ON THE TRAIL OF WINGED DEATH

Tuesday, January 15, 8.30 a.m.
“I almost quit smoking but now I am back at it, smoking packet after packet. I am here to see the situation,” says Abhijit Roychowdhury, block medical health officer (BMHO) of Rampurhat II block.
The stress of dealing with bird flu in Margram is showing. Roychowdhury begins his day at 6.30 in the morning, making rounds of villages, returning home only after 8.30 at night. He then spends the next few hours reading and analysing the daily reports submitted by health workers before sending his comments every night to Swasthya Bhawan in Kolkata, the headquarters of the state Health Department.
The avian flu that hit West Bengal last week was first detected in Birbhum district but quickly spread to the neighbouring districts of Nadia, Burdwan and Murshidabad. As the state Government quarantined the affected zone, it declared that over four lakh birds were to be culled in order to check the deadly H5N1 virus from spreading and announced a compensation package of Rs 3 crore for the affected families.
Roychowdhury stands outside his jeep at Rajpara bazaar, surrounded by anxious villagers who have a stream of questions for him.
He is looking at the birds still being sold in the market when a villager Murshed Khan walks up to him to tell him that all his 25 birds have died. “They started dying in late December. I went to the panchayat office and then to the block office but they said it’s the Ranikhet disease and sent me back home. Now, there are dead birds lying around in the village,” says Murshed, a rickshaw puller.
Roychowdhury urges him not to panic but he can’t hide his own alarm. He asks the health workers accompanying him to make a note of Murshed’s complaint. Then he, along with two workers, makes his way to Malibaganpara, the worst affected in the area.
Today, he is searching for a particular house. Finally, he finds it. The house belongs to Kalu Sheikh, a daily-wage labourer. Roychowdhury begins a round of questions. “I heard your children are ill?” he says. “For how many days have they had fever? How many birds in your house are dead?”
Kalu’s children—seven-year-old Anarul Sheikh and eight-year-old Tumpa Sheikh—have been running a fever for the past four days. Kalu tells Roychowdhury that they had seven hens. Four died last week and the rest fell ill. The family ate one of the birds a few days ago.
“When my four birds died, the children picked them up and threw them behind the house. The other three were ill, so we thought why not eat one. But why are you asking these questions?” Kalu says.
One of the health workers ventures to tell Kalu that there is a new disease in the area that could be fatal to humans. Roychowdhury interrupts him, asking him not to create panic. Don’t worry, he tells Kalu and his wife, putting his hand on the children’s foreheads.
“Keep a watch on the family,” he tells his staff as he leaves.
As Roychowdhury walks around the village, people come up to him, asking him to look at their ailing hens. The village lanes and fields are lined with dead birds. In one corner children play next to a pile of rotting dead birds. “We buried some of the birds initially but then there were so many dead that we just started to throw them outside our houses,” says 14-year-old Sheikh Zulfikar. “See there are two cranes dead near the pond,” he points at some white feathers beside a pile of dead chickens near a pond.
A health worker joins Roychowdhury, asking him how many houses they should cover today. “A hundred each day. Please try,” replies Roychowdhury.
Soon after he and his team leave the village comes the news: the Union Government has officially declared bird flu in West Bengal. The dreaded H5N1 virus has struck.

Wednesday, January 16, 12 noon
About 50 cars and jeeps are parked outside the makeshift control room at BDO office in Margram. Over 200 men jostle for space, queuing up at tables that are called the “registration” centre. In one corner of the compound is a temporary stall labelled “Supplies”. Villagers walk up to it but return empty handed.
Roychowdhury stands at the gate of the BDO office, shouting instructions over the din. Culling was supposed to start at 9 a.m., but got delayed. Workers of the Animal Resources Department (ARD) grumble about the inadequate arrangements for their stay and food.
“One small community hall with four toilets for 200 people. The breakfast is also awful. We have our unions, you know,” says Satyaban Das, a worker who has come from Murshidabad.
“We are working in separate groups here. The ARD staff is going in for culling. Our team is providing them with Tamiflu, the medicine for bird flu infection. You should have one too,” the BMHO tells a young doctor. “It is dangerous. We are giving them masks, jackets and other things for protection. We are also carrying out health checks of the cullers and you will have to be there.”
The BMHO walks into a small room where six doctors, all in masks, sit waiting. Packets of medicine lie stacked on tables. “Sir, we cannot control this,” a young doctor complains. “There are so many people, I heard there are 300 people from the ARD and we are just six. Do we have to check every one of them? It is humanly not possible. I have to visit the primary health centre also.”
Roychowdhury asks him to be calm and do his best. Three health workers enter with a new complaint. They need to go to Budhigram for a survey but have no vehicle.
Roychowdhury rushes to another room marked “Movement” and starts arguing with the officer. Finally, a car is arranged for the health workers. As they leave, the BMHO tells them to look for fever, watery eyes and respiratory problems, especially in children.
He then rushes to the second floor, where the main control room has been set up. Dilip Das, director of the state’s ARD, and AB Negi from the Union Government’s ARD, are in a meeting with Prasanna Kumar Mondol, the subdivisional officer, and top district officials.
Health survey reports are discussed and various problems like lack of vehicles and special protective gear is discussed. Some officials raise the issue of low awareness levels in the village.
“This is a backyard poultry case. There will be problems in culling, we should be prepared. We must also make checks for human infections. We want minute-by-minute information,” says Das.
Roychowdhury is informed that surveillance work is on, with health workers going from house to house with a standard questionnaire. But more men are needed for the survey. The 36 teams of five people each are not enough. The officials discuss problems like identifying locations for the burial pits for the culled birds.
“We are not getting enough land. Villagers have already started protesting. They will not be able to dig or till the ground for five years,” Das tells the other officials.
The meeting ends and Roychowdhury is back in the medicine room. Some villagers are complaining about the stench of rotting chicken lying on the ground. “Sir, please do something. We cannot stay at our homes,” pleads Ramen Mal, a labourer from Bamdebpur village.
Some ARD staff working as cullers walk in, looking for masks and protective gear. Sorry, say the doctors, no luck. Try using handkerchiefs.

