Sekotong, Lombok: Elawati blames herself for what happened to her son.
Rizki Ashadi is five and still wears a nappy. He sits on a rug on the porch, dribbling and contorting his limbs. The front of his sky-blue top is wet with drool and one of his beautiful liquid brown eyes points inwards.
Rizki cannot speak, but Elawati says he can understand her.
Before she realised she was pregnant, Elawati drank herbal concoctions to treat colds. The packet warned that the elixir should not be taken by pregnant women.
"I didn't find out I was pregnant for five months," Elawati says. "When I was pregnant I was sick a lot."
But an Indonesian NGO, BaliFokus, believes the cause of Rizki's disabilities might lie not in a herbal medication but within gold-processing machines, two of which grind away just metres from his house.
These rotating cylinders, known as ball mills, are the clattering soundtrack to life in Sekotong, an impoverished pocket of Lombok.
The island of Lombok is best known to Australians as a tourist mecca. It's less developed than Bali but has beautiful beaches and mountains and is a gateway to the car-free Gili Islands, where backpackers party and drink cheap cocktails.
But there is also jarring poverty, such as in Sekotong, where thousands of villagers eke an existence out of illegal gold mines that dot the dusty landscape.
The ball mills are used to crush ore extracted from the mines. After a few hours, water and mercury are added. Flecks of gold from the crushed ore bind to the liquid metal. The amalgam is then torched, which burns off the mercury and leaves behind a lump of gold. It's a popular technique, simple and cheap. But it can have devastating consequences.
The World Heath Organisation says mercury, a potent neurotoxin, can cause serious health problems and damage the brain and nervous system of children exposed in utero.
Elawati is one of 1044 participants in an international study that tested the mercury levels of women of childbearing age in 25 developing countries. The highest levels were found in Indonesian women from small-scale gold mining areas in Elawati's village of Sekotong in Lombok and Pongkor in West Java.
Elawati has not yet received the results of her test, but 94 per cent of the women tested from Sekotong had mercury levels greater than the internationally recognised safety threshold of one part per million (ppm).
"The harmful effects that can be passed from the mother to the foetus when the mother's mercury levels exceed 1ppm include neurological impairment, IQ loss, and damage to the kidneys and cardiovascular system," the study says.
"At high levels of mercury exposure this can lead to brain damage, mental retardation, blindness, seizures and the inability to speak."
The study released last month was produced by IPEN, a coalition of NGOs including BaliFokus from more than 100 countries that work to eliminate the harm to human health from toxic chemicals. It says where sampling was conducted in Indonesia there had been numerous reports of birth defects and people displaying symptoms of mercury intoxication.
According to 2014 figures, there are 250,000 illegal miners digging at 850 "hotspots" throughout Indonesia.
Yun Insiani, the director of hazardous and toxic material at the forestry and environmental ministry, says the symptoms of mercury-induced Minamata disease - dizziness, tremors, speaking difficulties and uncontrollable movements of body parts - have been observed in illegal mining areas: "The most at risk are pregnant women because they can deliver defective babies."
Insiani says the IPEN study is "shocking".
"The result is that Indonesian women are the ones most contaminated by mercury. And this is what we are afraid of because it means we may have lost a generation."
Indonesia has outlawed the use of mercury in small-scale gold mining, although the ban is not widely enforced. On September 20, Indonesian President Joko Widodo ratified the Minamata Convention on Mercury, a global treaty designed to limit mercury use and emissions internationally. (Australia has signed but not ratified the convention.)
The Minamata Convention is named after a city in Japan where a chemical factory dumped mercury waste into the bay between 1932 and 1968. For many years no-one realised that fish in Minamata had been contaminated by mercury and it was causing a strange disease. At least 50 000 people were affected and more than 2000 cases of Minamata disease certified.
"While the mothers were usually without symptoms of mercury poisoning, their babies were born severely damaged with microcephaly, cerebral palsy, severe mental retardation, seizure disorders, blindness, deafness, and other malformations," the 2010 paper Mercury Exposure and Children's Health says.
The Indonesian government says that by ratifying the Minamata Convention, it will more strictly regulate the use of mercury. "Ratification also opens opportunities for international cooperation to increase public awareness and knowledge about the dangers of mercury," the foreign ministry said.
'The doctor said there was no cure'
Sifaiyah is emptying out a ball mill, channelling silvery mercury into a bucket where it squirms like a live animal. She pours the mercury into a maroon piece of material and squeezes. A tiny nugget is left inside the cloth.
Sifaiyah tried wearing gloves once but they made her clumsy. Mercury-contaminated slurry from the mill sloshes over her bare feet and into a tailings pond. Later, chopping chillies in a tiny shack a few metres away, Sifaiyah assures us that she has been processing gold like this in Sekotong for eight years and everyone in her family is fine: "I have never heard of anyone getting sick because of mercury."
The most dangerous work of all is done at roadside stalls or, even more perilously, inside people's homes. Edo, an amiable man in a T-shirt covered with flamingos, operates out of a blue-walled concrete room, open to the street. "Beli mas" (Buy gold) says a big yellow sign.
