Bird flu blamed in Egypt child’s death

CAIRO —  Beyond smokestacks and whipped donkeys, past fish curled on dirty ice and sparrows skimming laundry hanging in alleys, the death of 6-year-old Ali Mohammed Ali brought mystery, health inspectors and truckloads of police to a poor Cairo neighborhood.

Ali, a first-grader and computer wizard from Shubra el Kheima, died last week in a hospital, his lungs full of fluid, a stent in his chest. Health officials say he had bird flu, but they can’t pinpoint where he picked it up: The market, the school, on the rooftops with the pigeon keepers or on a recent trip to his grandfather’s village in the Nile Delta?

Nobody knows. Homes and classrooms have been disinfected, neighborhood poultry has been confiscated and culled, and the man splitting chicken breasts with a machete next to the baker keeps watch for police in case he has to disappear in a hurry. There is alarm and nonchalance, talk of a health epidemic, grumbles of conspiracy.

“The Health Ministry came. They checked our flat, they took our blood. They tested everyone in this building for infection,” said Ali’s mother, Aleya Ismail. “But still they don’t know how it got into my son. Where can I raise poultry here? Under the bed? How could this virus have found him?”

Egypt has had 65 cases of bird flu, including 26 deaths, since 2006 -- the highest national toll outside Asia, where the virus, designated as H5N1, was believed to have first appeared in humans in 1997.

Ali’s fever and final hours in an intensive care unit came days before word came of the swine flu outbreak that is suspected in the deaths of more than 150 people in Mexico and has spread in the United States and into Europe and the Middle East. Egypt has ordered the slaughter of the nation’s 300,000 pigs.

Bird flu, which has killed hundreds of people worldwide in the last dozen years, threatens to be a pandemic but has yet to reach that critical stage, though it has become embedded in bird flocks and spread to dozens of nations. Arising mainly from direct contact with infected fowl, bird flu lingers at the edge of the swine flu crisis, another deadly squiggle of cells and strands beneath the microscope.

The World Health Organization is concerned that, like swine flu, the avian virus could mutate and become easily transmissible between humans. Scientists fear that if this happens the avian virus could be more dangerous than the swine flu outbreak, overwhelming cities such as Cairo, where overcrowding, poor sanitation, suspicion and cultural traditions are more potent than Tamiflu prescriptions and warnings spoken through the masks of health workers.

Shubra el Kheima unfolds where the Nile ripples through marsh grass as it flows north out of Cairo toward the delta. Apartment buildings of brick, dried mud and mortar heave against one another, keeping daylight out of the alleys until the sun is at its highest. The market blows with garbage, flies whirl, donkeys chew grass off carts, and cats slip past coal bins and into the butchers.

Most families, like Ali’s, arrived decades ago from villages. They were electricians, laborers, seamstresses. They hauled country life to the city; their sons and daughters raise chickens and race pigeons, and when they don’t know the exact address of a friend or cousin they yell names through alleys and are guided by fingers pointing this way and that. Anyone passing a corner can sip water from clay jugs, known as ollas, a communal drinking habit since ancient times.

God moves them; the loudspeakers at the mosque crackle with his name. They are suspicious of police and anything that bears a government stamp or imprint of officialdom. They have rocked one another’s babies, buried one another’s dead and finished one another’s sentences. And now they can’t believe that Ali, a boy they knew, is gone, taken by a virus whose name is two capital letters and two numbers.

“The police have seized the chickens from the market,” said Hayem Mohammed, a heavyset woman with gold looped earrings and an aluminum cane. “Why should we be scared? We all believe in God and God’s will.”

“I’m not convinced it was bird flu,” said Alaa Abou Donya, a burly man standing in the shade near a mechanic’s shop. “Ali’s family used to have pigeons, but they cleaned up their house a year ago. They buried Ali in a normal grave. You wouldn’t do this if the boy had been infected.”

Down another alley, men sip from ollas, their eyes following a stranger. No one sneaks in here; life and space are too compressed. The alleys open to the wide street. The cabbage man lifts his tarp at the market, green spills into the dust; women sell eggplant and red onions, and fish, long dead, bob in the water of melted ice. A thwack and a tug, bits of chicken tumble from Sayed Mohammed Ahmed’s chopping block; cats flock to his feet.

“I only sell farm-raised chickens,” he said.

“It’s the ducks and chickens raised in houses that are infected. But when the police come they take all the meat no matter where it came from. I have to hide when I see them.”

He skinned and sliced, handing two breasts to a woman; his sticky fingers reached for money from his shirt pocket.

“People aren’t scared,” he said. “They understand this bird flu scare is all a trick to kill the business of local chicken producers so importers connected to the government can make big money. That’s what this is all about.”

Behind a window with a pastel shutter, Ali’s mother sits on a bed in a room decorated with plastic flowers and a poster of Mecca. She is dressed in mourning black, except for the glint of pearl on the pin in her head scarf. The needle prick in her arm, where they drew blood to give her son, is weeks old now. She blames the doctors and hospitals for not figuring out what was wrong with him until he was too far gone to bring back.

“He had a fever,” Ismail said. “I took him to five doctors who said it was only a throat infection. They gave him antibiotics. Another doctor said he had pneumonia. We took him to a private hospital. They said his lungs were full of fluid that needed to be sucked out, but they didn’t have the tools. We took him to a state hospital. It took them three days before they drained the fluid.”

Her son started fading. A doctor asked if the family raised poultry at home. She said no. The flat was too small and cramped and her husband’s father had forbidden it years ago. The health inspectors came to investigate; no one else was sick. They widened the search to the neighborhood and Ali’s grandfather’s village in the delta. Nothing.

Ismail sat near her daughter, Noura, 8, and her 7-month-old son, Ahmed. A woman carrying groceries peeked in and headed up the stairs. The sun was high over the littered alley.

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jeffrey.fleishman@latimes.com

Noha El-Hennawy of The Times’ Cairo Bureau contributed to this report.