Jarkatans Urged to End Backyard Farming

[GaudiaRay]

[FONT=Helvetica, Arial]Jakartans urged to end backyard farming[/FONT] [FONT=Arial, Helvetica]Adisti Sukma Sawitri, The Jakarta Post, Jakarta[/FONT]

[FONT=Arial, Helvetica]The Jakarta administration has called on residents to slaughter their birds -- particularly chickens, ducks and pigeons -- to stop the spread of bird flu. [/FONT]

[FONT=Arial, Helvetica]Of 20 cases of human infection in the city, there have been 18 deaths. Jakarta could soon overtake West Java -- with 25 cases of infection and 20 deaths -- as the province with the highest bird flu death toll. [/FONT]

[FONT=Arial, Helvetica]"I hope residents voluntarily destroy their chickens and ducks before we come to their houses and force them to do so," Governor Sutiyoso said Monday at City Hall, Central Jakarta, after attending a coordinative meeting on bird flu at the Health Ministry's office. [/FONT]

[FONT=Arial, Helvetica]The administration is currently gathering data on the number of backyard farms in the city and determining the amount of compensation bird owners will get, while waiting on the central government to order a mass poultry cull. [/FONT]

[FONT=Arial, Helvetica]Sutiyoso said backyard farms were the first target because their owners did not keep them clean and thoroughly disinfected.[/FONT]
[FONT=Arial, Helvetica] [/FONT]
[FONT=Arial, Helvetica]Most people who have died of bird flu in the city lived near backyard farms. [/FONT]

[FONT=Arial, Helvetica]He said he would soon issue an ordinance prohibiting poultry breeding and slaughtering sites in residential areas. [/FONT]

[FONT=Arial, Helvetica]"Commercial breeders won't be the main target of the cull because they keep their breeding sites clean," he said. [/FONT]

[FONT=Arial, Helvetica]The Jakarta Husbandry and Fisheries Agency estimates there are about 700 commercial poultry breeding and slaughtering sites in the city, two thirds of which are located in Central and East Jakarta. [/FONT]

[FONT=Arial, Helvetica]People's awareness of the HN51 virus continues to be low, despite the promising results of an AC Nielsen survey, which showed most Jakartans were aware of the public service announcements on bird flu prevention aired last year on TV.[/FONT]
[FONT=Arial, Helvetica] [/FONT]
[FONT=Arial, Helvetica]The announcements have not translated into action as many people still lack knowledge on the symptoms, causes and prevention of the disease. [/FONT]
[FONT=Arial, Helvetica]Iwa Nugraha, a resident of Kebayoran Lama, South Jakarta, for example, said he did not know where to get the HN51 vaccine for his parrots. [/FONT]

[FONT=Arial, Helvetica]"I've been asking local officials but they couldn't tell me," he said. [/FONT]
[FONT=Arial, Helvetica]Many residents are refusing to slaughter their birds, saying they have been bird owners for years and always stayed healthy. [/FONT]

[FONT=Arial, Helvetica]Ahmad Toha, who lives in Jati Padang, South Jakarta, said he kept chickens because it meant there was always food around for his family. [/FONT]
[FONT=Arial, Helvetica]Puji Astuti, the Indonesian Red Cross' coordinator for bird flu, said Monday that people's low knowledge rates were the main obstacle to containing bird flu. [/FONT]

[FONT=Arial, Helvetica]The Red Cross volunteers, who have been tasked by the central government to raise community awareness in 10 provinces including Jakarta, often found that residents still thought their chickens or ducks died of Newcastle disease, she said.[/FONT]
[FONT=Arial, Helvetica] [/FONT]
[FONT=Arial, Helvetica]Newcastle disease is a contagious and fatal viral disease affecting all species of birds that does not infect humans. [/FONT]

[FONT=Arial, Helvetica]"That is why they don't think it is important to keep their environments clean," Puji said.[/FONT]

[FONT=Arial, Helvetica]http://www.thejakartapost.com/detailcity.asp?fileid=20070116.C01&irec=0
[/FONT]

 

[Laidback Al]

Re: Jarkatans Urged to End Backyard Farming

Slaughtering the birds will do nothing but eliminate an important component of livelihood of many local citizens of Jarkarta. The compensation to families that keep avifauna in their backyard must be equitable. Otherwise, the self-culling will not occur and we might be looking at the mixing vessel for the next pandemic.

