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Japanese encephalitis in China

Year: 1988
Setting: Electricite de France clinic at Daya Bay, China
Position: Resident physician

A Japanese encephalitis epidemic has struck southern China and I am in its midst at Daya Bay where Electricite de France is building a nuclear plant for the Chinese government. As the resident physician for the company, I see the local employees and their families. They all get immunized against the disease with the inactivated virus Biken vaccine, which comes from Japan and is expensive. By contrast, the Chinese government has not yet started an immunization campaign. However, I know from employees living in the area that people are dying from the disease in local health facilities. The extent of the epidemic in terms of morbidity and mortality remains unknown. The regime does not communicate statistics to health-care providers, much less to the domestic media. The international community also is left in the dark. This concerns me a great deal, particularly because one of the camp nurses is from Hong Kong and her family is worried about a possible extension of the epidemic into the British territory.

There are political, social and psychological tensions at various levels: between expatriate management and local workers, who would like their friends not working for EDF to be immunized; between EDF executives and local Chinese authorities about the lack of communication; and between people working on-site and outsiders. Providing medical care in this environment has been an eye-opener.

Despite official recommendations discouraging off-site travel, I manage to visit villages in the plant vicinity with a few Chinese friends. We witness first-hand the level of poverty in the countryside. Conditions are typical of developing countries: poor hygiene, children walking barefoot among farm animal excrement, ragged clothes, etc. I do not observe any sign of malnutrition, but I wonder how the children fare in the winter when the temperature drops below freezing level. With the help of my co-travelers, I inquire about the vaccination status of these children. No parents recall any recent shots. I compare this with the statistics the Chinese government has provided to the World Health Organization indicating that most of its citizens have been immunized. Something is not right!

After leaving the camp a few weeks later, I hear that the Chinese authorities have started a vaccination drive, which helps bring an end to the encephalitis epidemic.

Lesson for the doctor: Frustration and despair can reach an apex when a government does not provide the necessary health care to its population in times of crisis. Getting a true assessment of the situation may involve doing your own investigation among the people who live there.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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