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Local Medics Respond to Flu Outbreak in Karen State

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  • Local Medics Respond to Flu Outbreak in Karen State

    Source: http://www.irrawaddy.org/highlight.php?art_id=17796

    Local Medics Respond to Flu Outbreak in Karen State
    By JANE LEE and WITHAYA HUANOK Friday, February 12, 2010

    MAE SOT, Thailand ? Naw Wah Wah didn't feel well. Worried that her fever, cough, headache and diarrhea was malaria?common during Karen State?s long monsoon season?she roused herself from her sick bed and trudged through thick, red mud during a pause in a downpour, heading to the local clinic, an hour?s walk away.

    For many internally displaced persons (IDPs) such as Naw Wah Wah, the only health care available is provided by mobile health workers from the Back Pack Health Worker Team (BPHWT) and the Karen Department of Health and Welfare (KDHW).

    In Karen State, International humanitarian assistance is strictly blocked by the Burmese government. Health care teams are frequently forced to adapt to rapidly changing conditions to provide basic care.

    Recently, Karen health teams encountered a serious outbreak of flu that could have been the common variety or the more feared H1N1 flu, or bird flu.

    On Feb. 7, government troops attacked two Karen villages, Htee Moo Hta and K?Dee Mu Der, in Nyaunglebin District in northern Karen State, burning two schools and a clinic. The medics there were forced to flee into the jungle along with community members.

    However, the health team continued to provide what basic services they could, while planning alternate routes for re-supply and health care delivery.

    In a rough bamboo structure that served as the local clinic, Naw Wah Wah found dozens of her neighbors ill with flu-like symptoms, awaiting evaluation treatment.

    "I had read about the H1N1 flu and was familiar with the symptoms,? she said. When many villagers began to have symptoms similar to the H1N1 flu, I became very concerned. At that time, several members of almost every household experienced flu-like symptoms.?

    Saw Nyunt Win, a clinic health worker, said he had also read about the H1N1 flu.

    The outbreak of illnesses was reported to the nearest clinic in Tah Oo Der, and health care workers devised a plan for the best way to respond.

    Networking with other BPHWT and KDHW medics, Saw Nyunt Win quickly realized that Tah Oo Der was not alone. Other displaced people communities were experiencing large outbreaks of flu-like illnesses.

    The BPHWT coordination center in Mae Sot, Thailand, was notified. An outbreak investigation and control team, headed by a senior medic based in Papun District in Northern Karen State, was dispatched to the area.

    ?They conducted a workshop for health workers, on how the flu is transmitted, how to prevent transmission, and how to protect ourselves when we work with the affected population,? said Saw Nyunt Win.

    Because the main flu symptoms were non-specific and common to many infectious diseases, the investigation team worked with local health workers to collect respiratory samples. They were stored in vials which were placed in a battery-powered refrigerator and carried by medics on foot and boat for 12 hours, until they reached the Thai border.

    The samples, tested in a Thai hospital, showed the outbreak was seasonal influenza?not the dreaded H1N1 virus.

    But even before the test results were available, control procedures were well underway in affected communities. Medics encouraged sick villagers to stay home, distributed face masks, urged everyone to wash their hands often with soap and water and provided education to prevent transmission. Stepped up surveillance measures for influenza-like illnesses were also instituted and, when the epidemic subsided in November, 490 patients or 13 percent of the population, including Naw Wah Wah, had fallen ill with influenza. Four people died.

    "Even during this difficult time, by working directly with the community, we have been able to work together to educate villagers and attend to all of the patients presenting with flu symptoms," said Saw Nyunt Win, recalling the experience.

    The region was lucky, for now.

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    (Page 2 of 2)

    Under decades of military rule, Burma?s health system has collapsed and the country has become ?an incubator of infectious diseases,? noted a 2007 publication by the University of California and Johns Hopkins University titled ?The Gathering Storm.?

    In an age of influenza pandemics, Burma?s lack of health services infrastructure poses a regional threat. The global spread of H1N1 began in April 2009; on June 28th, Burma announced its first official case, a child in Rangoon who had recently traveled to Singapore.

    By September, Burma had 31 confirmed cases, and The New Light of Myanmar, a regime-backed newspaper, announced preventive measures, including "health screening at airports, seaports, and border gates to prevent the virus from entering the country."

    A new flu influenza outbreak now emerging in Rangoon underscores the difficulty of providing effective health care in Burma, especially in remote areas such as eastern Karen State.

    For Karen internally displaced people, community-based health care workers, forced to supply and coordinate their efforts across international borders, remain the sole source of surveillance, treatment and prevention of serious diseases and epidemics.

    "While the flu outbreak [in eastern Burma] could raise fears about the possibility of an outbreak that spreads into Thailand, we are not a problem. We are part of the solution," said Nyunt Win.
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