 

[AlaskaDenise]

Re: Jarkatans Urged to End Backyard Farming

2 other stories on the subject in http://www.flutrackers.com/forum/showthread.php?t=14824&page=2

.

 

[GaudiaRay]

Re: Jarkatans Urged to End Backyard Farming

For the record, Jakarta's population is 12.3 million people.

May I ask how likely it is that the request will be honored? In Indonesia, people are polite and cooperative, but we are talking about killing their pets.
How many here would kill their dog or cat, or other pet?

And realistically, the chicken and duck are the same as money and are crucial to their food supply. Indonesians eat a breakfast nearly everyday which is a lightly fried, runny egg on top of a bed of rice...just like we eat cereal, oatmeal, or even our bacon and eggs; this is eaten by nearly everyone who can afford the egg.

Removing this protein source will bring about anger and much worse, for many this will spell impoverishment, affecting directly at least hundreds of thousands of people, all at one time. I have no idea what will happen but the denial of a key and nearly free source of food will not make millions of people into vegetarians overnight.

 

[AlaskaDenise]

Re: Jarkatans Urged to End Backyard Farming

I suppose it would be like asking people in developed countries to NOT prepare homecooked meals and require all meals be consumed in a restaurant.....not likely for those needing to watch their budget.

.

 

[GaudiaRay]

Re: Jarkatans Urged to End Backyard Farming

This new law announced "today" reaches far beyond Jakarta, with it's 12 + million inhabitants.

There are nearly 100 million people living on Java.

The law includes three areas, Jakarta (which is central eastern Java), West Java and Banten. It affects easily 20+ million people.

Here's an observation about what is happening and about to happen there on Java: found at http://www.flutrackers.com/forum/showthread.php?t=14280&page=2 post #48 (thx to Theresa42)

>Whereas according to the Chairman of the Harmony of the Chicken Breeder in Priangan East, Herry Dermawan, the extermination plan of the commercial chicken, will experience the difficulty in his realisation. The community was still seeing the poultry cultivation as a culture in helping the family's economics and the increase in the family's nutrient.<

The effects of this first mass denial of animal protein are for me at this time unimagineable. Think about what's happening.

At the same time, the Ministry of Health still has not discussed the real probability that among the clusters appearing that the virus is transmitting H2H.

It's one thing to try to stop the transmission by eliminating the poultry. But there are sick cats, dogs, pigs, and assuredly rodents also.

I'm not sure that this ban includes pet birds. If it doesn't, this law is merely a bandage on a hemmorhaging wound.

And when the cats are culled, the rodent population will explode. And if the pigs are infected, as they were identified as so in Surabaya now nearly 3 years ago, their slaughter will also destroy a major source of animal protein.

The government is ignoring the virus in South Sulawesi, the heartland of their commercial chicken industry, where the workers have their own backyard flocks too.

I and everyone here wish them well in their effort to stop this disease from transmitting.

 

[GaudiaRay]

Re: Jarkatans Urged to End Backyard Farming

This ordered killing of the animal-protein food supply of tens of millions of people, not 10 million, but more like 40-50 million people will lose their ducks and chickens and eggs and microbe eaters, and bug eaters.

What impact will this have on the paddies? They live on rice from their paddies. If the paddies "need" the ducks in a symbiotic food relationship, you are invited to think about what this means.

What I've posted at PFI was posted there because of the momentary disruption at FT due to the new server being adjusted. So, I post what I would have posted here about 1 hour ago.