Edo roasts the amalgam with a blowtorch on a makeshift stand and then weighs and values the gold. The burning releases toxic fumes: WHO warns vapour inhalation may even be fatal. Edo is aware mercury is dangerous but isn't sure exactly why. He says he usually uses a mask but borrows one from us because he has run out.
Edo uses a blow torch to purify the gold and release foreign particles such as mercury. Photo: Amilia Rosa
Children cluster just metres away. Edo positions the fan on his wooden desk so the vapour goes elsewhere. "Sometimes at night I feel dizzy," he says. "But if I avoided fumes completely I wouldn't be able to work. That's the reality."
In 2014, BaliFokus measured mercury vapour at several locations in Sekotong and found medium to high concentration levels. Villagers are potentially exposed to a double whammy of mercury. Gold processing waste is often dumped near or in waterways where the mercury contaminates fish and rice. A 2012 study found Sekotong's mercury levels in rice alone represented a potential threat to the health of local residents.
Muhammad Fikri is almost eight. He lies listlessly on a mattress, his tongue lolling and his legs splayed at strange angles. He had a seizure after he was born and can't communicate or even chew. His family masticate his food and feed it to him as if he is a baby bird.
"The doctors said there was no cure, they can't fix the baby," his father Kurdi says.
Muhammad Fikri, aged eight, suffers from severe mental and physical disabilities. Photo: Amilia Rosa
BaliFokus co-founder Yuyun Ismawati estimates about 5 to 10 per cent of children in the area are born with birth defects and up to 15 per cent have delayed development. "I have observed many babies and children suffer from frequent seizures in many small-scale gold-mining hotspots."
But paediatrician Stephan Bose-O'Reilly, a world expert on health hazards posed by mercury in small-scale gold mining, says "unfortunately" he cannot confirm the children have birth defects due to their exposure to mercury.
"The only way to answer this question would be to set up a proper scientific study, with a birth defect register," he says. "But what I can confirm is that mercury is toxic for children."
A 2007 study, co-authored by Bose-O'Reilly, examined 166 children from gold mining areas in Indonesia and Zimbabwe. "Compared to the control groups, the exposed children showed typical symptoms of mercury intoxication, such as ataxia (lack of muscle coordination)," the abstract says.
Dr I Nyoman Adnyana, the head of the medical clinic in Sekotong, stresses there is no proven link between mercury exposure and birth defects in the area.
"Without a valid result we can't say one way or the other," he says. "Birth defects happen in all areas, not just Sekotong."
Adnyana points out that Sekotong is a tourism area. He says if a direct link between mercury contamination and birth defects was proven it would need to be exposed. But in the absence of this, he worries about the impact on the local economy.
In 2010, West Lombok authorities tried to shut down illegal gold mines in Sekotong. The community rebelled.
"The people said they could drink mercury and were fine," says Rachman Sahnan Putra, the head of the West Lombok health department. He says he has tried everything to educate the community on the dangers of mercury, including screening films and holding seminars. But the message isn't getting through.
A youth group recently contacted him wanting assistance to breed fish in an old tailings pond. "That's the limited understanding. If they can't see silver, they think there is no mercury."
Regulatory efforts have also been continuously frustrated. A ban on the supply of mercury saw it smuggled in on small boats. Rachman is sympathetic to BaliFokus' concerns but he is also a realist: "Stopping the use of mercury won't work unless local communities are offered an alternative so they can maintain their livelihoods."
The Association of Community Mining in Indonesia (APRI) says there are ways of processing gold that do not use mercury or even cyanide, another toxic chemical commonly used in gold mining.
"There's a way of processing using no chemicals, or using harmless chemicals," says association head Gatot Sugiharto. "The harmless chemicals are actually cheap, but we need to educate people to use them. That's why we want the government to work together with APRI."
Fatimah is another of the 32 women in Sekotong who was tested for mercury as part of the IPEN study. Last year her only son, Iqbal, died aged three.
"He couldn't do anything like a normal baby, like crawl or communicate," Fatimah says. "After 2?? years he started getting very sick and not wanting to eat."
Nursah, left, and his wife Fatimah hold photos of their son Iqbal, who died at the age of three. Nursah worked in an illegal gold mine where he used mercury. Photo: Amilia Rosa
Iqbal's father, Nursah, used to torch gold amalgam by the side of the house. Ismawati, from BaliFokus, warned the couple this might have caused Iqbal's illness.
"When Ibu [Ms] Yuyun advised me of the danger, I sold my ball mill and became a construction worker," Nursah says. "Mining is more profitable but it is just not worth it. I don't want what happened to Iqbal to happen again."
Fatimah shows us a photo of Iqbal, twisted in a strange angle on a green woven bamboo mat. Her eyes fill with tears and she stares downwards. The couple recently learned Fatimah is two months pregnant.
"We have concern of course that the baby will have the same problem, but we are praying," Nursah says quietly.