Upon graduation in 1914, he was attached to the Municipal Hospital at Surabaya and within a few months was initiated to combat as a public health doctor. Most of the next year was spent in outlying areas of East Java, Bali and Madura struggling to control cholera, plague and malaria outbreaks.

An assignment as medical officer for 1,500 prisoners working on an irrigation project at Kasian in Djember Regency in the swampy region of Eastern Java tested the character traits that have been his goad and guide. RADEN KODIJAT was to investigate the 10 per cent death rate among prison laborers that the Civil Health Inspector reported was caused by malaria. Lacking adequate equipment and assistants, he still employed rigorous scientific methods and primarily through postmortem examinations established that the chief causes of death were pneumonia and dysentery.

Miserable living conditions among the prisoners and poor health of new arrivals he concluded were the major contributing factors. He began sending back as many as one-third of the 60 odd new prisoners arriving each month as physically unfit for hard labor. This unprecedented action earned him a disciplinary transfer to distant Saparua in Ambon, but, before leaving in January 1917, he posted to the head of the Civil Health Service in Surabaya a full report with recommendations for bettering conditions for the prisoners. The authorities later acknowledged this report with thanks and his successor at Kasian benefited by a new dispensary, a head nurse and several nursing assistants.

Four ensuing years as medical and health officer for some 50,000 residents of the islands of Saparua, Haruka and Nusalaut often were arduous, but the need was great and the Ambonese responded warmly to his regular village visits. When the dedicated doctor left on transfer, his neighbors as a gesture of appreciation auctioned off his few belongings—a bicycle, a bed and some rattan furniture—and presented him with the proceeds amounting to more than 20 times his monthly salary.

He had taken his penance well and his principled stand at Kasian now was to be rewarded. After a brief period as physician at the Government's Central Hospital in Djakarta, he was given, in 1922, a coveted study-assignment to the Netherlands. On completion of his studies at the School of Medicine of the Municipal University of Amsterdam, he returned to Indonesia, in 1925, with a Dutch medical degree and a wife. After a year in Semarang with the municipal health service, the young couple lived for three years in Bandjarnegara where KODIJAT directed plaque control.

Dr. KODIJAT’s great work to eradicate yaws began in March 1930, when he was posted to Kediri in eastern Central Java as Residency Health Officer (a Residency is the administrative unit next in size to a Province). With this new scope for application of his ideas he was able to develop community-wide control methods that both cured the afflicted and prevented recurrence of this highly contagious disease. For 20 years prior to this time sporadic attempts had been made in Indonesia to treat yaws, but the endemic problem remained.

Yaws symptoms are readily recognizable to the practiced eye. The disease begins with a small boil erupting through the skin, advances to open lesions and finally attacks the bones, maiming and disfiguring. It is caused by a slender spirochete similar to syphilis but not venereal and spreads mostly among children. The name "Framboesia" is derived from the raspberry-like ulcers resulting from developed yaws. It is particularly common in the rural regions of the moist tropics.

After charting the epidemiology of the disease Dr. KODIJAT initiated the first experiments with mass treatment. This was followed by careful checking of the entire population in the treated districts and further administration of the arsenical compounds where indicated. Meticulous and repeated examinations and careful records established the soundness of this system of control; it was adopted by doctors elsewhere in Indonesia and endorsed by the Far Eastern Intergovernmental Conference on Rural Hygiene at Bandung in 1937.

Although the 12 years at Kediri were professionally challenging, it was also a time of personal tragedy. Following the birth of their son, Mrs. Kodijat never recovered her health. After long hospitalization she died in 1945. Dr. KODIJAT, meantime, was transferred, in 1942, to head the Public Health Service of East Java and a year later became health officer of the Eiseikyoku (Department of Public Health) in Djakarta, where he remained until the Japanese wartime occupation ended.

Upon formation of the independent Indonesian Republic in 1945, Dr. KODIJAT was appointed Acting Secretary General of the Ministry of Health. During the first postwar years, he served the revolutionary government with courage and dignity in Djakarta while under surveillance of the Dutch who still controlled the city. After conclusion of the independence struggle, the Ministry of Health, in 1950, proposed a mass program to control yaws. The disease had spread to almost every island in the archipelago, affecting some 12 million victims; it was crippling manpower and becoming a severe drain upon the economy. A national campaign had become administratively feasible with the discovery of the penicillin treatment and was made possible when the United Nations Children's Fund (UNICEF) agreed to provide penicillin, vehicles, other imported items such as needles, syringes and field equipment while the World Health Organization (WHO) furnished technical guidance.

Although his retirement was already overdue, Dr. KODIJAT in April 1950, accepted the directorship of a new Research Institute for Communicable Disease Control established in Djogjakarta. Concurrently, he organized the UNICEF-and-WHO- assisted Treponematoses Control Program for Indonesia, known as the Lambaga Penjelidikan dan Pemberantasan Penjakit Rakjat. Work started in Central and West Java and three years later was extended to other regions.

