Indonesia Stretched to the Limit In Battle Against Two Diseases

A nurse chats with 7-year-old Mutiara Gayatri, right, who is under observation for bird flu in a Jakarta hospital.
A nurse chats with 7-year-old Mutiara Gayatri, right, who is under observation for bird flu in a Jakarta hospital. (By Tatan Syuflana -- Associated Press)
By Alan Sipress
Washington Post Foreign Service
Sunday, November 6, 2005

TANGGAMUS, Indonesia -- When the first human case of bird flu was discovered on Indonesia's Sumatra island this fall, provincial officials raced to investigate. But local health officers were unavailable to help them because they were busy vaccinating thousands of young children against a polio outbreak.

Within the last six months, Indonesia has moved to the front lines of two global health crises, seeking to curb the spread of both bird flu and polio before they spill across the border.

"It has stretched resources and capacity to the limit," said Thomas Moran of the World Health Organization's office in Jakarta, the Indonesian capital.

Faced with the fastest growth of new polio cases on Earth, Indonesia launched a campaign this summer to immunize about 24 million young children. Then, just as officials were preparing in July for the first of three nationwide rounds of polio vaccination, Indonesia detected its first human case of bird flu and since then has registered more cases of the disease than any other country.

Since January 2004, more than 60 people have died of bird flu in Vietnam, Thailand, Cambodia and Indonesia. The virus has also spread through parts of Russia and to Eastern Europe.

Indonesia's two-front battle is straining the country's sorely underfunded health system, which had sharply eroded since the 1997 Asian financial crisis and was already unable to provide basic care across much of the far-flung archipelago.

"We've become a red zone for bird flu because it's endemic in livestock and infected humans here," said Ida Fitriati, deputy health director in Lampung province on Sumatra's eastern tip. "We're overwhelmed by this."

Health experts said the country needs funds to monitor possible cases, improve laboratories for testing and enhance medical facilities and supplies to include a larger stockpile of antiviral drugs.

Health officials said they worry that efforts to contain bird flu and polio could drain funding from other disease control programs that have begun to make progress in recent years.

Indonesia ranks third in the world for a high burden of tuberculosis, according to the WHO. Attempts to improve the detection of new cases regained momentum two years ago after stalling in the wake of the financial crisis and political upheaval after the ouster of longtime dictator Suharto in 1998.

Malaria remains endemic on many Indonesian islands, worsening in the late 1990s before foreign funding for control programs helped reverse the trend. Dengue and diarrhea-related diseases are epidemic.

"Anyone trying to manage public health, especially with an avian influenza risk, is faced with an extremely difficult and complex decision about how to get the maximum good out of limited resources," said Steven Bjorge, the WHO official in Indonesia responsible for managing bird flu, malaria and several other diseases.

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