Indonesia seems to be latest country to report human cases of bird flu

Behind the extra thick glass window of the intensive care unit, seven-year-old Mutiara looked tiny. One of the three adults hovering around her bed was her mother, the others were medics.But it was hard to tell which was which because they were all wearing the same baggy green overalls, face masks and caps. Mutiara was admitted to Jakarta's hospital for infectious diseases more than a month ago. Her initial blood test was positive for bird flu, but the doctor in charge, Sardikin Giriputro, said he was waiting for the results of further tests before he could be sure. This hospital is one of 44 designated by the government to handle human cases of bird flu. But it is chronically under-prepared. A new respirator has just arrived, bringing the total to just three. Staff are doing their best with what little they have. But "if there is a real pandemic, then all hospitals will collapse", said Dr Giriputro. "Even the health workers may stay at home and take care of their own families." That is the nightmare scenario everyone is now desperately trying to prevent.

Indonesia is the latest country to report human cases of bird flu. The first fatality was confirmed in July. The government now says a total of four people have died after contracting the virus, but most experts believe the true figure is almost certainly higher. "Absolutely, there are other cases out there that we're not seeing," said one Western health official who declined to be named. "In terms of animals they [Indonesian officials] are doing the surveillance but not taking action," he said. "In the human sphere they are not doing the surveillance but are taking action when cases are known." The government is now coming under pressure to do more. "They have a good understanding of the challenge," said Robin Davies, head of Australia's agency for international development in Indonesia. "They really do lack the technical resources, though, to undertake a proper level of surveillance at this time. That's why they're appealing for international assistance."

And the call is being heeded. Australia alone has given more than $11m, some of which was used to buy 50,000 boxes of the anti-viral drug Tamiflu. The United States is giving US$3 million. Japan, South Korea and Singapore have all offered technical assistance.

Laboratory facilities for testing will be improved; health and agriculture officials will receive extra training; and there will, eventually, be more equipment for them to use.

Yet a lack of resources is still the reason most often cited by Indonesian officials to explain their reluctance to carrying out an extensive cull to try to halt the spread of the virus among birds. The cost of compensating farmers would, in all likelihood, be prohibitive.

But money is not the only issue. There are practical problems too. Most of the chickens in Indonesia are not concentrated in formal poultry farms - they are in people's back yards. If chickens die on a farm it's easy to carry out a mass cull," said Indonesia's Agriculture Minister, Anton Apriyantono. "But not in a housing area. So instead we isolate, treat birds with anti-virals and increase biosecurity measures."

But first you have to find the sick birds. Public awareness campaigns have been launched to try to encourage the public to report cases, but without proper compensation there is little incentive on offer. And in any case the message does not appear to have filtered through to everyone, reports BBC news. I.L.