WORID HEm H ORGANIZAT Ioo
REQIONAL OFFICE FOR THE WESTERN PACIFIC TECHNICAL DISCUSSIONS WP/RC6/TD/Min/2 19 September 1955 ORIGINAL: KrNl1rES OF THE SECOND GENmAL SESSION OF THE . TECHNICAL DISCUSSIooS ENGLISH
REGIONAL COMMITTEE Sixth Session Singapore 13-19 September 1955
17 September 1955: 9.00 am
The meeting opened with-the presentation of reports fram the three Technical Discussion Groups. It appeared that groups had made different approaches to the subject, one having emphasized quality in training and qualification, whereas other groups had stressed the importance of providing midwives, whether trained or untr~ed, for rural health services. The Chairman pointed out that the purpose of the meeting was to discuss any points which had not been covered in the group reports, . and to di s cuss any differences' of opinion on any subje ct which might be evident fram the reports.
t.. In response to a que~ concerning the minimum age of mid.exy students, it was pointed out that 17 had been suggested as it was desirable to take girls straight from school. It was appreciated that the problem of untrained midwives was a serious one; experience had sho'WIl that in many cases these mid~ves trained their own successors, often a daughter or niece, and they resented trained girls wh() were not mown to them coming to work in the villages •. One countr,y had overcome this problem by giving priority in selection for training as rural midwives to relatives of untrained midvd ves. A representative said that as in his count~ the health services' were not developed they relied ver,y nmch on untrained midwives. The government, however, had a scheme whereby girls of 18 were taken fran the villages ani given six months' training in a hospital centre. Back in their own villages they worked harmoniously with the untrained midwives who eventually retired of their own accord, handing over to the younger girls.
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Another member of the -group quoted her own experience in holding quarter:q Eetings for all the untrained midwives in the area. The progranme at tbsse meetings ccnsisted of simple talks in their 0lIl language, followed by di scussion of their problems. TheY' gained not ~ Im.owledge, but also gained confidence because they CaDS to realise that the authorities were a:im1n.g to help them rather than to find fault with them. In the Philippines, the medical societies had asserted that unqual.it1ed midwives did not have the basic education necessa:q to . benefit from training. - HOlever, a compromise was reached, and a short training course was established and those who completed saliisfactori:q were provided with a UNICEF kit. It was doubtful whether the older women gained very much fran this course, but the younger ones did benefit. The course was entire:q voluntary-. In describing two WHO/UNICEF-assisted projects (China Hal and Philippines M:l.dw:i.fery) the role of professional personnel in
teaming and supervising untrained midwives was emphasized. Demonstration centres provided refresher courses for professional nurses and midwives who in turn conducted classes for untrained women and kept them under supervision. These women make regular visits to the health centres to report b1rt;hs, replenish equipnent and receive further instruction. ~ representative suggested two positive approaches to the problem of untrained midwives. The first was to give them a.s much tr~ as possible, through -courses and informal meetings. The second was to set up schools ot midwitexy so that midwives could be tull¥ trained and so replace the untrained personnel. Later it w~ shown that these two approaches should not be regarded a.s alternatives but could be made s1multaneous~.
It was stated that scmet:i.loos trained women preferred to st. in tbs cities :md were reluctant to go to work in tbs villages. The answers suggested were to offer better hOUSing, transport, equipment and higher pq for work in villages. One member of the group stressed the importance of health lofOrkers putting themselves on an equal status with the people they served rather than appearing superior. He also mentioned that though untra:ined personnel were otten uneducated they were not unintelligent, and there were elements in tbsir ritual which could be used as a stepping stone to modem methods; in this connection-he gave as an example ritual purification leading to modem h;y'giene. It was pointed out that the introduction of new techniques was causing disturbances
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in some carmun1ties, and an effort should be made to' give them. a sense of support rather than of disintegration. One wq to achieve this was to introduce medical services through the local midwife and headman, Wall the villagers would haw pt'ft:I.ous~ associated with such services. In th~se circumstances it would be better to give training to a large number of people at a 10liler level than to wait until high quality services could be built up from a small nucleus of professional midWives. . It was evident that opinions of representatives differed as to whethEr or not dOmiciliary midwifery was important in developing rural h~alth services. A discussion took place on the responsibilities to be assigned to the midwife - whether, in view of her access ·to the hallEls, she might also give vaccinations and help the campaigns against venereal diseases and malaria. It was emphasized that a midwife had not been trained for all these other duties. It midwives were given extra training to tit them for these duties, then their nam should be altered to, perhaps, nurse-m1d1d.ves, but the term tmidwife t alone should 1mpl¥ nothing more than ante~atal, intra~atal and post~tal care. to have one visitor to the hane carrying out all the duties, so that the famil¥ would get accustcaed to that one person and gain confidence in her. It was agreed that midwives, trained in public health nursing duties and working under a different name, would be a vital factcr in the approach to rural he~ services. The ante-1latal and post~tal periods offered exceitent opportunities for health education. Doubts wre expressed over the length of training required of Do person to undertake ~uch a variety of duties·; in view of the urgent need or trained personnel the tiDE factor would havo to be considered. It was stated that in most countries the period of training for a nurse-mid\dte seemed to be four years, and in the meantime untrained midwives wre given short periods of trdning in d1fferent subjects to enable them to carry on. One country is planning to prepare a "cOJllllUnity nurse" who will be trained in public health and qualified as an assistant nurse and a midwife. The next question discussed was whcther it was better to concentrate on encouraging domicilim-y midwitel'7, or mal:iemity hosp1t8J.s, - financial resources being equal in either case'. One representative thought that preference should be given to hosp~tals as they had all the facilities ald skilled statf' available to avoid injuries and fatalities. On the other hand, it was pointed out that
