Saturday, August 19, 2006

Doing The Math

Al, Neil Ferguson’s work with predictive models for disease outbreaks looks very interesting. My understanding of mathematical modeling is really pretty weak, but I understand the models must work by taking into account a set of variables that affect a disease’s potential to spread. Some of those factors must come from the disease itself, and some must come from social conditions of its hosts. His quote from a Guardian article:

"Indonesia is one of the more worrying areas of the world," Prof Ferguson said. "The education of the population is not high.
"Along with sub-Saharan Africa, it is one of the areas of the world to be worried about ... much more so than the occasional case in Europe. Here, we will deal with any outbreak effectively. In Africa, there is almost no control, and there is no monitoring."

I’m going to try to contact him by email and ask some questions about the work.

Here are some factors I’m seeing in Indonesia that may set it apart. I wonder if they can be quantified at all. If they can, are they already part of the modeling?

1. Bird owner’s reluctance to report symptoms among their flock.
2. Higher rates of contact between birds and children. (50 percent of victims so far are children)
3. Central government’s weak or restrained influence on regional government’s policy.
4. Misreporting of the number of destroyed birds in an area due to corruption.
5. Inconsistency in the kind of vaccine used.
6. Black-market sale of ineffective or false vaccine.
7. Lack of funding for public education, compensation, and vaccines.
8. International reluctance to give Indonesia money due to concern about corruption.
9. The deferential role of international agencies such as the WHO and FAO in Indonesia.
10. Strength of a region’s cultural identity and independence from central government.
11. Local bird owner’s distrust of both local and centralized government due to a history of corruption.
12. A lack of observance of standards for the handling of birds during culls.
13. Widespread unregulated trade of birds over long distances – racing pigeons, fighting cocks, and circulation of eating birds as currency.
14. Lack of both perceived and real threat to the population.
15. Lack of general medical care and health maintenance (screening, check ups, entry points for health education)
16. Backyard chickens in an urban megacity environment.

On the question of public education…

I’ve seen exactly one bird flu awareness advertisement on television here, and it was from a cable station that I think originated from Singapore. Jackie Chan was folding paper cranes and playing with some children. He tells them it’s okay to play with toy birds, but it’s never okay to touch a sick or dead bird.

The campaign is from Hong Kong, and it was in English. As far as I know there is nothing to match it yet in Indonesia.

But I have been told by the United Nations PR machine that there will be a big public awareness media blitz rolled out in September. I can’t wait to see what they come up with.

A reader has asked me what kind of media access the villagers in Karo have.

I didn’t see many satellite dishes, but there are televisions in the houses and warungs. Mountain communities often don’t have much broadcast reception, and cable in remote areas is not likely. Metro TV is the nation’s favorite local news source, and I know that they have access to it.

There are plenty of newspapers and lots of coverage of the bird flu outbreaks. I honestly don’t know the literacy rate, but I would guess that there are enough readers in families, especially young people, for such information to get around. People talk about the news a lot there – more than in many western countries I’ve visited.

As for public education materials like signs or pamphlets, I only saw a few scattered examples. Even in hospitals, I found the presence of bird flu awareness posters rare. There was one in a corridor at the Adam Malik hospital in Medan, and one at the main health department office in Kaben Jahe.

Getting safety messages out about bird flu to stick may be even harder than with other diseases. Keep backyard chicken coops free of feces, stay away from sick chickens, report chicken deaths to the police, wash your hands when you’re around birds – that’s not very practical advice for most fowl owners. Raising birds is full of potential infection risks, and they’ve been doing it the same way for thousands of years.

And really, they don’t have a lot to gain from changing their behavior. The percentage of those who get infected is so small that it doesn’t seem like much of a looming threat. But at this point they have a lot to loose by reporting chicken sickness to police. They could loose their birds. A lot of people use chickens as liquid assets to pay for things like medical care or school fees for children. And they could trigger such a panic that the whole local agriculture industry could take a nosedive.

What’s at stake is pretty abstract for them, really. The negative consequences of cooperating are much higher than the perceived benefit. At this point, it’s hard to say how the real benefits of cooperating could overshadow the hardships.

It’s an interesting message to deliver. How would you wage this public information campaign? What would the poster captions read?