[A-List] FW: Avian flu in Vietnam

["Sabri Oncu" <soncu@xxxxxxxxxxx>]

-----Original Message-----
From: Autoplectic 
Sent: Sunday, May 15, 2005 10:27 PM
To: Sabri Oncu
Subject: Avian flu in Vietnam


<http://www.guardian.co.uk/birdflu/story/0,14207,1484610,00.html>

Ravages of bird flu pluck heart from rural life

Jonathan Watts in Uong Bi village, Quang Ninh province, Vietnam Monday May
16, 2005 Guardian

Until last summer, Nguyen Thi Hanh used to watch flocks of ducks waddle
across the road outside her house, holding up cars as they wandered about a
tranquil village in which almost every family earned a major share of their
income by raising fowl. Since an nearby outbreak of bird flu, however, the
ducks have been slaughtered, so traffic now speeds through, while the
village economy slips into reverse. Hanh's husband has given up chicken
farming and taken up driving.

The erosion of the family's finances and lifestyle are among the many
consequences of the avian flu pandemic in Vietnam, which is at the frontline
of a global battle against a disease health experts believe could become
more of a threat to humans than the respiratory illness Sars.

Bird flu has ravaged poultry farms across 10 Asian countries since late
2003. It has also jumped to humans, but nowhere has suffered as badly as
Vietnam, where 36 of the 51 confirmed human fatalities have occurred. As
well as transforming medical practices, challenging traditional methods of
farming and rewriting countless restaurant menus, the H5N1 virus has ravaged
the rural economy.

But though it is in the world's interest for Vietnam to control the disease,
there has been little aid to help this impoverished country cope with a
pathogen that kills more than half the people it infects. Instead, the
residents of Uong Bi village and tens of thousands of other Vietnamese
farmers can only envy the billions of pounds that have poured into
neighbouring countries affected by the Boxing Day tsunami.

Hanh's family had to slaughter almost all their 1,000 chickens last year
after the discovery of infected birds in Hai Zhen, more than 20 miles away.
With government compensation of between a quarter and a half of the birds'
market value, the slaughter cost them about 20m dong (£666), half the
family's assets. "Apart from a dozen birds in the yard, we've given up
raising chickens. My husband has become a driver and my parents have moved
south to look for work," said Hanh.

According to the World Health Organisation, Vietnam has killed 46m ducks and
chickens in a campaign against avian flu that has so far cost the country
£120m. Most of the burden has been felt in the countryside, the home of the
poorest communities. And the costs continue to rise. Instead of allowing
birds to roam, farmers must now build pens to separate them from human
habitation. Last month, the government banned all incubations of duck eggs
except in large breeding farms where flocks are easier to test and control.

More culls are likely, particularly among the remaining 60m ducks, which are
a bigger threat than chickens because they can carry the disease without
showing symptoms.

"The virus still exists in birds, especially ducks, so we need to take
drastic action," said Bui Quang Anh, director general of the department of
animal health. The government aims to eradicate the disease by 2010, but Anh
acknowledges that the target will be difficult to reach because most
households keep small numbers of birds and many animals are smuggled in from
China, Laos and Cambodia, where surveillance is less stringent. "We are
having to learn as we go along," he said.

Isolation wards

Lack of funds is hampering monitoring and treatment of the disease in
humans. Vietnam's doctors have learned to minimise the risk of death; until
this year, mortality rates stood at around 70% but since January only three
of the 18 patients referred to Pichmai hospital in Hanoi, the main centre
for treatment, have died.

"The key is to relieve symptoms using drugs, ventilators, and fluids to
reduce fever. If patients can survive for more than 10 days the chances of
survival increase considerably," said Nguyen Van Thong, who has dealt with
more H5N1 cases than any other doctor worldwide.

She dismissed speculation that fatality rates were falling because the
disease had mutated into a less virulent form. "We have more experience at
dealing with the disease and the public is better informed, so they seek
treatment earlier."

Dr Thong led Vietnam's battle against Sars two years ago, but believes avian
flu, which leads to rapid deterioration of the lungs and other organs, is
more deadly. Until now, however, it has been less contagious. All her
patients were thought to have been infected through contact with birds.
WHO's greatest fear is that H5N1 will mutate and spread between humans. But
Dr Thong said only a sudden rash of cases would show that to be the case. To
prepare for that, Pichmai hospital set up an isolation ward with 35 beds and
made back-up arrangements at Thang Long hospital in Hanoi, which has 500
beds.

The problem is a lack of laboratory facilities in Vietnam, which could delay
identifying an outbreak. Pichmai hospital has to send blood samples to the
Institute of Clinical Medicine and Epidemiology, which takes up to a week to
return results. Dr Thong said the technical standards of the Vietnam lab
were also not good. "They are improving, but it is slow. Given the rapid
progress of this disease, we really need a lab in our hospital.
Unfortunately there are no funds for that."

Health officials are vaccinating big flocks, testing birds and launching
public education campaigns. But lack of resources is again an obstacle. In
Quang Ninh province, for instance, fewer than 150 monitors cover a
population of a million people, and many of the leaflets are anyway
difficult to distribute among remote hill communities where different
languages are also a barrier.

The tendency of local bureaucrats to withhold sensitive information also
raises concerns about the results' accuracy. Last month Hanoi doctors said a
woman from Quang Ninh became the first person infected with both HIV and
bird flu, raising worries that H5N1 might pass more easily between people
with weak immunity systems. It was not proved, but Quang Ninh health
officials refused to release local HIV statistics.

In Hanoi, chicken dishes have been crossed off the menus of many restaurants
and hotels. But in the markets of Quang Ninh, hawkers still sell gizzards,
organs and slabs of chicken on tables splattered with blood.

"The price has gone up by 20% because of bird flu but demand is as high as
ever," said Nguyen Thi Nguyet, who has a market stall in Minh Thank commune.
"I've seen the public campaigns, but I'm not worried. All my birds are
healthy. I slaughtered them myself - just the same way as I've always done."


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