Friday, June 09, 2006

Banned in China

Indonesia is a known problem spot for bird flu. An impotent central government, infected poultry everywhere, a huge but far flung population on thousands of small islands, and a poor and primitive health care system. Not a pretty picture.

But China may be as bad as Indonesia. A long story in Asia Times online is well worth reading. I'm surprised the reporter isn't in jail for revealing "state secrets" (infection with H5N1).
Having learned a bitter lesson from covering up the severe acute respiratory syndrome (SARS) epidemic in early 2003, the central government of China now is said to be taking a more positive, responsible attitude in dealing with avian influenza, or bird flu. But that hasn't filtered down to the provinces.

As the market economy has taken root in China, the country has become increasingly decentralized. Because of this, Beijing's tough orders regarding the prevention of a bird-flu outbreak may not necessarily be carried out at all levels. Overwhelmingly concerned with economic growth, some local officials still tend to cover up any outbreak of bird flu, defying Beijing's order to report new cases immediately.

Beijing has punished some local officials for their incompetence in dealing with bird-flu outbreaks. For instance, in May it was announced that five officials in Dazhu county in Sichuan province had been sacked for of dereliction of duty because they did not report and contain the local outbreak in time.

But during an investigative reporting trip to three locations in China, Asia Times Online found that in rural areas, local officials and residents really don't like any action that might expose a possible bird-flu outbreak, fearing the damage it would do to the economy. Because of this, they hate individuals who dare to inform authorities of any bird-flu case. (Asia Times online)
There follows chilling examples of cover-ups, retributions and missed diagnoses, not specifically at the hands of the Chinese government, but of the people in the rural countryside. It isn't just ignorance. It is deliberate cover-up. We posted in December about one of these instances, retribution against a local farmer who notified authorities there was infected poultry in his village. The Asia Times story has a follow-up and additional details. They aren't pretty, either. The reasons the whistleblower, Mr. Qiao, has become a pariah aren't hard to find:
Owing to wide coverage of Qiao, the poultry market in Gaoyou has slumped. "The price of eggs has dropped from 3 yuan [37 US cents] to 1 or 2 yuan per 500 grams, chicken prices are also down from 5 yuan to 2 yuan for half a kilo, even below the raising cost," Chen noted. "So no one wants to raise chickens now, even though chicks are free."


More than half a year has passed since the bird-flu epidemic in Tianchang city, Anhui province, was exposed to the outside world. A recent visit by ATol found residents there still eager to see their hated local informer turned into a criminal defendant, while little attention has been paid to prevention of a possible return of the epidemic.

Ducklings and goslings roamed all over Liangying village, showing that no one was paying attention to the Animal Epidemic Prevention Law. Among other things, the law stipulates a six-month ban on breeding poultry after an outbreak, and the current ban only expired on May 24. "We started raising poultry after the Chinese New Year, and village leaders never stop us," a local farmer said.

The poultry population of Liangying village and the surrounding area is growing again, and some households even raise birds, dogs and lambs together, despite warnings to separate them to prevent cross-breeding of diseases between various kinds of livestock. "We're poor, and raising poultry is the only way to enrich our tables and honor guests," an elderly farmer said, herding a gaggle in the fields.

All these words and scenes reveal a complete and willful ignorance of basic precautions against a possible revival of bird flu, as well as a deadly apathetic attitude toward epidemic prevention that is shared by the local authorities and residents alike.

To the local farmers in Tianchang, Qiao was just a "bad guy". Because of his tip-off, the government decided to destroy all reared poultry in the neighborhood, but the state compensation did not suffice to cover the colossal loss. This seething resentment against Qiao even extends to his his fellows from Gaoyou. "Gaoyou guys dare not come here to trade anymore. They are afraid we will beat them up," grinned a local Tianchang farmer.
The reporter goes on to tell the story of Li Juhua and her 6 year old son Ouyang, so far China's youngest bird flu case. Ouyang was diagnosed with bird flu, received treatment, and recovered. His mother was never diagnosed, although her symptoms were similar. She took sick first and died. The onset of symptoms was several days apart, suggesting possible human to human transmission in this small two person family cluster. The family details are revealing:
Last December 21, the family had dinner to celebrate the winter solstice. They were not rich enough to kill a live bird and could afford only dead chickens dumped by owners, which the poor collect and preserve for festivals.

The wife, Li Juhua, soon felt sick and was taken to the county hospital on December 23. At that moment, a grisly thought occurred to Ouyang that his wife might have been infected with bird flu, as he had watched news of the epidemic on television. Yet none of the doctors heeded his fears. Li died the next day, to which the hospital only gave a single-sentence explanation citing some rare dermatological disease.

A few days later, the son developed the same symptoms as his deceased mother. At the county hospital, the diagnosis given was tuberculosis. Ouyang dared not take a chance with the county hospital again and took the little boy to a hospital in Chenzhou, where the medical staff were concerned and referred the child to Changsha. There his affliction was finally diagnosed as bird flu infection.
The mother's quick death induced the father, now a widower with two young children, to get his son to the better equipped hospital in Chenzhou. Otherwise Ouyang would be another undiagnosed, faceless death instead of the China's youngest case. To date the mother's case has not been discussed or reported by authorities.

The local attitude is clearly a difficult problem for Chinese authorities. But the central authority's claim to openness on bird flu has more problems than this. The Health Ministry and the Agriculture Ministry are not always on the same page regarding transparency. And information is still carefully managed in China.

If you live in China you are not likely to read that information is managed, however. Not even on Effect Measure. We are banned in China.