THIS IS SERIOUS BUSINESS, WHAT IS HAPPENING IN INDONESIA NOW. There are yet uncalculated and enormous consequences. We can help the Indonesians and other leadership think about their actions and the consequences. I have started the discussion. These are my thoughts only. All ideas must be put on the table quickly and with as much brainpower as possible. The risks are obvious. They may be able to avoid some in future by smart planning. These are some ideas.

The Indonesian Government is ordering the culling/killing of all chicken and ducks in an area covering 20 million people: Jakarta, West Java and Bekan.

This order was announced this morning, Tuesday, January 16.

This is a heads up to all who govern Indonesia, and all other countries.

Should we be watching for a catastrophe in Java much, much bigger than the destruction of all chicken and ducks in Jakarta & West,Java to start, and then 11 more provinces, encompassing up to 100 million people ?

Maybe we should watch for this:

1. The destruction order is to every poor, ignornant family as well as to the educated. It is to the irresponsible, desperate, extreme...it is to everybody.

2. There are no clear instructions on how to slaughter and how to dispose of the now deathly dangerous birds. Please stop for a moment and think about this. This order impacts on "one quarter of all the people, probably 5 million people in 1 million households".

So, what do we humans do when we are told to get rid of the birds? Many of us will "THROW THEM AWAY".

And what does that mean? That means that if the Indonesian Government does not immediately tell their affected citizens:

DO NOT FEED THE CHICKENS AND DUCKS TO THE PIGS.

DO NOT THROW THE CHICKENS AND DUCKS IN THE LOCAL CANAL OR STREAM.

BURN ALL CHICKENS AND DUCKS. STAY AWAY FROM THE FIRE. KEEP ALL CHILDREN AWAY FROM THE FIRE.

OR, BURY ALL CHICKENS AND DUCKS SO DEEP THAT NO ANIMAL CAN DIG THEM UP.

EAT ONLY THE HEALTHY CHICKENS, NOW, FOR ONE WEEK, AND BY ONE WEEK FROM NOW, KILL ALL OF THOSE AS WELL.

If these orders are not issued immediately, this is a very realistic, and possible scenario:

A. The rivers and waterways will be poisoned with bird flu.

B. The farm animals, the livestock, and the wild animals will become infected, downriver, next door, nearby the place where the dead chickens and fowl are thrown into the waterways. That will spread right into all human food supplies.

C. The fish will become H5N1 infected and they will die. That will remove another major food supply for the poor and rural populations.

D. The infected water will be used to irrigate rice paddies, coffee and tea plantations, and all other crops. The animals working in those fields will not be immune from infection. (They too can sicken and die. I don't know which ones, but this question goes directly to the food supply.)

E. Immediately offshore are nearby and large shrimp farms. The government must inquire whether or not this infected runoff can poison the shrimp. If the shrimp can absorb the toxic virus, then the shrimp handlers all the way up through all the restaurants which serve the upper and upper middle class will be at risk. I know nothing about this topic. I am only exploring what may happen in this area. This may be completely off topic.

More economic issues will be explored soon, but this topic is vital.

The Indonesian government must tell its people to burn or to bury the birds away from their waterways and water supplies, and NOT to use the dead birds as food for their pigs or dogs.

And my most fervent hopes go out to the elected and appointed officials there who must carry out the government order....

 

[JJackson]

Re: Jarkatans Urged to End Backyard Farming

C. The fish will become H5N1 infected and they will die. That will remove another major food supply for the poor and rural populations.

What evidence is there that fish are susceptible to H5N1 infection?

If anyone has data on this please could they post a link.

Thanks
JJ

 

[GaudiaRay]

Re: Jarkatans Urged to End Backyard Farming

What evidence is there that fish are susceptible to H5N1 infection?

If anyone has data on this please could they post a link.

Thanks
JJ

I recollect that recently, the infected ducks were tossed into a waterway, and the fish in the pond next to it died. That's what I've seen.

I was there. I visited a home of a very wealthy man. His home had its own pond and recirculating water so he could take fish and "clean them" by letting them feed on safe food for a period of time before they were killed and eaten.

