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Hunting Bird Flu on the Cheap in Cambodia

"We try our best to build up the system for detecting avian flu in Cambodia," Ly Sovann continued. "Five years ago, it was nothing. Now I have computers, paper and stationery. It's better."

Ly Sovann received his undergraduate medical degree from a college in Phnom Penh and a master's in clinical tropical medicine from a Thai university. He was promoted to his current post after distinguishing himself by crafting an aggressive national response during the 2003 outbreak in Asia of SARS, or severe acute respiratory syndrome.

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)

Ly Sovann said that was when he realized he could make use of the country's extensive cell phone coverage.

Reaching behind him to a bulletin board, Ly Sovann showed the worn and smudged list of names and phone numbers he began assembling during the SARS program, covering scores of health care workers in Cambodia's cities and all 24 provinces.

Compared with Vietnam and Thailand, Cambodia is fortunate because it has fewer chickens and ducks to spread the disease, and its dense commercial farms, which could offer the virus a welcome roost, are few and well-monitored, according to international agriculture experts.

But the paucity of commercial farms also makes it difficult to track the disease. Large farms serve as a bellwether for bird flu outbreaks, because the death overnight of hundreds of chickens on a single farm is easy to detect. The vast majority of Cambodian chickens, however, live in the back yards of peasants, where the death of a few dozen birds typically goes unnoted, especially because many die of fowl cholera, Newcastle disease and other common poultry maladies.

Ly Sovann set out before dawn one day this month on a three-hour drive to Cambodia's southern Kampot province, the home of Tit Sukhan, a 24-year-old woman who had died of bird flu on Jan. 30. His goal was to repeat his frequent public plea that suspicious illnesses be reported.

Arriving at the local community hall, he set up his laptop computer for a visual presentation, fished his personal digital assistant from the breast pocket of his white dress shirt and waited his turn beneath the humming ceiling fans. The reception from officials, activists and farmers proved skeptical. Several approached the microphone to question whether the virus had even entered the province.

A week before Ly Sovann's visit, the father of the dead woman had said in an interview that he still doubted that bird flu had killed her, even though most of his 40 chickens had died without warning shortly before she and several other family members became ill.

Uy Ngoy said his 14-year-old son was the first to develop a fever, diarrhea, breathing problems and a bad cough. The family took the boy to a private clinic that provides basic care in the local town of Kompong Trach. A clinician took the boy's temperature and blood pressure. Two days later, after the boy's condition worsened, the clinician sent him home so family members could pray to their ancestors in case the illness was caused by an affront to the spirits. The boy died soon afterward and his body was cremated.

No tests were run, but WHO officials now suspect the cause of death was bird flu.

After embracing the boy's body at his funeral, Tit Sukhan, his sister, developed the same symptoms, Uy Ngoy recounted. The family took her to another, slightly better-equipped clinic, where an ultrasound test revealed lung damage. Then they took her across the border for medical care in Vietnam. Doctors there diagnosed bird flu, and she died soon thereafter.

The health workers who ran the two Cambodian clinics said in separate interviews that they had believed the siblings were suffering from pneumonia, extremely common among villagers, and never thought to report the cases to Ly Sovann's department or any other official.

After Ly Sovann learned about Tit Sukhan's case from news reports nearly two months ago, he rushed to Kampot province with his team and remained for a week. Blood samples were taken from family members, villagers were canvassed and health warnings were broadcast from loudspeakers mounted on motorbikes. Ly Sovann's mobile phone rang relentlessly, he recounted.

Even after that, until he was confident the outbreak had been contained, Ly Sovann said, he worked in his Phnom Penh office from daybreak until 7 p.m., when the power was cut. Every night, he found his way out of the darkened building by the light of his mobile phone.

Staff writer David Brown in Washington contributed to this report.

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