Three Days With a Bird Flu Sleuth
Monday, February 6, 2006
JAKARTA, Indonesia The maroon minivan had just edged into morning traffic, but passenger Gina Samaan, a field investigator for the World Health Organization, admitted she was already a bit worried.
This much was for sure, she said, reviewing the case from the back seat on an excursion one day last month. A 29-year-old Jakarta woman hospitalized with acute pneumonia had died two days before, and the early diagnosis was bird flu. Her samples had tested positive for the avian influenza virus at a government laboratory and another, little-publicized lab run by the U.S. Navy across from the capital's main prison.
The local news media were reporting that chickens in the woman's neighborhood had recently fallen sick and died, suggesting she had caught bird flu from poultry like other Indonesian victims. But Samaan disclosed that bird samples tested by the city's veterinary department had all come back negative.
If the source was not chickens, could it have been another person? If so, it might mean the virus had mutated into a form more easily transmitted among humans -- signaling the earliest stages of a global influenza pandemic that could potentially kill millions.
That ominous prospect seemed to grow for a time as this influenza gumshoe followed a trail of clues that led her unexpectedly into a neighboring province and back again.
As in many cases on the influenza beat, Samaan, 29, might never be able to nail the culprit. But she was bent on determining whether human infection was at least the likely explanation.
If the evidence pointed to a chain of human cases, WHO might have to sound a global alert. Since the middle of last year, more people had died in Indonesi a from bird flu than anywhere else, and international health experts were warning that if a worldwide epidemic were to erupt, there was no likelier starting place for it than here.
Day 1: East Jakarta
Samaan, her dark eyes earnest and intent behind rimless glasses and her brown hair tied back in a ponytail, wasn't taking any chances. She had stashed several masks in the back of the WHO van. In her bulky brown pocketbook, she kept a small bottle of pink antiseptic hand sanitizer and a cheap thermometer. She had been taking her temperature twice a day since arriving in Jakarta eight months earlier from Australia's Health Department.
She had donned simple shoes with covered tops to protect her feet from sources of contamination, such as bird droppings, and with flat soles that were easy to clean. She said she washed them in the sink after each outing and, as a result, was going through a new pair every other month or so.
But for all her preparations, Samaan wasn't expecting what she saw when she pulled up in the victim's neighborhood, accompanied by her Indonesian interpreter and an official from the Health Ministry's national lab. WHO and Indonesian health officials allowed a reporter to join investigators on condition that the names of the victim and her relatives, home address and place of work be withheld for medical privacy reasons.
It was as if the whole neighborhood had turned out in a single grassy yard to wait for Samaan. Several men crowded around her, confirming that two chickens had died about a month earlier not far from the victim's home and that the carcasses had been quickly burned.
Samaan listened intently, lips pursed, jotting down the details in a spiral notebook. Two dead birds, no samples. It was hard to conclude they were the cause.