For the Birds

The Jakarta Post ,  Jakarta   |  Fri, 05/23/2008 7:38 PM  |  Cover Story

As citizens of the country hardest hit by avian influenza, Indonesians are inundated with messages about the disease. Increasingly it appears that bird flu is joining the list of other serious and persistent ailments, such as dengue fever, TB and HIV/AIDS that have to be controlled from the ground up. Emmy Fitri reports.

Homemaker Yuli Rosmalia is confident she knows the ins and outs of bird flu – “who doesn’t these days?” -- from the relentless public information blitz on TV and in print media.

As she talks, the 30-something occasionally uses the English term of avian influenza, a knowledge gained from reading up on the disease.

“For sure, it has nothing to do with eating chicken. People get sick when they have contact with dead chickens. That’s why I never want to keep chickens in my backyard,” she says.

It was a typical afternoon in her low-income residential neighborhood in East Jakarta, located near a military complex. Yuli sat with four other mothers, feeding their children. The restless youngsters scampered off in their bare feet across a vacant lot, crossing paths with a hen and her chicks that pecked up fallen crumbs of food from the children.

“We know whose chickens they are,” says Ibu Sapto, another one of the mothers.

“They’re owned by a retired Army soldier. He has chickens that are not caged so they range freely during the day, and doves that are kept in a cage in front of his house.”

“She (Rosmalia) already complained to sub-district officials about the birds. I don’t think the officials dared to say a word to him, that’s why they are still there,” she adds, to the laughter of the others.

Although the sub-district head was not available for comment, an official said he knew about a resident who owned free-ranging chickens nearby -- a crime according to a Jakarta administration bylaw on poultry containment issued last year under then governor Sutiyoso.

“[B]ut we have repeatedly asked the owner to cage the chickens and keep the cage clean. Maybe he thought they’re just chickens so why make a fuss. Typical,” the official says.

Second only to neighboring Banten, Jakarta accounts for almost half of the total human fatalities from bird flu in the national tally, which, as of April 20, stood at 107. The capital is home to densely populated slums and low-income kampongs marked by poor sanitation. Compounding the problem is that many residents keep small backyard farms to help make ends meet.

Yuli’s apparent knowledge of bird flu transmission while allowing her children to play in a potential danger zone is a contradiction. However, she and her friends are probably typical of most Indonesians when it comes to the disease. Knowledge does not instantly change lifestyles and risky behavior.

As Richard Fielding, associate professor of medical psychology at the University of Hong Kong, said last year, varying perceptions among people about backyard farming and the sale of live chickens explain why it is difficult to draw up a single set of rules about what is healthy.

His colleague, translational public health expert Gabriel M. Leung, also points out that densely populated Asia, where animals and people live in close proximity and some of the world’s most virulent epidemics began, will continue to be a hotbed of disease. For bird flu, much of the problem stems from traditional methods of rearing poultry.

Regulating the poultry industry – from factory-style farming to backyard operations – is imperative but no guarantee for resolving issues arising from the complex nature of the industry. Chicken and other poultry products remain the number one affordable animal-based protein source for most of the population here.

Bird flu, caused by the H5N1 virus, is endemic in a tropical, agricultural country like Indonesia, where poor sanitation is the norm, especially in rural areas. Almost all of the 33 provinces in the country have reported outbreaks of avian influenza, and short of the drastic and unfeasible step of culling entire poultry populations, the virus will remain endemic in domesticated birds.

Chief executive of National Commission for Avian Influenza and Pandemic Preparedness, Bayu Krisnamurthi, contends it is not possible to stamp out the disease from the country completely.

“There is no history in other countries of complete success in eradicating this disease. This continues with diseases we face today, like TB or dengue. Diseases that we have to deal with in our daily lives.”

Facing myriad problems in many sectors, Indonesia, according to Bayu, has shown great effort in dealing with avian influenza.

“Preparedness is the key because the virus has been with us all along and is going to hover around us. It’s literally in our hands to stop it from catching us,” he says, referring to the commission’s slogan about the importance of hand washing to prevent the spread of infection.

“And we all are now, not only Indonesia but the world, in the learning process while preparing for the worst from this virus. What we need to do is to prevent bird flu from becoming a pandemic.”

The fact that most people who have died of bird flu came from low to middle-income families fuels the assumption bird flu “picked” its victims, based on poor lifestyle, an unhealthy environment and lack of access to information. The doubters point out that the first person to die of H5N1 in the country, a Tangerang resident in 2005, was from an affluent background.

“That remains a big question,” says Tjandra Yoga Aditama, the former director of Persahabatan Hospital and now the Health Ministry’s director for infectious diseases. “It’s hard to trace back the contact history of a patient and identify the source of infection because we live in this vast, mobile community, like Jakarta, Tangerang and Bogor. They’re interlinked.”

The problem is that this first death is just one of many question marks hanging over the disease.

“There is still more to learn about this disease. Clinicians, doctors and hospitals are learning too because it’s something new,” Tjandra says.

In the much-feared worst-case scenario, avian influenza would spiral into a full-fledged pandemic. Scientists have always said that no country can ever be truly primed to respond to a pandemic, especially in this age of international air travel where diseases can spread between continents in days.

So, many people keep their fingers crossed, hoping that the ugly historical examples of the 1918 Spanish flu pandemic, 1968 Hong Kong pandemic and 2000 SARS outbreak will not be repeated on a greater scale.

Preventing that from happening starts in the home, with simple, basic hygienic practices. Yuli and her friends already know that – now they just have to start putting it into practice.

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