Poverty and Superstition Hinder Drive to Block Bird Flu at Source

November 3, 2005
Poverty and Superstition Hinder Drive to Block Bird Flu at Source
By KEITH BRADSHER
PREY ROGNIENG, Cambodia - When the half-starved chickens started dying
this summer and the barefoot children developed fevers here in this
village of thatched huts and emerald rice fields, residents were
terrified and deeply divided about the cause of their misfortune.

Some blamed bird flu and took their weakened children to a clinic in a
nearby provincial city, where a medic diagnosed human influenza
instead. But other residents said it was witchcraft by the only village
resident not born here, 53-year-old Som Sorn, who moved here eight
years ago when she married an elderly local farmer.

When Mrs. Som Sorn's husband went into the jungle to cut wood one
afternoon and she began cooking rice over a fire on the dirt floor of
her hut, a local man with a machete took action and later collected $30
in donations from grateful neighbors, a month's wages.

"The assassin grabbed her hair, pulled her head back and cut her
throat," said Ya Pheorng, the village leader. "Her neck was almost
completely severed."

The sorcery allegation and grisly killing underline what United Nations
and American officials describe as the difficulty of preventing a
global human epidemic of bird flu: the disease is most prevalent among
poultry and wild birds in impoverished rural areas of Southeast Asia
with low levels of literacy, high levels of superstition and very
little health care.

If the disease does make the jump from transmission by birds to
person-to-person transmission, the crucial question will be whether the
first few cases can be isolated quickly. If not, frightened people
nearby could start fleeing, carrying the disease to big cities and then
around the world by jet. In a telephone interview at the end of a
recent weeklong trip to Southeast Asia, Michael O. Leavitt, the
secretary of health and human services, compared the early stages of a
flu pandemic to the beginnings of a forest fire.

"If one happens to be at the source of the spark, it's simple to put it
out with your foot," he said. "The question is, will we be there?"

Only four countries, all in Southeast Asia, have had
laboratory-confirmed human cases of bird flu so far: Cambodia,
Indonesia, Thailand and Vietnam. Cambodia is the poorest, with the most
rudimentary health system outside urban areas.

Cambodia's difficulties and small successes in fighting bird flu are
indicative of the struggle that lies ahead. Scientists predict the
struggle could last for many years and may have to be fought in other
poor areas as well, notably in India and Bangladesh and East Africa.
But United Nations officials say the disease will probably remain most
prevalent and most dangerous here in Southeast Asia, where chickens
wander freely in and out of homes and even apartment buildings, mixing
constantly and intimately with people to an extent not found in most
other countries.

In two decades of turmoil beginning in the 1970's, most of Cambodia's
doctors died in the Khmer Rouge's killing fields or fled the country.
Many of the country's current generation of health care professionals
can scarcely read or write and received rudimentary medical training in
Vietnamese, a language they barely speak, during the Vietnamese
occupation in the 1980's.

Since the first chickens began dying of bird flu in Cambodia in January
2004, the country has made some progress, with modest foreign
assistance, in controlling the disease in poultry and keeping people
healthy. Yet formidable gaps linger in the country's defenses.

Those gaps highlight the continued mismatch between limited efforts to
slow the spread of bird flu among poultry in developing countries and
increasingly large efforts by industrialized countries to prepare for a
possible human outbreak. The United States and other industrialized
countries are spending billions of dollars to stockpile antiviral
medicines and other gear for treating people who may become infected.
But the United Nations' Food and Agriculture Organization has been able
to collect only $30 million from industrialized nations since February
for a campaign to delay or prevent an epidemic, a little over one-sixth
of the $175 million and rising that the F.A.O. says is needed.

In Phnom Penh, Cambodia's capital, American and German foreign aid has
just helped supply the latest Western equipment to a virology lab at
the Cambodian government's animal health department. But the virus
samples are taken for testing from chicken carcasses brought in from
all over the country to a moldering building next door. Researchers cut
apart the carcasses in a room with no air-conditioning and a fan that
blows air out the windows and across an alley. A crowded elementary
school with no glass in its windows is just 10 yards away.

"They need to completely seal this area," said Dr. Lu Huaguang, a
Pennsylvania State University avian virologist temporarily working in
Phnom Penh to help set up the virology lab.

At the Food and Agriculture Organization's office a few blocks away,
Tsukasa Kimoto, the chief representative, talks proudly of an
innovative program to train the country's 6,000 village animal health
workers to identify bird flu and report it immediately. But only 500 of
these workers have been trained so far, he acknowledged, and the virus
may be back soon, as it appears to be most active here from December
through March.

Most of the poultry in Cambodia roams so freely that if one bird is
found sick, it is practically impossible to catch and kill nearby birds
to curb the spread of the disease, Mr. Kimoto said.

"Chasing those chickens one after another is a rather tedious thing -
we don't have the people," he said.

At Cambodia's Health Ministry nearby, Dr. Chea Chhay, the under
secretary charged with leading his country's fight against avian
influenza, proudly described how teams of researchers were ready to
drive on an hour's notice to regions reporting bird deaths. But many
villages lack phones, to say nothing of doctors, and it may take a day
or two during the rainy season for anyone from a remote village even to
reach a phone.

[President Bush asked Congress on Nov. 1 to approve $7.1 billion for
bird-flu prevention and treatment, including $251 million for early
detection overseas.]

Drive just 35 miles west from Phnom Penh to this small village and the
logistical challenge of confronting bird flu is even more apparent. The
government built a small concrete-walled clinic eight years ago in an
adjacent village, but electrical lines were never extended from the
nearest town and no generator was installed so the clinic's lights have
never worked.

The clinic's director, Pol Wana, was about to complete junior high
school when the Khmer Rouge took over in 1975 and shut all schools. He
never returned to school, but leads a staff of 10 in diagnosing
ailments and prescribing and distributing medicine.

The government asked him to look out for bird flu, he said, but has not
given him a clear list of symptoms.

Mai Morm, a 76-year-old farmer, stopped by the clinic late one morning
to pick up medicine for a chronic cough. He said if any of his chickens
fell sick, he would not tell anyone for fear the government might
arrange for the rest to be slaughtered without compensation. "If they
were very sick before they died then I might throw them in the brush,"
he said. "But if they were only a little sick, I'd probably eat them."

The killing of Mrs. Som Sorn was first reported by the small Cambodia
Daily in an article about sorcery. The killer had not expected anyone
to identify him to the police, and was surprised to be arrested and
sentenced to 15 to 20 years in prison, Mr. Ya Pheorng said. Neighbors
who paid her killer were not prosecuted after making further payments
to the police, the village leader added.

Besa Korn, a 51-year-old village resident who was not among those
making donations to the killer, said the true cause of the summer
illnesses might never be known. But life has clearly improved since
Mrs. Som Sorn's death, she added.

"Everyone in the village has been very happy since then," she said.
"And we have had no more illness."



Copyright 2005 The New York Times Company

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