When independence came, there were only 1,100 doctors and 5,500 nurses available to treat Indonesia's population of 80 million. It was apparent that a mass campaign against yaws could only be accomplished by utilizing lesser trained workers. Dr. KODIJAT started with a staff of three doctors, 25 male nurses and 20 administrative workers. They selected elementary school graduates who were given special training in yaws diagnosis, known as djurupateks. Male nurses, or mantris, assigned to the staff of the public health polyclinics, were given more advanced training, administered the injections and made follow-up examinations.

The scope of this work expanded rapidly Beginning with 250,000 examinations and 33,000 treatments in 1950, the campaign that Dr. KODIJAT directed examined 14 million Indonesians in 1955 and that year treated 1.2 million yaws cases. Today, the halfway point has been reached in this program. Approximately 55 million people have been examined—some several times—and 7.5 million cases of yaws treated in addition to protective treatment given to another 1.5 million exposed cases. The organization now numbers some 2,000, including 156 supervisors scattered throughout the archipelago.

Recognizing the highly contagious and recurrent nature of the disease, Dr. KODIJAT’s method calls first for a thorough survey. Everyone in the designated community is examined. All cases of yaws detected are treated immediately to eliminate sources of infection. A, reexamination follows to identify cases missed in the initial survey and those treated are rechecked.

In any community where the incidence of yaws exceeds 30 per cent, the probability is that most citizens have been in contact with the disease; in such instances the entire population is treated. If the rate of infection is less than 30 per cent, all those with yaws symptoms are treated and close contacts of infectious cases are given a preventive shot of penicillin. Treatment also is given to everyone in areas where repeated visits would be time-consuming and expensive.

The cycle of survey, treatment, and reexamination is repeated until the number of cases is reduced below two per cent of the population and the number of infectious cases is under one-half of one per cent. Then, the area is placed under careful watch by the regular health service and polyclinics, which continue to examine school children who form the most susceptible group. After a year, the entire population is examined in a re-survey. If the percentage of yaws has increased, yaws control teams return to repeat the cycle of treatment and reexamination. If the incidence remains under two per cent, the next re-survey is done after two years, and the third re-survey after another three years, and so on until the last yaws case is eliminated.

Yaws is a vicious and elusive enemy. Unless repeated checks are made, reinfection can wipe out early gains in a few months. Statistical reports showed that some villages with an incidence of 25 per cent infection during the initial survey experienced a recurrence following the first treatment; after five years of repeated surveys and treatments, as much as 50 per cent of the population might have been infected at some stage.

Recognition of Dr. KODIJAT’s scientific accomplishment came in the form of an invitation from WHO, in 1952, to serve as a member of the Expert Advisory Panel on Venereal Infections and Treponematosis (including yaws). WHO later gave international attention to his methods for treatment and control in its technical publications.

Outside of the medical field Dr. KODIJAT remained in relative anonymity until 1956, when he was awarded an honorary doctorate by the Medical Faculty of the University of Indonesia, the first such laurel to have been bestowed upon anyone since the founding of the institution. Characteristically a modest man, he kept the news to his wife and himself for three months. His staff at the headquarters of the yaws campaign and his close friends learned of it from the newspapers.

This calm, dedicated doctor chose to forego the lucrative prospects of private medical practice, even as an adjunct to his official duties, in determined service to his people. Now married again, Dr. KODIJAT and his personable Javanese wife live simply and quietly in their modest home in Djogjakarta. Occasionally the doctor gardens, but he is more likely to devote his leisure to scientific reading, making notes far into the night.

Dr. C. J. Hackett, world-famous expert on yaws working for WHO, after a visit to Indonesia wrote aptly: "In the presence of Dr. KODIJAT, one can only feel humble.'

August 1961
Manila

REFERENCES:

Council for Sciences of Indonesia. "Report on Dr. Kodijat."

Curriculum Vitae (R. Kodijat). Courtesy of UNICEF Regional Office, Jogjakarta, December, 1958.

Hackett, C. J. "The Indonesian Yaws-Control Campaign: a Report on a Study in Indonesia from 19 January to 6 March 1956." Geneva, WHO/VDT/217. July, 1956.

Keeny, Spurgeon M. "Half the World's Children." National Board of Young Men's Christian Association. New York, Association Press, 1957.

Kodijat, R. "The Indonesian Treponematoses-Control Programme, Simplified (TCPS); Directions on Measures To Be Taken in the Consolidation Phase." Indonesia, WHO/VDT/218. September, 1956.

Ling, Jack. "The World's Largest Yaws Campaign" (Part I). "The Ten-Year-Old Fight Against Yaws" (Part II). "The Frail Strongman" (Part III). and "Kodijat of Indonesia" (Part IV). Bangkok, UNICEF Asia Regional Office, 1960.

Manila Times, October 28, 1960.