~
Han1' thought it
~tter
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infection ..Tas COJllllon in hospitals, and mothers prcforrl:ld on thtl ~4hole to have normal deliverios in their homes, It was finally' decided that the traditions of the particul~ country in question would have to bo taken into consideration, as the level of educ:.-.tion and public opinion varied in different countries. Consideration was then given to the topice for next; ye:,r's Technical Discussions. The topics put forward were t 1. The approach and man::'.gcment of the pre-school child,
(from 1 - 6). 2. The collection and an~sis
of health statistics.
3. The
im.prove~nt
of nutrition in rural communities.
These to,pics "TOre put to the voto, and the result was 17 representatives ~ observers in favour of Topic 1, and 10 in favour of Topic 3. Questionnaires lvera then passed around tor the evaluation of the discussions. Participants 'trore: asked to state thoir opinions on the length of the' discussions and the status they should have in the Regional meeting. The Chairman concluded by thanldn~ a.l.l those wl\o had contributed to tho success of the discussions, including all visitors and observors whose co-operation W·.?.S great~ appreciated. .~
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ADDRESS CF THE DIRm:CTOR-GENERAL
This is the third time that I have the pleasure of attending a meeting of your Committee and I gladly welcome the opportunity I shall have in the next few days to renew contact with my friends in the I'lestern Pacific and to examine vuth them some of the important problems of this Region. Both the Report of the Regional Director and the proposals for the progrGjIllme of work in 1957 bear witness to the vitality of your organization in serving the fundamental purpose of vJHO which is to mobilize all internationally available resources for strengthening the permanent foundations of tm health services of the various countries. Viewed against the background of this basic aim of the Organization, the increasing number of inter-country programmes is undoubtedly one of tre mas t promising features of th e collective effort you are making to improve health conditions in the v-lestern Pacific. It is indeed fortunate that despite th3 urga1.cy of "the health needs you have to m3et in your own countries, you have given priority to the solution of problems at: common interest to the r;1ajori ty of Member States in the Region~ I an thinking for example of the seminar held last year in Nevt Zealand at whiich experts fr"o.rn 21 countries in the Western Pacific, South East !~ia and the Bastern Mediterranean Regions exchanged their views on some of the important dental health problems and discussed the methods whereby dental health programmes can be made 'an effective part of general public-health services. I am also thinking of the seminar which took p,lace this year in Suva where participants from 20 countries examined such essential matters as the basic education of nurses, the relationship of hospital and nursing service administration to edl.lc,ational programrre s for nurses, and the training of auxiliary nurses and midwives. As a final- example of important inter-country projects, may I refer to the Second Asian Malaria Conference of last November which played an instrumental role in the shaping of our new antimalaria policy as adopted by the Eighth World Health Assembly. It lias indeed the general feeling of the 30 experts coming from three Regions to attend this Conference that there was no other rational v'lay of planning control than to aim at malaria eradication in the shortest possible time before the anophelene vectors become completely resistant to insecticides. I am looking forward to the discussions y'Ou will have on the mos t practi cal ways in which WHO can effectively contribute to the elimination of malaria from this Region. vJhile the success of any eradication campaign depends obvious lyon the efforts made by the national administrations, WHO has an important role to play in providing tech..l'lical assist-
lance and training ••.. ·
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ance and training facilities to individual countries, in assessing the resultS', and in general by ensuring co-ordination in the mobilization of available resources and in the timing of operations. One particular aspect of malaria work undertaken in this Region is the response of the vector. Indeed, as you know, in many countries it is the anopheles minimus which transmits the disease and because of the domestic res,ting habits of thev.ector it is easier to control the malaria carried by this mosquito. One of 1:he most gratifying developrrents in the Region is the expansion of health activities in the South Pacific Islands. The mass campaign against yaws launched early in the year by the Fijian Government vlith UNICEF and vJHO aid is progressing most satisfactorily. Six local teams led by assistant medical practitioners trained by a WHO yaws specialist are already engaged in intensive control operations covering a number of islands. Assistance is being given to the Government of \vestern Samoa in its fight against yaws am in due course the control work will be extended to all territories wh3re tre disease prevails. Another imp or tan t feature of the work carried out in this part of your Region