Cambodia's bird flu ignorance

Jehangir S. Pocha, International Herald Tribune

Friday, February 25, 2005

Kok Chamkar, Cambodia -- "Ah, the bird flu place! It's that way," a young girl said cheerfully, when we asked for directions to the site of Cambodia's only official avian influenza-related human death.

Everyone in this village near the Vietnam border seemed to know the way to 47-year-old Oi Ngoy's blue wooden house. In late January, Oi Ngoy's 24-year-old daughter, Tit Sokhan, became the first Cambodian to die officially of the disease. Several weeks earlier, her 14-year-old brother Tit Chiang had also died, though no tests had been run to determine the cause of death.

According to the World Health Organization, the latest outbreak of bird flu, or the A(H5H1) strain of avian influenza, has killed 42 people in Southeast Asia since late January.

In Cambodia, where many villagers do not know about the epidemic, experts are worried that a combination of public ignorance, bureaucratic inefficiency and under-financed medical clinics will bring about a major health crisis.

"I still don't know what it is," Oi Ngoy said of the disease that killed his daughter. "I'm worried about my family and the future. But I don't know what to do."

Despite the fact that the WHO had warned countries to take firm preventive measures, Oi Ngoy and his neighbors said they had received no warnings from the government.

In January, when the three dozen chickens Oi Ngoy kept around his traditional stilted house started falling ill and dying, he and his family thought nothing of eating them. "We just plucked them and cooked them," he said. "No one told us not to."

 A few days later, Oi Ngoy's 14-year-old son, Tit Chiang, fell ill.

"He had a fever and couldn't breathe normally, so we took him to the hospital," Oi Ngoy said. "The doctors gave him two bags of saline solution, then they told us to take him home. They said maybe we'd done something to offend our ancestors, and we should make an offering to them."

A week later, on Jan. 19, Tit Chiang died. Whether he had died of bird flu was never established; his body was cremated before tests could be run.

Hearing of her brother's death, 24-year-old Tit Sokhan rushed home.

According to Oi Ngoy, she hugged her brother's dead body and wept over it.

Immediately after the funeral, Tit Sokhan came down with a fever as well.

This time, Oi Ngoy took his daughter across the border to Vietnam, just five kilometers, or three miles, away, where health services were said to be better and cheaper.

"But they said they couldn't do anything for her," Oi Ngoy said.

Vietnamese authorities, who had been on high alert after 11 people died of bird flu in the country in January, confirmed that Tit Sokhan had died of the disease on Jan. 30.

"Some officials came here after that," Oi Ngoy said. "They took our blood and told the neighbors not to pass through my house. But people still passed by our house. No one told us anything more."

Cambodia has been slow in reacting to the bird flu epidemic. According to Vietnam's state media, neighboring Vietnam has killed about 1.5 million chickens and ducks as a preventive measure; in comparison, Cambodia has only ordered the killing of about 100 poultry.

Kong Ngoi, 35, who lives in the house next to Oi Ngoy, said that when his pigs began to get sick he did what he thought was best: He sold them to a villager, who in turn took them across the border and sold them in Vietnam.

"Cambodia's facing very significant challenges compared with other countries," said Jim Tulloch, the WHO representative in Phnom Penh.

The government spends just $3 per capita per year for health. Even with an additional $6 per head spent by international donors, "that's not enough to provide even a basic health service," Tulloch said.

Sok Touch, the director of the Center for Disease Control in the Cambodian Ministry of Health, said that the government was aware of the threat and doing all that it could.

"We're training workers and teaching people how to identify sick birds, and what needs to be done to avoid contact with sick and dead poultry," he said. "We've also set up a hot line for people to call if there's a suspected case so we can track any new outbreaks. It's a good plan, and I hope that with international assistance we can be prepared."

Given the bird flu's 76 percent fatality rate in known cases, prevention and education is almost more important than finding a cure, said Dick Thompson, a WHO spokesperson based in Geneva.

Bob Dietz, the WHO's spokesperson in Cambodia, is helping the government spread the word through radio, TV and even cyclists armed with portable loudspeakers, who announce the message to remote areas. But it is not clear if such patchwork measures can arm this country against the threat of a pandemic.

"There's a vast amount of virus spread over lot of area," said Dietz. "And it's an unstable virus that could mutate rapidly and spread from human to human. If that should happen then we won't be able to contain it."

Cambodia, one of the poorer countries in Southeast Asia, is still recovering from decades of war and turmoil. About half of Cambodia's national budget comes from international donors. The World Bank recently named Cambodia one of the most corrupt countries in the world.

The effects that these problems have on average Cambodians was clear at the Angkor Chey Referral Hospital, about 50 kilometers northeast of Oi Ngoy's village. This is where smaller health clinics in the area send serious medical cases. The hospital lacked basic equipment such as oxygen tanks, which are vital for bird flu victims who usually suffer respiratory problems.

Nieng Chantou, a medical assistant, said he was not sure what he would do if he had to treat someone with the bird flu. "I missed attending the workshop on that," he said. "But I think my boss attended and he said that if we get a patient we should isolate them."

The problem is that the hospital has no isolation facilities. "We're very short of rooms, so we'd just have to put the patient, even though we know he has the symptoms of bird flu, in the same room as others," he said.

In Tram Kok, a dusty highway town about 40 kilometers northeast of Oi Ngoy's village, a group of chicken vendors sat surrounded by chickens and ducks tied together in clumps of six or eight. The birds stepped in their own excrement, squawking and pecking at each other. To fatten them up, the villagers held them down by their necks and force-fed them.

The chicken vendors said no government inspector had visited them in over a year.

"It's all a rumor and I don't believe it's true," said Doung Ohn, 28, one of the chicken vendors. "There is no such disease, and no one's ever died of any bird flu."

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