In a flap over bird flu

How does India steer the course between panic and complacency in its response to the bird flu threat? Between flapping around like a headles...

How does India steer the course between panic and complacency in its response to the bird flu threat? Between flapping around like a headless chicken and diving into a well of denial? This could, arguably, prove to be the biggest challenge facing the administration of public health in India in a long time, possibly since the outbreak of the 8220;plague-like8221; disease that had manifested itself in Surat in September 1994.

It may be useful then to revisit that period of public panic. There was, on the one hand, too little accurate information on the 8220;Surat plague8221; and, on the other, too much inaccurate information. The local press literally fed on people8217;s fears, carrying headlines like 8220;The Plague Serpent Will Bite Everybody in Surat8221; and 8220;Somebody has cast an Evil Eye on Surat8221; all this embellished with visuals of snarling rats and skulls and crossbones. The city8217;s medical system, such as it was, practically collapsed, with doctors and nursing personnel joining the ranks of those who were fleeing the city. For a brief and ugly moment Surat had reverted to the medieval ages, and those who left the city in search of more congenial surroundings found themselves treated like pariahs. There was little understanding of how the pathogens got transmitted, and some even believed they were only safe if they kept the windows of their homes shut tight!

Fortunately, that bitter experience brought its own cure. Which only goes to prove that nothing addresses a public health trauma of this dimension better than a rational approach to it. It was quickly realised that 8220;Surat8217;s plague8221; was caused by the almost totally unplanned manner the city was allowed to grow, with its houses fringing swarms of fetid, stagnant water. Garbage, flung directly from houses on to the streets, was left uncleared for weeks on end. There were no landfills for dumping the garbage 8212; since land was considered too precious to be spared for so prosaic a use 8212; and there was no sewage system worth the name. Practically everything in the city, from water connections to eating places, were unauthorised. It wasn8217;t for nothing that Surat came to be known as 8220;Badsurat8221; ugly.

Just one dedicated municipal commissioner could turn Surat around and the centrepiece of his intervention was effective, timely garbage clearance. That another 8220;plague8221; has not visited this city in all these years testifies to the basic truth that finally health is an outcome of the intimate relationship between human beings and their habitation.

Bird flu is a disease of a different feather entirely. But three insights gleaned from Surat8217;s trauma of 1994 can prove useful in dealing with it. First, accurate information, not just to the public at large but 8212; specifically 8212; to the farmers and residents of the affected regions. This presupposes scientific monitoring of the progress of the H5N1 virus, with the relevant details conveyed in a transparent manner. Second, qualified and protected health teams must be on stand by, should a health crisis present itself in the near future. Mass panic can only be addressed if people have the necessary confidence that the system will work for them. Third, we need to review the state of hygiene in our poultry and egg farms 8212; and not just in the big hatcheries but in the innumerable small egg and poultry farms scattered all over the country. Public health has to come back to the public agenda. Hopefully P. Chidambaram8217;s budget will reflect this concern.

Influenza has a strange public profile. Even its generic meaning, 8220;the influence8221;, is non-threatening. After all, everyone gets the flu, and most recover in a few days. It does not appear half as frightening as tuberculosis or malaria, and is certainly not in the AIDS/HIV league. But the world has not forgotten the 1918 flu pandemic. Andrew Nikiforuk, in his The Fourth Horseman reminds us that it had led to the death of 50 million around the world in 18 months 8212; India is believed to have lost 12 million to its tragic touch. There was even a little doggerel put out by the Illinois Health News: Flu?/ If we but knew/ The cause of flu/ And whence it comes and what to do/I think that you/ And we folks too,/ Would hardly get in such a stew./ Do you?

Things haven8217;t changed that much. We still are fairly clueless about handling the latest strain of influenza, although we have titled it 8220;H5N18221; and have rustled up some medication for it. But at least we need to keep our heads as we steer our way through this crisis in a manner that is both rational and effective. And, yes, we need to do it together as a country, and as a part of a world grappling with the fear of flu.