A lab technician at the Disease Investigation Centre near Yogyakarta, Indonesia checks for the avian flu virus in samples taken from poultry. Credit: FAO

By Kanis Dursin
JAKARTA, Indonesia, Jul 10 2017 (IPS)

Poultry farmer Bambang Sutrisno Setiawan had long heard about biosecurity but never gave serious thought to it, even when the highly pathogenic avian influenza H5N1 forced him to cull thousands of his layer chickens in 2003 and 2009.

Eighteen years into the business, however, Bambang, who is called Ilung by friends, is now converting his second farm into a three-zone biosecurity poultry with a strong conviction that it is the only way to save his business amid continued threats of bird flu and other animal diseases.Indonesia detected its first bird flu case in 2003. Since then, the H5N1 virus has killed millions of poultry in 32 of the country’s 34 provinces.

“My second poultry biosecurity will soon operate, hopefully in July,” Ilung told IPS by phone from Semarang, Central Java, a one-hour flight east of the capital Jakarta, in mid-June.

The 44-year-old has two poultry farms, each accommodating around 30,000 layers, and one day-old chick site that can hold 10,000 chicks.

Ilung converted one of his farms into biosecurity poultry in November 2015 after attending seminars and trainings organized by local Livestock and Animal Health Services and Food and Agriculture Organization’s Emergency Center for Transboundary Animal Diseases (ECTAD).

Three-zone biosecurity is one of programs ECTAD Indonesia is promoting to contain the highly pathogenic avian influenza (HPAI) that continues to plague the country of 250 million people since its first detection in 2003.

The model divides a farm into three separate areas: a red zone for high disease risk external areas, yellow zone for medium risk service areas, and green zone for clean and highly secure access-restricted area where the chicken flock is located. Access from the red zone to the yellow zone requires showering and a complete change of clothing and footwear, while further inward access to the green zone requires a second change of footwear to maintain biosecurity standards.

According to Ilung, biosecurity keeps animal diseases out and cuts disinfectant and medicine costs by 30 percent and 40 percent, respectively.

“Production also rises to 60 kilograms per 1,000 layers now, compare to 50 kilograms previously, and more importantly, I have not had disease outbreaks since November 2015,” said Ilung.

In 2009, Ilung culled half of his layer chickens after bird flu struck his farms for the second time. Prior to that, the father of two was forced to prematurely sell 11,000 chickens to cut losses after 300 layers were found to have died of H5N1 in 2003. He has been in the poultry business since 1999.

Robby Susanto, a 62-year-old poultry farmer in Solo, Central Jaw said biosecurity has proven to bring a lot of benefits to poultry farmers like him.

“Our net profit has increased by between 11 percent and 35 percent since practicing biosecurity poultry,” he told IPS by phone from Solo, an 80-minute flight east of Jakarta.

Susanto started his poultry farming in 2010 after participating in ECTAD’s biosecurity pilot projects together with five other farmers.

“Biosecurity keeps avian influenza and other animal diseases out of his 100,000 layer chickens and help maintain production of five tons of eggs per day,” he said.

A study by ECTAD Indonesia shows that for every cent spent on three-zone biosecurity, poultry farmers gain as much as 12 cents in profit.

Ilung said he spent around 5,000 dollars for each biosecurity farm.

Indonesia has been listed as one of the global hotspots for human H5N1 avian influenza infections since 2005, prompting ECTAD to open an office in the country in 2006.

James McGrane, FAO ECTAD Indonesia Team Leader, at his office in Jakarta. Credit: Kanis Dursin/IPS

“Since 2005, Indonesia has been one of the global epicenters for human H5N1 avian influenza infections with more human cases and fatalities than any other country until 2014,” James McGrane, ECTAD Indonesia Team Leader, told IPS in an interview in Jakarta.

Indonesia detected its first bird flu case in 2003. Since then, the H5N1 virus has killed millions of poultry in 32 of the country’s 34 provinces, disrupting the livelihoods of large numbers of people dependent on poultry-keeping, according to ECTAD Indonesia.

Up until 2017, the World Health Organization has recorded 199 confirmed human cases of avian influenza in Indonesia, with 167 deaths. That figure is the highest in the world, with Egypt coming in second with 120 deaths out of 359 cases, and Vietnam third with 64 deaths of 127 cases.

Negligence on the part of poultry farmers – not wanting to follow proper security standards – has been cited as the main reason human deaths were high in Indonesia.

Aside from promoting biosecurity, ECTAD Indonesia helped the central and local governments develop and implement a community-based Participatory Disease Surveillance and Response (PDSR) system to contain HPAI in backyard poultry in 32 provinces.

By 2015, PDSR had 2,500 trained officers working in 350 districts in 30 provinces. The system, according to McGrane, was able to detect and attend to over 10,000 HPAI outbreaks over the years.

“In 2009, following an evaluation of the PDSR system, greater emphasis was placed on working with the commercial poultry sector, and a program was initiated to strengthen relations with and surveillance in the commercial industry,” said McGrane.

Since 2012, ECTAD has helped implement biosecurity poultry in six pilot commercial layer chicken farms.

Fadjar Sumping Tjatur Rasa, Animal Health Director of the Livestock and Animal Health Directorate General of the Ministry of Agriculture, said biosecurity has succeeded in reducing avian influenza cases in Indonesia.

“We still have bird flu cases every year but their number has continued to decrease every year,” Fadjar told IPS on Tuesday, June 20, 2017.

The agriculture ministry recorded 255 H5N1 cases in 2016, compare to 123 cases in 2015, 343 in 2014, and 470 in 2013.

Indonesia suffered its worst avian influenza outbreak in 2007 with 2,751 confirmed cases before it went down to 2,293 cases in 2009 and 1,502 cases in 2010. The ministry of agriculture has so far recorded 94 cases in 2017.

Fadjar expressed optimism that bird flu cases would continue to fall now that Indonesia has adopted One Health approach in dealing with various human and animal diseases.

One Health recognizes that the health of humans, animals, and ecosystems are interrelated and thus any potential or existing health risk calls for collaborative efforts between health practitioners (including vets, doctors, public health officers, epidemiologists, ecologists, toxicologists) and related institutions to attain optimum health for people, animals, wildlife and the environment.

“Now the ministry of health alerts us [the Ministry of Agriculture] and other stakeholders if they suspect a patient is suffering from an avian influenza virus. We too have to inform the ministry of health and other stakeholders about suspected bird flu outbreaks,” said Fadjar.

ECTAD Indonesia also helped the government establish the Influenza Virus Monitoring (IVM) Online platform to monitor circulating HPAI and other influenza viruses. According to McGrane, since its launch in 2014, the platform has seen increases, among other things, in the number of H5N1 isolates being uploaded to IVM Online, isolates that have been antigenically and genetically characterized, and improved knowledge on circulating AI viruses in Indonesia.

“Influenza virus monitoring and characterization is crucial for the development of local vaccines, effective against the circulating strains of HPAI in Indonesia,” said McGrane, adding: “The selected challenge strains are used to test the efficacy of new vaccines developed by local commercial vaccine companies.”

“ECTAD today continues to support the control of HPAI and other endemic zoonotic diseases such as rabies and anthrax, while also focusing on new or re-emerging global health threats which spill over into humans from animal populations, such as Ebola, MERS-CoV and Zika,” said McGrane.

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)