Ana Sayfa

Turkey’s Bird Flu outbreak: one year later

CALEB LAUER
DOĞUBAYAZIT - Turkish   Daily News
 

Fatma Özcan's aunt gathers laminated copies of two newspaper articles from another room and brought them into the Living Room Both articles are dated Jan. 16, 2006, the day after 16-year-old Fatma died. The headlines read: “Hiç Yaşamadı Ki” and “Ve Fatma Öldü' Rough translation: “Too short a life” and “Fatma is dead.”  A year ago, here in Doğubayazıt and Van, Turkish doctors and international experts were fighting an outbreak of bird flu that killed four children including Fatma Özcan. One hundred thousand doses of the anti-viral drug Tamiflu were flown in. More than 600 were examined at one hospital alone. There were almost 300 suspected cases with 12 cases confirmed. The planet hadn't seen so many cases at once before. Within the first two weeks of January, more children, Mehmet Ali Koçyiğit, Fatma Koçyiğit, Hülya Koçyiğit had died along with Fatma Özcan.  Now one year later, the bird flu outbreak in eastern Turkey offers no clear verdict or lessons. The story is a mix of tragedy, science and politics.

   In the fall of 2005, the H5N1 influenza virus that killed the three Koçyiğit children and Fatma Özcan had probably traveled with wild birds migrating from China and infected chickens and ducks across Turkey. As the virus circulated among domestic poultry under-detected and under-appreciated, Agriculture Minister Mehdi Eker said: “There is no bird flu in Turkey.” Two days before Mehmet Ali Koçyiğit died, Mr. Eker was quoted saying there was ‘no cause for concern.'  On Jan. 2, 2006, the day after Mehmet Ali died, reputable public health internet blog Effect Measure posted this entry: “The New Years' weekend saw a worrying report of six cases of suspected bird flu in Turkey…Today the wires are full of the good news from the Turkish health ministry that tests on the 14-year-old who died yesterday ‘didn't show any trace of the disease or any other form of influenza.'…It is a natural tendency of state bureaucrats to minimize problems. I am not yet ready to dismiss these cases.”  Three days later, the World Health Organization (WHO) made its first announcement about the situation in Turkey. The sober statement began: “The Ministry of Health in Turkey has confirmed its first two cases of human infection with avian influenza caused by the H5 virus subtype. Both cases were fatal.” The second case was 15-year-old Fatma Koçyiğit, Mehmet Ali's older sister.  One month later, Dr. Joseph Bresee of the US Centers for Disease Control was quoted saying, “This is [a] good opportunity to show how well things can go.”  The irony and confusion are accurate. Even today there is confusion over how old Fatma Özcan was when she died of bird flu; the WHO says she was 14, Fatma's stepmother says 16. Some newspapers say she was 12.  Eventually, Turkey did respond well, as Dr. Bresee suggested. But first the penny had to drop, and as indicated above, it was a long drop. On Jan. 8, 2006, the London Times reported that, “When Muhammet Ali Kocyigit, 14, became Turkey's first avian flu victim last week, a government spokesman criticized doctors for mentioning the disease because they were ‘damaging Turkey's reputation.”' Because the Turkish government didn't appreciate fully the significance of the flu outbreak in birds it was allowed to spread. And when people who lived near the bird outbreaks started showing up in hospitals with flu symptoms, the instinct seemed to be denial. “Most of the government officials said no there is no bird flu, [they were] not believing such a situation [could happen],” said Prof. Dr. Ahmet Faik Öner during an interview in Van. Dr. Öner was the lead doctor during the outbreak and is chief of pediatrics at Yüzüncü Yıl Üniversitesi Hospital in Van where eight of 12 patients with bird flu were cared for.  But once officials accepted that bird flu had infected humans they moved effectively, said Dr. Nikki Shindo, an infection control specialist with the WHO. Dr. Shindo arrived to Van on Jan. 6, 2006, with the first WHO team. She said in a phone interview from Geneva that Turkey's response, once the situation was understood, was characterized by fast and willing reporting: “Very quick, immediate, no hesitation,” she said. Today in the suburbs of Doğubayazıt, the snowy streets are cleared and lined with cement or stone walls; every 20 meters an iron or steel gate seals the opening to an enclosed compound. Inside these home compounds, clothes are hung to dry in the freezing cold and hay and straw are piled for the household's animals. The homes themselves are usually low cement or cinder block buildings with one or two small windows and are heated by woodstoves. Judging by the satellite dishes, almost all have electricity.  Fatma Özcan's parents, brother, and sisters live at a small settlement of low cement homes on the side of a gentle hill outside Doğubayazıt.

    Only two colors break the monochrome here: orange tarpaulins that cover the back door of the Özcan's home and blue sky. Everything else is white snow, plain grey cement, or brown wood piled on cement ready for the woodstove. Under the orange tarpaulin and through the back door, a low hall leads to a sitting room, which is completely incongruous with the home's bunker exterior. It is a small, colorful and cozy room with carpet and upholstered couches, a tea table and shelf unit with a TV that was showing some version of a Turkish western. The only feature that matchs the outside is the ceiling – the rafters are made of tree limbs.  Fatma's aunt brings tea and offers bayram candy. Fatma's stepmother said, “In the week before Fatma died she was overly affectionate, always wanting to kiss me, to sleep in the same bed as me, hugging me.” Fatma's mom implied that Fatma must have sensed something was about to happen.  Fatma's stepmother sat quietly on the carpet in front of the woodstove and began to cry as the newspaper articles were passed around and translated. Fatma Özcan was 16 when she died, the article says. Like more that 80 percent of Kurdish girls in eastern Turkey, Fatma never went to school.

    On the same laminated page as the headlines announcing Fatma's death, there is a picture a very young boy lying terrified in a Hospital bed; gloved hands are trying to comfort him and an intravenous drip is hooked into the back of his hand. The boy is Mohammed Özcan, Fatma's brother, who also was infected with H5N1 and hospitalized in Van. But Mohammed survived. A year later, he is cuddling with his mom in front of the woodstove, looking healthy and crying at the camera. Mohammed's dark hair and dark skin electrify his blue eyes.  It was a brief visit. Fatma's uncle, Hikmet, smiles and makes jokes about the problems of a language barrier as we speak through a translator. Of course, platitudes about the family “recovering” would be silly. Even as we discuss Fatma, the family smiles, laughs and cries; small clues about how a family moves on from tragedy.  Tomorrow: Knowing what you don't know  

  BOX  Avian influenza or “bird flu” is caused by the H5N1 influenza virus. Influenza viruses are classified according to the proteins on the surface of the virus. (The Spanish flu in 1918 was caused by the H1N1 virus.) H proteins allow the virus to bind to cells in a victim's body. N proteins allow new viruses to spread throughout the body. The pattern of these proteins on the surface of the virus determines which Species the virus likes. The surface pattern of H5N1 today allows the virus to bind easily to bird cells, but not easily to human cells. This is why H5N1 has been killing so many birds and relatively few humans. Since the current outbreak began in 2003 up to 500 million birds have died as a result of H5N1, while 157 people are confirmed to have died of the virus as of January 10, 2007. The first time H5N1 infected humans was in 1997 in Hon kong. This outbreak was halted when Hong Kong officials killed all of its 1.5 million chickens within three days. Viruses replicate themselves in a haphazard way meaning they mutate often. The current fear is that the H5N1 virus will mutate in a way that allows it to bind easily to human cells and be easily spread from person to person. This would cause a human influenza pandemic. Because mutations occur randomly, the more viruses out there means there's a higher chance of this “pandemic” mutation happening. This is why the massive outbreak in birds across the world is such a concern.