Thursday, January 17, 6.15 p.m.
Today Roychowdhury is travelling to Buropith Mollahpara in Margram. On the way, children are playing with birds, carrying them home. At Buropith, four people dressed in special de-contamination suits, goggles, gloves and footwear face an angry mob of 60 villagers. “We got only a handful of birds here but the villagers are not willing to give them up. What should we do?” asks one of them.
The mob immediately turns towards Roychowdhury and his team. The compensation of Rs 40 per grown chicken and duck is too little, they say angrily. They complain that no awareness camps had been organised in their village and they had no clue about the bird flu outbreak till some officials came and asked them to hand over their poultry.
Nabiyara Khatun, a housewife, is screaming. “I had 25 birds and four ducks and most of them died 10 days ago. I have just four chickens and two ducks left now. Each chicken will fetch me around Rs 120 to 150. The ducks will fetch me more.”
“These people say that the Government is going to give me only Rs 40 for each big chicken and duck. My husband is a daily labourer and the birds are precious to us. We will cook and eat them, but will not hand them over to the government people,” Khatun shouts.
Montu Sheik, another villager, joins the angry chorus. “Today, the government people have come and they say that our birds are dangerous. No one came before, when they were dying.” The health officials try to reason with them in vain.
By late evening, only 12 birds have been culled in the village of 300-odd houses.
Some children are helping the cullers. The contrast is stark: the children bare-bodied, the cullers in their full-body protective suits. The birds are killed and put into gunny bags.
Roychowdhury tells his staff to keep the children away from the dead or dying birds, but nobody listens. His people say they need help.
Roychowdhury tries to make them understand and then calls up the district magistrate. But the DM says he is busy: too many complaints are coming in. ARD officials rush to Roychowdhury’s side, only to face the ire of the villagers. The officials fail to cool down tempers.
Tired, Roychowdhury and his team return to the control room, where the BMHO sits down for yet another meeting.

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What is bird flu?
Bird or avian flu is caused by types of viruses. The most contagious strains, which are usually fatal in birds, are H5 and H7. There are nine different types of H5—some of them are highly pathogenic while others are harmless.
The one that West Bengal is currently battling is the “highly pathogenic” Asian strain of the H5N1 virus. Scientists have discovered four different subtypes of H5N1 but there could be more.

If the virus affects only birds, why is culling going on in West Bengal?
H5N1 usually affects only birds but humans have been infected as well. But almost all who have been affected are poultry workers who came in close contact with birds. H5N1 cannot pass easily from human to human. Migratory birds, especially wild ducks, are natural carriers of the viruses, and pass it on to domestic birds, which are more susceptible to the virus.

How do humans catch bird flu?
The first human cases were reported in Hong Kong in 1997. Since then, human cases of bird flu have been reported in Asia, Africa, the Pacific, Europe and the Middle East.
Humans catch the disease through close contact with live infected birds. Birds excrete the virus in their faeces, which when dry can spread the infection.
Often, flu viruses that cross from animals to humans originate in areas where people live in close contact with birds and pigs. Pigs are susceptible to infection with both avian and human viruses and so are a ‘‘mixing bowl” in which viruses can exchange genes. Symptoms in people with infection are similar to those in other types of flu—fever, sore throat and cough.

Could we have stopped the virus from entering West Bengal?
There is no foolproof way really. Experts say proper poultry controls—such as preventing wild birds getting into poultry houses—are essential. Monitoring of the migratory patterns of wild birds should provide early alerts of the arrival of infected flocks.

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How many people have been affected across the world?
As of January 2008, the World Health Organization (WHO) had confirmed 350 cases of H5N1 in humans in Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Lao People’s Democratic Republic, Myanmar, Nigeria, Pakistan, Thailand, Turkey and Vietnam, leading to 217 deaths.

Can it pass from person to person?
Most people who have contracted the virus have been those with close contact with infected birds but there may have been examples of human-to-human transmission.
A case in Thailand indicated the probable transmission of the virus from a girl who had the disease to her mother, who also died. In 2004, two sisters died in Vietnam after possibly contracting bird flu from their brother who had died from an unidentified respiratory illness. In Hong Kong in 1997, a doctor possibly caught the disease from a patient with the H5N1 virus— but it was never conclusively proved.