is the effort undertaken to strengthen the nedicaJ. school in Suva. There is no doubt that this school which has already opened its doors to students from Guam, Cook Islands, Papua, etc." "Till, ' become the centre for medical studies in the South Pacific, Islands.. It is nofuvl0rthy 'that the six medical practitioners who are now' carrying out the yaws campaign in Fiji are'graduates from this school. The strengthening of the Central Medic al Schoolin Suva is part ' of the important effort you are making to improve tre edoo ation and professional training of medical and health personnel. An outstanding feature of the work undertaken in this field is the increasing interest shown in exchange programmes between medical schools wi thin the Region I am pleased to see that, in line with the general and outside it. policy of the Organization and implementing the Resolution your Committee passed at its 4th Sess'ion, a grovdng number of fellowships is being awarded for study in the Region. There is no doubt that Regional fellowships~ in addition to the obvious saving in travel expenditure, have t he advantage of enabling fellows to study under conditions similar to those prevailing in their own countries, so tha t the procesD of adapting their acquir ed knowledge to their h0100 environment is easier. You will undoubtedly iv-ant me to say a few words on tie role played by vmo in the historic conference whic h took place in Geneva last month on the peaceful uses of nuclear energy. According to the l'J'ishes expressed by the Eighth World Health Assembly, the public-health programme that the WHO representative outlined at the Conference has as its prinary aim the protection of populations against the dangers of /radia lion••••.
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radiation. International action, lYe beHeve, could usefully contribute to the follo~dng essential activities: (1) (2) the training of health personnel in nuclear technology; the dissemination of knowledge on radiation health problems including both the protection of populations and the use of radio-active isotopes in medical research, as well as for the diagnosis and treatment of diseases; a v.Torld-wide scientific study of the somatic effects of low-level radiation on humans in relation to the increase in ambiant radioactivity; and a similar world-wide study of the genetic effects of radiation on the human race.
(J)
(4)
The Organization is of course ready to accept any other work which may be assigned to it as part of the collective undertaking initiated by the United Nations to make use of the discoveries of nuclear energy for curing some of our worst social and economic ills, and for bringing better health and greater prosperity to all mankind. In closing I would like to refer to the statement made by the delegate of the USSR at the summer session of the Economic and Social Council of the United Nations on the attitude taken by his country towards WHO. liThe World Health Organization l1 , he said, and I quote, I1which has major tasks of considerable importance before it, is doing useful work. vJishing to take an increased part in international collaboration in ti,e field of medicine, t he Soviet Union joins the World Health Organization." I am sure that I am speaking for all of you when I say that one of the essential conditions for the realization of the aims to which we are dedicated is the fullest participation in our work of all Member States vJhic h took part in the founding of our Organ:ii.zation. The skills, knmvledge and experience ac~uired by all nations must be made available to WHO if it is to play its role in the building of a healthier and happier world for tomorrmv. Once again I am grateful for tre experience I shall have in the coming da~ in meeting with you, and I i>.1.sh you every success in your endeavours. Thank you.
ADDRESS OF DR. F. S. MACLEAN (Retiring Chairman)
Fellow Representatives, I must first express great regret at my unavoidable absence from this sixth sessbn of the Vre stern Pacific Reg ional Committee and my inability to give this address in person. It is my sincere hope that your deliberations will be valuable to yourselves and will provide effective stinru.lus to the good work that is being carried out by the Organization in this region. I must express our gratitude and thanks to the Government of Singapore for inviting us to hold the sixth session in this city •. Some three years ago I was unavoidably detained in Singapore for several days, through a delay in air schedules, and my period of detention was greatly relieved by the friendly and spontaneous hospitality I received from the public-health officials in Singapore. I was shown as nru.ch of their public-health organization and its functioning as was possible in the time available, and I was amazed at the very low incidence of infectious disease that exists in this city. I would venture to suggest that the City of Singapore in this' respect will compue most favourably with any city of corresponding size in both the tropical and temperate areas of the world. For this reason, if for no other, the holding of this meeting in Singapore will provide an opportunity for the representatives of all the countries of the Region to profit by studying the way in which the ·Public Health Administration of Singapore attacks and solves the problems which confront it • . It will be a matter of great satisfaction to representatives to have the Director-General present at this session. The framework of ~BO which provides for decentralisation in the planning and carrying out of the Organization's activities has rightly been acclaimed as contributing toward the vitality and efficiency which is so evident to all of us, but nevertheless it is essential that a close relationship should be maintained between the Region &nd our Headquarters in Geneva. There is no better way of contributing to this than by the attendance of the Director-General, or his representative, at Regional Committee Meetings. He is thereby enabled to acquire a clearer lmowledge of the Region's needs, and has the opportunity to assist our counsels from his broad experience of WHO's past achievements and his knowledge of its future possibilities.
