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 32km away. With government compensation of between a quarter and a half of the birds’ market value, the slaughter cost them about 20-million dong ($1 231, R7 781), 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 46-million ducks and chickens in a campaign against avian flu that has so far cost the country $221-million. 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 60-million 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.”
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 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. 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.” – Guardian Unlimited Â