I believe that the fish eat everything thrown into the water. Whether H5N1 can infect fish I do not know. All I recollect is that in the past 2 weeks, this information of the fish die off posted here or at FC was surprising and noteworthy to me.

 

[Jeremy]

Re: Jarkatans Urged to End Backyard Farming

What evidence is there that fish are susceptible to H5N1 infection?

If anyone has data on this please could they post a link.

Thanks
JJ

Here is the closest article I was able to find.

http://www.nzherald.co.nz/section/story.cfm?c_id=5&objectid=10361729

Wednesday December 28, 2005
By Michael McCarthy
Bird flu may be spread by using chicken dung as feed in fish farms, a practice now routine in Asia, the world's leading bird conservation organisation believes.

Fertilising fish ponds with poultry faeces, which can dramatically improve fish growth, may in fact set up major new reservoirs of avian influenza infection if the chickens providing the manure are infected themselves, according to BirdLife International, the Cambridge-based umbrella body for bird protection groups in more than 100 countries.

The suggestion, which has echoes of the BSE problem in Britain, in which cattle were infected by organic feed, is an explosive one, on an international scale.

It puts a serious question mark over a technique firmly backed by the UN's Food and Agriculture Organisation (FAO) as a primary means of providing protein for mushrooming populations in the developing countries - suggesting that millions of people, instead of being helped by it, might ultimately die because of it, in a global pandemic.

Known as integrated livestock-fish farming, the technique involves transferring the wastes from raising pigs, ducks or chickens directly to fish farms, with chicken or duck sheds sometimes sited directly over the fish ponds themselves.

At the right dosage, the nutrients in the manure give an enormous boost to the growth of plankton in the ponds, which are the main food of fish such as carp and tilapia.

This is taking place on an enormous scale. According to an FAO report from two years ago, it is now the main basis for aquaculture in China and neighbouring countries.

"Livestock wastes purposely used in ponds, or draining into them, support the production of most cultured fish in Asia," the report said.

"Much of the vast increase in China's recent inland aquaculture production is linked to organic fertilisation, provided by the equally dramatic growth of poultry and pig production."

BirdLife International is now calling for an investigation into the possibility that these thousands of manure-fed ponds across Asia may be the means by which the new, potentially deadly strain of avian influenza, H5N1, is being spread.

BirdLife points out that outbreaks of H5N1 have occurred this year at locations in China, Romania and Croatia where there are fish farms.

The Chinese outbreak, which involved a big die-off of 6000 wild birds, mainly bar-headed geese, took place in May this year at Qinghai Lake, a location where the FAO helped establish an integrated livestock-fish farm in the early 1990s, BirdLife said.

"This outbreak helped lead to the widespread media speculation about wild birds spreading H5N1," said BirdLife's Richard Thomas.

"We pointed out that bar-headed geese migrate from India, where H5N1 has never occurred, and migrate early, so they must have contracted the disease locally, at Qinghai."

BirdLife does not think that wild birds are vectors - carriers - of H5N1, and believes that the widespread speculation during the autumn that migratory birds would spread bird flu from Asia far and wide into Europe was entirely misplaced.

"Millions of birds have now migrated, and it hasn't happened," said BirdLife's Director and Chief Executive, Dr Michael Rands.

"Wild birds are victims, not vectors, of avian influenza. We believe that when wild birds get it, they're very susceptible, and die before they can move very far. Some fall over straight away."

Although no mention was been made of the possible links between manure-fed ponds and influenza in the recent alarm over bird flu, it has been raised before, and the FAO, although actively promoting the technique, is well aware of the threat.

A FAO report from 2003, "Integrated Livestock-Fish Farming Systems," noted: "Recently, livestock and fish have been implicated in the irregular occurrence of influenza pandemics; the global impacts on public health of promoting livestock and fish integration are huge if these claims are substantiated."

In fact, the FAO has been aware that some scientists think there is a risk for very much longer.

The references to the 2003 report include one to a paper published in Nature, the international scientific journal, as long ago as 1988.

