Cablegate: East Java: Suspected Ai Death Exposes Local

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DE RUEHJA #7614/01 1660924
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R 150924Z JUN 06
FM AMEMBASSY JAKARTA
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TAGS: TBIO AMED CASC EAGR AMGT PGOV KFLU ID
SUBJECT: East Java: Suspected AI Death Exposes Local
Underreporting

JAKARTA 00007614 001.2 OF 003

1. (SBU) Summary: A 10 month old child in
Tulungagung, East Java is suspected to have died
June 4 of Avian Influenza. The inexperienced local
hospital doctor did not recognize the AI symptoms
and released the child's body for burial prior to
taking any blood samples. Regency health officials
are treating the death as though caused by AI. A
Surabaya newspaper reported June 8 that local animal
husbandry officials were not disclosing the full
extent of the AI outbreak in the Tulungagung poultry
population, motivated by fears of "public panic" if
the full extent of the outbreak were made public.
End Summary.

Possible AI Death in East Java
------------------------------

2. (SBU) Jawa Pos reported June 6 that Aditya Bima
Saputra (10 months old) of Sukowiyono village,
Tulungagung Regency, East Java died June 4 at Dr
Iskak Hospital in Tulungagung of suspected Avian
Influenza (AI). The child was reportedly sick for
three days with AI symptoms before dieing. The
article also stated that approximately 100 chickens
recently died not far from the child's house and a
goat that lived next to his house collapsed and died
instantly the previous day.

3. (SBU) ConGen Surabaya staff followed up with
local hospital officials that treated the child and
Tulungagung Regency human health and animal
husbandry officials. Tri Widyo Agus Basuki, Public
Affairs Director of Dr. Iskak Hospital in
Tulungagung stated that the child died and the
child's body was removed from the hospital for
burial before any medical tests were done.
According to Basuki, hospital staff on duty at the
time the child was admitted did not consider testing
for AI. Apparently, Aditya was admitted on a Sunday
and the medical lab was closed. The inexperienced
duty doctor decided to wait until the lab opened
Monday morning at 8:00 am to draw blood samples.
Aditya died at 5:00 am Monday morning and, as is
local custom, his parents took him home for burial
half an hour later. It was not until a neighbor
noticed the victim's older brother Rizal Prasdana
Efendi (7 years old) was ill with similar symptoms
that anyone thought to test for AI. By then, it was
too late because Aditya was already buried.

4. (SBU) Rizal was admitted to the local hospital on
June 7 with a high fever and respiratory infection
symptoms. Basuki informed ConGen staff that Rizal
was in much better condition than his brother at the
time of admission but is being isolated and was
tested for AI. Basuki confimed on June 12 that
Rizal's AI tests were negative, relieving the
suspicion of an AI cluster in Tulungagung.

JAKARTA 00007614 002.2 OF 003

5. (SBU) Affandi, head of Technical Operation Unit
of Basic Health Office in Tulungagung, confirmed
that local government is treating Aditya's death
like an AI case and conducted a large disinfectant
spraying campaign in the patient's neighborhood and
some of bird shops in Tulungagung. His office has
distributed Tamiflu tablets to 28 local medical
clinics in Tulungagung and doctors were briefed on
AI symptoms and when to use the drug. Affandi
admitted it is standard procedure to draw blood on
any patient with a high fever as soon as they are
admitted and that the hospital did not properly
follow procedure.

Animal Health Official Spills the Beans
---------------------------------------

6. (SBU) In a June 7 interview with ConGen staff,
Danduk Sudarham, head of Tulungagung Animal
Husbandry Department, disputed the facts presented
in the Jawa Pos article claiming that only 43
chickens in the regency had perished from AI in the
regency in the past month. He stated that the
deaths now were nothing compared to the 600,000
poultry that died from AI in the regency from
October 2003 to February 2004. He seemed defensive
and concerned that ConGen was taking an interest in
the case. On June 8, Surya newspaper published a
story that the Tulungagung Animal Husbandry
Department was withholding information that
thousands of birds had recently died from AI in the
regency. Surya claims to have read confidential
information from a file on Sudarham's desk when he
left the room during an interview, revealing a much
more serious AI problem in the Tulungagung poultry
population that had been publicly reported. The
story also claims that when confronted with the
stolen information, Sudarham admitted to
underreporting the problem and pleaded with the
journalists to not publish the data for fear of a
public panic.

7. (SBU) The following day both Surya and Jawa Pos
newspapers reported hundreds of AI related poultry
deaths in Tulungagung regency and Surya published a
photograph of a pit filled with several hundred dead
birds being cremated. The story published remarks
by Sudarham downplaying the situation stating that
the incidents were isolated and not indicative of a
more widespread problem. After repeated efforts,
ConGen was able to make contact again with Sudarham
on June 13. He claimed that the information
uncovered by the reporters was from 2005 and that
what he had told us was accurate. Sundarham was at
a loss to explain the photograph of the dead birds
or his previous statement to ConGen staff that there
were no reported AI poultry deaths in Tulungagung in

JAKARTA 00007614 003.2 OF 003

2005.

Health Expert Calls For Transparency
------------------------------------

8. (SBU) East Java AI expert, Dr. C.W. Nidom, PhD,
publicly called for government officials to be more
transparent in reporting the AI situation in
Indonesia to the public in a June 12 interview
published in the Jakarta Post. Nidom is a leading
researcher on AI at the Tropical Disease Center of
Airlangga University, Surabaya's largest public
university, and a longstanding and vocal critic of
local, provincial and the national governments'
attempts to "cover-up" or downplay the severity of
the AI problem in Indonesia. Nidom is working on
research at the University of Tokyo, based on
samples taken from Indonesian swine, he claims shows
the H5N1 virus in East Java has mutated to become
transmittable to humans.

Comment
-------

9. (SBU) In light of the economic and social damage
facing the North Sumatra village caused by the Medan
cluster, local animal husbandry officials may be
sorely tempted to not report or underreport AI
outbreaks in their districts. The motivation to "not
cause a public panic" is strong because the public
is likely to panic if facing a serious AI outbreak.
By the time Aditya was taken to the hospital, he was
too weak to have blood taken. However, had local
health officials and doctors been aware of the
extent of the AI outbreak in Tulungagung's poultry
population, they would have certainly tested Aditya
for AI prior to releasing his body to the parents.

AMSELEM

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