Thursday, June 01, 2006



According to the most recent figures, Indonesia now averages three human bird flu deaths a week.

The World Health Organisation seems to be sliding into a battle against the massive, though fragmented, bureaucracy of the Indonesian government as it tries to implement strong rules for containing the outbreaks in poultry and humans.

Indonesia, an archipelago of 17,000 islands with a population of 220 million people, has a patchwork of local, regional and national bureaucracies that often send mixed messages. The impression, health officials said, is often that no one is truly at the helm.

"I don't think anyone can understand it unless you come here and see it for yourself," said Steven Bjorge, a WHO epidemiologist in Jakarta. "The amount of decentralization here is breathtaking."

The WHO claims the familial "cluster", which killed seven blood relatives in an Indonesian village in May is isolated, and there is no solid proof of the virus being transmitted human-t0-human outside of the one family involved.

"We're tying to fix this leak in the roof, and there's a storm," World Health Organization spokesman Dick Thompson said. "The storm is that the virus is in animals almost everywhere and the lack of effective attention that's being addressed to the problem."

Thompson claims that while Indonesian Health Ministry officials will meet with outside experts to work out how they are going to fight, and contain, the spread of bird flu, the officials don't hold the kind of power and sway within the government to get the new plans implemented.

"Their power only extends to the walls of their office," Bjorge said, adding that the advice must reach nearly 450 districts, where local officials then decide whether to take action.

"The local government has the money, thus the power to decide what to prioritize," said Hariyadi Wibisono, director of communicable disease control at the Ministry of Health. "If some district sees bird flu as not important, then we have a problem."

Indonesia has clocked up 25 human bird flu deaths since January.

The majority of the 127 human bird flu deaths, so far, are spread between Indonesia and Vietnam.

Because the bird flu virus has not been seen to be spreading amongst other humans in the village where seven family members died, WHO experts are still considering the possibility that there is a genetic vulnerability to bird flu infections, and deaths.

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