Posted on Sat, Sep. 02, 2006
Indonesian bird flu victims fled from doctors
PREVENTIVE MEASURES THWARTED
By Alan Sipress
Washington Post
JANDI MERIAH, Indonesia - Dowes Ginting, the most wanted man on Sumatra island, lay dying. He had abandoned the hospital where he had seen his relatives succumb one after another, and he had fled deep into the mountains, trying to outrun the black magic he feared had marked him next. For four nights, witnesses recalled, a medicine man hovered over him in a small clapboard home, resisting the evil spell.
Ginting, a wiry 32-year-old, had watched disease burn through his family over the previous two weeks, killing six and sickening two others, including himself. International health experts grew increasingly concerned when laboratory tests confirmed they were sickened by bird flu, the largest cluster of the disease ever recorded. But
Dowes feared medical treatment more than he did the flu. And so he ran, potentially exposing villagers across the province to the highly lethal virus.
In the end, the outbreak in May did not presage the start of a worldwide epidemic. But the enormous difficulties that Indonesian and international disease specialists confronted in investigating the outbreak and protecting against its spread raised fundamental questions about whether bird flu could be contained if it mutated into a form more easily spread among people.
``If this were a strain with sustainable transmission from human to human, I can't imagine how many people would have died, how many lives would have been lost,'' said Surya Dharma, chief of communicable disease control in North Sumatra province.
Officials from the World Health Organization (WHO), drawing on sophisticated computer modeling of a theoretical bird flu outbreak in Southeast Asia, have suggested that a pandemic could be thwarted through a rapid containment effort in the affected area, including the right mix of drugs, quarantines and other social controls.
To succeed, the anti-viral drug Tamiflu would have to be distributed to 90 percent of the targeted population, roughly defined as those within at least a three-mile radius of each case. The drug would have to be administered within 21 days from the ``timely detection'' of the initial case of an epidemic strain. Residents would have to stay home, limit contact with others and take the medicine as prescribed.
In the case of the North Sumatra cluster, almost none of this happened, according to extensive interviews with health officers, family members and villagers. The underlying problem was that most family members and villagers were convinced that magic, not flu, was to blame.
``How can you ever get people to cooperate if they don't even believe you?'' Dharma said.
Scientists are still working to determine how bird flu is transmitted to and between humans. More than 200 people worldwide have contracted the deadly H5N1 strain of the virus since 2004. Most of the cases have resulted from contact with infected live or uncooked poultry, or with surfaces contaminated by infected birds.
Health investigators have concluded that the eight-person cluster in Sumatra began with Ginting's older sister, who fell ill in late April. They suspect she was infected with bird flu from live chickens sold in a market where she peddled oranges, limes and chili peppers, or from contaminated poultry droppings in manure used in her garden. She died and was buried before any samples were taken to confirm bird flu.
Several days after she became sick, the extended family had gathered in the village of Kubu Sembilang for a feast of roast pig and chicken curry to celebrate the annual harvest festival. That night, many of the relatives slept in the same small room with the sister, who had developed a serious cough. By the time she died, a sister, a brother, two sons, a niece and a nephew had become ill. Flu specialists said the final victim, her brother Dowes Ginting, in turn probably caught the virus from his infected son.
Health experts have concluded this was the first time the bird flu virus had been passed from one person to another and then on to a third person.
``None of us thought it was bird flu. We thought it was black magic,'' said Anestia Tarigan, the wife of the youngest Ginting brother, Jones, the only victim to survive. ``Everyone in the family was getting sick and no one else was. Someone had put a spell on our family. Black magic is very common in our place.''
Indonesian and WHO investigators discovered that many residents in Kubu Sembilang were unwilling to share information or give blood samples that could reveal how widely the virus was circulating. Many villagers believed that claims of bird flu were a lie. Some even threatened the investigators. When a team of officers first arrived from the provincial health department, they were warned by their local counterparts that it was too dangerous to enter the village.
``We chased them away,'' said Hendra Tarigan, whose wife, one of the Ginting siblings, died. ``Each time they came back, we gave them no information. We just told them to leave.''
Investigators were able to take samples from only two people in the village, including the local midwife, said Diana Ginting, chief of the district health department, who shares a common surname in the region.
Indonesian health officials working with an international team returned day after day to the village and made progress. They recruited 20 local volunteers to monitor fellow residents for fever and set up a temporary health post on the soccer field offering free medical care. The investigators methodically pieced together the chronology of the outbreak. They traced those who had contact with the victims and provided them with Tamiflu.
But many of those closest to the Gintings refused to take it.
As a medicine man treated Dowes Ginting, Indonesian and international health investigators finally tracked him down and urged his family to take him to a hospital. They demurred: He needed two more days of traditional treatment, they said. That night, he took a turn for the worse and died.
https://registration.mercurynews.co...om:80/mld/mercurynews/news/world/15425359.htm
that we may be getting less "Bird Flu" news from Indonesia in the future.
