (lung infection). Blood investigations done had ruled out TB and cancer, but the chest x-ray doesn’t look good. But to know more, they are going to proceed with a detailed imaging HRCT and an echocardiogram sometime next year. 

When I saw her again, her blood cough had stopped. She said that after she got discharged, she went to local Darul Syifa’ (Islamic alternative treatment centre) to treat her ailment. The ustaz who treated her said  that she had fall under a witchcraft and a number of treatments is recommended for her. There are many types of local witchcraft, or sihr, and one of them is santau. Santau, or its other name tuju-tuju, is a poisoning type of witchcraft which can be delivered to the intended victim via food and drinks or through entities such as djinns.

At first I dismissed this talk of santau. But then my staff started telling me stories about how the place we are in is actually a hot zone for witchcraft. We are situated near the sea and traditionally, witchcraft ceremonies are done near the sea, where they can do things like sending offering to sea “deities”. Perhaps influenced by Hindu culture, of which you can see from how many of temples in Bali, Indonesia are constructed on a cliff or on the beach. 

Apparently, at the end of every year there is a spike (hihi, pun intended) of cases of santau. It is believed that those who learnt witchcraft are not the locals here, but outsiders who came to this place to practice what they are learning all year. I didn’t think witchcraft syllabus include a practical internship programme but these guys seemed eager to pass with flying colours. It is actually a concern in local communities that they are very much wary of any strangers coming here. My MA recalled the time when he was first moved into the quarters here when he got transferred. He was being stopped and interrogated by the local folks at a roadside warung, asking who he is and what he’s doing here until a senior colleague who with him explained to them that he was a new staff working at the clinic. The lady I saw thought that she might got it from a roadside eatery (warung makan) as well that she went to earlier that day. I forgot to ask which warung she went to lest I know now to avoid going. 

I don’t know how to detect poisoned food or drinks but there are untested claims of how to know whether there is santau in front of you or not. While there’s very little thing to do once we are targeted with a tuju-tuju (think of it as magic puffball of micropoison being cannoned into the air like a shooting star, hurtling towards the victim), I remembered when I was in Form 1 a batchmate of mine, Wawa, claimed that she and her family once saw a tuju-tuju in the air and they chanted “tuju-tuju pecah tujuh!” or something to break it off. Sounds really sketchy to me, but inherently it’s very super uber cool as well. I doubt Wawa still remembers this story, but somehow it stuck to my memories till now.

The usual treatment at Darul Syifa or any other Islamic alternative treatment centre involves the reading of ruqyahs, or in plain English, exorcism. Mind you this is nothing remotely similar to the Christian’s way of “THE CHRIST COMPELS YOU!” type of exorcism. Ruqyahs are verses of Quran which have protective and dispelling properties towards the devils and their associates. Even if one is not under witchcraft, it’s always a good practice to read the ruqyah verses regularly. 

Before we ended the review, she showed me the video when she was being treated at the Darul Syifa’. The video is grainy, but apparently the ustaz managed to take out something from her body. It looks like a really small insect, a-grain-of-fine-salt-sized white insect that moves around. I tried not to look skeptical in front of her, but as I already confess I know nothing about the realm of sihr and how to treat it, I remained expressionless. At that point I was already glad that at least she didn’t abandon modern medical treatment. What she does extra to get better is entirely up to her.

Wallahu a’lam (And Allah know best).