You will by this time have had an pportunity of studying the Regional Director's Report on the year ended 30th June last. As he rightly remarks the ~ork done during the past year has been significant for its expmsion both in breadth and depth. When one surveys the scope of the work done, it is hard to believe that this report is only the Fifth Report, so confidently.and effectively has this beneficial work proceeded. Much of the credit for this must go to the efficient planning and organisation of the Director and his staff, but he himself would be the first to agree that great credit is due also to the governments concerned who have undertaken wholeheartedly the improvement of their people's welfare with the stimulating help of
WHO. Time does not permit detailed comments on the report" but with your permission I should like to refer briefly to one or two'matters. Reference is made throughout the report to the aim of strengthening the public-health services of our individual countries, and this surely must continue to be one of the chief, if not the chief, function of WHO. The importance of environmental sanitation is also stressed, and rightly so •. vmo has had, and is still having, its spectacular victories over such widespread diseases as malaria and yaws, but the basis of all effective pub1ic-health.achievem~nt is surely environmental sanitation. It has been due to environmental sanitation that the so-called developed countries owe the favourable position that they occupy today, and it will only be through attention to environmental sanitation that the so-called under-developed countries will reach their full development. Unfortunately, environmental sanitation is costly, progress is necessarily slow and . unspectacular, and for this reason, public attention is more easily caught. by the specta~ular achievements I referred to earlier. '!he possibilities of malaria erad ication have come to the forefront recently, and it is satisfactory to note that good progress is being made in this respect. A healthy sign is the growing tendency of neighbouring countries to cooperate in these activities as instanced by Brunei and Sarawak. This is surely a case in which "Union is strength", and a heavy investment in malaria eradication over the next few. years can be counted on to yie 1(1 rich div idends in the future. Education and training is undoubtedly the basic essential for pub1ichealth achievements, and the expansion of fellowsh,ips, and the developing pattern of assistance from well established and well endowed Universities by exchange programmes with Medical Schools and other training establishments in need of help, is worthy of the greatest encouragement. Several instances of this are referred to in the report, and the idea is one which merits further development. Tuberculosis continues to be one of the principal health problems ina number of countries, and valuable work has been done in carrying out BOG vaccination campaigns. The Director has rightly stressed the great
importance of overall tuberculosis-control ~rojects. This, like environmental sanitation, is costly and will call for adequate training of the skilled p3rsonnel involved. WHO's chief function in this field is to provide the stimulus and to assist governments in training personnel and planning their programmes on a long-term basis. The Director and his staff can only achieve their best work i f their office accommodation is adequate and comfortable. Unfortunately, the present Regional Office leaves much to be desired in this resp3ct. It will be noted that at least a site has become available for a new office, and it is to be hoped that in his next Annual Report the Regional Director will be able to refer to further substantial progress toward obtaining satisfactory accommodation for himself and his staff. Turning to the agenda, your maLD responsibility will as usual be to review the approved programme for 1956, and to consider the proposed programme and budget for 1957. Another most important duty which is placed upon you is the nomination of a Regional Director for the five-year period beginning 1st July 1956 at which time Dr. Fe.ng will have completed the term for which he was appointed in 1951. The Regional Office has been singularly fortunate in its Director who has guided its infant footsteps during the early formative years. It is largely due to him tha t the lusty infant has grown into a sturdy adolescent. I will not say adult as growth and development is still evident. Dr. Fang possesses the happy combination of executive ability and a friendly and agreeable p3rsonality. re all appreciate his ability as much as we enjoy his company on less-serious occasions. There can be no doubt in the minds of anyone tha t the work of the Region has been organized and guided wisely during his term of office. It is my sincere hope that our Regional Director will consent to nomination for a further term. I have already taken up too'rnuch of your time, and I shall conclude by once again welcoming you to this sixth Bession of the Western Pacific Regional COmmittee, and express the hop; that your discussions will materially help forward the work of the Organization with which we are all proud to be associated.