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Hunting Bird Flu on the Cheap in Cambodia

Government Team Struggles Against Threat of Epidemic

By Alan Sipress
Washington Post Foreign Service
Wednesday, March 23, 2005; Page A10

PHNOM PENH, Cambodia -- The man who might save the world from a devastating bird flu pandemic makes $38 a month.

As Cambodia's chief of disease surveillance, Ly Sovann is responsible for spotting the stirrings of an epidemic in a country where the public health and veterinary systems are so impoverished that experts acknowledge they are probably failing to detect most of the human cases and have no idea how rampant the virus is among poultry.

Duck sellers watch a cockfight in Kompong Trach, Cambodia. A boy treated at a clinic there died in January of suspected avian influenza; the disease later killed his sister. (Chor Sokunthea -- Reuters)

That poses a profound danger well beyond Cambodia's borders. International health specialists warn that avian influenza could kill millions of people worldwide if it has a chance to develop into a form easily spread among humans.

Ly Sovann, 36, a physician, is a full-faced man with dark, playful eyes and sloping shoulders. He heads a team of 10 Cambodian flu hunters struggling to head off an epidemic from their 12-by-10-foot office on the third floor of the Health Ministry. They share one Internet line and even at times of crisis have to go home by 7 p.m., when the power in the building is switched off.

Ly Sovann's epidemic alert system is nothing more than a network of personal cell phones. But through his wide-ranging contacts and charisma, he has cobbled together a national network of informants. Cambodia is seeking $10,000 from foreign donors to purchase prepaid phone cards to allow local health workers to report on suspicious respiratory cases.

But the monitoring effort has stumbled. Cambodia's one confirmed human case of bird flu was not recognized by local doctors two months ago and was diagnosed only after the victim's family took her across the border for treatment in Vietnam, where the health system is more advanced.

So far, international health specialists report that the disease is less prevalent in Cambodia than in Vietnam and Thailand, another neighbor, where a total of 45 people have died since early last year. But health specialists are concerned about the rudimentary level of medical and veterinary care in Cambodia and its destitute neighbor Laos. They fear that those countries' primitive health care systems may not be able to diagnose or report human cases of bird flu, allowing the virus to spread.

The avian strain now has difficulty infecting people. However, each new human case gives the virus an opportunity to undergo genetic changes that could eventually allow it to be transmitted easily from person to person.

"The chain is as strong as the weakest link," said Klaus Stohr, director of the World Health Organization's global influenza program. "Cambodia and Laos are certainly the ones that need beefing up."

Bird flu was first confirmed in Cambodian chickens in January 2004. Since then, international health officials have speculated that human cases have probably gone unreported. Nevertheless, Jim Tulloch, WHO's top representative in Phnom Penh, said he was confident that a concentrated outbreak would be spotted. The question is how fast.

"If we start seeing the disease spread more quickly, speed will be everything to contain it," he said. "It's a matter of chance if we know about it as quickly as we like."

Still struggling to recover from decades of war and political instability, Cambodia's government spends only $3 per person on health care each year despite high rates of HIV/AIDS, tuberculosis, and infant and maternal mortality, according to Tulloch. Foreign donors contribute twice that amount for specific health programs, but because the money is earmarked, it cannot be used for tracking new diseases, such as bird flu.

Cambodia lacks trained doctors and clinicians, laboratory facilities, referral wards, epidemiologists and an overall health system tying them together for the fight against avian influenza, experts said. The government cannot even afford to produce warnings about the disease for radio and television.

"We've had over 30 years of war. We need time to build up our system of public health," Ly Sovann said from behind his modest metal desk while a small air conditioner whined in the window. He said he had secured his lone Internet connection only after prevailing on the health minister to seek help from the prime minister's office.

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