In December 2006, an outbreak of Rift Valley fever was reported in Garissa, the capital city of Kenya's North Eastern Province. Rift Valley fever was mainly an animal virus that sometimes affected humans, according to the World Health Organization. The virus was transmitted from infected mosquitoes to livestock, then onto humans.
The case immediately grabbed the attention of international organizations such as the Red Cross, WHO, World Food Program and Doctors Without Borders. The global organization of epidemiologists TEPHINET, or Training Programs in Epidemiology and Public Health Interventions Network, contacted all its members to help, including Taiwan.
While Taiwan had carried out medical missions before, this was the first time it was able to participate in an international mission as an equal partner to other countries. The nation's medical specialists were summoned to fight the RVF outbreak because of Taiwan's experience of dealing with severe acute respiratory syndrome in 2003.
Taiwan International Health Action (TaiwanIHA), an organization that provided medical assistance to developing countries, closely watched the development of the disease in Kenya. On Dec. 18, 2006, Dr. Chen Hou-chaung and several other medical specialists were sent to Kenya to find out what might be needed and in which areas Taiwan could help. TaiwanIHA accomplished this by contacting personnel from organizations such as the U.S. Centers for Disease Control and Prevention, local health authorities and international health organizations.
"TaiwanIHA is a professional organization, not a charity," said Chen, an orthopedist who had served at the Central Hospital of Mzuzu, Malawi from 2004 to 2006. "I made some careful preliminary assessments of the situation there based on my professional experience."
Chen had also traveled to Indonesia to assess the medical needs of survivors from the Dec. 26, 2004 tsunami. Chen identified two goals for TaiwanIHA's operation in Kenya: prevention of the disease and gathering scientists who had experience with SARS, which was similar to the RVF virus, in that both had no cure and were transmitted by infected mosquitoes. "I found that, even with the help of some of the top scientists and medical experts sent by those international organizations, they also needed more epidemiologists and biologists to carry out further research into the virus that caused the epidemic," Chen added.
On Dec. 25, 2006, Chen personally visited the contaminated area of Garissa, close to the border of Somalia, with a population of about 350,000. Most of the people were Somali nomads who lived and slept with their livestock. Chen found that the local hospital had a shortage of isolated wards, preventive gowns, sanitation programs, informational data and laboratories.
Chen sent a message back to Taipei with a list of requests and a warning about an ongoing civil war between rebels and government troops in nearby Somalia. A task force had to be formed immediately, Chen told the Department of Health, which promptly requested its Centers for Disease Control and Prevention to assemble a list of qualified experts.
The lead doctor was Ho Bin-sheng, a family physician who was experienced in coordinating scientists from different fields. He was recommended to take command, due to his fluency in English and enthusiasm for serving rural communities.
A team of three biologists was to take charge of lab work to analyze the disease, conduct testing and write lab reports: Yang Jyh-yuan, Yang Chen-fu and Huang Jyh-hsiung. Among them, Yang Chen-fu was recently recruited to service after leaving his job at the U.S. CDC, where he had worked for 18 years. Jiang Dah-shyong, a specialist in dengue fever, headed up the epidemiology team. Chuang Ren-hsiang, a chief intelligence officer, and Huang Ji-jia, a specialist in parasites and mosquitoes, were also recruited. Hung Min-nan, in charge of infection control, proved critical in providing appropriate treatment to RVF patients. The team's mission and destination were clearly defined, and equipment, medication and scientists were made ready for deployment to Kenya for three weeks.
By Jan. 12, however, the disease had taken more than 130 lives. On Jan. 14, the mission led by Ho first flew to Nairobi, the capital city of Kenya, where the U.S. CDC had set up a mobile lab. The three biologists in the mission plunged into their lab work as soon as they arrived in the city.
"I think by the time we got to Garissa, roughly 400 or 500 kilometers away from Nairobi, the disease was actually at its highest point," said Ho. "It was also when the international operation needed us the most." The mission treated patients in Garissa Provincial Hospital and worked with local doctors, as well as specialists from France, the United States and Canada. The WHO and North Eastern Provincial Medical Office--the main local agency--coordinated meetings of all the international health organizations involved in the effort. Taiwan's doctors got the chance to collaborate with their counterparts from around the world.
Ho said the three biologists worked in the mobile lab trying to find a cure for RVF. A new vaccine called MP-12 had been developed by the U.S. military but had not been tested or approved by the Food and Drug Administration, a 2007 TaiwanIHA report stated. Yang Jyh-yuan and two other colleagues volunteered to be injected with the vaccine, risking their lives as human test subjects. Ho pointed out that working in a laboratory like the one in Nairobi posed additional threats to the health of the three biologists, because they could be exposed to more viruses.
Huang Ji-jia, who specialized in parasites, ventured out into the swamps to do fieldwork. Back in Garissa, he shared his knowledge of vector control, which was how to exterminate mosquitoes. Huang trained local medical workers in basic techniques to protect against the insects, such as by using pesticides.
For most of the team members, living in Garissa was a challenge. Jenkins Liu, a correspondent from Taiwan's Central News Agency stationed in Johannesburg, wrote about the operation in a Jan. 27 report: "The sanitary conditions in the city were appalling. The members of the mission were staying at a 'five-star hotel,' and it probably was, at least in the eyes of local people. However, once you stepped into the room, you would find bugs, beetles, flies and mosquitoes crawling on the floor or flying around."
Many people in the area lacked televisions or access to newspapers, so local health authorities took over the public address systems of mosques, according to the CNA report. In mosques, loudspeakers broadcasted information about the disease. Announcements provided the latest news, explained methods to improve personal sanitation and encouraged infected people to check into hospitals.
Local-level cooperation was critical to the success of the mission, and Ho spoke highly of the North Eastern Provincial Public Health Officer. "Without their help, nothing could have been done," he said.
Thanks to the combined efforts of international health agencies, the fever was contained to eastern Africa and did not escalate into a full-blown epidemic consuming the entire continent. Although no definitive cure for the fever had been found, the experimental vaccine MP-12 showed limited success in its preliminary trials.
Lin Ding, the deputy director-general of the CDC in Taiwan, concluded that the medical mission to Kenya was significant. He pointed out that it was the first time that Taiwan has ever sent a medical mission to work with the WHO and other international organizations.
The Kenyan government praised Taiwan's prompt response, according to a 2007 TaiwanIHA report. Having the U.S. CDC welcome TaiwanIHA's contributions in the mobile lab was also a significant step toward Taiwan becoming more of a partner in global health, which grows ever more important in an age where epidemics know no borders and can strike anywhere.
Write to Alexander Chou at alexchou@mail.gio.gov.tw