Despite potential fatality, Department of Health responses sluggishly to prevent H1N1 outbreak

Slowly response in handling H1N1 flu may put vast community in danger.

NUR Arafiah, a 24-year-old nurse at state-run public hospital in West Jakarta, Indonesia, a bit surprises while reading a newspaper article. The article quotes Ministry of Health, Dr Siti Fadillah Supari, statement regarding the current number of H1N1 infection cases.

A billboard at Jl HR Rasuna Said, Jakarta

The report says, within few weeks the pandemic has reach to tens of cases and cause two fatalities. On the last Tuesday, Indonesia recorded its second death from what was believed to have been H1N1, in Sanglah Hospital, Bali. The first was reported two days earlier, a nine-year-old boy died at the Mohammad Djamil General Hospital in Padang, West Sumatra, from an alleged H1N1 virus infection. However, Health Department of Indonesia could not confirm whether the two deaths were in fact caused by H1N1. The Department had also recorded at least 142 confirmed cases of H1N1 in Indonesia this week. Most of these cases were in Jakarta and surrounding areas.

Arafiah recently has much aware of the pandemic because newspapers, radios, and televisions airing the outbreak, including her colleagues at the hospital often to talk about it.

Of course, as a nurse it would be embarrassing if I don’t know anything about the pandemic,” she tells me.

Yet, while growing cases are confirmed across Jakarta and Indonesia at large throughout various media, she never heard the hospital management issues any official order, statement or general publication to its medical staffs regarding certain measures of preparation in facing the potent dangers of the new flu strain.

Perhaps, it’s because in our hospital has yet been found or served any swine flu suspect or the cases alike,” she predicts.

She however thinks if she and her peers got well-prepared and to have sufficient knowledge how to handle the H1N1 suspect, she would always remain ready to apply appropriate measures. Also, it will be helpful as she might inform other patients in the hospital and her neighborhood to be alert as well.

It’s very different when the country hit by avian influenza outbreak. There are many public outreaches, billboards and other publications in order to prevent mass infection case,” she said.

Lack of information

Comparing the last avian influenza (H5N1) pandemic alert campaign to the current outbreak, she draws the lack of information regarding the H1N1 pandemic might lead to another disaster since most of Jakartan people seem to be unaware about the possible dangers of the later.

According to the World Health Organization (WHO), as of February 2008 Indonesia had amassed 105 fatalities in 129 confirmed human cases of H5N1 infection. The national case fatality rate is 81%, in contrast to the global average (not including Indonesia), which is approximately 53%. This has put Indonesia the world’s highest human fatality rate of H5N1 infections.

Rafiq Anshori, program coordinator of avian influenza and influenza pandemic at Indonesian Red Cross, admits that Indonesians were not quite understand and aware of in facing a possible H1N1 flu epidemic rather than the H5N1.

Calling it ‘swine flu’ has caused people to think the virus is only transmitted through swine and anything that related with it. And since most of Indonesians is Moslem and not eat pork, they think they are free from the H1N1 virus and nothing to worry about,” Rafiq tells me in recent interview.

As growing number of H1N1 case across the state, Minister Supari now admits that she was mistaken in drawing conclusion about the H1N1 virus strain. As reported in ABC News website in April 2009 titled “Climate ‘shielding Indonesia from swine flu’”, Supari previously disregarded the possibility that the virus will be spread in Indonesia by saying the H1N1 swine flu virus may be more of a problem for people of Spanish origin than Indonesians. Therefore, there no need to worry about it. She also stated that H1N1 could only survive in cold weather, such as Australia.

It does not like what I predicted,” she stated in the press conference this Wednesday. “It can now obviously be spread in tropical region, here in this country. It is now human influenza.”

She also orders to the state-run hospital in each province to raise alertness and serve those who felt the H1N1 ill-likeness or symptoms. Surveillance team in every Center of Public Health Service that already formed during the avian influenza outbreak are now must be more active and cautious toward community report.

Prior to the latest publication of the ministry of health statement, Nursyahrudin, a coordinator of Communication Disease Prevention at Center of Public Health Service in Palmerah district, West Jakarta, considered the virus is only transmitted through the swine. But he now recognizes that he was also mistaken about cause of pandemic. Unlike the avian influenza epidemic, which the infections are mostly caused by animal-to-animal population and animal-to-human transmission, the current pandemic could quickly succeed through human-to-human transmission.

In fact the current pandemic is quite different with the avian influenza pandemic as it mostly spreads through contact with someone who infected by H1N1 flu virus or stay in a region or a country that had widespread infected by the virus,” he said.

He and his team are now preparing to arrange community outreach and campaign program in Palmerah district. Also there are two member of surveillance team who will always ready to follow up the case from community report.

Meanwhile, Rafiq says, the Red Cross are now applying door-to-door campaign in six provinces of the country in order to raise pandemic alertness, including providing sufficient knowledge and basic skill to the community how to identify the H1N1 symptom and report it to the local surveillance team.

The last challenge remains

Learning from the last pandemic, Minister Supari now fears if the H1N1 virus strain mixed with H5N1 as it could change into a form that people can pass easily to one another, and sparking another deadly pandemic. Despite low case fatality rate (according WHO is only about 0.4%), the H1N1 strain is powerful in speed of spreading. While the H5N1 is low in spreading speed, but it comes up with high of case fatality rate.

If these two strains mixed, it could be change into fast widespread and deadly virus flu,” she said. “And I’m demanding all of Indonesian to stay vigilant by applying clean and healthy life.”   END


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