This paper, by Christoph Scholtissek from the University of Giessen in Germany and Ernest Naylor from the University of Bangor in North Wales was headed "Fish Farming and Influenza Pandemics", said that bringing together fish farms with farm livestock "may well be the creation of a considerable human health hazard."

However, the FAO has continued to promote integrated livestock-fish farming actively throughout the ensuing period.

Dr Rands said: "There appears to be some circumstantial evidence that one of the ways in which the disease might be spreading is through the use of chicken faeces for feeding fish.

"We are not aware that people have confirmed that that is a likely cause - but people have suggested it. If it's a possibility, and if it presents a serious human health risk, it certainly ought to be researched, and if it has been researched, the research should be out there for us all to see."

He went on: "Wild birds are often being blamed for the spread of avian influenza, but as far as we can tell there is no clear evidence, in fact no evidence.

"The science that there is suggests that wild birds are not to blame for the spread. If you look at migration routes and spread of the disease, the correlation is really quite poor. Millions of birds migrated this autumn, and if they really were the means of spreading bird flu, it should be all over the place in Africa and southern Asia - and it's not happened."

- INDEPENDENT

 

[JJackson]

Re: Jarkatans Urged to End Backyard Farming

Thank you Jeremy.

 

[Niko]

Re: Jarkatans Urged to End Backyard Farming

GR, you've raised some critical points for discussion. I hope your postings here get the attention of the authorities who need to consisder all the implications should this "urging" become law.


Fish:
http://www.flutrackers.com/forum/showpost.php?p=58069&postcount=53

More on the 20 sick children in Bogor -- suspicious chicken deaths the day before -- some dead poultry thrown in local pond where fish subsequently died -- children swim in the pond...

toggletext-ed from Indonesian:

Bird flu Again swallowed fatalities
Jan 11, 2007

JAKARTA (Pos Kota) -

**snipped***
20 Bogor children HOT

In Blok Sumur, the Sukaresmi District, Kecamatan Tanah Sareal, the Bogor City, 20 sudden children experienced hot high was accompanied by the fever, it was suspected was attacked by bird flu. His article a day before fell ill, several chickens in his territory died suddenly.

From dozens of chickens that died suddenly this, three including being thrown away to the fish-pond. At intervals of half of the hour, suddenly hundreds of fish that was in the pond died and was floating. ?Saya suspicious, they were sick the high and hot fever because of being affected by bird flu. The fish in the pond in died, after having the resident who threw three chickens that have died to the pond away. The children that was sick this, after they bathed in MCK that his location was neighbouring with the pond of fish,? Asih Muhtar, the mother RT local.

However as far as this is concerned, Dinkes did not yet ascertain the illness that was suffered by dozens of children in the Tanah Sareal this.

http://www.poskota.co.id/news_baca.asp?id=28894&ik=6

 

[Laidback Al]

Re: Jarkatans Urged to End Backyard Farming

Thanks Niko. This bears directly on GaudiaRay's post about fish ponds above. (post #7)

 

[Sally Furniss]

Re: Jarkatans Urged to End Backyard Farming

From dozens of chickens that died suddenly this, three including being thrown away to the fish-pond. At intervals of half of the hour, suddenly hundreds of fish that was in the pond died and was floating. ?Saya suspicious, they were sick the high and hot fever because of being affected by bird flu. The fish in the pond in died, after having the resident who threw three chickens that have died to the pond away. The children that was sick this, after they bathed in MCK that his location was neighbouring with the pond of fish,? Asih Muhtar, the mother RT local.

A couple of points.

There is no time interval given between when the dead chickens were thrown in to the pond and when the fish died.

Is it saying the fish 'were sick the high and hot fever'?

The sick children swam in the pond next to the pond with the dead fish.

What was the time interval between when the chickens were thrown in the pond and the children became sick?

 

[Niko]

Re: Jarkatans Urged to End Backyard Farming

A couple of points.

There is no time interval given between when the dead chickens were thrown in to the pond and when the fish died.

