Lack of cash hobbles Cambodia’s bird flu battle

Since her daughter became Cambodia’s first confirmed bird flu victim, 42-year-old Tim Ran has stopped eating chicken.

However, her decision is not based on fear of the H5N1 avian flu virus that has claimed at least 47 lives in Southeast Asia and has the potential to mutate into a form that could unleash a global killer flu pandemic. She just doesn’t have any chickens left.

“At first I was afraid, but then my test results came back and showed no signs of bird flu, so I don’t believe it any more,” she told Reuters while gutting fish outside her stilted wooden house near the border with Vietnam.

“The doctors said you catch bird flu from being close to birds, but I’m the one who prepared and cooked the chickens while the others were away in the rice fields. So how come they got it and not me?” she said.

As she tries to rebuild her family following the death of her 25-year-old daughter, Tit Sakhan, at the end of January doctors are struggling to convince the likes of Tim Ran that H5N1 is real and that stopping it is of international importance.

The virus, first detected in Hong Kong in 1997, has killed around 70 percent of the people known to have been infected, but it does not pass easily from birds to humans.

However, experts fear it will eventually combine with a human influenza virus to form a highly contagious virus capable of killing millions of people worldwide.

The longer it remains in communities in developing countries, such as Cambodia or neighbouring Vietnam, where poultry and people live on top of each other, the higher the chances are of this happening.

But getting that message across in one of Asia’s poorest nations, in which the annual health budget is $3 per capita, is far from easy. Many fear Cambodia has become the soft underbelly of the world’s assault on bird flu.

CALL ME IF YOU GET SICK

Tit Sakhan’s death sparked a flurry of activity in southeast Cambodia as doctors used anything at their disposal to educate villagers about the basics of bird flu, its symptoms and how to avoid it.

Radio stations ran eight broadcasts a day, giant speakers mounted on pick-up trucks blared warnings across the rice fields and doctors toured villages on bicycles spreading the word - and pre-paid mobile phone cards have been given to local officials.

“I’ve given my number to all the village chiefs and private clinics and asked them to call me if they see anybody with symptoms,” said Som Sambo, a Russian-educated doctor in Kompong Trach, 100 km (60 miles) south of Phnom Penh.

The two-week public information campaign, for which doctors were paid a bonus of $1 per day, certainly had some success.

Un Thouk, an 8-year-old in charge of a flock of 250 ducks wandering through parched, dry season rice fields - the former “Killing Fields” of Pol Pot’s Khmer Rouge - knew exactly what to do if all his birds suddenly died.

“I have to dig a big pit and bury them,” he said.

But with just $2,500 in funding from the Ministry of Health, the campaign’s impact was short-lived and most villagers admitted they slipped back to old habits the moment doctors or ad hoc village health volunteers turned their backs.

“I did follow the guidelines for a bit, but when the doctors left, I ate dead chickens. Chickens always die at this time of year and I need the meat,” said Tim Ran’s neighbour, Khan Sa An, sitting beneath her house with her infant son.

A few scrawny chickens that managed to avoid bird flu and an official cull pecked at the dust around their feet.

In the market at Kompong Trach, a haphazard collection of wooden shacks in the middle of town, traders lament that chickens have become scarce - and therefore expensive - since bird flu struck, but deny the virus is to blame.

“It’s not true. Those who died of bird flu really died of AIDS and then talked about bird flu. I’ve been a chicken seller for a long time, working every day, and I’ve had no problems,” said poultry dealer Lao Kuy, 32.

“It can happen in Vietnam and other countries, but it cannot happen here in Cambodia. My chickens are fine,” she said.

LIMITED RESOURCES

The World Health Organisation (WHO), which is leading a push for $829,000 in international funding for bird flu surveillance, says Cambodia will be unable to prepare adequate defences against bird flu without outside help.

“Clearly the tools here are limited,” said Jim Tulloch, head of the WHO in Phnom Penh, saying that Cambodia cannot be expected to divert already meagre public health funds away from its other myriad woes.

“When you look at the other pressing problems here - maternal mortality, child mortality, HIV/AIDS - you have to ask how much of that $3 per capita per year Cambodia can spend on preventing an outbreak of bird flu,” Tulloch said.

But until money arrives, Cambodia and the world will have to rely on the informal mobile phone and radio tip-off network set up by the Disease Surveillance Bureau, headed by 37-year-old doctor Ly Sovann.

“People are more alert now,” he said, sitting in his tiny office in the Health Ministry, surrounded by files, faxes and phone lists pinned to the walls.

“Every village reports when somebody dies, no matter what the cause. We haven’t found any bird flu - they all died of something else, TB or high blood pressure - but at least it shows the system is working,” he said.

Provided by ArmMed Media
Revision date: July 8, 2011
Last revised: by David A. Scott, M.D.