Published on April 20, 2005 - It was pure coincidence that Thailand’s public health authorities learned of what many believe was the country’s first case of human-to-human transmission of the H5N1 bird-flu virus - instead of detection by efficient medical surveillance.

So, the Public Health Ministry last October called on 800,000 village health-volunteers to become the country’s frontline defence in early detection of influenza outbreaks in both birds and humans.
Despite ongoing fanfare about the merits of this approach at both government and international levels, the atmosphere in the villages is one of fear, mistrust and rebellion.

“I want to ask the government: Why have us do something risky with no training whatsoever?” demands Kanikar Wongpha, head of Baan Wat Boat health volunteers in Suphan Buri.

“We had to get samples from the chicken’s asses using cotton buds. What do we have to protect ourselves if the chickens are sick? True, they sent us bags of masks, gloves and gowns - but without instructions. The rubber gloves they gave were too big and stiff, and the plastic gowns were so thin! So some just did it with their bare hands.”

Public health experts see monitoring at village level as critical.
Backyard poultry kept by many families are at greatest risk of exposure to viruses from wild birds, says Public Health Minister Suchai Charoenratanakul.

While new regulations are seeing far fewer outbreaks and affecting fewer birds in commercial farms, such containment measures are virtually impossible in rural areas where chickens and ducks roam freely and mingle with wild birds that share the same water sources, he adds.

Yet, in those same rural areas, there’s barely controlled anger. “People think we know so much because we use thermometers and can take blood pressure, but we don’t know anything about this virus other than it can kill people,” Kanikar says.

Besides taking specimens from chickens, which happened only once last October, health volunteers are also asked to monitor poultry numbers and their health. They have been told to send monthly reports to their district health office, which forwards them to the Livestock Department.

“We stopped sending reports several months ago,” says Chamnong Nakaew, a volunteer member from Kanikar’s team. “I don’t want to criticise anyone, but the Bt2,000 they promised to our village last October for taking care of chickens was reduced to Bt1,600, and it remains pretty much on paper.”

Their story is a familiar tale among volunteers interviewed by The Nation. Usawadi Yusathaporn, a health volunteer in Kanchanaburi’s Muang district, is supposedly res-ponsible, with 11 colleagues, for their village of 135 families.
They were asked to beef up their routine monitoring of everyone in the village and to direct people to doctors if they had flu symptoms.

“What do we have to protect ourselves?” Usawadi asks. “We have to be the first ones to reach sick people. We can’t show that we want to protect ourselves when we make contact with sick villagers. If I put on my mask when I take their temperature, they will think we’re discriminating against them.” Volunteers are also upset that the government has given no assurances they will be taken care of if they get sick. “We are being asked to do potentially dangerous work without proper protection or training,” Usawadi says. “I want to ask the Human Rights Commission to look into this.”

Jongrak Boonmanuch, whose son was Thailand’s first confirmed H5N1 fatality, became a health volunteer because she was furious with government’s failure to warn of bird flu.

“I lost my son because we didn’t know something was going on with all the chickens dying, so I hope I can help others by being a volunteer,” she says. “But we still don’t know much about a pandemic. I heard about it on TV. There is no aggressive prevention campaign in the village. I guess the government is just taking its usual approach - don’t tell us much until they are forced to.”

The volunteers say far more training, resources and coordination is going to be required if they are to be much value for bird-flu surveillance and pandemic preparedness.

Nantiya Tangwisutijit
The Nation