Avian influenza has struck the human population of Kampong Cham province only once: here, in this small village, a short drive along highway 7 from the Vietnamese border, in April last year.
Bird flu took the life of 13-year-old Chheat Phanny, who succumbed to the H5N1 virus after a desperate battle by her parents to save her that, between the first symptoms appearing and her death, lasted only four days.
The girl’s illness, which quickly included fever, headache, diarrhoea and vomiting, displayed the typically aggressive clinical course for which bird flu in humans is notorious.
There has been no confirmed human or animal outbreak anywhere in the country since. Phanny was the seventh Cambodian to die from H5N1 in the current disease outbreak.
“We had no real idea about bird flu then,” says her mother, Chhen Pheap, 31, who takes the comfort she can from the girl’s siblings: 11-year-old Phanna, 10-year-old Neath and her new baby boy, three-month-old Ty.
“We only ever kept about five chickens, although Phanny mentioned to the doctors that she used to pluck the few we slaughtered.” Shortly before Phanny fell ill, the family’s birds had begun to die.
Pheap and her husband, Chhean, who now assists with bird-flu education in villages, rushed their sick daughter first to the local doctor, who she says incorrectly diagnosed typhoid; then to the district hospital, which provided some treatment but no diagnosis.
Only when they finally got to the Kun Tak Bopha 4 paediatric hospital in Phnom Penh, about 150km away, was avian influenza finally confirmed.
Culling
It was an extraordinary misfortune. There have only ever been four confirmed animal outbreaks of H5N1 in the whole of Kampong Cham, all dealt with by culling, according to Ros Sareth, director of the Cambodian Red Cross (CRC) branch in the provincial capital.
The Cambodian government has relied mainly on culling to defeat bird flu, while the Vietnamese next-door use mass vaccination of animals.
“Now, after the government’s publicity drive and ours,” Ros adds, “people are more aware of the dangers and more willing to report sick birds, even though the compensation if they’re culled isn’t really adequate.”
“And if sick birds’ owners don’t report them, their neighbours probably will.”
There have been a total of 22 distinct animal outbreaks of H5N1 in Cambodia since the current episode began a few years ago, according to the authorities.
Now the government and all the agencies involved are keeping their fingers crossed that the huge preventive effort aimed mainly at backyard poultry farmers in the countryside may have eradicated the disease.
But it’s too soon to relax.
Ten per cent of the nearly 400 volunteers available to the CRC in Kampong Cham still spend all their time on avian and human influenza (AHI), holding – in Laak and other villages like it – three classes a month on the safe handling of poultry.
This week the Cambodian government and the UN Food and Agriculture Organization (FAO) jointly announced a special “community forum” in north-western Siem Reab province, which has one of the largest concentrations of poultry in Cambodia and is a centre of the poultry trade – much of it sourced from remote villages.
It’s intended to encourage good practice in the safe handling of birds and early reporting of apparent outbreaks.
Communities must have “the knowledge that it’s within their power to prevent the spread of the disease, as they stand to gain more from preventive actions,” the FAO’s Maria Cecilia Dy told the International Federation.
“Only by keeping communities aware of the nature and risks…can we succeed in fighting this lethal disease and safeguard the livelihoods and food security of the majority of Cambodians who depend on poultry, either as food or as income.”
Porous borders
CRC bird-flu work in Cambodia targets 11 other at-risk provinces as well as Kampong Cham, mostly bordering Thailand of Vietnam. Five are earmarked for special support by the Finnish Red Cross as part of the International Federation’s global appeal.
The porous borders with Vietnam and Thailand – respectively the second and fifth worst-affected nations in terms of human deaths – make it “important for Cambodia to remain vigilant for the possible re-introduction of the highly pathogenic avian influenza virus,” according to the FAO.
One aspect of the value-added the CRC has been able to offer, meanwhile, is its ability to get public-health messages across to ethnic minorities like the Pnong, in Mondol Kiri province, who neither understand nor speak Khmer.
“They’re more or less immune to government health messages on radio and television,” says Hang Chan Sana, the CRC programme manager, “and even to some local NGOs. Local volunteers are really the only way to reach them.”
Cambodia has also begun to work preparedness for what’s referred to as “PI” – (human) pandemic influenza – into national contingency planning in which the Red Cross participates.
The Red Cross in Kampong Cham, for example, together with the provincial health and agriculture authorities and the local committee for disaster management, is now included in a AHI plan for the province that sets down who does what during a pandemic that affected large numbers of people.
In order to make best use of limited reserves of volunteer time, says Hang, the CRC is also piloting the integration of fieldwork on dengue fever and AHI in southern Takaev province.
If it goes well, CRC volunteers will be able to address two of the most serious health threats facing Cambodia with a single field visit to a village.
“Free-range”
In Laak, Chhen Pheap says her family no longer keep poultry or eat chicken –a very understandable reaction to the loss of her daughter.
But properly cooked chicken is safe – and poultry can be kept, handled and slaughtered safely.
Above all, under a code of practice being disseminated by the CRC and its project partners, including UNICEF, many of Laak’s residents – against all tradition – now keep their birds penned.
A few houses down from the Chheats, 42-year-old Ly Kim Seang, rather nervously shows off to the local CRC project coordinator, Min Song, her improvised but perfectly secure chicken coop.
She admits that what goes down in the official reports as “an improvement in bio-security” doesn’t feel quite right – “free-range” has much the same appeal in the South-East Asian countryside as in western supermarkets.
But in Laak, for the most tragic reasons, the CRC may be largely preaching to the converted.
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Chhen Pheap, whose 13-year-old daughter Chheat Phanny died of avian influenza in Laak in April 2007, with the girl’s sister, 11-year-old Phanna. The Cambodian Red Cross (CRC) organizes three public-health seminars a month in Laak as part of a global appeal first issued by the International Federation in 2006. (p17848)
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A woman cooks a meal in Russey Douch village, Svay Rieng province. In June 2008 poultry in the village had begun to die from a seasonal illness that was determined not to be avian influenza. But whereas before bird flu villagers say they would have cooked and eaten sick birds quickly as soon as the first symptoms appeared, now they bury them. It’s one of the locations chosen by the CRC, with special support from the Finnish Red Cross as part of the International Federation appeal, for regular instruction from volunteers in how to handle poultry safely. (p17849)
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The Cambodian Red Cross (CRC) organizes three public-health seminars a month in Laak as part of a global appeal first issued by the International Federation in 2006. Here villagers listen to instruction from CRC volunteers on how to keep and handle poultry safely. In the foreground is Mom Kim Sen, a 57-year-old Red Cross volunteer. (p17850)
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Villagers in Russey Douch, Svay Rieng province, listen to instruction from Cambodian Red Cross (CRC) volunteers in how to handle poultry safely. It’s one of the locations chosen by the CRC, with special support from the Finnish Red Cross as part of the International Federation appeal, for regular instruction from volunteers in how to handle poultry safely. In June 2008 poultry in the village had begun to die from a seasonal illness that was determined not to be avian influenza. But whereas before bird flu villagers say they would have cooked and eaten sick birds quickly as soon as the first symptoms appeared, now they bury them. (p17851)
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