Postcard from Bishkek

There were a couple of very sad items in the news last week … and one of them led me to a shock discovery and a “moral dilemma”.

It concerned the death of a fifteen year old boy.  Tragically sad in itself, the article was even more poignant because it went on to report that it was thought that the boy had died of bubonic plague and all the people that he was not to have had contact with had been placed in quarantine – isolated and under medical surveillance and the village is cordoned off by police and health workers.

It seems that he lived in a remote region at the extreme Eastern tip of the country, and had been his father, a working shepherd, when he complained of feeling ill and returned home to his village.  After a period when he didn’t seem to get any better, indeed he became feverish and developed swellings in his armpits … they family took him to the local hospital where the doctors diagnosed the likely cause and tried to treat it.  Unfortunately, however, it was already too late – the disease was too far advanced and boy died the same day.

The authorities were quick to react, not only setting up the quarantine but also establishing a regional control center and dispatching the necessary medical supplies to treat all those possibly affected.  A statement was issued which hit the local and regional news – but I haven’t seen any mention of it in the international press – so far.

In a way that doesn’t surprise me.  Although, when a squirrel was discovered to be infected in park in Los Angeles earlier this year, there was quite a bit of coverage, but that may well have been because the authorities there immediately closed the park.  In fact, there are something between one and two thousand cases diagnosed around the globe every year … even in the South Western states of America …  and they don’t all get covered in the media.

For someone who was brought up on stories of the Black Death,  the Great Plague of London in 1665/6, and reading Albert Camus’ existentialist novel The Plague, the images that sprang to mind when I heard the news were quite alarming … after a little research, however, I began to feel a little more at ease.

 

For the record: Bubonic Plague is a disease caused by bacterial infections carried by fleas.  The name comes from the Boubos which refers to one of the classic symptoms – swollen glands under the armpits or in the groin.  It, along with two forms of plague, are thought to be the cause of the Black Death which swept through Europe in the 14th Century and is said to have wiped out something like a third of the world’s population at the time.  It is not only contagious, (conveyed by flea bites), if it isn’t treated then most victims will die within days.

The symptoms are numerous and diverse, including: gangrene of the extremities such as toes, fingers, lips and tip of the nose; Chills; a general malaise, (ill feeling); a high fever (39° Celsius or 102° Fahrenheit); muscle cramps; seizures; smooth, painful swellings of the lymph glands commonly found in the groin, but may occur in the armpits or neck, most often at the site of the initial infection. Sometimes the swellings may be preceded by a pain; color changes of the skin – to a pink hue in some very extreme cases; heavy breathing; continuous vomiting of blood; aching limbs; coughing, and extreme pain; extreme fatigue; gastrointestinal problems; black dots scattered over the body (which led to the name Black Death); delirium, and coma.

Treatment is possible, however,  if administered in time – the sooner the better but preferably within 24 hours of the appearance of the first symptoms. Several classes of antibiotics, for example, are known to offer effective treatment.

 

In fact, the Center for Disease Control, (CDC), seem to think that preventative measures – especially avoiding contact with wildlife – don’t pick up dead animals, etc. – is a good preventative measure.    The also advise educating the public in likely areas of infection of the risks; regular surveys of the wildlife population, controlling rats on ships and docks and in warehouses; wearing gloves whenever handling carcasses and immunization.

In the event of an infection such as this one, they advise immediate reporting to the authorities so that remedial action can take place: isolation and quarantine (for seven days – the incubation period of the disease) and delousing of contacts, their clothes and belongings, disinfecting surroundings, and administering medical treatment.    Further steps are advised to be taken in the event that it is not an isolated case but develops into an epidemic scenario.

 

Normally, when researching a topic, I am delighted to discover that Central Asia in general, and Kyrgyzstan in particular, may the home of something: tulips, for example, or rhubarb; apples or walnuts … and so on.

I wasn’t so happy to discover, however, that Issyk Kul could be the home of the original Black Death which swept through Europe in the fourteenth century.

Apparently, the news reports of this case included a comment that the remote region where his father was tending his livestock “is considered a natural focus of the plague” with occasional outbreaks – but the last reported case was in 1980.

The Issyk Kul region is certainly a prime habitat for marmots, which are known to carry a virulent form of the plague.  (It seems that the family had caught and eaten marmot).

Unfortunately the course of the disease in Asia is not as well documented as its history in Europe.  Many scholars seem to think that the disease began in Western China, and some actually point the finger at Lake Issyk Kul and that it spread Westward along the Great Silk Road together with the Mongol hordes who, according to some sources, even used it as a form of what we would call today “biological warfare” – catapulting infected corpses over city walls of Kaffa in the Crimea to spread the plague among the defending population.

Archaeological excavations on the shores of Issyk Kul reveal that the Nestorian Christian trading community there was ravaged by bubonic plague in 1338-39 when the settlement’s  death rate shot up from a 150-year average of about 4 people per year, to more than 100.

It is also possible, however, that traders from further east brought diseased fleas with them to the shores of the lake.

 

So, what was the “moral dilemma” that I faced? – whether or not to write a postcard about it.

I work in tourism and aim to attract potential clients to visit Kyrgyzstan and its mountains.  Bad news like this may be enough to cause them to think twice about Kyrgyzstan as a possible destination – if not actually positively dissuade them.

On the other hand … I have a moral duty and responsibility (if not a legal obligation) to inform clients of any material risk that they may face.

Also, on a purely practical point, it is likely that people may get to hear about the case and so, I decided, we need to be prepared to answer any and all questions that do arrive.

As a result, I decided to write this postcard.

 

The Ten Commandments exhort us that we should “not bear false witness against thy neighbour” … which is frequently simplified to “Don’t Lie” … which, it seems to me, is actually much stronger.

I keep telling people that this should also be a fundamental rule of marketing … don’t let people think that they are going to land in the seat of luxury but be honest – although there are five star hotels in Bishkek, for example, and some good quality accommodation around Lake Issyk Kul, most of the accommodation in Kyrgyzstan is fairly basic – Bed and Breakfast or akin to camping, (for example in a yurt).  Tell the clients “up front” so that there can be no misunderstanding and they know what to expect.

It’s not even a case of “put a positive spin” on the story.  Be honest and realistic – Tell it as it is – “warts and all”.

In this case where someone has died of bubonic plague … tell people … tell them what the risks are and what precautions they need to take to avoid exposure to the disease … and plan accordingly.   As it happens, none of our tourists are likely to visit this particular region so the risk they face is fairly minimal … but if there was a serious risk then we would inform them and make alternative arrangements.

 

Although this is the first time time I have come across plague – Kyrgyzstan is an area where Rabies is known to exist … and we occasionally get questions from prospective clients about the risks.

I have written a postcard about that in the past … indeed, I have been bitten by a stray cat, myself, and had to have injections of anti-rabies serum.  Once, also, I was bitten by a dog in France – although it wasn’t a particularly serious bite it did break the skin and I admit to being quite concerned at the time.

In fact, the risks pretty negligible – at least for most tourists, especially if they follow the basic guidelines of avoiding contact with wildlife – for example, refraining from picking up dead animals.

 

Tags: Health, In_the_News, Marketing