Source: IRIN
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DILI, 23 November 2009 (IRIN) - Ask Afonso de Jesus what he knows about avian influenza (H5N1) and the answer is worrying. "What's that?" the 27-year-old chicken vendor asked, holding a bird he hopes to sell on the open market in Dili, the Timorese capital. "I don't know what bird flu is. My chickens are absolutely fine."Awareness of the deadly virus remains low, say health specialists in Asia's newest but poorest nation. "This is our biggest challenge. This is where we need work," Milena Maria Lay dos Santos, head of the communicable disease control department in the Ministry of Health, told IRIN.
The problem is particularly pronounced in rural areas, Dos Santos said, where most of the country's 1.1 million inhabitants live. More than 50 percent of the population had a general knowledge about what bird flu is, but most had only limited knowledge as to how it was actually spread, she reckoned."Getting the message out is difficult. Many of these people are illiterate and have little to no access to television or radio." "Communities are aware of the disease, but less so on how the virus is contracted," Megan Counahan, an epidemiologist with the World Health Organization (WHO) in Dili, agreed.
No cases yet
There has yet to be a single reported case of H5N1 in the country – either in birds or humans – but the risk remains. Afonso de Jesus hails from southwestern Covalima District along the border with Indonesia, where at least 115 people have died of the disease – the highest number in the world. Despite a government ban on Indonesian poultry products along the country's 228km border, chicken smuggling between west and east Timor continues. "This is a very porous area and difficult to control," Abebe Wolde, team leader of the avian influenza programme for the UN Food and Agriculture Organization (FAO), told IRIN. "This is why awareness campaigns are so important."
Yet poor communications and difficult terrain make reporting difficult, and most farmers have no access to veterinary services. Moreover, the country does not have a comprehensive nationwide animal surveillance system in place, a major weakness in dealing with a possible outbreak. Should a large number of chickens die suddenly, farmers will often blame Newcastle disease, a highly contagious and fatal viral disease affecting domestic poultry and wild birds, which is endemic in the area, when the real cause could be H5N1.
Progress
But despite the challenges, including limited resources, the Timorese government is making inroads. Efforts over the past year to address the threat of swine flu (H1N1 2009) have given bird flu preparedness a boost. "Preparedness levels are much better now because of H1N1," Dos Santos conceded. "People better understand the risk factors, not just of H1N1, but H5N1 as well now." The government now employs a district public health officer in all 13 districts with a mandate for preparedness and response, including raising awareness.Moreover, each district now has a rapid response team that can be dispatched when needed should a suspected human case occur, while at the same time efforts to boost community awareness are also in place. With the Ministry of Agriculture, FAO is working to explain key prevention methods through mass media campaigns, as well as drama presentations to villages in high risk areas, with some 24 villages reached since September. The UN agency has established a pilot programme for animal surveillance in three districts this year, including Dili, Covalima, and the eastern district of Lautem, with the hope of replicating it nationwide."This will allow us to detect at the village level a number of animal diseases early on, not just H5N1," the FAO's Wolde said.
According to WHO, human testing of the virus can be undertaken in Australia, isolation and treatment facilities are available in Dili, and the country now has a healthy stockpile of Tamiflu, the drug used globally to treat avian flu in humans. "We're much better prepared now," said Counahan of the WHO, citing efforts by the Ministry of Health. "However, we're still not where we need to be in terms of awareness."
At least 442 human cases of bird flu have been reported worldwide, including some 262 deaths, mostly in neighbouring Indonesia, the world health body reports.
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