Is it saying the fish 'were sick the high and hot fever'?

The sick children swam in the pond next to the pond with the dead fish.

What was the time interval between when the chickens were thrown in the pond and the children became sick?

No idea. Purely circumstantial at this point. More/Most importantly, have any studies been conducted on fish - lab infected, samples from fish kills, etc.? I haven't seen any.

Sorry for the thread drift - I believe GR's points about feeding a population without their customary foodstuffs was the main topic, but the fish question is part of that equation (for Indonesia and beyond)

 

[Shannon Bennett]

Re: Jarkatans Urged to End Backyard Farming

We have read of fish kills in the past but nothing is verified. Just rumors and nothing else so far.

 

[Sally Furniss]

Re: Jarkatans Urged to End Backyard Farming

yes. The link between the chickens, the fish and the children seems very weak at this point.

edited to add: There may well be a connection between chickens and fish. I don't think the above news item provides enough information to say whether that occurred in this case.




I wonder what the chickens are usually fed.

What would the fish be fed if chicken waste is not available.

What else are the fish fed other than chicken waste.

 

[AlaskaDenise]

Re: Jarkatans Urged to End Backyard Farming

this may not be the same location, but it is the same issue....
http://www.turkishdailynews.com.tr/article.php?enewsid=64079

Last thoughts on the cost of public health

Wednesday, January 17, 2007


CALEB LAUER
ISTANBUL - Turkish Daily News



Ali, a young man who worked in a Doğubayazıt internet caf?, said his mother loved her chickens so much that during the bird flu outbreak here in 2006 he had to wait until his mother was out of the house before he called the government to come and kill the chickens.

At around the same time, the Food and Agriculture Organization of the United Nations (FAO) reported that a village chief who had similarly called the authorities said that, ?Our women were really angry with us for calling authorities. I even had to leave the village for a couple of weeks until things blew over.?

Yaşar, a hotel manager in Van, recalled the flip side of the mass cull in Doğubayazıt and Van that was designed to stop the spread of the bird flu virus. The outbreak would end-up killing four local children. ?[It was] very voluntary. They would give their poultry to the government. Even at my home, I had nine chickens. I gave them to the government. They were very healthy, but honestly, I didn't like them anymore.?

In a restaurant, Baran, a local translator, wouldn't eat the chicken. He said it made him nervous. But taxi drivers laugh and brush their hands together at any mention of ?Kuş grippe.? Ali said, ?People aren't scared anymore.? When told of Baran's fear of eating chicken, Ali laughed and couldn't believe it.

?The public awareness of chicken danger has changed,? Yaşar, the hotel manager, said. ?Before people wouldn't do anything with sick chickens except eat them. Now they won't even touch them. Everybody in this area realizes that if a chicken is ill they will not touch it. Now they get rid of it. Even the children, they will never.?

But some villagers still keep chickens, secretly and illegally. Dr. Ahmet Faik ?ner of Y?z?nc? Yıl ?niversitesi Hospital in Van, where most bird flu victims received care during the outbreak here, said only 95 percent of the chickens are gone. Yaşar guessed every thousandth household might still keep some chickens.

Baran was more declarative. ?Yes,? people still keep chickens, he said. ?They have to.? No one in the city keeps chickens, he said, because it is too easy to get caught. But in the villages you can still find chickens.

?People in Doğubayazıt, they are not rich, they're poor people,? said Ali.

?They'll open a little shop or a small market to take care of their family and when the bird flu came, they couldn't sell chicken, or the chicken they had they had to throw away and they really lost a lot of money.?

Take me not my chicken:

The Turkish government did eventually give money to chicken owners who handed over their chickens, once the owners applied for compensation.

The government paid ?market prices? for each bird: about YTL 6 per chicken or duck, YTL 17 per goose, and YTL 23 for a turkey. But the FAO estimates that the eggs, chicks, and meat from a single chicken might yield as much as a 700 percent return per year on costs. By this estimate, a family who handed over 10 chickens during the cull and was compensated YTL 60 gave up YTL 420 of income for the year ? the ?give a man a fish and he eats for a day, teach a man to fish and he eats everyday' proverb dumped on its head. Baran said some villagers, in a theatrical protest, offered their necks and a knife to authorities in place of their chickens.

