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St. Paul, Minn. — Dr. Peter Yang's medical clinic in Saint Paul is busier than usual. He's examined at least 200 patients in the last six weeks who are preparing to travel to Laos and Thailand to celebrate the Hmong New Year.
Chue Vang and his wife Roseann Lo are visiting Dr. Yang to update their immunizations before they travel to Laos. Dr. Yang takes the chance to examine Vang and Lo to make sure they are healthy enough to travel.
Then he prescribes Vang and Lo medications to prevent malaria and diarrhea. He adds some advice: stay away from rabid dogs, only drink bottled water. It's the same advice he's been giving patients for years before they travel back to Asia.
But then he adds something new.
"Do not touch any bird. Do not go play with any thing that can fly or has wings. Just stay away from them."
The lecture seems to work, at least on Vang's wife, Roseann Lo. She was somewhat concerned about bird flu before seeing the doctor.
"I scared of chicken. I scared of disease," she says.
She and her husband laugh nervously as she swears off eating chicken while she's away. But then she says she'll trust anything prepared by her big brother, the brother she's going to visit.
Yang encourages his patients to be diplomatic so as not to offend relatives, but his instructions are clear. If family members offer the traditional sacrifice of a chicken to celebrate their arrival, Dr. Yang says don't eat anything that hasn't been cooked.
And then there's more.
"If you seen anyone who has the flu, cold symptoms or cough, stay away from this person. Because they might already have the flu and they could give it to you," he says. Dr. Yang believes his patients are at risk from the bird flu that has infected 130 people in Asia. "I do feel a little frustrated," he says. "I know that these people are going. And they are prone to get (the bird flu). I'm worried they'll come back sick and be a risk to the population here. I'm worried they'll come and get me sick, because I'm the one who's gong to be taking care of them."
The Centers for Disease control have a similar concern. The agency is worried about people coming back from Asia carrying disease into the U.S. That's why the CDC has created 18 quarantine stations at U.S. airports including Minneapolis-St. Paul. The office here opened up only a few months ago.
Pam Lutz runs the station along with a doctor. She says the CDC chose this airport because of the high international traffic.
"We want to make sure that we're here to identify any passengers arriving from any international location," Lutz says. "This airport is actually the 16th busiest airport in the world."
Right now, Lutz and the doctor meet planes when someone is reported sick. So far, she's not doing anything differently just because there's lots of news about bird flu. But Lutz says they're prepared to act in case of an outbreak.
In recent years, only a few major airports had quarantine stations. Then came SARS, severe acute respiratory syndrome. Lutz says the CDC learned a lot from the SARS outbreak which spread from Asia to Canada a few years ago.
"In the event of SARS, inspectors actually met every plane from countries that were infected with SARS," she says. "And if people were sick they evaluated them. It's just not clear because it's hard to imagine what the scope might actually turn out to be."
Lutz says in an emergency she would call for help from other CDC employees around the country. She'd also lean on local public health officials to pitch in.
Minnesota state health officials say they're ready to identify and quarantine bird flu if someone travels here with the disease. In fact, state epidemiologist Harry Hull says the system is already working.
"It's not unusual for us to get a call from a physician who's caring for someone who's just returned from Asia with a respiratory disease," Hull says. "It may be a severe respiratory disease where they're hospitalized, where they ask us if this person is infected with avian flu. Our answer to them is lets get some tests."
And all of those tests, so far, have come back negative for bird flu.
Dr. Peter Yang says that's not enough. He needs help preventing his patients from getting sick while they're in Southeast Asia. Dr. Yang says he needs up-to-date information and printed materials for his patients. When asked about this, public health officials in the Twin Cities, including Dr. Hull, point to a new television show for non-English speakers.
ECHO TV, which stands for Emergency and Community Health Outreach, makes short health education programs in several different languages. Each episode starts with music special to the ethnic group targeted by the program. The Hmong host starts the episode on flu by saying that she's helping the public health departments reach Hmong residents. She says viewers should look to Echo and the public health departments in an emergency. The program airs on public television once a month in six different languages. Episodes have covered health and safety topics from back-to-school shots to winter driving.
Dr. Peter Yang has appeared on two episodes created for Hmong viewers. He says the Echo shows are a good idea, but not the best way to reach his community in an emergency because there's a time lag.
"I think it's a good idea to (make the show) but it takes time to get it out to the public. It could take three to six months before it's out in production," Dr. Yang says.
Producers of ECHO are working on a new episode dealing specifically with bird flu. It's set to air in February. But that's long after Dr. Yang's patients come back from their trips to Laos and Thailand.
ECHO producers do want to get health information out more quickly. Next year they're starting a telephone hotline with emergency messages in different languages.