Veiled disease
Government assurances that an outbreak of Rift Valley Fever has been contained offered cold comfort to victims and their families, as Reem Nafie found out in Kafr Al-Sheikh
Hundreds of people were waiting at the entrance of the Medical and Tropical Diseases Hospital in the village of Sidi Salem in Kafr Al- Sheikh, anxiously seeking answers from doctors regarding the conditions of their relatives who had been diagnosed with Rift Valley Fever.
Many of those who were waiting had spent the night right there in front of the hospital, unable to garner even a single piece of information about their ill kin. "My sister was fine," said a distraught Mansour El-Rifaie, "then suddenly she got a fever and now she's gone. I don't understand what happened."
RVF first appeared in the small Nile Delta village of Sidi Salem nearly two months ago. The most recent statement from the Ministry of Health indicated that, "only 33 people have died" from the disease, which primarily affects animals, but can occasionally be transmitted (usually via mosquitoes) to humans. That was an adjustment from earlier claims by the ministry that the disease had been contained, and that only four out of 35 people diagnosed with the fever had died.
According to a World Health Organisation (WHO) report, RVF is a zoonosis, or a disease primarily spread amongst animals via infected mosquitoes; the virus can then spread to humans via a mosquito that stings an infected animal, and then later stings a human. The death rate of those infected with RVF is usually quite high.
The disease was first isolated in 1930 during an epidemic at a sheep farm in Kenya's Rift Valley. Since then, there have been outbreaks in sub-Saharan and north Africa. In 1997-98, there were major outbreaks in Kenya and Somalia; in September 2000, RVF was reported outside the African continent for the first time, in Saudi Arabia and Yemen.
Farmers in Sidi Salem all seem to believe that the viral outbreak first began after a farmer slaughtered an infected cow. Apparently, the infected blood was not cleaned properly from the ground, which resulted in mosquitoes feeding on the blood, and subsequently transmitting the disease both to other cows as well as humans.
"I had an infected cow, but I slaughtered it right away and immediately cleaned up the mess," said Arafa Gamil, who owns a farm near Sidi Salem. "Many others have discovered sick cows," Gamil told the Weekly, "but some people aren't being honest about it because they don't want to get a reputation for having sick cows, and thus have a hard time selling their livestock."
Perhaps making matters worse, even the General Authority for Veterinarian Services seems to be in denial. They issued a statement on Tuesday saying, "There are no cases of RVF amidst the livestock in Kafr Al-Sheikh, Damietta or Daqahliya."
Meanwhile, the ramifications of the RVF outbreak continue to be felt, even far beyond the boundaries of the small village of Sidi Salem. Saudi Arabia, an importer of Egyptian livestock, has announced a temporary ban on the import of live goats, sheep, camels and gazelles from Egypt, as a result of reports of the disease. Within days of this announcement, the Egyptian Ministry of Health and Population issued a statement saying, "even if some livestock is infected, eating the infected meat would not affect human health. It will only lead to the loss of the meat's nutritional value."
While officially denying that the disease is spreading amongst the livestock population, the government has also simultaneously been taking steps to contain the RVF outbreak. By spraying large quantities of insecticides around Sidi Salem and neighbouring villages, the government hopes to eliminate most of the mosquitoes there, as well as their breeding grounds.
An intensified animal vaccination programme is also underway, in an attempt to prevent livestock from catching the disease. Many farmers, however, have been refusing to allow their livestock to be vaccinated. Abdo Sherif, one of the veterinarians assigned to vaccinate livestock on Kafr Al-Sheikh farms said he could not "force farmers because in the end it is up to them".
When Reda El-Essawi, the owner of a large farm in Kafr Al-Sheikh, was asked why he had refused to vaccinate his livestock, he repeated the same 'old wives' tale' that many farmers firmly believe. "If I inject my livestock with a vaccine before the animal actually shows any signs of the disease, it will increase its chances of getting the disease rather than decrease them." Because of this basic ignorance regarding the logic of vaccination, El-Essawi, like many others, has refused to vaccinate his livestock since the animals have not shown any signs of being infected.
"If my livestock begins to show any signs of the disease," said Mohamed Siddiq, a friend of El- Essawi's and the owner of a neighbouring farm, "I will call a vet immediately. But I cannot take the risk of vaccinating them now."
Neither farm owner felt that by refusing to vaccinate their livestock they could be increasing the chances of RVF continuing to spread in the area. "It is not up to us to assess the damage," they said. "This is the government's role. We have a business to run."
Meanwhile, the death toll continues to rise. According to Mohamed Ezzeddin, a doctor at Sidi Salem's Medical and Tropical Diseases Hospital, "the people who were admitted to the hospital suffered from an influenza-like illness, with a sudden onset of fever, headache, muscle pain and backache. Some patients also develop neck stiffness and vomiting." Patients who experienced these kinds of mild symptoms were sent home after a seven-day incubation period.
Others, however, developed a much more severe form of the disease. "Many of those who came in suffering from serious eye problems or severe fever," said Ezzeddin, "soon ended up dead."
