Tuesday, April 29, 2008

Bird flu: Indonesia's trial run

In the backstreets of a Bali village, all hell has broken loose.

The Balinese rural calm has been invaded by men with megaphones and masks, there are sirens wailing down the main street, and at the centre of it all, Putu Arini sits quietly on the porch of her house, waiting for the police.

Parts of Bali have looked like the set of a germ-warfare film

A few hours ago, her husband was taken to the local health clinic, with bird flu-like symptoms, and now investigators have told her she is being quarantined.

Luckily, all this comes as no surprise to Putu Arini. In fact the village has been planning this for months.

Indonesia has spent the past few days simulating a human bird flu pandemic - according to the World Health Organisation (WHO), the largest ever such simulation in the world - and Putu Arini is one of the star players.

And now, as detailed in the script, police are on their way to rope off her house, and stop anyone from entering. Not that anyone would want to, she says.

"Everyone is scared," she told me, getting into character.

"Only a few people are brave enough to go outside their houses. Even my relatives are too scared to visit me here, and I can't leave the house either."

Countries around the world are watching for signs of a human bird flu pandemic, and they are watching Indonesia closest of all. Almost half the world's total human deaths from bird flu died here - 107 people.

And every time someone gets infected, it gives the virus another chance to switch from a disease we catch from poultry, to a disease we catch from each other.

Is Indonesia prepared for an outbreak of bird flu?


The simulation - which lasted from Friday morning until Sunday night - involved 1,000 people and 20 different institutions, from the armed forces to medics, to the foreign and trade ministries. The airport was affected, as was the district's main hospital.

The aim, said Nyoman Kandun of Indonesia's health ministry, was to "examine the government's readiness to quickly cut off a pandemic".

"We want to show the world we are prepared," he said, "ready to contain and stop the virus if a pandemic happens."

The head of the WHO here, Subhash Salunke, admits the simulation was also about learning where the gaps are.

"The world is looking at this as an experiment," he said.

"The plan is very scientific. Implementation is the critical issue. And that's what we're going to learn from the simulation exercise: which are the gaps, what are the holes, and how do we really breach them when it really strikes."

For the past three days, the hospital where Putu Arini's husband was taken has looked like the set of a germ-warfare movie. Medics clothed head to foot in white protective clothing - goggles, gloves and masks - moved like ghostly astronauts around the field hospital tents set up outside the main building.

But this is wealthy, well-connected Bali, and they have been preparing for this for months. Every event was tightly scripted, and the virus emerged in an easily-contained village. Would it look like this for real?

One of those watching the simulation was Ibu Irma from Jakarta's Centre for Disease Control. Indonesia she hinted, wasn't ready to tackle an epidemic in a city.

The simulation had to be as realistic as possible


"We've started with the simple one," she explained. "If we start with the big city? Well, I don't know."

Here at least, she said, houses had large backyards and were well-spaced. If the pandemic starts in the densely packed alleyways of Java's big cities, it could be much harder to handle.

Of course, it is the human story that grabs the headlines, but with bird flu all roads lead back to the same place - the birds that carry it.

Indonesia has been heavily criticised for not containing the virus in its poultry population - it is endemic across most of the country.

It wants to show the world it will do better should a human pandemic emerge here. And whether or not it can does not just matter here - it matters right around the world.

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