Since the current global outbreak of bird flu began in 2003, authorities in different countries have been trying to figure out the best way to compensate people for handing over their poultry during a mass cull.

Promise too little compensation, or none at all, and farmers will hide their chickens. Promise too much compensation and farmers may have an incentive to infect their flocks.

Still, a cull of all local poultry is considered the most effective public health emergency measure against bird flu. Hong Kong may have prevented a pandemic in 1997 when they killed all chickens (1.5 million) in the city inside of three days.

Making it work:

Dr. Nikki Shindo arrived to Van on Jan. 6, 2006. She was part of the World Health Organization (WHO) response team in Turkey during the outbreak. Dr. Shindo is an infection control specialist and she advised local doctors on how to protect themselves from the H5N1 virus and advised how to control infections within a hospital.

?The WHO cannot just come into a country and order doctors around, we need to be invited,? said Dr. Shindo from Geneva. ?Turkey has a basic public health response capacity and a country like that may want to try to manage the outbreak alone. But Turkey's invitation came immediately.?

When the WHO gets to a country ?we need to learn culturally and socially acceptable ways of implementing infection control measures,? Dr. Shindo said. ?In an outbreak, the WHO's mission is to reduce human suffering and contain the outbreak.? She said that unless there are already contacts made, getting to know the people and the local medical culture uses-up valuable time. It is important, says Dr. Shindo, to establish relations ? trust-building ? beforehand so there is a history and familiarity between WHO officials and local medical professionals. This is a lesson of emergency management mentioned by veterans of emergencies like Sept. 11, 2001 ? whose numbers you have in your mobile phone can determine how effective you'll be. Personal contacts move information and get things done as much as established protocols.

After the last confirmed bird flu infection, the WHO team waited for two full incubation periods before they declared the area clear of bird flu.

(When someone is infected with the bird flu virus the virus incubates before symptoms show up. The exact period is debated, the WHO says the best guide is seven days.) After the outbreak, WHO teams stayed in Van to organize training to improve future responses. Poverty may make future responses worse.

In eastern Turkey, water sanitation and waste management are inadequate, says Dr.?mit Sahin, a public health specialist in Istanbul, but the basic problem, he says, is the lack of a real public health system in eastern Turkey, one that would emphasize surveillance and prevention, not just treatment.

Under Turkish health reforms, Dr. Sahin says, all treatment is becoming privatized. ?The government doesn't call it privatization, they call it reform,? says Dr. Sahin. ?If you don't have access to free and public health it's up to the money in your pockets,? Dr. Sahin said this is especially consequential for children's health and pregnant women. Poor people will simply not be able to afford being inside a hospital.

This will have serious consequences for surveillance efforts designed to detect the next bird flu outbreak.
Dr. Shindo, of WHO, says that along with public awareness the most important element in a public health strategy against bird flu in humans is having a well-connected and well-informed ?sentinel? hospital such as Y?z?nc? Yıl ?niversitesi Hospital in Van. These are the hospitals that receive reports of suspect illnesses from surrounding hospitals and issue warnings and updates to the medical community.

For a similar reason, the WHO maintains contact with Y?z?nc? Yıl in order to monitor any new cases of severe acute respiratory illnesses (SARI).

During the bird flu outbreak, doctors at Y?z?nc? Yıl were aware and watchful enough that they could appreciate the cases of mystery illness in neighboring Doğubayazıt for what they were, before they were diagnosed. When the Ko?yiğit children arrived to Van, Dr. ?ner and his team could immediately begin treating them as bird flu patients and send out warnings and watch lists to other hospitals. This probably saved lives. But if sick people aren't getting into the hospital because they can't afford to get inside, then poverty will have rendered a good surveillance system shortsighted.

.