On 22/6/97 Dr Chong Hoi Hee wrote about the outbreak of a series of Paediatric death that was occurring in Sarawak.

At the time there was still no clear sign that the end of the crisis was in sight. The article aimed to convey the sate of chaos during the outbreak and the inter-play of various factors:

One day towards the end of May 1997, a vigilant doctor in Sibu noted that several young children have died under similar mysterious manners: unexpectedly of a very short illness.

The hospital doctors look into the matter. Soon the Chinese press splashes daily Headlines.Worse, more deaths were occurring. 

The Sarawak Medical Department swung into action. Announcements were made. A team of Specialists was set up consisting of Paediatricians, Virologists and Epidemiologists. Reinforcements were sent in. No effort for intensive care was spared.

After all, Sibu was highly sensitive, politically.

More deaths reported, some consistent with the clinical picture, others not. Panic set in Sibu's streets became deserted of children.

Sarawak Medical Department appealed for assistance via Internet and Government channels. CDC (Centre for Disease Control) experts expected in next few days. Diagnosis of Coxsackie B Myocarditis made public, and earlier reports of possible Japanese B Encephalitis and Kawasaki Disease refuted.

Government and private medical clinics over-flowing with patients, many seeking immunisations. Since none is available,vaccines for Jap B , Hep B, HiB would do, I guess because they all have the alphabet B! People are sending their children out of Sibu, as far away as Australia, Singapore, KL or even Miri was a better refuge. Workers in fast food outlets were smacking flies - a local past time when business was bad. People weren't travelling to Sibu if they can help it.

More deaths reported. Now in Kuching, next in Miri. The whole scenario was multiplied many folds. Schools' mid-year holidays were coming to an end and demand that schools be closed were heard from many quarters.

Meanwhile, kindergartens , nurseries and public swimming pools were closed by official orders.

Schools open as usual; not as usual, no or few children turn up. Town schools were closed de facto. More demands, some suggesting quarantine be imposed: some in Miri think Sibu should be quarantined, not realising that others outside Sarawak probably think the whole of Sarawak need be quarantined; yet other might think likewise be done for the whole of Malaysia.

The State government appointed its second man to head the control, a doctor by training; rules were made that all pronouncements be made only by the Minister of Health or the State Minister. The national Opposition Party (DAP) leader demands that the press be free, demands that children be given Selenium and generally becomes quite an expert in the disease. Many experts proffer remedies. Black-feathered roosters go into extinction as they are said to confer protection. While other businesses face a down turn, those who claim in possession of special remedies and means for protection are smiling to the banks.

Many people are now feeling the effect. Children are staying home and need to be entertained. One parent, usually the working mother, may now need to quit her job to look after the babies: nurseries and baby sitting are not in fashion. Hotels are empty. Businesses are down many folds. Far sighted businessmen worry about how to collect debts in the next few months.Leaves for Medical Department staff are cancelled; those already on leave are recalled for duty. Ministers appear nightly on TV's. Armchair commentator hacks at his computer key-board.

Internet has been busy: hotch potch of information, multitudes of opinions, some suggesting extreme measures, flow around Cyberspace.

Fortunately, fewer deaths now. Hand-foot-mouth disease, even the lowly Aphthous ulcers, previously thought innocuous strike great fear in even the most level headed. Just as things are calming down, a local newspaper reports, quoting an Internet source, that certain milk formulae are implicated. Parents rush to supermarkets to look for alternative feeds for their dear ones.

An Opposition politician, retired, writes aptly: no such wide spread panic has been experienced in Sarawak in living memory, since the days of the Japanese Occupation.

Unfortunately, investigation results produce not a single villain but a few. Luckily they still are in the group of Enteroviruses and the same measures of prevention apply. The Medical Department appeals for the grieving families to grant consent for autopsies. The press comes out in support and several religious leaders have come forward to encourage and support.

Meanwhile one or two autopsies have been done. The results are painfully slow to come, such being the nature of things. Viruses do not normally grow faster in the laboratories on our command.

We don't hope there will be any more deaths; but if they do occur, please do the autopsies.

Viruses are well known to go into hiding and strike again when we least expect. Next time round, I hope we will be armed with more knowledge of our common enemy.

A lesson we may have learned is that a crisis like this affects everyone. We must work as a team: we make suggestions but not demands; the Ministry of Health must by right and duty be the leader. We follow and assist in which ever way we can, in good faith.

Information is a double edged sword. In by gone days probably no one would have heard of the outbreak until it is well over. In this era, our best weapon will be to seek knowledge and the truth.

Meanwhile I and my committee members of the Sarawak Society for the Blind, Miri Branch, have to decide whether to hold, as planned, our first Food and Handicraft Sale on 29/6/97. :-(

 On 3/7/97 Dr Chong Hoi Hee wrote again:

Now that the crisis is hopefully coming to and end, we may have to contemplate on the lessons which can be learned from this event.

Firstly, I think most people were caught unprepared for the way to handle news of an epidemic of deadly illnesses, in this era of Information Technology. As a result the state of panic almost became uncontrollable. Thus I believe this is an area where much thought needs to be focussed.

Secondly, I feel that the medical profession in Sarawak where the outbreak caused such panic, were not kept continuously informed and up-dated. In the process of getting myself informed, I have inadvertently created a mailing list for some Sarawak doctors and a few others who showed particular interest in the crisis. From feed backs I received, most were happy to be kept informed of the crisis as well as the various suggestions that were proffered. A few doctors who were not on the mailing list (because I didn't have their e-mail addresses) later requested to be put on, though they had kind of missed the boat earlier.

Similarly, I noted that the Guide-line issued by the Ministry and sent to me via the usual 'snail mail' channel took almost 2 weeks to reach me.

Thus I feel that a mechanism can be worked out for better dissemination of information for doctors in similar crisis in the future. Fuller use of the Information Technology is the way to go.

Thirdly, every attempt should be made to discourage people to cash in on such as a crisis because they invariably make the crisis worse. An example would be various utterances for political gains.

Fourthly, there is no better way to control an epidemic and the ensuing panic than by trying to get to the true cause as quickly as possible. This crisis has exposed a glaring defect in our Health Care system. The ability or perhaps even the willingness to perform autopsies as the means to the goal was not there. I believe our autopsy rate generally is at a deplorably low level and some means must be found to improve that.

Dr Chong Hoi Hee,
Miri, Sarawak. 3/7/97.