Indonesia’s response to a fatal bird flu cluster was littered with failings, according to international experts, and would have speeded rather than slowed the global spread of the virus had it involved a pandemic strain of H5N1.
In interviews with the Financial Times, international experts and local health officials detailed a catalogue of problems in the health system’s response to the seven deaths in one family over the past six weeks.
Key among those, they said, was a shortage of protective equipment that might have led to the infection in hospital of the last family member to die and the unchecked movement in and out of hospital of patients.
The difficulties of Indonesia, which has suffered more human deaths from the virus than any other country in the past 12 months, mean it is often cited as a possible launching point for a global influenza pandemic should the H5N1 virus mutate into a form more easily transmissible among humans. In the event that did not happen with the cluster on the Indonesian island of Sumatra.
But the failings uncovered in the investigation into the cluster illustrate the challenges facing Indonesia and other developing countries as the world’s possible frontline against an eventual pandemic.
Part of the problem is a stalemate between Indonesia and international donors on how to fund the response to bird flu in the country.
Jakarta has asked for $900m (£494m) in grants over three years to finance a plan it submitted to an international donors conference in Beijing. But international experts argue $200m a year is far more realistic. More-over, many of the things Jakarta is asking for are things it should be prepared to pay for itself, they add.
“It’s a little bit absurd. I don’t know why people don’t call them on this,” said one expert. “What is this money going to be used for? It’s going to be used to build government institutions that should be there in the first place. It’s not [bird flu] specific. It’s things . . . any civilised country should have.”
With no laws to stop him, the father who died in the cluster checked himself out of the hospital and went into hiding even as epidemiologists were examining samples from him.
Lab results have since shown the man caught the virus from his 10-year-old son, who in turn is thought to have caught it from an aunt. The father was one of a number of family members to visit infected relatives without wearing protective equipment. Because of that, the World Health Organisation and others believe he may have caught the virus while caring for his son in hospital.
Dr Muhammad Nur Rasyid Lubis, who runs the avian flu unit at Adam Malik Hospital where the cluster patients were treated, said a shortage of protective gear meant it rarely went to doctors and nurses, who also often reused gowns designed to be disposed of after one use.
The hospital in Medan city also lacked an isolation ward, he said.
Additional reporting by Taufan Hidayat
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